When the University of Texas Medical Branch went on emergency status Sept. 11, I evacuated to Central Texas where our family has ranching interests.
The next morning, I drove to a nearby piece of property at Mosheim that I own with my son.
We have been restoring the prairie there on land worn out by too many years of cotton. I also wanted to see four heifers of mine pastured there. Near the front gate, I noticed two calves that were in the road, and I suspected they belonged to my son, and probably had squeezed through a nearby water gap on a small live creek that had been compromised by a recent rain.
After I counted his calves, I returned to coax them through the gate. I was pleasantly surprised to see the calves already inside, and a man standing in the road who had obviously directed them through the gate.
He introduced himself as Johnnie, and I recognized he was a neighbor that I had not met. My son had recently worked with him to rebuild a common fence, and we subsequently shared expenses. He was a trim Hispanic man in pressed Wranglers with crisp creases and a white straw Resistol.
I learned he lived across the road in the brick home, and that he and his wife had both lived in the immediate area all their lives. It was apparent from the conversation he was likely in his early 70s, although he looked younger.
He knew I was a physician and asked me where I worked. When I told him Galveston, his eyes lit up, and he asked if I worked at UTMB. After I related I did, his eyes brightened further, and he became very animated and repeatedly said what a wonderful place and hospital it was.
In the late 1960s, his young daughter developed kidney failure, and the physicians at the Goodall Witcher Clinic in Clifton referred her to UTMB. She would receive a kidney transplant here in the 1970s, and she was followed at UTMB through the 1980s, her kidney lasting 28 years.
While this conversation was not expected on a one-lane Bosque County road on this eve of destruction, I have heard its theme many times. In between stints in academic medicine, I practiced in Waco, where many of my patients with complicated problems came from small and rural communities.
I learned there that most patients from small-town and rural Texas with a complex medical problem have a trail that does lead through Galveston and UTMB. It does not matter whether they are the banker or the uninsured laborer. I have always felt the care of patients from small-town Texas has always been my role, particularly since my brother, father, grandfather and great-grandfather all spent at least some of their medical careers as small-town doctors.
Moreover, one of the reasons I returned to UTMB in the autumn of my career was to be able to help care for these patients in an academic setting.
While Dr. Kenneth Shine, the University of Texas Board of Regents and the UTMB top brass try to redefine what they want a downsized UTMB to be, I believe they should not forget this crucial role that UTMB has played in the health care of Texans from less populous and doctored areas.
These patients have loved coming here, and they have much preferred the easiness of Galveston to the hectic confusion of Texas Medical Center. They have also been terrific teaching patients for students and residents.
In a 1968 landmark article, “The Tragedy of the Commons” in the publication Science, Garret Hardin, a Texan, discussed how a group of herdsmen on a common plot of land can coexist, but when times are tough, each will make the decision to add more animals, which leads to overcapacity with destruction of the grass, weed growth and starving animals and herdsmen, which results in irreversible harm.
While Hardin used this as a metaphor to address overpopulation, several writers have drawn an analogy between this concept and our health care system, i.e. when an area is over-doctored and over-hospitaled, costs go up and quality goes down, and the uninsured receive less, not more, care.
UTMB is using most of its energy and resources for entering the suburban Houston and Mainland medical market, including a plethora of physicians and buildings. While some of this is necessary, UTMB officials need to consider long-term effects, and the fact there are under-grazed commons elsewhere.
Those heifers I checked on Sept. 12 represented attempts to preserve some favorable characteristics in our herd that represented several generations, but they also were bred by a new bull with some different traits.
Financial and political realities mean UTMB and Galveston must have some changes. A growing mainland presence is inevitable, and there must be a county or regional hospital district.
However, it remains important for UTMB to continue to serve the needs of the smaller and medium size counties in Texas. With a few exceptions, such as the regional obstetrics program and chronic disease programs in internal medicine, UTMB has been steadily moving away from its original model that focused on overall needs, and that is in itself a tragedy.
I hope the University of Texas Board of Regents and the Texas Legislature understand what UTMB has contributed during the years, and they care enough about health care for average Texans to preserve the important qualities of our medical center.
I do know that if D.K. Royal Memorial Stadium was hit by a bad tornado and destroyed, it would be rebuilt to its former grandeur in no time. Hopefully, sick Texans are as important.
Dr. Ned Snyder is professor of medicine at the University of Texas Medical Branch and the immediate past president of the UTMB School of Medicine Alumni Society.
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