Like father,like son

Like father,like son

If there could be a single moment that defines a human being, for Anderson “Andy” Spickard Jr., M.D., and his son, Anderson III, M.D. it could probably be traced to a stormy, spring afternoon in 1950 on the eighth hole of the Belle Meade Country Club Golf Course.

Spickard Jr.’s father, Anderson, a World War II veteran, successful businessman and, at the time, the only member of his family with a college education, was struck and killed by a bolt of lightning on May 28, 1950 — a bolt so powerful that it knocked three others standing with him to the ground.

The event so deeply shook Spickard Jr., professor of Medicine and Psychiatry, Chancellor’s Chair in Medicine and medical director of the Center for Professional Health, that it led him firmly to a career where he could help others, says Sue, his wife of 45 years.

“I’m not at all sure he would have gone to medical school, although it was an option. There were no doctors in his family, no role models around who might have pushed him in that direction. It was just a huge wake-up call. It touched something so deeply within him, about personal need and being there for others. It was the defining moment,” she said.

In turn, Spickard Jr. has been such a strong role model for his three children, that his oldest son, Anderson III, assistant professor of Medicine and one of Vanderbilt University School of Medicine’s Master Teachers, followed not only in his footsteps as a physician, but also in his specialty, general internal medicine, and, like his father, has become a medical school faculty leader.

Spickard Jr., 73, an 18-year-old freshman at Vanderbilt at the time of his father’s death, was the eldest child in his family. His sisters, Amelia and Pat were 15 and 9, so he was responsible for the sobering task of identifying his father at the mortuary.

“I took out his wallet and inside, on a piece of paper, were his life’s goals, to become president of the General Shoe Corp. and to be a good father,” Spickard Jr. said. “They were goal-setting people back in those days,” Spickard Jr. said, in a southern drawl that is surprisingly not all that common at Vanderbilt.

Spickard Jr.’s hopes for becoming a doctor were buried beneath his grief for a while, and he decided he would probably go into business like his father.

“I didn’t have any money and I didn’t think I could pay for a medical education. It was disturbing and unsettling for a young boy. I didn’t know what I was doing, if you want to know the truth. I had to take care of my two young sisters and had to physically carry my mother to my father’s burial.”

But three weeks into his junior year at Vanderbilt, on a walk across campus, in front of Furman Hall, the thought raced through his mind, “I’ve got to be a doctor.” The rest, so they say, is history. Spickard Jr. would attend Vanderbilt Medical School and spend almost his entire career at Vanderbilt.

But his quest to become a doctor wasn’t without sacrifice — his own and that of his entire family. His mother started the SpickAndy Company and purchased plastic toy guns that shot out pingpong balls from the Kusan Company, a plastic manufacturing company in which his father had invested $10,000. She and Spickard Jr. bought boxes for shipping and advertised their company in the New York Times.

“That ad cost us an arm and a leg,” he said. “But we got orders from all over the country for that little toy. We sat on her bed and put them together in these boxes and mailed them off. It was just a blur.”

Then his mother got a job as a social columnist for the Nashville Banner where she wrote about weddings and funerals, and the SpickAndy Company closed. With the help of the plastic gun money, aid from his maternal grandfather, and a job selling life insurance for Mutual Benefit Life Insurance Company, Spickard Jr. got his wish and was able to go to medical school.

“My grandfather had instilled in me an innate curiosity to know the truth, the facts. I really wanted to know,” he said. “I read some books, Great Adventures in Medicine by Samuel Rapport and Eleven Blue Men, studies of diagnosing obscure diseases, and I was ready to go.”

After making up some classes he had failed to take, because he wasn’t sure he was going to medical school, Spickard Jr. graduated from Vanderbilt, and was accepted into its Medical School. “It wasn’t a high-powered thing back in those days. Dr. Sam Clark was the dean. I took the exam and he said ‘come on,’ and that was the end of it.”

Spickard Jr. said his first year of medical school was difficult. He had trouble with the absolutes of medicine — how the femoral nerve snakes under muscle, the number of holes in the skull, etc. — and during his second year, struggled with bacteriology. But when he walked into his second-year pathology course, he “knew it was worth it.” In those days, there was no lecture and no computerized photographs or illustrations; students were just given a copy of Gray’s Anatomy and a pick (for finding nerves).

After graduating from medical school in 1957, Spickard Jr. served two years of his internal medicine residency here, a year at Johns Hopkins and two years at the National Institutes of Health, then came back to Vanderbilt in 1962 as the first Hugh Morgan chief resident of Medicine under David Rogers, M.D. He married Sue in 1959, and soon had three children — Susan, a graduate of the Vanderbilt University School of Nursing with a master’s degree in cardiac care from the University of Virginia is a nurse who is married and lives in North Carolina with her husband and four children. Anderson III, and David, who is also married with four children and lives in North Carolina. He works for Jobs Partnership in Raleigh, N.C., a Christian agency that helps unite those who are jobless with businesses interested in hiring.

Spickard Jr. did research in infectious diseases in 1963, and then joined the internal medicine practice in the Medical Arts Building with Josh Billings, M.D. in 1964. After five years, Spickard Jr. left to help establish The Vanderbilt Clinic and organize the Vanderbilt Professional Practice Plan.

“I knew I had a lot to offer academically,” he said. “I wanted to be part of the action, but working to establish the Clinic and the VPPP was very hard. It sort of broke me down emotionally and every other way. There was so much pressure and it became very important to have extra help.” The extra help he’s talking about is his faith, which became even more important to him during this time.

“In these very troublesome, difficult patient care situations and administrative situations, supernatural help by your God is a very wonderful thing,” he said. “I learned the spiritual strategies that are defined for me in my faith, and that has been the backbone of my being.”

During his career at Vanderbilt, Spickard Jr. served as medical director of the Vanderbilt Occupational Health Service from 1975 to 1989; began and directed the division of General Internal Medicine from 1976 until 1993; is now medical director of the Center for Professional Health, which offers CME courses for physicians, and is chairman of the Vanderbilt Physician Wellness Committee, a committee organized to address the issues of physician/faculty well being. He also founded and served for 12 years as medical director of the Vanderbilt Institute for the Treatment of Addiction (VITA), the inpatient and intensive outpatient treatment program for persons with substance dependence. His interest began in the 1980s when one of his patients, a VUMC colleague, suffered from alcoholism and committed suicide.

“I was well-trained in the physical effects of alcoholism, but did not know about the emotional or spiritual parts. Because of the denial and manipulation and the events that accompanied the death of my colleague, I decided I needed to be trained in the so-called whole person concept of the treatment of alcoholism — the physical, emotional and the spiritual.”

His immersion into the field led to his co-authoring a book, Dying for a Drink with North Carolina free-lance writer, Barbara Thompson. The book is now translated into seven languages and Braille.

Peter Martin, M.D., professor of Psychiatry and director of the division of Addiction Psychiatry, first met Spickard Jr. when Martin was being recruited by the department of Psychiatry in 1986.

“I was very excited about the fact that someone in another department other than Psychiatry was so interested in addiction. We really hit it off. I really liked him, and he was instrumental in my coming here.”

When Martin joined the faculty, he and Spickard III reached a “gentleman’s agreement” to run VITA together, because the two realized that addiction is a complicated area that requires both psychiatric and medical knowledge. In a trailblazing way of treating addition patients, the two would see patients on addiction unit rounds each morning and collaborate on their care. Martin quickly learned that Spickard had a unique way of dealing with patients facing addiction — he would often confront them in a stern, challenging, but kind way. He might call patients “hard-headed” or warn them “you’re going to be six feet under in a pine box.”

“I would teach him psychiatry and he would teach me medicine,” Martin said. “It was a very collegial and friendly and happy time in our lives. And I think he would say the same, that it was a very stimulating part of our careers,” Martin said. “I was a young doctor at that point and had spent most of my time doing research. I learned a lot from him — mostly how to be a good doc. I picked up a lot of his excellent bedside manner skills. He was sort of your family doctor. He would go to the funerals of patients and would make house calls. He is the kind of doctor you would trust to be a doctor to the people who are dearest to you, one whose opinion you listen to. And I think he would say that he learned from me about the complexities of human behavior and psychiatry from discussing the same patients together during rounds.”

Martin said that not only was Spickard his introduction to Vanderbilt, but to Nashville and the South as well.

“I’m a Canadian. I didn’t have a clue. But he taught me so much about how to be effective at Vanderbilt, and how to relate to a different culture. Andy exemplifies the positive of all those negative biases that people from the North often come to the South with. From Andy, I learned how smart Southerners are, how sweet they are, how much integrity they have, and what good friends they are.”

From 1989 to 1996 Spickard Jr. was the national program director of a $50 million grant program, “Fighting Back: Community Initiatives to Reduce Demand for Illegal Drugs and Alcohol,” funded by the Robert Wood Johnson Foundation. Through the program, 14 cities received grants to organize their communities to fight against alcohol and drug abuse.

Good judgment is also an attribute that Spickard possesses, say those who know him best. So, last month, in his 40th year of practice, he wrote the most difficult letter of his career —telling his 140 remaining patients (their average age is 70) that he would be retiring from his internal medicine practice to concentrate on the Physician’s Wellness program, teaching and writing.

“One of my first patients was referred to me for an insurance physical,” Spickard Jr., said. “I found a thyroid cancer on him. He’s well today. That’s the kind of case that’s hard to stop. We’ve been through so much together.”

Spickard Jr. said although his career has been full, he would most like to be remembered for how he has taught medical students, residents and others to treat addiction. He has traveled to Moscow to introduce the Russians to a 12-step Protestant-based treatment program known as OPORA. Today more than 4,000 people in 40 communities in Russia have trained to become OPORA counselors. “That will stand as the most definitive thing I’ve done. It’s had incredible implications.”

In Spickard’s Oxford House office, filled with numerous family photos and certificates, there is a large frame that stands out. The print includes individual photographs of his mentors, the School of Medicine’s past and present teachers and leaders —Hugh Morgan, Josh Billings, John Shapiro, Vernon Knight, H. William Scott, Grant Liddle, John Oates, J. William Hillman, David Rogers and Steven Gabbe, all of them doctors.

“No matter how bad things get in any other area, when you work in an academic medical center, you’re centered by caring for patients, using the skills you’ve learned from others before you” Spickard Jr. said. “This,” he said, pointing to the framed portrait, “is where is Anderson and I get our stuff.”

Footsteps to Follow

Several years ago when Vanderbilt medical students didn’t have pagers, they might receive an overhead page on the rare occasion they were needed at the hospital. For most students, this didn’t cause confusion. For Anderson Spickard III, it did.

“I was on a surgery rotation and my name was paged overhead. My father heard the page, and picked up the phone and answered. My surgery senior resident, who was extremely irritated he couldn’t find me, launched into the conversation with a ‘where in the blank are you?’” Spickard III recalls, his laugh sounding remarkably like his father’s. “That night, Dad called me at home and said ‘I don’t know what you’re doing, but you’d better get better,’ tongue in cheek, of course.”

Following closely in his father’s footsteps has never been a hindrance, rather an honor, says Spickard III. While his interests have led him in different directions, the regard with which he is held at Vanderbilt is nearing that of his father.

He decided to leave Nashville for his undergraduate degree, and graduated from the University of North Carolina, Chapel Hill, in 1985 with a bachelor’s degree in Psychology. While at UNC, he played a game of one-on-one basketball with a college classmate — Michael Jordan. “It doesn’t matter who won the game,” he says, laughing. “Let’s just leave it that it happened.”

Medical school was not always in his life’s plan. “It wasn’t until I got into Vanderbilt early decision that I decided to do it, the notion being that not many people get this opportunity,” he said. “One thing my mom and dad taught me was how to recognize a good opportunity and use it well. I grabbed it while I could.”

Like his father, medical school was not easy for him. He remembers when he got his first anatomy grade (it was “horrible”) his father said, “well, you may not be that good.” It was when he reached the wards during his third year that he knew medicine was the right career choice for him.

He received his medical degree in 1989 and left Nashville again from 1989 to 1993 for his internship and residency, at the University of Washington in Seattle. He was chief medical resident, then moved to Charlottesville, Va., from 1993 to 1995, where he was a fellow in the division of Internal Medicine at the University of Virginia School of Medicine, and received a Masters of Science degree in epidemiology.

With all three children gone from home, his parents were so sure Spickard III wouldn’t return to Nashville that they went out and bought a dog to fill the empty nest. He called the very afternoon they brought the miniature dachshund home and surprised them by saying he and his wife, Margaret, and their two children were coming home, that he had accepted a position as assistant professor of Medicine at Vanderbilt, and had been hired to direct the primary care medicine clerkship at VUSM. The Spickards kept the dog, Sam, anyway.

In his short time at Vanderbilt, he has directed the Programs for Technology Innovation in Medical Education in the department of Bioinformatics; is director of education programs for the division of General Internal Medicine; and directs the third- and fourth-year medical clerkships in the department of Medicine. He was also chosen to be among the first cohort of Master Clinical Teachers for the Medical School in 2003, and has been honored for his teaching abilities, receiving the 2001 faculty-selected School of Medicine Teaching Award for teaching in the clinical setting.

“Anderson is one of our true scholars in medical education,” said Robert Dittus, M.D., Joe and Morris Werthan Professor of Investigative Medicine and director of the division of General Internal Medicine. “He has built his career as an outstanding clinician and teacher. His career work is pioneering and innovative and he’s created a foundation under which the entire structure of medical education will be re-formulated and he’s doing it in a thoughtful and scholarly way.”

In his role as director of the required third-year medicine clerkship, Spickard III has provided remarkably effective administrative leadership, said Gerald S. Gotterer, M.D., Ph.D., senior associate dean for Faculty and Academic Administrative Affairs at VUSM.

“The clerkship Web site is a model for such sites, providing students and faculty with a clear statement of clerkship objectives and expectations for students and faculty. The clerkships have been highly regarded by the students. The summary of the student evaluation of the clerkship notes that the students’ satisfaction can be attributed in part by ‘the responsiveness and involvement’ of Dr. Spickard.”

Spickard III was also responsible for guiding two students in the development of the KnowledgeMap, a powerful computer tool for searching course materials for specific content.

The tool is quickly becoming an important resource for students in researching their course materials, for faculty in improving coordination of their teaching with that of other teachers, and for school committees assessing the curriculum content. He has also recently taken on the role as co-chair of one of three major task forces in charge of reforming the curriculum of the School of Medicine.

Spickard III said he has no negative feelings about charting his own course in waters that have already been explored, and well, by a Spickard.

“I have always been proud of my dad, have always had a consistent stream of positive feelings. I guess I might have felt like it was too much to live up to if I had not been loved so much. But I was always accepted. I don’t recall the bar being set continually that I would have to jump over. There was never a theme of disappointment from my mom or dad that would make me competitive. There was space. It was an environment that offered freedom.”

The two have a close relationship, sharing a love of sports, particularly tennis and fishing, and he has a file filled with notes from his father, always a note writer.

He inherited a strong faith from both of his parents, a faith that has only grown since his college days.

“I’m comfortable with the level of expression of my faith, which comes in very personal settings, with my patients and with the occasional colleague or student. There’s no agenda. I’m here because I feel like a vessel of healing, that there’s something bigger going on, and medicine, in my view, is a gift from the Lord. I guess I’m a minister of it, yeah, I guess I’m a minister in a way.

“My father and I pray often together. He’ll come into my office and we’ll pray,” he said. “We high five on that all the time, that we have this relationship, this ability to communicate. On the other hand, we give each other a lot of space. I could move from here and be fine, with the next chapter of my life not being here. It’s not a physical necessity, needing to be together, as much as it is just being able to finish each other’s sentences.”

Spickard III married his college sweetheart, Margaret, 18 years ago. “She is the most important person in my life. We have a great thing going,” he says. They have three children, Anna, 12, Lucas, 10 and William, 7. William has Down syndrome, which is both a struggle and blessing to his parents.

“Meeting William’s needs can be hard work, at times a daily struggle. Yet William is a joy,” Spickard III said. “He reminds me that life isn’t only about what I’m aspiring to. In a sense, that’s one of the greatest gifts. He helps slow me down, to stay in perspective, and to listen to the pain of others.”

Although his days are filled with teaching and caring for patients at the Medical Center, he has a strong sense of family. (Both he and his father have always made a point to be home for dinner, even if it means returning to the Medical Center in the evening to finish unfinished work.) Spickard III is also a gifted athlete.

In high school, he played three sports — basketball, track and cross country — and tried out for the junior varsity basketball team at UNC, although he didn’t make the team. He plays tennis, runs nearly six miles three times a week with his two closest male friends, Gif Thornton, an attorney, and Tom Douglas, a songwriter, and runs marathons. In fact, he qualified for and ran the Boston Marathon this year.

“It was the second hottest day on record in Boston that day,” he said. “People fell out like flies, but I finished. It was a goal that was achieved. That itch has been scratched.”

“Running has saved us thousands on therapy and counseling,” Thornton said, laughing. “We figure things out in the hills,” he said of their 5.8-mile, 5:45 a.m. runs at Percy Warner Park. “Tom and I are very happy with our accomplishments, but Anderson is a real athlete.”

The three friends attend church together and are in a Bible study with their wives.

“Faith is a big part of Anderson’s life, and is central to our relationship,” Thornton said. “I read about men who have difficulty in finding intimacy with other guys. I read about it and shake my head. I’ve got that. I’ve got two good friends who know everything about me, both good and bad, and love me in spite of that.”

Spickard III said that as much as he enjoys his multiple roles at the Medical Center, patient care still remains his top priority.

“Patient care is the golden part of my day. Hopefully, that will never go away. It centers me and is my reason to be here. It’s an honorable place to sit every day.”

Spickard III said his mother, a longtime community volunteer, gave him his ability to accept people.

“She told me to make sure that I’m starting from their perspective, that I understand what it takes to park, find the clinic, go through the co-pay, and sit there in a culture that is completely foreign, to remember that when we arrive all bouncy and righteous with what we think needs to happen next.”

His compassion, like that of his father, extends not only to his patients, but his friends as well. Thornton’s father was recently diagnosed with cancer, and Spickard III has been instrumental in offering support and seeing that he gets the best care.

“Anderson is a mature man who knows who he is. and who is equipped to handle life as it come,” Thornton said.” But his excellence in the way he lives his life and practices medicine, and his compassion is a reflection of what he has learned from his father. His father is a model of a life well lived.”