The search

By Bryant Boutwell and Charles M. Balch

On Saturday, July 13, 1946, The University of Texas System Board of Regents unanimously named Dr. R. Lee Clark permanent director and surgeon-in-chief of the new M.D. Anderson Hospital for Cancer Research. He would be paid $12,000 a year and have an operating budget of $162,630. The hospital’s acting director, Dr. Ernst Bertner, could now assume the challenge of building the new Texas Medical Center from a 134-acre forest behind Hermann Hospital.  

Four other potential candidates had passed on the job, noting that the old Baker estate was a hodgepodge of unappealing wooden buildings. The consensus was that seeing patients, hiring faculty and planning construction for a new cancer hospital while being paid a meager salary was in no way attractive — perhaps not even humanly possible. While they walked away from the challenge, Clark ran to it. 

He was unequivocally confident in his abilities, stating in his March 26, 1946 application for the job, directed to then acting UT President Dr. Theophilus Painter: “I feel that there are few surgeons that could handle the position as well as I think I could. … As far as enjoyment in attacking a new project, building and organizing, few persons are as willing as I to devote hours and energy in attempting to attain the best.”  

A Texan with a successful surgical practice in Jackson, Mississippi, Clark had aimed to do more than establish a flourishing private surgical practice there. Part of the lure had been the Mississippi governor’s invitation for Clark and several Mayo colleagues to help plan a four-year medical school in the city. That venture failed for a number of reasons beyond his control, but he learned volumes and would put that experience to use someday when the right opportunity came along. It was an article on Texas’ new state cancer hospital in the Sept. 26, 1942 issue of the Journal of the American Medical Association (JAMA) that first brought that opportunity to his attention. 

Clark’s Mississippi surgical practice of more than 600 surgeries a year included his wife, Bert, a skilled anesthesiologist often working by his side. His pace was exhausting by any normal standard, prompting one Mayo mentor to write, “Now Clark, you’re too young and inexperienced yet to understand why you can’t always keep on the go 24 hours a day. For God’s sake, start now to take it easier.” Slowing down was not in the cards as Clark increasingly became the go-to surgeon in the South for cancer patients.  

As the UT Regents’ search began, Lt. Col. R. Lee Clark was stationed at Randolph Field in San Antonio, finishing up a distinguished military career including the last chapters of a 357-page surgical textbook for the Army Air Force. His service would end soon, and the next phase of his medical career was in limbo. With a wife and two young children, he pondered whether to return to his practice in Mississippi or to seek opportunities closer to his Texas roots. What he really wanted to do, he confided to Bert, was build a medical institution much as his father and grandfather had built educational institutions. Seeing the JAMA announcement about the new cancer hospital likely caused his eyebrows to dance a bit before narrowing when he realized Dr. Ernst Bertner had the job.

“Now that’s something I would really like to do,” he said. “It’s too bad they have already named a director.”  

Actually, he misread. Bertner was acting, not permanent, director.

As far back as his medical school days, Lee Clark dreamed of building his own hospital. As he hitchhiked with his roommate, Jack Worsham, from summer jobs in Texas back to the University of Virginia School of Medicine, he was nearly blinded by the pink glow of a hospital as the sun rose early one morning. On that day the two were sleeping on the grounds of Emory University to pinch pennies, and the pink glow lifted his spirits with inspiration. He told Jack on the spot that if he ever got a chance to build his own hospital, it would be pink. In time, he made good on that pledge with the pink Georgia Etowah marble that would clad the new M D Anderson in 1954. 

As acting director of the new cancer hospital, Dr. Ernst Bertner got MD Anderson started in 1942 on temporary grounds at the old Baker Estate, also known as the Oaks. As planned, he would soon take a bigger assignment from the trustees of the M.D. Anderson Foundation to convert the forest behind Hermann Hospital into a medical city. From the beginning, he envisioned the new cancer hospital as the centerpiece for his new medical center. The success of MD Anderson would directly define his success building the medical center. Finding the right permanent director was essential. Moreover, as the war ended and restrictions on construction and building materials eased, time was of the essence. In September 1945, Bertner urged the UT System Board of Regents to fill the permanent directorship sooner than later with a capable physician who possessed the vision and the skills to succeed. 

Several of the potential candidates who rejected the offer to interview added to their concerns the volatile politics in Texas at the time. Dr. John Spies, dean of The University of Texas Medical Branch at Galveston, had been fired in August 1942 by the UT Regents. UT’s president, Homer Rainey, was fired in November 1944. As the regents addressed a hotbed of faculty displeasure, UT was censored and placed on academic probation in 1945 by the Southern Association of Colleges. The shock waves reverberated far and wide in academic circles. 

Clark had the passion and desire others lacked and saw in M.D. Anderson his dream job. Little did he realize as he first read the JAMA article about Bertner and the new cancer hospital in Houston that his name would soon to come to the attention of Dudley Woodward Jr., chairman of the UT System Board of Regents.

By happenstance, Woodward found himself at a Mayo Clinic Christmas party in Rochester, Minnesota. The party abounded with faculty members who had become fans of Lee and Bert Clark during their five years of postgraduate training at Mayo. When Woodward mentioned he was looking for promising names for the MD Anderson job, it didn’t take long for Clark’s name to surface. Two of his Mayo mentors, Drs. Claude Dixon and Howard K. Gray, suggested Woodward call up Clark and ask if he might be interested. Woodward took note. 

Dixon alerted Clark the next day, to which Clark responded: “Your last letter was one of the most interesting ones that I have received, and I certainly appreciate your keeping me in mind. I presume the job you spoke of is the proposition that you spoke about; it is exactly what I would like.”

Clark wrote Chairman Woodward in Dallas, who replied two days later: “I have received your letter of January 3rd, advising me that you might be interested in the cancer research program at The University of Texas. I am forwarding your letter to acting president T.S. Painter.”  

On Jan. 15, Clark drove the 80 miles from San Antonio to Austin at Painter’s request. The interview went well as the two became acquainted, even talked about their love of hunting and the outdoors. 

Painter was impressed and suggested Clark meet with Dr. Bertner in Houston as well as Dr. Herbert Poyner, a Baylor faculty member who was a trusted adviser to Painter. Bertner and Poyner also were impressed. Clark formally requested to be a candidate, adding in his letter to Painter: “The whole program seemed almost too good to be true and it is certainly something that a person would willingly devote the remainder of his life to seeing consummated.” 

Clark had his first meeting with the UT Regents in Austin on Feb. 22, 1946, and it seemed to go well. In Clark’s words: “Mr. Woodward, the chairman, was a delightful person and he told some anecdotes he’s learned about me from Dixon up there at Mayo. Dr. Caleb Terrell, from Fort Worth [chair of the Regents’ medical committee], knew my family and all about the TCU background.”

While all seemed to go well, there was a problem. Regent D. Frank Strickland, a key figure in the firing of Drs. Spies and Rainey, wanted Dr. Raymond Gregory for the job. Gregory, a respected internist at UTMB, was Stickland’s personal physician but admittedly had little cancer-related experience. The Regents’ vote was 8-1, with Strickland objecting. A unanimous vote was required. Painter, as acting president of UT, was not going to push the Regents. Clark was advised to be patient and meet with the Regents again on March 22. His mentors, military and medical, provided sterling recommendations, and Clark’s detailed organizational chart and vision for MD Anderson impressed all — except one. Again, the Regents’ vote was 8-1.  

Clark hit a low point and wrote his mentor in New Orleans, Dr. Alton Ochsner: “It is so snafued at the present time that I have decided that it would be best for me not to become involved with the program. Also, it is problematic whether or not I could secure it. Anyway, I will be getting out of the Army in May and must have some definite place to go and I cannot afford to wait any further in a state of suspended animation.”  

Strickland held tight for Gregory, but in the end it was Gregory who asked to be removed from consideration, noting he did not feel qualified. Gregory would go on to become UTMB’s highly respected chair of Internal Medicine, retiring in 1968. Clark recalled years later that Gregory had called him with the news that he had dropped out of the running and offered his support. The tide had turned. The regents met July 13, 1946, and their vote was unanimous. Clark was called into the room for the news. 

Years later, Clark reminisced: “I was pleased with the board’s attitude and their reactions when they brought me back. … They wanted to know if I was going to accept the directorship and I said we had just a few things to settle.”  

He itemized three conditions: 

• He would report to the UT president, not the UTMB dean. 

• The institution should be available to those who can and cannot pay for treatment.

• He would have a full-time, paid university staff.   

The Regents agreed, and Clark casually responded: “With this I am sure we can build a place of quality.”   

By morning, newspapers across the state and beyond announced Clark’s appointment as congratulations poured in. There was much work to do moving his family from San Antonio to their new Houston home at 1909 Sharp Place near the River Oaks residential community. Once in Houston, he would build upon Bertner’s work at the Oaks, add facilities, recruit faculty and staff and oversee the care of patients as surgeon-in-chief. If that wasn’t enough, add the task of planning the construction at decade’s end for MD Anderson’s permanent home in the new Texas Medical Center.  

The search was over. Lee Clark was ready to begin Making Cancer History®.

Next article: Clark at the Oaks