Tireless “Tarp” — John Tarpley serves as beacon for residents, students

Tireless “Tarp” — John Tarpley serves as beacon for residents, students

One of the lowest points in John Tarpley’s life came five months into his surgical internship at Johns Hopkins.

He was exhausted from the 20-hour days required of a surgical intern and some of his patients weren’t getting well. He felt he didn’t know everything he needed to know and couldn’t succeed using what he did know.

“I was struggling. I almost quit,” he said.

Tarpley would pass by a statue inside the hospital entrance with an inscription from Matthew 11:28-29. “Come unto Me, all that labor and are heavy laden, and I will give you rest.”

“I would say, ‘God, I’m weary! I’m heavy laden!’ The adjustment from medical school to internship was very difficult,” Tarpley said. “I made very good grades in medical school and was able by sheer effort, by energy and discipline, to succeed as a medical student. But when I went into the clinical arena as an intern, I couldn’t use those same skill sets. It took me the first six months to realize my old systems wouldn’t work. I had to retool and get new systems. I had to burn off a lot of the non-essential stuff to be able to focus and prioritize and let some things go. Everything didn’t have to be perfect.”

But in what would turn out to be a life-changing experience, two older residents saw that Tarpley was distraught and jumped in to help. They showed him a way to become more efficient—simply carrying a clipboard with patient information attached—and counseled him to keep going.

“They really ministered to me and helped me get through a low place,” he said. “I vowed if I ever got out of there, because that was so important to me, that I was going to do it for other people someday.”

And he has.

Tarpley, 57, is professor of Surgery and Program Director for General Surgery at Vanderbilt University Medical Center. Affectionately known around the Medical Center as “Tarp,” he is also chief of General Surgery and Associate Chief of Surgical Service at Nashville’s VA hospital.

The friendly, sandy-haired, mustached, bow tie-wearing Tarpley is also nicknamed “Tigger” because of his high energy level and his non-linear way of lecturing.

“I think I’m a decent surgeon with average technical skills, but I have a lot of energy and every day I thank God for HEAT—health, energy, appetite and my thyroid gland.”

Vanderbilt-educated (both undergraduate and medical school), Tarpley says he “bleeds black and gold” and is an avid Vanderbilt sports fan. From 1962-66, during his undergraduate training and into his medical school years, he served as manager and trainer for the Vanderbilt basketball team. In fact, he often interviews general surgery intern candidates wearing his 40-year-old manager’s jacket. He has season tickets to Vanderbilt basketball and football games and is a member of the Rebounders Club, a group of former Vanderbilt basketball players and managers who meet for lunch with former coach Roy Skinner once a month during basketball season and at halftime during home games.

Tarpley began wearing bow ties in the late 1960s, patterning himself after Dr. Robert Dilts, a Vanderbilt University chemistry professor who wore bow ties exclusively.

But Tarpley found out that bow ties are also practical for surgeons who don’t want their ties to billow out, touching a patient’s wound. He now owns 62 bow ties, most of which have a story attached or a connection with a friend.

Tarpley wears three different hats at Vanderbilt: general surgeon at the VA Medical Center, instructor of medical students and coordinator of the residency program in general surgery.

“I could be exclusively a clinical surgeon,” Tarpley said. “I could do it and enjoy it, but I get energized by interaction with my colleagues and these young folks coming along.”

A fourth child

Tarpley and his wife Maggie have three grown sons, but he considers Vanderbilt’s general surgery residents a “fourth child.”

Tarpley and his able associate, Doris Risley, program coordinator for General Surgery education, help recruit the program’s residents, then work hard at training, retaining and mentoring the group. It’s a job they’ve done together since 1993. “She’s dynamite,” Tarpley said. “That’s one of the best things about my job, working with people of that quality who care.”

The residents are a close-knit group and the bonding process begins with the residents’ first visits to Nashville, where they are given pizza parties hosted by the Tarpleys and Risley.

“Doris and I want to treat the residents the way we would like to be treated. We see this as a ministry opportunity. Residents work exceedingly hard. Everybody’s on their backs. They need an advocate. Their time is important. Their time with their family is important. Their training is important. That’s really the driving force of my Vanderbilt years, helping them. We say we’re the den mothers for 69 cubs.”

Tarpley, who has been able to successfully blend his strong spirituality into his work, becomes not only “boss” for the residents, but a trusted friend as well.

Once a group of residents caught a limping mouse outside of the VA Hospital. They found a cage for the ailing mouse with fine reddish-gray hair, gave it food and water, and noticed after a couple of days, it began to run around its cage. They named it “Lil Tarp.”

His former residents send him pictures of growing families, and he even served as best man in one of his resident’s weddings.

“He’s just a kind person,” Risley said. “It’s not unusual for him to ask me to put a patient on my prayer list. He solicits prayers for his patients if they’re going through a bad time.”

Tarpley often intervenes when he sees a resident working too hard, spending too many hours at the hospital. The life of a surgical intern is difficult and there are fewer women in the program than Tarpley would like.

“The life of a surgical house officer is very difficult,” Tarpley said. “It’s not for everybody. The price is really high. We need to be nicer to our junior house officers than we are. They need some time off. Many of them see me as the boss, the guy that gives them the bad reviews, but the residents are really important to me.”

Alan Herline, who completed his general surgery residency here last year, said that Tarpley’s optimism about his patients and his residents is unmatched.

“We can be struggling, not at all feeling sharp or crisp about our abilities, and Dr. Tarpley makes us think we are the next Michael DeBakey,” Herline said.

Tarpley tells new interns that they’re entering their residencies, fueled by accolades.

“I tell them they’ll go on energy for a couple of months, then about October or November they may become depressed, discouraged and ready to quit. I just say ‘Hold on, hold on. Work through all that stuff. Come January or February, you’ll start getting some skills. Histories and physicals won’t take so long. Just stay the course.’ It’s a ministry opportunity for me.”

Jonathan Eliason, in his last year of general surgery residency, has benefited from Tarpley’s compassion.

The main reason he picked Vanderbilt first from the list of residency interviews was Tarpley.

“To have a senior, established surgeon take a very personal interest in you, one you know will make your time here productive and warm is the reason I ranked Vanderbilt first after my interview,” Eliason said.

The personal attention paid off during a difficult time last year.

“I was feeling demoralized and worn out during my fourth year of residency,” Eliason said. “I felt like I wasn’t a good husband or father. I felt like my residency was long and burdensome. I knew right away that Tarpley’s door would be open. So I walked into his office and spilled my guts and shed a few tears. Tarp prayed with me and for me and for my family. And when I left, everything was all right.”

Dr. Walter H. Merrill, professor of Cardiac and Thoracic Surgery, has known Tarpley for 28 years, since they were residents together at Johns Hopkins.

“Anybody can be a purveyor of information, but John purveys both information and values, like honesty, focusing on the patient and being there for the good of the patient, to his students,” Merrill said. “He epitomizes the love of teaching.”

Merrill said that Tarpley is up-front about his spirituality without pushing it on others who feel differently.

“He says, ‘This is what I think and what I believe. If you believe the same thing, fine. But if you feel differently, that’s fine, too. We don’t have to think just alike.’”

In addition to his resident-teaching duties, Tarpley also co-teaches three medical school electives—Topics in International Medicine, History of Medicine and Spirituality in Medicine, which he helped get off the ground in 1996 as a symposium. In 1998, Vanderbilt received a John Templeton Grant for Spirituality and Medicine through the National Institute for Healthcare Research.

A strong foundation

Tarpley has been a Christian for as long as he can remember. Born in Nashville, his father was a Baptist minister and his mother a homemaker and teacher. The family moved several times but ended up in Jackson, Miss., in the early 1950s. His mother died in 1997 of Alzheimer’s Disease, but his 89-year-old father has remarried and still lives in Jackson. Tarpley tries to spend every New Years Day in Jackson with his father, watching bowl games.

“Everybody starts out with their parents’ inherited faith,” Tarpley said. “Then you have to decide if you’re going to have your own personal faith or not.”

The defining year for Tarpley was his sophomore year at Vanderbilt. He began reading a chapter a day of J.B. Phillips’ “The New Testament in Modern English.” By the time he had gotten through four and a half books of the New Testament, he had started developing his own beliefs, his own faith.

During his junior year, he met Maggie Johnson in a line at Rand Hall and the two soon became engaged. They were married in March 1966, five months before Tarpley enrolled in medical school.

When he started medical school in 1966, he saw a notice on the bulletin board about a Christian Medical Society. He and Maggie met with the group of like-minded students for about an hour each week during medical school.

“We had decided to attend church and not take a sabbatical on our religious life while we were in medical school,” he said. “We wanted Christianity to be a part of our marriage, family, home and career.”

Tarpley said he never really considered becoming a minister, although his faith was strong enough to warrant substituting the pulpit for the operating room.

“I didn’t feel like I had a call to be a minister. I was more interested in science and in people, and medicine allowed me to do that.”

Maggie’s job as an elementary school librarian was Tarpley’s unofficial medical school scholarship. Tuition rose from $1,600 to $1,800 during his four years. Maggie was making $5,000 a year in her public school job. The couple lived in Vanderbilt housing for $60 a month in 1966.

“We were able to graduate from medical school debt free, with money in the bank,” he said. “Students today can’t do that because tuition is so high. But we lived, and continue to live beneath our means.”

As an illustration of his frugality, Tarpley drives a 1965 Ford Mustang, his wife’s $2,200 college graduation present from her parents. The car has no heat or air, no radio, and is only driven to and from work, six miles a day, five days a week. The car has only accumulated 180,000 miles.

Tarpley and his wife do not have cable TV (they mostly watch PBS) and do not own cell phones. His Palm Pilot is a paper pad with a Palm Pilot-like cover, given to him as a joke. An avid reader, he buys books at Goodwill and tries to read some of a non-medical book every night before he goes to bed.

From Baltimore to Ogbomoso

After medical school, Tarpley went to Johns Hopkins and the NIH for seven years of a general surgery residency and training. Tarpley decided that instead of becoming an academic surgeon in Baltimore, he wanted to be an academic surgeon and teach in Nigeria.

“Baltimore needed another academic surgeon like it needed a hole in the head,” Tarpley said.

He had read a letter to the editor of the New England Journal of Medicine when he was a senior in medical school, pleading for help in Nigeria. He never forgot it.

“The letter basically said, ‘I’m the only doctor for a million people here in Nigeria. My son is sick. I’m going to have to return to the States. How about some of you bleeding heart liberals who are protesting the war on Saturday and going to your country clubs on Sunday, getting off your butts and coming over here to help with some of these sick folks?’”

So in 1978, the Tarpleys left Baltimore to spend three years in Nigeria, then one in Baltimore, repeating the pattern for 15 years. He and Maggie basically decided to “tithe” their careers.

“Maggie agreed to go. She saw this as important and wanted to teach, too. But it wasn’t necessarily her first choice.”

By this time they had two sons, Jamie and Van, who were in first and second grades. A third son was born in Nigeria in 1982. He was named Ayobami Abiodun, the two names meaning “joy has come by” and “born in the holiday season.” He goes by Leeman in the United States but Tarpley calls him “Ayobami.” Jamie is engaged to be married and is a Ph.D. student in French literature in Pittsburgh. Van, in Bloomington, Ind., is working on his dissertation on 19th century Russian mapmaking. Leeman is a sophomore at Kenyon College in Ohio, majoring in theatre and drama.

In Nigeria, Tarpley became the director of a small, but expanding, residency training program in Ogbomoso, working with medical students and residents in Ogbomoso and Ibadan, helping train them to become teachers themselves.

By 1993, Tarpley’s mother’s Alzheimer’s Disease had progressed and his father was having problems with his vision. Maggie’s mother lived alone 35 miles from Nashville. The couple believed that some physicians he had trained in Nigeria were ready to take over leadership positions. So in 1993, they returned to the United States and Tarpley joined the Vanderbilt faculty and assumed his position at the VA in March.

Compassionate care

Tarpley is a full-time VA surgeon by choice.

“It gives me freedom. I have more control of my schedule, and I personally like going in and talking to a patient and it making zero difference to my salary line whether or not I offer him an operation,” he said. “There’s no wallet factor involved when I talk to him and say, ‘Mr. Jones, you’ve got this problem. These are our options. These are the advantages and disadvantages and here’s what I recommend for you.’ And that doesn’t help me pay the rent. My rent is irrelevant to that patient’s recommendation.”

“I like making sure the patients get good care. I like being their advocate. And the VA is a tremendously important historic and current location for the training of residents and medical students. The VA is America’s experiment with socialized medicine. I think we ought to make health care available to all Americans. I think it’s a disaster we are the only major western, capitalistic, civilized society without a national health care program of sorts. The VA is a leader in research and education. We provide very good, compassionate, up-to-date care for our vets and I like trying to make that happen.”

Tarpley is at the VA early each morning, has time during the day for his medical school teaching and resident duties, then stops by to check on his patients before he leaves each night. Wednesday nights he leaves the VA by 7:15 so he can attend choir practice at one of the two churches he and Maggie attend. Every Saturday or Sunday, Tarpley makes “howdy rounds” at the VA, just to touch base with the nurses and the patients.

“Despite the stereotype of a surgeon who just wants to operate and leave, John is very concerned about his patients and their families and is dedicated to making them better,” Maggie says. “He sees the work he does as a ministry. It’s not just a job to him. He loves people and is motivated about everything he does. He’s a loyal, optimistic person. He really sees the best in people. “

Watering relationships so they don’t wither and die

Tarpley returns to Nigeria for about two weeks each year. He leaves Nashville with carry-on luggage containing his clothes and two large suitcases carrying donated medical supplies.

“Basically I go back to water relationships,” he said. “I maintain that friendships will wither and die if you don’t nourish them regularly. The people there are some of the most important people in my life. I go back to visit with them, chat with them and commiserate with them, because they have it very hard financially, economically, politically and socially. Basically, I just go back to see my friends.”

Tarpley occasionally takes along Vanderbilt colleagues who offer continuing medical education courses for physicians in Nigeria. Those from Vanderbilt who have gone with Tarpley include Drs. Jenny Franke, former assistant professor of Urologic Surgery, Wallace W. (Skip) Neblett, professor and chair of Pediatric Surgery, and Frank Freemon, professor of Neurology.

“We have 10 invited lectureships this year at Vanderbilt,” Tarpley said. “We can afford it. The whole goal is to go and equip and enable our Nigerian colleagues to do what they’re doing but to do it a little better. We consult and teach in clinics, make rounds and assist in operations. We learn a lot as well.”

But Tarpley said the trips leave him with conflicting feelings.

“On one hand you feel great because you’ve gone and done this. But on the other hand, you realize that basically you’ve kind of scratched the surface of an ocean. Yes, you’ve helped 15 patients, but there are 15,000, 15 million that you didn’t do anything for. These people are laboring under difficult circumstances and I’m not there to suffer with them. Their needs confront me. Part of me wishes I was there all the time, but in reality it’s a very sweet life living here in Nashville. It’s nice to have photocopiers, air conditioning and libraries. But these people suffer. There’s too much inequality. There are so many things you’d like to solve but you don’t have the wherewithal, the energy, the money or the capability to solve all of it. It tears you apart.”

Tarpley said that one day, “God willing,” he would like to return to live in Nigeria, or perhaps somewhere else in Africa where the need is as great.

“I want to continue doing something meaningful and worthwhile.”