Interview with Jacqueline Anne Noonan, Decenber 5, 2008

CLANCY: Hello. I'm Karen Clancy, here with Dr. Jacqueline Noonan on December 5th, 2008 for the University of Kentucky College of Medicine 50th Anniversary Oral History Project. Dr. Noonan is one of the original physicians hired by the College of Medicine in December of 1961. She was recognized earlier this year with a lifetime achievement award for her accomplishments in pediatric cardiology, including fifty years of work caring for children with heart disease. Dr. Noonan is one of the most important individuals in the history of American pediatric care and is internationally known for her identification a genetic disorder now called Noonan syndrome. She chaired the UK Department of Pediatrics in many years-- for many years, and has earned numerous national awards. Was honored with the establishment of an endowed chair called the Jacqueline A. Noonan Children's Miracle Network Endowed Chair. We're here today to talk about her involvement in regional pediatric clinics that have been held throughout Kentucky 00:01:00since the beginning of the College of Medicine. Good morning Dr. Noonan.

NOONAN: Good morning.

CLANCY: Tell us a little bit about the early regional pediatric heart clinics. What were they? Um, how did they get started? Where-- where were they?

NOONAN: Well, it's interesting because before I came to Kentucky there were regional heart clinics in Kentucky. Um, uh, the University of Louisville, uh, did the clinics throughout the state. And Dr. Joe Little, who was a pediatric cardiologist in Louisville, as soon as I arrived, he divided up and gave me the-- the eastern half. And I came here in December and I believe as early as January we went to our first heart clinic. And I believe it was in, uh, Beattyville. And it was, uh, kind of slippery and all, uh, in those days. So we started out very early doing the heart clinic. But you know, at the beginning, 00:02:00the regional heart clinics were held in the health departments. We had a small grant from, the, uh, Disease and Chronic Illnesses, it was the, uh, source of payment, because we did not charge patients-- uh, the Health Department paid us, uh, enough to pay our expenses, like, uh, essentially. And, uh, and the other people who were part of this clinic was the American Heart Association. Uh, they had, uh, people who worked out, the-- you know, uh, throughout the state. And they would attend the heart clinic, uh, oh, what was his name, Finley Booth, was the, um, uh, the person assigned to eastern Kentucky. And he would come to each heart clinic, bring the EKG. He did the EKGs and we had papers, uh, that we used to fill out the notes that the heart-- that the American Heart Association provided. We did that for a number of 00:03:00years. And, uh, actually, uh, we had adults at the same clinic, adult heart clinics. Dr. Jack Reeves, who was, uh, who was one of the, uh, only two people from Kentucky on the original, uh, medical school faculty. Dr. Harold Rosenbaum came as chairman of radiology. And Jack Reeves, uh, who grew up in, uh, uh, I believe it was Hazard, Kentucky, um, came, uh, back from-- he was-- did his training in Colorado. He came, uh, to do the, uh, cardiac catheterization as a cardiologist and he would go to clinic with me. And Ruth Pitman was a social worker, and Ruth Pitman went on those clinics with us, at the beginning. And, uh, we, uh, would go to clinic, and I'd see the children and Jack would see the adults. And if I finished first I helped him. And if he finished first he helped me. And, uh, then as time went on, of 00:04:00course, uh, we had more faculty and we had cardiac fellows and, uh, we continued to have clinics that included both adults and children for a while. But after a while, the adults stopped doing those clinics. Uh, and I can't remember just how long, uh, it was, uh, just Chronic Diseases that was funding this. Um, but I can remember in the early days, uh, when we went to these clinics and we had many of them all over eastern Kentucky, it was before the Mountain Parkway was finished.

CLANCY: Wow. (laughs)

NOONAN: And, uh, --(coughs)-- I can remember, uh, Dr. Mazzoleni coming on one of those clinics to Prestonsburg. (laughs) And it was a lot of --(laughs)-- uh, a lot of curves and he was pretty green by the time we got there. (Clancy laughs) So we were all very glad when the, uh, Mountain Parkway finished. And, it-- it finished fairly, uh, early on. 00:05:00And --and I can remember that was a-- a big deal, uh, going to these clinics, uh. So early on it was-- it was, uh, fun. We, uh, we went on these clinics and-- and --and it was really kind of fun because the patients used to refer to me as "the free heart doctor." (both laugh) Because they came to the clinic and saw --(laughs)-- a heart doctor and-- and of course they didn't have any money anyhow. And, uh, uh, so, uh, uh, the, uh, we-- we didn't charge and I-- 'cause I think the heart department'd either charge, you know, whatever they could pay, which was usually nothing. Uh, but we-- we got to see children and we got them into the hospital, and, uh, for surgery and all kinds of things. And very early on, one of the first things we did, Dr.-- when Dr. Frank Spencer was our heart surgeon, uh, we very early applied for, uh, to be recognized by the, uh, at those time was called Crippled Children Services. Uh, because Crippled Children Services, uh, was, 00:06:00uh, available to pay for the cardiac catheterization and surgery before Medicaid, uh, came around. You know? And so you had to be approved and all that. So we did that very early and, uh, we both were approved. (laughs) So, uh, uh, we-- the children seen in those clinics, when they came to Lexington, would be enrolled in the, uh, Crippled Children's Com-- uh, Commission. Uh, well that-- so for a long time it was, uh, these clinics were, um, uh, were supported by a, uh, a contract from Chronic Diseases. But as, uh, time went on, I think it was when John Y Brown was, uh, governor, you know, they changed a lot about the health departments in-- at that time. And, uh, so then they- - they-- they had their own districts and, uh, some of the --(laughs)-- some of the districts had health departments didn't really get along, like, Hyden and Harlan in the same district. And so things kind of 00:07:00got messed up at that point. And instead of having Chronic Diseases, the health departments themselves would support. And so some of them did it and some of them didn't. And I wish I could remember, but I can't remember when the, um, Crippled Children's, which is now called Commission for Children with Special Health Care Needs, when they, uh, uh, dev- had, uh, developed programs all throughout eastern Kentucky. And we now hol-- all our heart clinics are now supported and held at the sites that, uh, the Commission for Children with Special Health Care Needs have their clinics. Many of them have their own buildings. We still go to a few places where we hold them in the health department. But the commission nurses come and, uh, and so that's the way it's done now. It's been done that way for quite a few years. Uh, I don't have the exact, uh, date that that all happened. But that's sort of been the way the-- the, uh, heart clinics have gone. We still 00:08:00have, um, I think Suzanne said we have about twenty-three of them right now. So we're going, um, I still do all-- I go --(laughs)-- to all of the, uh, heart clinics, regional heart clinics. And we have, uh, uh, I think an average of two a month. And where they used to be, uh, we'd go down, uh, late that-- we'd go down in the evening and spend the night and then get there early in the morning and work all day, um, uh, we now do a number of 'em, we-- we go down early in the morning, see children that day, spend the night and then do some more the next day. Uh, because, uh, you know, it's not as easy to see patients now as it was, uh --(laughs)-- thirty, forty years ago. The paperwork that people go through, it takes-- it takes so long to get the patient into the doctor's room, it's really funny. Uh, and-- and we used to see, 00:09:00uh, early on, oh, the-- the heart clinic in Pikeville, with the adults and children would both be there, we'd have over 100 patients.

CLANCY: Wow.

NOONAN: We had patients out in the, uh, waiting outside the health department. Uh, it was, uh, I'd have a-- uh, I had-- well Dr. Linda Walters was, uh, was with me at that time. And we'd have, um, a, uh, uh, a medical-- a-- a resident or a medical student. Usually it was a resident that went with us. And, uh, we'd have a room in which we had a sort of a quilt, uh, separating two, uh-- and so I'd see patients on one side, the-- the resident on the other and then I'd check what they did and I'd dictate and dictate their note. And we'd go through a-- a lot of patients in a-- in a very short time and-- and that I can remember Pikeville. Now Pikeville has a lovely, uh, uh, nice health department. And, uh, things are much different. And of course we don't see as many patients either as we did, uh, in those 00:10:00days. Uh, but it's, uh, it's been a very, uh, interesting things to see things going on and, uh, you know, it was-- it was really, uh, very exciting, the beginning, because we'd see children --(coughs)-- some of who'd had, you know, never been to a hospital. They'd never seen an elevator. Uh, you know, when they came. And I can remember one little boy who lived in, I think, uh, Goose Creek or, uh, Goose Creek I think. And --(coughs)-- he had terrible, uh, rheumatic heart disease. And, uh, was really very bad off. And we-- we had him, um, come-- he was going to have to have heart surgery. And, uh, you know, this family had nothing. They had, you know, no sophistication with the medical center. But they had an aunt that lived in Chicago and they all got together to-- to-- to try to find-- in those days we had 00:11:00to have the family donate blood, because in those days heart surgery took a lot of blood. It's not like that anymore. But, so that was the aunt from Chicago helped. I can remember, uh, you know, this was a really big deal for not only this family, but, you know, all of the-- unfortunately it didn't work out well. The child actually did not survive the surgery. But it was still a-- a-- you know, it was a really-- uh, a very moving experience, the whole thing. (coughs) So we had-- we had a lot of good successes, but, you know, in those days everything wasn't successful. Uh, but, uh, and I-- you know, I can remember another, uh, family, I think they were from --(coughs)-- I think from Harlan. And the boy had, uh, uh, a-- a bad heart. And I'd seen him several times. And we're going to do surgery on him. And I had him come to the hospital. Well, the family came and some resident was gonna see him. And they said, "Dr. Noonan's --(laughs)-- his 00:12:00doctor." They would hardly let anybody else-- and, after he had his surgery and I came out to the waiting room to tell 'em that, uh, that Raleigh had done alright, uh, they then were gonna start telling me about some of their illnesses. And so I had --(laughs)-- 'cause since Raleigh did alright, uh. But it was-- it was amazing. You could see that --(coughs)-- uh, once people trusted you, uh, you know, they would do anything at all that you, uh, asked them to do or suggested to them. (coughs) Uh, I mean I found them people who are very, uh, grateful for whatever you do. Uh, so it's been a real reward. I-- I, uh, have become very fond of the, uh, people in eastern Kentucky. (coughs) They have --(coughs)-- a hard time. But, uh, they, uh, they are a very warm, uh, loving, uh, people.

CLANCY: Yes. Can you talk about one-- one of your experiences, perhaps, 00:13:00just thinking about the clinic? What would happen from the morning, the beginning when you were getting up and leaving Lexington until completing and getting back. Just kind of what the experience was like?

NOONAN: Uh, well, you know, I'm still doing the clinics and --(laughs)-- uh, well we've just, uh, you know, a couple of weeks ago we went, uh, to, uh-- I think, well, we went to Hazard not too long ago and I think we left-- that was the day we left early-- well, we left, like, at, uh, seven o'clock in the morning and, uh, got to Hazard and we were gonna start seeing patients at ten. And we went to our favorite restaurant called Francie's. It's in Hazard. And they have the best bacon and eggs. So we went and --(Clancy laughs)-- had breakfast. And then we went over to the, uh, commission place. And the-- and I-I- I just-- that's my favorite heart clinic, is Hazard. The-- the nurses there, they-- the other people that work there. I just-- so wonderful. 00:14:00Everybody, they-- you know, just they all do whatever needs to be done. It isn't, "This is your job and this is my job." They all just get the job done. And, uh, and-- and they're just-- it's a really, a very warm friendly place to be and-- and they're really good people there. So, we, uh, we-- after we had breakfast we-- we go over and, uh, the uh-- they're a very efficient place also. The patients start coming in. And I always see the-- if I've seen a patient before, I see the same one again. And, uh --(coughs)-- Doc Vranicar-- Doc-- uh, Mark Vranicar is one of the cardiologists. He usually goes to Hazard. So he would be seeing patients and I'd see patients and we'd, uh, work until we finished all the patients for that day, and we spent the night. Well, you know, the Hazard Heart Clinic is-- it's an interesting place. If you know Hazard, you remember where the Holiday Inn is, right up on the mountain. Well, it used to be Holiday Inn and we used to stay there 00:15:00all the time. Well, early on we actually stayed in La Citadel, but they don't-- I think La Citadel is gone now. But we stayed-- we stayed in the Hazard-- in the, uh, um, Holiday Inn. Well, it-- things got bad and so it was no longer a Holiday Inn, it was a Holiday House or something different. (laughs) And, um, it-- you know, it's a-- the-- the motel is almost falling off the mountain. Well, fortunately they now have a Hampton Inn in Hazard. So we've really come up in--

CLANCY: You've come up in the world.

NOONAN:-- we've come up in the world. (Clancy laughs) So we stay at the Hampton Inn, which has wonderful beds and it's clean and all of that. So we spent the night at the, uh, Hampton Inn. And I guess we had dinner that night at Applebee's, which is right close to the-- to the-- uh, and then we got up the next morning and, uh, went back to clinic and saw patients until we finished that day. We usually finish by about three o'clock that afternoon so we can get home hopefully before dark. But going to Hazard is just so pretty. There was still a little 00:16:00bit of the, uh, uh, pretty le-- trees left. And it's just a very pretty drive. Uh, we really enjoy driving on the Mountain Parkway and enjoy those clinics. Uh, we have some clinics where we have to go on I-75 and that's not quite --(both laugh)-- as much fun. And then when we go to Somerset we have to go on Nicholasville Road all the way from --(laughs)-- Lexington to-- to

CLANCY: A lot of starting and--

NOONAN:-- Somerset.

CLANCY:-- stopping.

NOONAN: (laughs) Yeah, so it's, uh, but we, uh, sort of know the way and, uh, uh--

CLANCY: So it's--

NOONAN:-- and Suzanne Norman is a nurse that now has been going on those clinics with me for over thirty years. She wasn't there at the very beginning, but since that time, uh, she's been the, uh-- even-- the-- when we were part of the Chronic Diseases, uh, very-- as soon as she came she started coming with me. And today, just to, you know, to keep track and do all of that, you need-- it takes a lot of, uh, work. And she knows all the patients and-- and when, uh-- and if they're gonna 00:17:00be coming back for studies or surgery and all of that. She's the one that's in contact with them. And, uh, is very much part of the team and is-- I don't know what we've-- what I'd do without her. So she-- --(laughs)-- she wants to retire. But --(laughs)-- I won't let her retire till I stop doing the clinics. (laughs) So, it's, uh, it's, uh, been a very-- a really wonderful relationship to have, uh, the same nurse going with you for, you know, thirty years at these-- at least thirty years in these-- at these clinics.

CLANCY: Yes. What are the value of these clinics to Kentuckians?

NOONAN: Well, you know, uh, I don't really know how we'd get patients treated without clinic-- in-- in many places. Trav-- drive-- driving from Harlan or Prestonsburg or Hazard to Lexington may not seem like much to most people. But many of these people do not have that kind of transportation. They have to hire somebody to ha-- they have cars, but their cars are not really good to get to Lexington. And finding 00:18:00your way to Lexington. And, uh, we get very good follow up. You know, after you've fixed a child's heart --(coughs)-- most of the time it's not perfect. It needs to be followed. And some-- you know, you do the best you can to fix a heart. But you can't make a, you know, a-- (laughs)-- as they say, a silk purse out of a sow's ear. So, uh, they-- they have to be followed. And we get good follow up because they will come back to the clinic. But if you tell somebody, "I want to see you next year" and they're feeling fine, you're not gonna get people to come all the way back to Lexington on a-- on a regular basis. So we get good follow up. And that way, if something happens that they're not doing well, we can, uh, identify it and-- and treat them. And, um, and for many people, uh, I'm-- I'm-- they've got more continuity of care by coming to the heart clinic once a year than they have because their primary care doctors come and go and, uh, so you have the same 00:19:00person seeing them forever. And I must confess, sometimes I have them come back even though they're doing fine and I really-- they-- but I have a lot of, uh, you know, kids with Down Syndrome that had their heart fixed and this is their-- their-- their day. They like to come back and see me, you know, once a year. And so, uh, it's-- it's a big day and, uh, and that way you would pick up something that might have, uh, been missed. Because, uh, people don't go to the doctor just for checkups, uh, in eastern Kentucky. You only go when you're sick. (laughs) And-- and so, uh, this time they can come when they're-- when they're not sick. But they're coming for their sort of heart check up anyhow. And, since I'm also a doctor --(laughs)-- besides being a cardiologist, we sometimes find other things that need attention.

CLANCY: So can you tell me a little bit more about some of your special experiences that you-- you recall from some of these clinics? Some of the things that stand out in your mind, experiences that you had with 00:20:00families and with the children?

NOONAN: Well, I can tell you one story that's funny. You-- you mentioned about Noonan's Syndrome. Well, Jack Reeves and I were at a clinic, and I can't remember which one it was. I can't remember which place it was, whether it was Manchester, 'cause we used to --(laughs)-- go to Manchester, but different places. But, uh, we went-- Jack was seeing adults and I was seeing the children. And I came in the health department and I looked and there was a gentleman sitting on the bench. And I looked at him and I said to myself, "He's got Noonan's Syndrome." And so I said to Jack --(laughs)-- passing, I said, "Jack, you see that fellow, he's gonna have pulmonary stenosis." So, I went and started seeing patients and he started seeing patients. And about halfway through the day he comes out --(laughs)-- of my office and he says, "How'd you know he had pulmonary stenosis?" (laughs) It was a-- it was a, uh, a gentleman, the first really adult that I had ever seen with-- he was a thirty-something year old adult that had-- that, uh, 00:21:00had, uh, Noonan's Syndrome and had never been to school, and, uh, had really terrible pulmonary stenosis, and, and, and had surgery after that. But I can remember that. That was a-- that was, uh, kind of a-- a funny story. And the other one I remember is Dr. Mazzoleni, you know Dr. Mazzoleni?

CLANCY: Um-hm.

NOONAN: Well, he came on one of the clinics and, uh, we just had a kind of a, just a plain piece of paper to take our notes on and then we would dictate and send notes to the referring doctor or to the health-- and to the health department, the people that might know something about this patient. And, but Alberto thought, well, we should have, you know, more of a standard form. So he --(laughs)-- had come up with the standard form. And --(laughs)-- and was asking these patients questions. So he called me, he says, come-- "Jackie, come on, uh, in." So I came in while he was talking to this --(laughs)-- to this man. And he says to the man, (with accent) "Now, is the pain sharp or dull?" And the man says, "Yes." (laughs) So then he says, (with 00:22:00accent) "Now is it constant or is it coming and going?" And the man says, "Yes." (laughs) He said-- so after he got these kind of questions for a while, he decided --(laughs)-- that form wasn't really going to work. (Clancy laughs) So it was-- it was a-- again, another, uh, uh, funny little story that-- that happened, uh, there in eastern Kentucky. But, uh, it-- it's-- we've had a lot of, uh, a lot of fun going to the-- to-- and we've, you know, we've had fun with our residents coming with us. You know, uh, that's been fun. Uh, at one time the, uh, adults fellows used to go on the, uh, clinics and they'd see, uh, and we'd sort of see-- whoever was finished we'd see-- we could see each other's patients, you know. But they don't go on those clinics anymore. Uh, and a lot of, you know, things have changed so much in the-- in medicine and here, like every place else, uh, and, well, I 00:23:00mean I re-- I was at the time at the-- at the hospital when we didn't really, uh, it looked like nobody cared whether anybody was able to pay their bill or not at the very beginning. We didn't turn anybody away for anything. And, uh, uh, it was before Medi-- Medicaid. And then as those things, uh, happened, uh, of course --(laughs)-- in order to run a hospital --(laughs)-- you do have to collect --(laughs)-- money and all. And so-- so things changed. But, uh, and we have been, uh, I think now with the-- the Commission, that's helpful for people who-- who, uh, have some insurance, but the insurance with the co-pays would really devastate somebody having heart surgery. So the Commission still helps out in-- in those areas. So it's-- it's, uh, and-- and we, uh-- the-- our-- my nurse, Suzanne, is very-- Suzanne Norman, that's one of the things she worries about, is the families, how are they going to get to Lexington, how are they going to pay their bill, who-- all of these kinds of things. And, uh, uh, she's the one that will 00:24:00call them, remind them and keep, you know, track of things and see them when they come up here for their surgery. Uh, but, you know, it's-- what's bad is that, uh, when you turn twenty-one you're no longer eligible for the Commission. And, uh, many times your medical card-- your Medicaid doesn't cover you as you get to that age. And, uh, you still have the same heart problem that you had when you were twenty.

CLANCY: Um-hm.

NOONAN: So, uh, we are trying, I think, and what I'd love to see before I completely retire, um, is that we will be able to have some clinics in eastern Kentucky, where, uh, in fact Prestonsburg, I was at Prestonsburg last-- well, the other day. Um, and that's a clinic which is held at the health department. It's not a Commission one. And we do see adults there, because the health department will see them, uh, for a nominal fee if they don't have any insurance. And so I saw, 00:25:00oh, I don't know, uh, probably, uh, probably six or eight, at least, adult congenital heart patients there that, uh, uh, I could see without having to worry about whether they're going to get a-- a big bill that they can't pay.

CLANCY: Um-hm.

NOONAN: Uh, you know, and if they come up here we certainly will see them. But we can't-- we can't see them for nothing. Well, we see them for nothing, but they have to get a bill and then, you know, if they have-- it's-- you know, they're proud people. They don't want to come and-- and have people harass them that they-- that they-- that they owe this money which they can't pay. And so, it's-- it's a real problem. I keep hoping I'll live long enough to see when we'll have medical care for-- everybody in the country. 'Cause we really need, uh, I think-- I really think, medical care is a-- is a right. And I hope one of these days it'll happen. Uh --(coughs)-- which doesn't mean we shouldn't 00:26:00be-- have-- still having those clinics, because it's still going to be inconvenient for many people to-- to travel, uh, to-- to Lexington.

CLANCY: You've seen over the last fifty years, um, changes in pediatric cardiology in Kentucky.

NOONAN: Um-hm.

CLANCY: And can you talk about just some of those changes that you've seen, uh, throughout, uh, in regards to pediatric cardiology services in Kentucky?

NOONAN: Well, you know, uh, there's been so much change in pediatric cardiology, not just related to the clinic. But, you know, when I finished my cardiology training, which I finished in 1959, uh, and during my training period, I wrote two papers. The first one was on babies born with, uh, only one ventricle or had a very, uh, hypoplastic, uh, left ventricle. And I actually-- the name of my 00:27:00paper was Hypoplastic Left Heart Syndrome. And it was talking about how these babies, you could diagnose them clinically from the way they presented. And-- and I-- we had, uh, this when I was at Boston Children, we had a lot of, uh, of pathology there. I mean we, uh, so I studied all of those and reported, so that how you could tell, uh, clinically, uh, this-- make this diagnosis. All of those babies with complete, I mean really bad hypoplastic left hearts died. We didn't have any treatment for them. Um, I didn't realize until much later I'm given credit for-- for coming --(laughs)-- up with that term, hypoplastic left heart, uh, syndrome. Uh-- and then the other condition that they all died was transposition of the great arteries. And, uh, Dr. Nadis was the, you know, the doctor at Boston. And we all had to do research projects. So my other one was transposition. And, uh, we-- I, uh, looked at all the cardiac casts that had been 00:28:00done on them, and what happened and depending on what else you had with transposition. And, uh, and rel-- right about that time Dr. William Rashkind who graduated from Louisville actually and was a wonderful man, he was in Philadelphia and he was the first person to develop a catheter with a balloon on the end so he-- we-- what we knew from the study I did and from what other people knew is the only babies with transposition who lived for any length of time, unless they had a-- another hole in their heart like a ventricular septal defect, was if they're-- in the ope-- you know, the upper part of the heart there's a, uh, atrial septum. And it's always a little bit open when they're first born. But pros-- unfortunately when transposition, it really was just a small patent foramen ovale. And that wasn't enough to allow any mixture. But every once in a while there'd be a baby born with 00:29:00a-- we had one child in my series that was born with a natural big ASD (Atrial Septal Defect), and he was, although he was quite blue, he was alive and doing reasonably well when he was seven years old, which was the, you know, remarkable. Well, I think other people must have seen similar things and Dr. Rashkind rat-- rationalized that if you could open the atrial septum, uh, they-- you know, that would help. So he developed this balloon and pulled it across and-- and we started doing that here. Uh, but at the same time that happened, that was in the mid sixties, a little bit later on, two doctors, Dr. Mustard up in Canada and Dr. Senning in Sweden figured out a way to change the way blood came back into the heart by cutting out the atrial septum and putting some baffles in. And you couldn't-- you didn't switch the arteries, but you switched the way the blood came back. And so these children, uh, would be pink. We call that now, uh, a atrial switch operation. 00:30:00We used to call it Mustard or Senning. Um, and these children would be pink, and it was exciting because, uh, the f-- first person doing it in the United States was Denton Cooley in Texas. And so we sent, uh, two patients to him. Uh, and then we started doing 'em here. You know, uh, you know, you don't start with-- with a brand new. And so I can remember those two patients that, uh, went to Texas and it was really funny because this one girl, we kept her alive until she was about three or four years of age. She was blue, but she was doing pretty well. And they used to do them later then. Now when-- they do everything in practically newborns. So she went to Texas and Dr. Dan McNamara was chief there. And every day the mother would call me to tell me what they were doing to see was it alright. (laughs) So it was really cute. They--(laughs)-- she'd say, "This is what it's like." I teased Dr. McNamara, that, you know --(laughs)-- I had to approve everything they--

CLANCY: That's right.

NOONAN:-- were doing on-- on rounds. And, uh, so that was, uh-- and 00:31:00now, you know, now a days, you know, we do hypoplastic left hearts here. We do transpositions here. And then in the, uh, oh, about eighties I guess, because of the work that had been done in coronary arteries, it was now possible to instead of changing the way the blood came back, you switch the arteries. And, uh, because to do that you have to also transpose the coronaries over to the-- to the-- to the left side of the heart. And surgeons couldn't do that until they started learning about how to do coronary artery disease. Well, I mean I have, during my career, seen all of this develop. It's been, you know, I've just-- I was born at the right time I guess to see all of these things happening. And they've affected, you know, what we do in the heart clinic and what we do here, uh, just the progress that's been, uh, made in heart surgery in general. And, uh, fortunately 00:32:00we've had-- you know, we've had our ups and downs. Surgeons come and go. But we have a wonderful surgeon right now, Dr. Mark Plunkett came from UCLA recently and he's top notch and we're doing, you know, we're doing hypoplastic left hearts here, and they're doing well. You know? So it's, uh, uh, and transpositions. So that, uh-- it's very exciting to see all of this being-- all of these things happening and, uh, uh, to have seen them, you know, kind of, uh, develop, uh, in one's lifetime. It's pretty exciting. And, uh, I-- I remember not long-- long ago when we started doing these transpositions, switching the arteries, and this child was coming out of the ICU going to the ward and the house staff were still making their notes. And they said, "Oh, this is transposition coming out." And I thought, this young man has no idea what-- what-- how really-- what an accomplishment that is from, 00:33:00you know, thirty years before or forty years before, uh, those babies weren't able to be fixed like that. And so much we take for granted today, uh, is, you know, it's-- it's-it's- it's new and it's not something, uh, many people appreciate what uh, progress has been made. You know, we've had other clinics besides heart clinics in Kentucky.

CLANCY: Yes. Do you want to talk about those a little bit?

NOONAN: Sure. Um, early on, uh, we had very few pediatricians in eastern Kentucky. And, um, oh, what's her name, uh, trying to think who was, uh, head of, uh, the Commission here. But we-- we-- we developed some, uh, heart clinics in eastern-- I mean a heart clinic-- general pediatric clinics throughout eastern Kentucky. And Dr. Wheeler was chairman at that time. And, uh, we had various people go to these clinics and, uh, see patients there, of-- do an evaluation, uh, uh, do 00:34:00what they could do there. And then find out what other things might be a problem. And then, uh, they would be referred up here. These were general pediatrics clinics. And, uh, they would then, uh, if there was-- there-- there was a program that could help [noise] support them when they came here at that time. And those went on for quite a few years. But as pediatricians went to, uh, different parts of eastern Kentucky, that was no longer such a priority. But we did have other priorities. Uh, I don't remember how many years ago, uh, the state and-- that-- I guess federal and then state had-- developed a program for, uh, for genetic problems. And Dr., uh, Brian Hall has been--

CLANCY: Yes.

NOONAN:-- on, uh, doing those for many years. And they're, uh, he's still doing --(laughs)-- them. He retired. He's still doing the genetics clinics. And, uh, so that's another place we can refer if we see-- I mean when we see a patient in the heart clinic, uh, and they need that, we-- the nurses from the Commission will see that they 00:35:00get, uh, uh, sent to one of the, uh, uh, gen-- genetics clinics. And then, uh, our endocrine people, when Dr. Mayberry was, uh, uh, running that division, um, became necessary for us to have some clinics out in eastern Kentucky for children with diabetes. Uh, you know, we would see children come in from eastern Kentucky in, uh, ketoacidosis, a new diabetic. And you'd-- you'd treat them and you'd have, you know, you'd-- they'd come in-- when we used to have our care by parent unit, we'd bring a child in, and you'd have a nurse, a nurse, uh, educator, a dia-- a nutritionist. And all you'd-- we-- we used to be able to keep the patient in the hospital for about a week so the mother could learn all about it and learn how-- well now you can't do that anymore. (laughs) But anyhow, they would get them so they understood the diabetes. And, uh, then if you're going to keep track of them, um, 00:36:00they-- they had some of these, uh, uh, diabetic clinics. It wasn't something covered by the Commission, but Dr. Mayberry was able to get some money from the Appalachian Foundation and, uh, we would, uh, and so they would go to a-- uh, not every place, but they had a number of places they went to in eastern Kentucky; they're still doing that. And, uh, Dr. Mayberry says since they've been doing that, they've not had any children come back into the hospital with ketoacidosis, because they, uh, they-they- they know the people. If there's a problem, they can call, somebody will answer 'em. They can do their check ups to look for early, you know, uh, ki-kidney problems or eye problems, things like that by seeing these children on a regular basis. So, uh, I just, you know, there's a shortage of some pediatric sub specialists. And so, you know, we're limited in how many of these clinics we can have. We just don't have enough bodies to do as much as we'd-- we'd 00:37:00like to do. But, uh, those clinics are still going on. And then as part of the Commission, uh, the pediatric, uh, neurology people go on those clinics. The Shriners people do all the orthopedics at the-- so we have a wonderful relationship with Shriners. And, uh, uh, when I was chairman actually we-- we-- we, uh, had, uh, Dr. Meyer was over-- was hired over there and was, uh, sort of their director of the medical part of the Shrine. And our house staff would, uh, be able to, uh, uh, go over there for some training and, uh, and in that area. And so that's-- that's another wonderful, uh, opportunity for patients to-- can get excellent orthopedic care. Uh, and uh, and there's such a good collaboration, there's always been a good collaboration between the Shrine and the, uh, Commission and with us, so that, uh, you know, everybody tries to see that the children get the best care they can. 00:38:00And instead of having to go to the Shrine, the Shrine doctors go to the Commission clinics out in eastern Kentucky. So, uh, as does neurology from here. So, we have a number of people that are traveling around the state in-- in-- in eastern Kentucky.

CLANCY: So in addition to, uh, providing access, uh, giving patients the ability to be able to-- to-- to access specialists, uh, what are some of the other ways that-- that these clinics have brought value to people in Kentucky, to the-- to the pediatric patients?

NOONAN: Well, I think that, I-- I think that the, uh, people in eastern Kentucky, I think, have, uh, recognized that the-- the-- the-- the College of Medicine here, uh, that they're-- we're interested in them. That they're-- that they're a part of-- a part of us. And, uh, uh, they're-- you know, uh, Dr. Bricker, our-- our present chairman, he goes on several of these clinics. And when he goes he's always strives 00:39:00to be sure that he goes and thanks, well the people at Wal-Mart. You know, the-- the Wal-Marts in eastern Kentucky for that Children's Miracle Network. They, uh, are very generous. And these are the-- you know, these are people without much money. But they'll have bake sales or they'll do this or that. And, you know, five thousand dollars from this little town, five-- I mean that's-- that's uh-- those are things that, uh, are, I think, because they know that we do care and that we're out there. And so he --(coughs)-- always tries to go by and thank them for, uh, what they've done, and, uh, it's, uh-- so I think-- I think that's part of-- and because, you know, they're kind of a-- uh, they can be kind of a lost civilization if you-- --(laughs)-- if nobody really recognizes the're there. And, uh, and of course the whole College of Medicine, uh, you know, we're-we're- we're very interested in having our students understand about rural health and all of that. 00:40:00So, uh, it's-- it's been part of our mission since the beginning. And I think that's, you know, if you're gonna carry out that mission, uh, there's a lot of things you have to do. And-- and I think one of them is, uh, helping to, uh, provide care where it's not available. Uh, you know, it's wonderful. We've got a lot of pediatricians now in eastern Ken-- not as many as we need and not as many doctors, but a lot more than we had. But you can't-- you can't have-- a pediatric sub specialist. They can't-- you know, that you-- you need a certain volume of patients to do that. And so they-- those are the kind of people that we-- we have to se-- go out and-- and, uh, and provide some, uh, support for-- for those, uh, those kind of specialties that, uh, you can't expect that you're going to have a pediatric endocrinologist or a pediatric nephrologist out in every little town. That, you know, we need good pediatricians out there and they can, working with the-- you 00:41:00know, we send letters back and we, you know, they're available to call us and things like that. So it's-- it's a partnership.

CLANCY: Wonderful. Um, talk a little bit about the importance of the-- the educational, uh, part of our mission, uh, in regards to these clinics. How has it helped us in terms of training our residents and our students?

NOONAN: Well, as I say from-- at early on, we almost always had a pediatric resident on every clinic. And we-- we'd also have the, uh, junior medical students who are taking their rotation on pediatrics. Um, we don't have-- you know, now they changed all these rules for --(laughs)-- the working time for, uh, residents. And so it's-- if we have an overnight clinic, that makes it more difficult for them to come. And I'm disappointed, we're not having as many, uh, pediatric residents go on the clinics we used to. Uh, we still have, uh, hopefully the junior medical students. But again, if they-- if it's 00:42:00an overnight clinic, that's sometimes a problem. But they really enjoy it. It's a wonderful experience for a, uh, for a third year medical student to come on the clinic, because, uh, they just come in and they-- they-- I think it's a wonderful training for 'em, because, two-- for two things. They-- they, uh, hopefully see a good role model in seeing a physician how they interact with patients and how you can get something done without spending a whole hour on it. And --(laughs)-- and then they get to listen to all these heart murmurs. They'd have-- you know, if they do the c-- the heart clinic here at Lexington, they get a new patient. Well a new patient in er-- in a cardiac clinic in Lexington is, you know, 90 percent of the time is not gonna have any heart disease. Gonna have an innocent heart murmur or a chest pain or a so-- you know, something that somebody wants us to evaluate. But it's not anything that's-- is going to uh, be, uh, very 00:43:00helpful at learning much --(laughs)-- about congenital heart disease. In these regional heart clinics, if they go they'll hear a murmur of a ventricular septal defect. Aortic stenosis. They'll see a post aptotrology (??). They have all these murmurs. Then they also see the innocent murmurs that comes, the kids with chest pain, and they see how does it-- how does a real doctor, uh, interact with, uh, people. And, uh, uh, you know, you can kind of tell some of them just really love the clinics and some of 'em, who I guess --(laughs)-- don't ever expect to listen --(laughs)-- to a heart again aren't that turned on. But most of them are. And I think it's a-- a great opportunity. And when I see, uh, some of our graduates years later, they can almost all remember having gone on a heart clinic with me in wherever, you know. So it's something that they remember when they graduate and--

CLANCY: How wonderful.

NOONAN: Yeah.

CLANCY: Um, you want to talk just a little bit more about Noonan's Syndrome. You-- you mentioned that earlier, that, uh, you were documenting cases and then you were surprised later that it was named 00:44:00Noonan's Syndrome. Tell us a little bit about Noonan's Syndrome.

NOONAN: Uh, well, no, uh, when I finished my, uh, training in-- in Boston and went to Iowa, that's was my first job. I went there in July of, uh, 1959. And I was, at that point, still thirty years old. I wasn't gonna be thirty-one until Oct-- October. And I went to-- to start a pediatric cardiology division, uh, because there weren't pediatric cardiologists all over the country at that point. So you finished your training one day and you went out and started it. Well, you know, if you-- if you're gonna go to, uh, medical school, you-- you've got to do some kind of research. And I had noticed during my time as a pediatric resident, which I did at Cincinnati Children's and during my fellowship, that many children with heart disease had, in addition to their heart problem, other congenital malformations. And 00:45:00nobody had paid much attention to that, you know, reading about it. That wasn't anything people paid much attention to. And in those days heart surgery was not like it is --(laughs)-- today. The mortality was high and-- and, uh, I thought, gee, it sure would be nice if we could figure out what caused heart disease. Surely it would be better to prevent it than to try to fix it after the fact. So when I went out to Iowa I decided I was going to do a project in which we would look at all kinds of-- of, uh, factors that could be causes of heart disease and also look for, uh, associated anomalies. Well this was before computers, so I had a little five by seven card and there was a doctor out there, Dr. Dorothy Ehmke who, uh, was going to be half time chief resident and half time my fellow in cardiology. So we would-- every patient I saw was a new patient because I'd just gone there. So, uh, we collected 833 cards of patients with congenital heart disease. And, 00:46:00you know, uh, on the-- on the card would say how much they weighed, what family history, whether the mother had rubella. Uh, we'd look for whether they were a twin. All kinds of things like that. And if they had any other congenital malformations. And during that, there were nine children that looked just like brothers and sisters. (laughs) They had, uh, faces that were similar. Uh, uh, they have-- sort of-- usually have their ears are usually a little low set and posteriorly rotated. They have wide placed eyes called hypertelorism. They might have little droopy eyelids. They often had a chest deformity. They were short. And they all had pulmonary stenosis. So, uh, I thought that was interesting. (laughs) So we, uh, collected all of our data. And then by hand I did all my cards and figured out and put all this together to give a-- at-- uh, I present-- presented an abstract-- 00:47:00actually I was already in Kentucky by that time, in 19, uh, I think it was, uh, '61. I'd-- I came to Kentucky in, uh, December '61. So I think maybe it was '62. The-- the meeting was in Cincinnati. It was the Midwest Pediatric Research Society. So I had my-- the-- the talk was about associate anomalies in congenital heart disease. So I gave that data. And then I showed, uh, a picture of the two children, a-- a male and a female, uh, with what I-- what's now called Noonan's Syndrome. And, uh, talked about that. And, uh, there was a lot of discussion at the meeting. Uh, I proposed that it was a new syndrome. And because before that there were girls born with what we've now know is Turner's Syndrome. And just be-- it wasn't until the middle--early 00:48:00fifties that we knew enough about chromosomes to know that Turner's Syndrome is due to a-- an, uh, a sixth chromosome abnormality. And then there was some males that looked a little bit like Turner Syndrome. So people --(laughs)-- came up with a term, Male Turner. So you had Female Turner's and you had Male Turner's. Uh, well, from these patients that I saw the girl that had this syndrome did not have Turner's Syndrome because chromosomes had just become available and we were able to show she did not have. And the males, uh, and the females we thought were one syndrome. And so, uh, now the interesting thing was that while I was at Iowa doing this, Dr. John Opitz who's become quite a famous geneticist was an intern at--(laughs)-- at Iowa. So when he finished, uh, his training there, he went to Wisconsin to study 00:49:00genetics, dysmorphology with Dr. David Smith who was quite a famous, uh, geneticist. And as he was there he'd see a patient, he'd say, "Oh, there's a girl with Noonan's Syndrome." And they'd say, "John, why do you call it Noonan's Syndrome?" Well, he said, "That's what Dr. Noonan taught me" when he was at Iowa, when I was a --(laughs)-- brand new faculty member."

So he kept talking about this. And, uh, uh, in the meantime I was in Kentucky, and, uh, I found ten more patients here. So, uh, he said to me, "You know, it's--." And he kept talking about Noonan's Syndrome and put it in abstracts here and there and-- and he finally said, "You know, it's hard to call it Noonan's Syndrome when Noonan hasn't published on it." So I then published the, uh, the 19 pat-- uh, patients and it was published in the American Journal of Disease of Children. And John Opitz, uh, there were several other articles on the same syndrome, but they had, you know, they hadn't called it-- they-- some of them were mostly males, I think. I don't think-- I 00:50:00don't know that there were any, wa-- females with that. So anyhow, uh, John Opitz, uh, I think, convinced the editor that this should be called Noonan's Syndrome. And it turned out the editor of AJDC was Dr. Ashley Weech. And Dr. Weech had been my chief when I was a resident at --(laughs)-- Cincinnati. So my paper came out, I think it was Turn-- uh, Turner phenotype something. I mean I didn't use the word, "Noonan's Syndrome" at all. But across every-- every page of the thing was written "Noonan's Syndrome." So that's how Noonan's Syndrome got it's name, John Opitz named it that. And, then, uh, Dr. McKusick, who was very-- a very famous geneticist from, uh, Johns Hopkins, had a, uh, something in the seventies, early seventies, um. He had a program in-- at-- at Johns Hopkins looking at syndromes with heart problems. And one of the things they talked about was Noonan's Syndrome. And 00:51:00he used the term Noonan's Syndrome and put it in his book. And so, you know, very soon thereafter you went to Index Medicus, which nobody --(laughs)-- does anymore, you could look Noonan's Syndrome and look at-- now you go to Pubmedicine and you put in Noonan's Syndrome, and used to be, uh, oh, uh, till a few years ago you'd go to look up Noonan's Syndrome in, uh, Index Medicus, there might be one or two articles a month maybe. And they were usually another case report. Well, in 2001, I guess it was, 2003, somewhere-- the-- the first gene for Noonan's Syndrome was found, PTN-eleven mutation. And-- and then it turns out that this gene is involved in a very important pathway, metabolic pathway. And so the basic scientists have gotten involved. And now if you go to Pubmed, if I don't go every week I get behind, because the-- they're-- people are writing it like mad. And since 00:52:00I have sort of retired, as you know I'm-- you know --(laughs)-- how retired I am. But --(Clancy laughs)-- I have been writing more and giving more lectures on Noonan's Syndrome then I had. I, uh, it's-- it's a very exciting time because it turns out that, uh, uh, this-- these genes for Noonan's Syndrome, and then there's two other, uh, syndromes that are very similar to, uh, to Noonan's Syndrome. And I'm involved in, uh, one of those other ones, cardiofaciocutaneous. I'm on their medical advisory board. I'm on the Noonan's Syndrome advisory board. And, uh, uh, so it's-- it's very exciting because uh, we're learning more about that every day and, uh, and it's just kind of fun to, uh, have sort of started it all --(laughs)-- I guess. Uh, I'm sure somebody else-- wouldn't have been long before it would have been, uh-- and I remember when I went to Hopkins to-- uh, for Dr. McKusick's, uh, uh, he asked me to give a-- say a few words. And I said a few 00:53:00words. And I said, "Well, hopefully one of these days we'll find out what the cause is. And then we [noise] can give it, you know, it's name." (laughs) Well, turns out that, uh, I don't think we're gonna come up with a-- a different kind of name because you can't call it, heh, you know, it's-- there's-- it's-- it's one of these genes that, PTN-eleven gene. Are you gonna call --(laughs)-- it PTN-eleven gene or what? And-- and then it really turns out that this pathway in which the Noonan gene is in, uh, and there now of at least four Noonan genes that have been found, uh, cardiofacial and cute-- and Costello and neurofibromatosis, they're all, uh, germ line mutations in this same pathway. And that pathway people thought was involved in cancer. But they did not know it had anything to do with fetal development. And it turns out it's very important in fetal development. So, uh, the 00:54:00possibilities of understanding more about that and even the possibility they're-- there might be ways of affecting the effects of that gene, because, if you've got an abnormal gene it doesn't stop working when you're born, it's-- and-- and we-- we had no idea what happens when they become adults. And that's one of the things I'm trying to learn more about now as-- as patients I've seen have grown up, to follow them and-- and see what's going on. So, uh, I just hope I can live long enough to --(laughs)-- to, uh, learn a little bit more about the adult with Noonan's Syndrome. Uh, so.

CLANCY: How exciting. Uh--

NOONAN: Oh, it is. That's very exciting, yes. Um-hm.

CLANCY: Okay. Let me ask you, uh, a couple of questions about, uh, your career. When you came here in 1961 you came as an assistant professor. And I think in your, uh, earlier, uh, interview with, uh, Dick Smoot back in-- in the 1980s you talked about the excitement of being able to develop a new program.

NOONAN: Um-hm.

CLANCY: Uh, tell us a little bit about, uh, about that and what were 00:55:00your experiences as a-- a female assistant per-- uh, professor when you first came? I think there were only a couple of females. So how did that-- how did that work?

NOONAN: I didn't have-- I didn't have any problem --(laughs)-- with being one of a few women, because that's the way it --(laughs)-- was in those days. Uh, uh, you know, in medical school there weren't very many women. In-- in pediatrics there's always been more women. And, uh, uh, so I never, uh, I've never had any problems being, uh --(laughs)-- a woman among, uh, men. That, uh, I have not felt, uh, discriminated against or anything like that. Uh, my own personal feeling is a lot of that's in the eye of the beholder. And, uh, you know, if I didn't-- if I didn't get this residency versus that one, I never just assumed it was because I was a woman. I-- you know, there's --(laughs)-- there's a lot of people sort of doing the same things. And, uh, I-- and I've just felt I have been-- and I, I enjoyed medical 00:56:00school. I-- I-- I never had, uh, felt I was discriminated against. And, uh, uh, I certainly have not felt that. I think that hardest part was when we got into the seventies when, um, uh, women's lib came along and --(laughs)-- now you had to be on so many committees to be --(Clancy laughs)-- the token woman. And-- and that was-- that was more of a --(both laugh)-- of a challenge than when they just left you alone. And-- and then when I became chairman in 1974 I was the first woman chairman in-- in the College of Medicine. And, uh, so what I-- and then we had, uh, and as we, uh, as the chairmen would meet, you know, they said, "Well, what are we gonna call you? Are we gonna call you chairwoman?" I said-- I said, "You know, I used to be called chairman when I was in grammar school --(laughs)-- if you're-- I said, "I-- I don't think of that-- I think of that as a non, uh, sexist name. And chairman is fine." And so I-- I had-- I had a wonderful time 00:57:00with the other chairman. I never-- they-- they treated me very well. And then when KMSF (Kentucky Medical Services Foundation) stuck-- got started and, uh, you know, that was, uh, right after --(laughs)-- I became chairman that we had a couple of years of getting the-- going into our practice plan. And everybody-- the-- the way the practice plan was, everybody was gonna have to stand on their own two feet. And they were all very worried about whether-- how pediatrics would make it. But it turned out pediatrics did fine. (laughs) We didn't have any problems. Part of it was we were paying ourselves such low-- low salaries we --(both laugh)-- didn't have any problems. And-- and we actually were able to increase our salaries. But, uh, it-- it was an exciting time. Uh, my name is over there on the KMSF 'cause I was the first secretary. So, uh, I've just been treated so well at the university. I-- I have no problems. Uh, many years ago when Dr. Singletary was there, he named me, uh, one of the alumni professors. And I think I was the first woman to, uh, alumni professor. So, 00:58:00uh, I never-- I-- I've not really felt any, uh, uh, time that being a woman has been a-- uh, I suspect in some ways --(laughs)-- maybe it's been an advantage. (laughs) Uh, but, uh, and I think that what's been exciting to me is to see how the increase in women in medical school has changed medicine. Uh, much of it for the good. Uh, and, uh, what women I think brought to it was, uh, a sense that there's more to life than just --(laughs)-- working all the time. And, uh, women who wanted to, obviously have families and-- and have, uh, some time for themselves, uh, said, you know, "We're not gonna work, uh, seven days a week. We'll work four days and take some time-- take our turn for, uh, weekends" Well, you know what, the men said, "That's a great idea." 00:59:00(Clancy laughs) And everybody's doing it now. So-- and everybody's in groups. They're the-- you know, you can't have much life if you're the only-- if you don't have any partners. So it's changed the way medicine is practiced. And that's good for, uh, the physicians and for their families. It, I think in some ways, uh, takes away a little bit of that one on one doctor patient, because, you know --(laughs)-- you see your pediatrician when you're well. But if you're sick you see whoever's on call. And somehow --(laughs)-- if my --(laughs)-- if my baby was sick I'd like to take-- see the pediatrician that I really know and have great confidence in. So, uh, things have changed that way. And I think the-- the closeness of doctor patient relationships, it's a little more difficult to-- to-- to have that. But, you know, that's-- you-- you have some good and you have some uh, not so good. But, uh, I think that, uh, uh-- and, and the other great thing about 01:00:00it is, I remember in the seventies when it was woman's lib and you couldn't just be a doctor. You had to be a super-super doctor. You had to be, you know? And I remember --(laughs)-- this part of this time I was on some committee of women in medicine, and we didn't --(laughs)- - have that many, so the dean pointed me to that. And I had-- went to-- and then the AAMC asked me to go to a meeting in Washington DC. And I went there and I-- I was in some kind of a-a-a program. And then they had this dinner meet-- I mean they had this big conference at night. And Rosalyn Ya-- uh, Rosalyn Yalow I think her name was, uh, she was a Nobel prize winner professor at Cornell or some place. So she gets up and does one of these Rah rah (laughs)-- speeches. And in the audience-- I mean I'm not lying, it was full of these young doctors, half of them were about eight months pregnant. And they're sitting 01:01:00--(laughs)-- with their eyes bugging out. And she's going on and on --(laughs)-- about, you know, the Nobel-- wait, winning the Nobel prize and doing this and that and being married and raising a family and all this. (laughs) And these poor kids are looking up with their-- I finally couldn't stand it. I said, "Isn't anybody gonna say it's okay if they just become a good doctor?"

CLANCY: Um-hm.

NOONAN: You know?

CLANCY: Um-hm.

NOONAN: And-- and-- but it was very hard on women when they first-- now with-- with 50 percent or-- well, not at UK --(laughs)-- but you have 50 percent overall of the class are women, they do not feel that pressure. They don't feel they have to be a-- a chairman of pediatrics to be successful. They don't-- and, you know, some of them want to do that. And they can. Most of them don't want to do that. You know, most men don't want --(laughs)-- to do it. It's a lot of work. (laughs)

CLANCY: The point is more people have more choices.

NOONAN: Yeah, they have choices. And-- and nobody is gonna look down on them because they-- but there was at that time, I think, a lot of pressure on women that they had to be super women. They had to be able to do it all. And, uh, it was a lot of pressure. But fortunately as 01:02:00more women came in, uh, the-- the pressure's off. They do-- and the thing's interesting-- (laughs) is the men like it. And they're doing the same thing. (laughs) So I think it has made, uh, medicine a more compassion, more family friendly and certainly like that, where, uh, you know, I-- I can remember one of our --(laughs)-- when I had to come back and be acting chairman of-- a Chief of Cardiology when the cardiologist left. I did that after I'd retired. I came back and did that for a year. And I had all these new, young faculty. (laughs) And they-- you know, they were worried about getting back from clinic in time to go to their son's, you know, boy scout meeting. (laughs) And I thought, you know, that would never have even dawned on us --(laughs)-- you know? But-- but it's good. You know?

CLANCY: Um-hm.

NOONAN: That's-- but it's-- it's just interesting. But you can't go to your-- your son's boy scout meeting unless you have enough faculty to do that.

CLANCY: Um-hm.

NOONAN: And so what, uh, you know, we have, like, eight, I think, 01:03:00cardiologists now. And we don't really do any --(laughs)-- more than we did when there were two of us. It's interesting to--

CLANCY: Um-hm.

NOONAN:-- see. But--

CLANCY: What would your, uh, suggestions or words of wisdom be to-- to women coming up, uh, as, uh, physicians, as-- as med students, as residents? What are your, you know, words of wisdom for the future?

NOONAN: Well, I-- you know, I think that-- I think medicine's a great, uh, profession. I would certainly-- I think women are very well suited to it. And I think that they should do what, uh, they should not feel compelled to-to-to, uh, to follow any particular path. They ought to-- they have choice. They should choose what they want to do and, uh, uh, I think that if somebody wants to, you know, to-- to work very hard and do their thing and wants to advance, that's fine. If they-- they-- they choose to just do a good job as a-- as a physician, that's certainly more than --(laughs)-- enough too. So, I-- I don't-- I don't 01:04:00have any great words of wisdom. I-- I just hope that they-- whatever they do, that they'll enjoy it as much as I have. (coughs) 'Cause I-- I mean I really, uh, like what I do.

CLANCY: Hmm, that's wonderful. You mentioned earlier about the practice plan. Um, can we talk about that just for a minute? Um, can you give me sort of an overview of the practice plan, how it has changed since you've been here. I mean, the differences, I know there have been some significant changes at different points.

NOONAN: Um, well, you know, it-- the-- the practice-- I mean this-- it was a very difficult time, Dr. Bosomworth was the chancellor at that time. And if-- I don't know if you remember, but the surgeons were about to walk out because the way the system was in the university, we had limits on how much one could increase anyone's salary. And you had people who had been here for twenty years or fifteen years --(laughs)-- 01:05:00that couldn't make as much as new people coming in because you-- there was not much limit on how much you could pay a new hire. But you were limited in how much you could increase somebody's salary. And, uh, this was at a time when, uh, the people out in the community were making money hands over. And the people at the university were doing a lot of work and they were-- but, uh, it-- we didn't have a practice plan as such. And we had this PPS or whatever --(laughs)-- it was called, system, where it-- it wasn't-- the people-- they-- they were not really efficient in collecting money and all of that. And we-- it was a difficult time. And many other places had already established a practice plan. And so, uh, uh, the first thing I became chairman --(laughs)-- we started having all these discussions. And I would say it was one of the hardest things for me to do, is to-- I had been, what we call, uh, a, you know, full time. And, uh, you got your-- you got 01:06:00your salary and you didn't worry about --(laughs)-- anything else. And now you were gonna have to earn your money by, you know, documenting and-- and all of that. And so we became what's called geographic full time. And, uh, I had to sign that, which I did, because I knew it was absolutely necessary. And, uh, uh, and-- and money became much more, uh, important than it had ever been.

Uh, I think in pediatrics we had a very, I think, fair practice plan. What we were able to do is to get everybody's salary not up to what they wanted, but more into what the, uh, southeastern, whatever, getting it up to that. And then because part of the whole overall practice plan had to be in incentive and that bonuses could be given for high achievers --(laughs)-- or whatever, uh, we-- we did that as well. 01:07:00But we did it in a little different way in that even people who did not generate their-- their salary, which some don't because they're-- they just are not high earners, like infectious disease and things like that, um, they got their salary. And then they would get, uh, uh, we would proportion their earnings somehow-- anyhow, everybody got some bonus. Of course the bonuses --(laughs)-- were low if you were a low earner. But you got something. And then we had, uh, everybody got some, uh, oh, money for trips and things like that. Now at the beginning the cardiologists and the neo-natologists did very well. And I kept reminding 'em, these bonuses --(laughs)-- were bonuses and you really ought to live on your, uh-- and then the, uh, government came in or somebody came in and began to cut down on how much you could get paid for echocardiography. That made a big difference in the, uh, 01:08:00cardiology, uh, people. Not only pediatrics, but adult as well. Uh, neo-natology, we were fortunate. Uh, I hired Dr. Doug Cunningham. He was my first faculty member I hired. And, uh, he, uh, was very good at keeping track of everything. And neo-natology was able to, uh, generate, uh, a-- which was really-- I mean that was-- I had a lot of interesting things happen during my-- beginning of my chairmanship. Uh, this was when we hired Doug-- Doug Cunningham--

CLANCY: Um-hm.

NOONAN:-- we had a nursery that was not really adequate to ta-- to take care of very many babies. And he came and was going to do it right. Which meant we could not take all the babies that we needed. And I don't know if you remember the, uh, that babies were being-- having to be transported to Cincinnati and to Vanderbilt and to wherever, 01:09:00uh, because we did not have enough beds. The dean and people at the College of Medicine said, "We do not need any more neo-natal beds for our teaching program." And the state-- in fact it turns out Governor Beshear was lieutenant governor at that time, and he was one of the people that helped push through the, uh, and, uh, uh, it was-- it was an exciting time. And, uh, we'd see on the television there'd be showing --(laughs)-- the babies being transported past --(laughs)-- UK up to-- up to, uh, uh, Cincinnati and, uh, so it was an exciting time. But what happened is the-- the state legislated that they would fund money to build a neo-natal intensive care unit. And that has been wonderful. I mean, uh, so the neo-natal intensive care unit was, 01:10:00uh, funded by the state. And, uh, uh, you know, the universe-- the hospital was so concerned that it was gonna be a money loser. It is not a money loser. I don't know if it makes a lot of money, but it is not a money loser because, uh, they keep very accurate, uh, count of what they do and they get reimbursed for what they-- they do, and they keep-- you know, it's, uh, Dr. Cunningham --(laughs)-- was so precise in being sure that-- that they met every Medicaid requirement 'cause many of our babies are on Medicaid. And, uh, and it's been, uh, you know, wonderful, the-- the neo-- you know, neo-natal transport system and all of that. And it's developed into a, you know, a really first class neo-natal unit. And, uh, and that all --(laughs)-- happened the beginning of my, uh, time as, uh, chairman, uh, having to go through that. Uh, which was a hard time. We did not like having to send babies to Cincinnati. But it wouldn't be fair. Before that, 01:11:00you know, if we had too many babies, they'd put two babies in the same bassinette. Well, you know, you do that as a-- you know, as an emergency. But that's not the way you run a hospital and a medical school. And so, you know, uh, Dr. Cunningham was right, even though-- and I supported him. And, uh, and it worked out. But, uh, I-- that was a-- that was a pretty --(laughs)-- exciting time of my--

CLANCY: Yeah.

NOONAN:-- yeah, of-- of my chairmanship. And then I was of course the-- as-- as time went on with the KMSF, they-- there was one time when they decided we had too many Medicaid patients and we weren't making money and-- and they were going to limit the number of Medicaid patients based on how many we'd had the year before or something. And we're going through that and I remember saying to 'em, "Look, if I get a child with leukemia who comes in and, uh, has Medicaid and we're over our limit, I'm not sending that child home, you're going to have to." (laughs) So we never turned anybody away it turns out. I 01:12:00think the only thing that did happen is that there were children who were not, uh, there were children with surgical problems who did not have insurance that would, uh, that they would not be able to do. I think they were-- had to limit or wait on those. Uh, and of course sometimes they'd get into trouble, and then you have to do 'em 'cause an emergency and it costs more then. Uh, but when I finally left, when I retired, uh, I remember the-- the last day I was --(laughs)-- at the, uh, KMSF meeting, they did say --(laughs)-- that, uh, they were losing the conscience of the --(laughs)-- of the --(both laugh)-- KMSF. So, uh, that was, uh, I was pleased with that. (laughs) They were probably glad to get rid of me. (laughs) But, no, they're a good group and--

CLANCY: I'm sure they weren't glad to get rid of you. (both laugh)

NOONAN: But-- but I-- I did keep, uh, keep at them. Uh, and I know, I understand that, you know, one has to have money to run a medical school. And, uh, but, uh, and I'm just so delighted with our present 01:13:00administration who seem to, uh, you know, be able to, uh, to take risks. And that's one of the problems that is hard for people to take risks. But if you don't take risks, you don't make any progress.

CLANCY: Do you want to talk about the Children's Hospital a little bit? Your role in that?

NOONAN: Oh, uh, well I'm just so pleased. Uh, you-- you don't know how pleased --(laughs)-- I was when they hired Dr. Bricker to be, uh, chairman of pediatric-- and I didn't-- I didn't know at all that they were considering him. But I-- I knew Dr. Bricker 'cause he's a pediatric cardiologist. And actually he had invited me to spend a week, uh, at-- at Houston, after I retired we-- and, uh, had a wonderful time there and got to know him a lot more at that time. But I, uh, had known of him. And, uh, such a nice man. And so then to have another pediatric cardiologist come to be, uh, chairman of pediatrics was just absolutely wonderful. And he has done just such a terrific job, uh, in 01:14:00the, uh, you know, uh, Dr. Moncott was here when the-- you know, my -- (laughs)-- the Children's Hospital was a dream of mine. And --(laughs)- - I don't know if you remember, uh, uh, uh, you know, when uh, Joy was the-- here. Uh, the two of us would --(laughs)-- Frank Butler would get so mad at us every time we had the Miracle Telethon. We-- we'd talk about the Children's Hospital that we wanted. And he never wanted to talk about that. And as soon as I retired they hired a new person and they built a Children's Hospital, it was sort of --(laughs)-- uh, but I was glad that it came finally. And, uh, and-- and now, uh, Dr. Bricker has really, uh, taken that. And we-- we did-- they did have their own board, but he has really brought it to a-- another level. He's gotten very active people in the board. He's gotten people, uh, he-- the first thing he did is change the name to Kentucky Children's Hospital. Uh, as he says, if they come from Murray to a basketball 01:15:00game, they can come from Murray to the hospital. (laughs)

CLANCY: That makes sense.

NOONAN: So-- it does make sense. (laughs) So, uh, and they are-- there are people in western Kentucky that are very much UK. And so we're trying very hard. And, uh, and it's real exciting, uh, uh, to, uh, see them, uh, reaching out to all parts of the state. And, uh, and then to have so much support coming in there. You know, I guess they're about to start their big campaign, because in pediatrics you need-- pediatric sub specialists can not generate the amount of income that we need to provide the kind of care we want to provide. I-- I-- for example, endocrinology. If you're taking care of a child with diabetes, you can not do a proper job without a nurse, a nurse educator, a nutritionist. All of those are part of your team. Who's gonna pay for them? The faculty had to pay for 'em with their earnings. 01:16:00Well, they could hardly make their own salary, never mind those. And so, uh, when Dr. Moncott was here, that was always a problem because the endocrinologists --(laughs)-- would keep being told how they were in the red. And, uh, my feeling was, it wasn't their fault they were in the red. Somebody else has to help them. And-- and I think that's where, uh, when they raise money for Children's Hospital, it's gonna be for programs. It will be so that we can have enough endowment that we can help support these people because they don't get paid for doing what needs to be done. (coughs) So, uh, I'm just delighted that we will hopefully develop enough of a, uh, endowment that we can get support for the, uh, programs that need to have, uh, that kind of support to do the job that needs to be done.

CLANCY: Wonderful. Uh, Dr. Noonan, you have won --(Noonan coughs)-- do you need to stop--

NOONAN: No--

CLANCY:-- for a minute?

NOONAN:-- it's okay.

CLANCY: Okay. You've won all kinds of awards. You-- you, uh, won the Harpers Bazaar --(Noonan laughs)-- uh, top 100 women physicians. And you have the Noonan's Syndrome named after you. And you've won the top 100 physicians in the country. Uh, you have the endowed chair. Uh, there've been numerous other awards, your lifetime achievement award. Tell me, of all of these things, what has given you the most satisfaction and the most delight?

NOONAN: Well, I don't know that you'd call an award being made-- uh, being the, uh, chairman of pediatrics. But I think that was probably, uh, something that I'm-- I'm probably the proudest of, uh, because of the effect you have on, uh, so many people. (coughs) I mean I've got, you know, people who I trained many years ago are actually just being here at the university where, uh, I've had so many, uh, medical students that are now, uh, then end --(laughs)-- up now retiring, which is kind of funny. But I can't go anyplace without running into a, 01:18:00a, a doctor that-- that I've had some, you know, small part at least in their training. Because they couldn't come through here without having, uh, had, uh, a lecture or something by me. And, uh, and even now, even though I don't, uh, do that much teaching anymore, I-- I do, uh, if-- if they come to a regional heart clinic. And I do teach an ethics class, uh, to the junior students. So I-- I sort of feel I still have-- oh, and I'm still teaching CPS, so, uh, I still am doing some teaching. So I can feel that I'm still teaching a little bit of every class that's graduated from here. That's-- that's really fun. (coughs) To think that, uh, you know, you've had a role in, uh, over fiv-- well it will be fifty years in 2010. So--

CLANCY: Wow. You certainly have influenced --(Noonan coughs)-- uh, a lot of health care here.

NOONAN: Well, I-- I mean it's, uh, it's uh, it's been, uh, very rewarding.

CLANCY: Well, let's wrap up. (Noonan coughs) Uh, one more question about the, uh, regional clinics. Is there anything that we're-- that we need to cover? Anything that we haven't talked about yet, um, that you would want to talk about with the clinics, the regional clinics?

NOONAN: No, I think that, uh, I-- I really think that if we had more faculty and more support for regional clinics that there is a role. Uh, I-- I'm-I'm-I'm sure that we could do more in the diabetes-- in-- in, uh, following diabetics. I think the area that I would love to see us have some input in is in-- if we could have some asthma clinics. Every place I go in eastern Kentucky the kids all have asthma. I saw a girl yesterday and I saw her last year, she still was wheezing. She's a great big tall girl, uh, and I say to the mother, well, you know, uh, she takes a couple of medicines that somebody's given her. And I said, "Now do you think you could come down to Lexington and talk to one of our--?" No, she didn't think she could get down there. 01:20:00And, you know, if we could just-- there are-- there are some good, uh, ways of treating asthma today. Uh, not just having 'em have an inhaler, which they use when they wheeze and whatever medicine that the druggist told somebody to take. I mean there are ways that one can really improve asthma. And that's such a very common problem. And I-- I could see how having an asthma clinic, uh, in various parts of the state would really, uh, be-- be helpful. And-- and I-- I know that it's just hard for people to-- to, to get up to Lexington for anything but sort of life threatening --(laughs)-- sort of things. You know? And, uh, and then I think even if they come they probably have a pretty long waiting time before they can get into the clinic here. Uh, but poor Dr. Conga, you know, he-- he-- (laughs)-- he finally, again has three. He was alone and then he-- there were two and then there were 01:21:00three. And then as soon as the, uh, as soon as the, uh, the third one came, the-- the second one left. So he was back to two again for a long time. And now there are three of them. But, you know, with three of them busy doing all their cystic fibrosis and doing their bronchoscopy and all that, they just don't have enough, uh, bodies to do, uh, eastern Kentucky. And, uh, I just think that that would be an area I'd like to see, both increase in the diabetes and in, uh, asthma. I think those are two areas which are important, uh, chronic illnesses in eastern Kentucky.

CLANCY: Is anything else?

NOONAN: (laughs) I think that's enough.

CLANCY: (laughs) Okay. Well, we want to thank you so very much for your leadership and your service at UK. And thank you for your interview today.

NOONAN: Well, thank you. I enjoyed it. Is that my voi--

[End of interview.]