The thoughts of others
    Were light and fleeting,
    Of lovers' meeting
      Or luck of fame.
  Mine were of trouble
    And mine were steady,
    So I was ready
       When trouble came.

Contributor: Frank Neelon Chief Resident: 1969-1970

I came to North Carolina in 1962, to serve as intern under Eugene Stead in the Department of Medicine at Duke. I was a veritable pig-in-a-poke, never having visited Durham to see or to be seen by Dr. Stead and his department. In lieu of a visit I sent a letter explaining that I had no money for the trip and skylarking about what I would like to do in medicine. I had a false confidence that I would intern in Boston or Cleveland and had no thought that I would ever come to Durham and Duke. I do not know what Dr. Stead saw in that letter or why he put my name on his list when several other department chairmen demonstrably did not put me on theirs; even now, 30 years later, he remembers details from the letter that most department chiefs would never have noticed in the first place. Whatever the reasons, his decision (and the Hand of God) sent me to Durham. I am everlastingly grateful.

Each year Dr. Stead had offered to his Chief Residents the opportunity to undergo psychoanalysis with Dr. Bingham Dai. By 1969, Dr. James Wyngaarden had replaced Dr. Stead as chairman of the Department of Medicine. When he asked me to serve as chief resident, Dr. Dai had retired and analysis was no longer available; I had to figure out some other educational adventure for myself. At that time, Dr. Stead was rounding every other day throughout the year on Osler Ward and I decided to attend those rounds as my own personal tutorial. I retain the memory of those mornings on Osler, not so much because of the individual patients we saw but because of the overarching lessons that Dr. Stead wove into each encounter:

• We never discussed a "case."
  We went always to the bedside of the patient to hear the history recounted by intern or student and to interact with the patient herself. If the intended patient was indisposed or otherwise unavailable, we saw someone else. Often the house staff fretted at this implacable rule, wanting to talk about the "fascinating" disease borne by some recent patient who, unfortunately, could not be seen and talked with at the moment. But the implications of Dr. Stead's posture were always clear to us: we could learn about "disease" by ourselves from books and from consultation, but it was the patient and her problems that interested Dr. Stead. These were the essential elements of our time together on Osler.
• Clinical Epistemology:
  The lessons of the bedside, whatever else they were, touched two main themes:
  • How do we know what we know (and how do we know that we know it)?
  • What is the role of the doctor in this patient's illness?
  Dr. Stead never put things quite so baldly, but he constantly wove these themes into specific questions for specific patients. When the intern said, for instance, that he had ordered "a rose bengal scan," Dr. Stead wanted to know, "What is rose bengal?" Not "Why do you want that?" or "How will you interpret the results?" although those questions might come later. Dr. Stead wanted to know what is rose bengal itself. Such seemingly simple questions led intern after intern to a string of encounters with books and journals and experts and consultants. The conversations with Dr. Stead (and therefore, of course, with the rest of the rounding team) continued for weeks. We all learned, again, how often we used words (and ordered procedures) whose meanings we did not know - and how quickly we were prepared to act as though we did.
• Clairvoyance
  Dr. Stead had a sixth sense at the bedside; he could always detect the moment one's attention drifted from the patient and the case presentation. There was no privilege of rank and so as soon as I, the chief resident, began to count the ceiling tiles or to think about what I had to do for the rest of the day I would hear: "Do you agree with that, Frank?" or "Does that make sense to you, Frank?" Since it was impossible to fake otherwise, I would admit my lapse of attention and then we all (interns, residents, students, nurses) would be treated to a few Steady words about how one might as well learn something as long as one was going to be standing around the patient's bedside.
• The First Principle of Education
  One day on Osler, our rounds were accompanied by the sounds of Sesame Street, playing on the television in the background: "One, two, three, four, five, six; one, two, three, four, five, six; one, two, three..." Dr. Stead, quite independently and clearly unaware of the television, was asking, in turn, each member of the entourage: "And what is the first principle of education?" No one remembered and so Dr. Stead had to tell us, again, "The first principle of education is repetition."
• Pecking Orders:
  Everyone was equal at the bedside with Stead. The student nurse, the intern, the resident, the visiting professor, the chief medical resident - everyone standing with us around the patient's bed was asked to look, to think, to listen, to contribute. Any observation was considered and all were subjected to the same Steady scrutiny. The best ideas were chosen for further reflection, usually to be continued at the next meeting of the team. All that was required to join Stead's Club was clear thinking, a sense of responsibility to the truth (as best we could know it), and an open mind to learning whenever and from whomever we could. It was a revelation!
• Pecking Orders (again)
  For more than eight years I have worked with Dr. Stead as his associate editor for the North Carolina Medical Journal. That position provided more learning for me. I was always fascinated to see how different was the working of Dr. Stead's brain compared to mine. When we sat in committee meetings I tried to think of how I would answer questions or respond to the problems posed. Dr. Stead always answered in some way that I did not think of. His responses were always unique, always new ways of looking at the bird in hand; I never ceased to be awed at the breadth and depth and apparent preparation of his seemingly spontaneous thoughts about things.

Years earlier, as a student in Boston and thinking of where I might serve my internship, Dr. Eugene Eppinger told me I should put Duke on my "list." I had never heard of Duke. But, dutiful son, I complied. I came to the house that Stead built. I could not have asked for better.