Frank Lepreau Interview

Frank J. Lepreau, Jr., MD, is retired from his long career as a general and thoracic surgeon. He is
Assistant Professor Emeritus, Brown University, and served as Medical Director of Hôpital Albert Schweitzer for nine years (1964-1973). Dr. Lepreau also practiced medicine at the Friends African Mission in Kenya and served as both medical director and surgeon to the Frontier Nursing Service in Wendover, Kentucky. In 1998, he was honored by the Massachusetts Medical Society as the 1998 Senior Volunteer Physician of the Year. He was selected for this award based on his extensive work at Stanley Street Treatment & Resources (SSTAR) in Fall River, Massachusetts, which he founded in 1977 and where he served as medical director. In 2000, Dr. Lepreau received a Brown Medical School Clinical Faculty Emeriti Award of Appreciation. He was interviewed by HASAA secretary-elect, Patti Marxsen.

PM When did you first become interested in medicine as a career, and would you make the same choice again?

FL I became interested in it in my senior year at Dartmouth College. And I certainly would make the choice all over again. It was one of the best decisions I ever made.

FL Oh no! I was never an academic whiz at anything. I was admitted into Dartmouth because of a good high school performance in Illinois, and I foolishly majored in Chemistry, which was way above my intellectual capacity. Many of my classmates went on to work for Dupont and big companies like that. I didn’t know whether I really wanted to go to medical school on my own, or because all my good friends were going. Anyway, I finally decided to apply to medical school at Harvard in the Winter of 1934, the year I graduated. It was very chancy to get into a place like Harvard at that late date, but I made it.

PM There must come a point, during or after the long preparation, when you really feel like you’re finally a doctor? When did you become a doctor?

FL I think it happened in my junior year. I had all my surgery rotations at the Peter Brent Brigham Hospital and all my medical rotations at Boston City Hospital. At the Boston City Hospital there was The Thorndike Memorial Laboratory that had all the best medical men in the world there as teachers: Soma Weiss, Big Bill Castle, Wesley Spink, Henry Jackson, George Minot, all a bunch of stars.

FL I sure was. There was Doctor Cheever who made a big impression on me, a big impression. I remember watching him in the big amphitheater at the Brigham. I think we were first- or second-year students when a nurse and Doctor Cheever came in with a patient to do one of those huge old mastectomy dressings. David Cheever was so kind and gentle to this patient while doing this horrendous dressing that I said, “Whoosh, boy, I want to be like Doctor Cheever!” A couple of years later when I was further along and had some experience, Dr. Cheever came back from a year away in Arizona because of bad arthritis and lo and behold, I was designated to be his first assistant on his first operation after his return. Frank Lepreau, a third-year student assisting Dr. Cheever!

FL My wife’s best friend in college lived in Pittsburgh and she married a fellow named Clee Ray who was a real player in the financial and social world out there. We made plans with them to rendezvous at Tanglewood where Monny and I went every year. After the concert, we were walking back to the parking lot to pick up the car and I was rattling around about my life and thinking about being a missionary. Clee looked up and said, “There’s guy down there in Haiti named Mellon who has gotten a hospital going. You should write to him.” Period.

FL Sort of. I wrote to Mellon and didn’t hear anything for a year, so I went to Kenya for a couple of months to our church hospital and when I came back there was a letter from Larry that said maybe you should come here.

PM Were you motivated spiritually to do these things? Or was your mission primarily medical?

FL I’ve never been focused on being a classic missionary. I’m a Quaker but I just wanted to take care of people’s physical health. It was in Africa that I discovered how much I enjoyed the medical part of it, even though it was very primitive. I quickly found out that I had enough experience and I could handle most anything surgical. As any number of people can tell you, there’s some rather technically challenging surgery that goes on in places like that, sort of like working with a long-handled spoon and a knife and fork. But I liked it.

FL It was, and, but it was too restrictive in terms of social rules. Monny came out with our two children for the second month I was there and she brought a bottle of sherry with her. It stayed in the suitcase under the bed all the time we were there, and she was smoking and she had to blow her smoke up the chimney. My wife was wonderful and I just couldn’t ask her to live like that.

PM Everyone who has gone to Haiti, and to HAS, has a first impression of the country and the hospital. What was your first impression of Haiti? And what was your first impression of the hospital?

FL Well, my first impression of Haiti was total chaos. There was a small airport there in 1961, a very small building. The place was dark. It was nightfall and somebody took my bag and threw it out of the window into a crowd of black people.

FL Everybody else’s was also thrown out. There was a mass of humanity, and total confusion.

FL The Mennonites were there to meet me, so that made me feel comfortable. It was raining all the to Deschapelles and the road was terrible; there was mud everywhere, as well as chickens and goats.

FL Not really. You know, when you sign up you sign on to whatever living conditions exist. I don’t need a golden-plated faucet for my bathtub.

PM Now you were a medical director starting in 1964. The word on the street is that your leadership was not just professional, but that there were all kinds of extra-curricular things going on, campus activities that you initiated and got involved in. Talk a little bit about community life at HAS during your tenure, and how that aspect of the job worked out for everyone.

FL Oh, we had a great time. It was super. We danced a lot. I don’t think I could do that now, but they all said I was a good dancer. I tried to learn the merengue, which turned out to be very simple. I was struggling to learn with one of the Haitian nurses once and she said, in Kreyol, “Dr. Lepreau, let your body go. Dance to the music. You don’t have to worry about anything else”

PM You were there for such a serious purpose, but it sounds like part of what worked about your leadership was finding ways to have fun at the same time.

FL I always thought it was very important to have fun. I wouldn’t have stayed there almost 10 years without a leitmotiv. For example, I cooked up the idea of a staff dinner on Christmas or New Year’s Eve at the Mellon’s house. The deal was that Monny, my wife, and Gwen were to be dressed in blue heavy denim dresses and be barefoot and wait on us and not say a word.

FL Oh sure. And we had this wonderful meal that they put together for the staff of about ten of us, five on each side of their long table. Larry was up at one end and I was at the other. We made dessert.

FL Crepes Suzettes! I had the fancy copper and brass apparatus and Larry had an electric frying pan. It was all we really needed.

FL Yes, and it was a great success. We also played tennis and volleyball and all that that.

PM I was going to ask about some of your memorable experiences with Larry Mellon and what it was about him that inspired you. What was special about him? For those of us who didn’t know him, he is kind of like an icon.

FL Well you’re right. And he should be. He was a classic example of being your own man.

PM There is a quote I’ve heard many times about his realization that while he trained to be a doctor, and went to Haiti to be a doctor, at some point he put down his stethoscope and pick up a hoe or a shovel. He really understood that connection between development and health, didn’t he?

FL Larry Mellon was a savvy guy. His first project was to fill a health need: clean water. He brought his skills and personal qualities together and put them to use searching for a spring in the surrounding hills, surveying for a pipeline, and digging a trench alongside the Haitians. It was all wrapped up in a practical effort. And he was always out there. But I can’t comment on why he changed his emphasis to community health. The truth is, we never discussed these things. You didn’t really get to know Larry Mellon except by being around him. I had a Tuesday morning session with Dr. Mellon, built around real tangible things. I didn’t get there and discuss the Bible or ethics or philosophy or anything like that.

FL Exactly He wanted to be out there doing something. And that appealed to me. That was one of the things I liked about him.

PM He trusted you, obviously. Maybe he didn’t think there was anything much to discuss because you were doing such a good job.

FL When I needed his advice, I soon learned not to go down to his house to see him, though I was always welcome. Instead, we’d sit down on the benches in the midst of a busy clinic and I’d have a couple of papers or my question ready and we’d settle it in about five minutes and off he’d go. He made decisions, boom!, like that. And that was fine with me.

FL After a while I decided not to bring borderline personnel cases to him, because I knew he’d say, “Well Frank. There’ll be a bus going to Port au Prince tomorrow morning and maybe he could be on it.” Meaning he could be back in Pleasantville, New York, tomorrow. Period.

PM Were you a little less decisive, or a little kinder-hearted? Or maybe a little more patient?

FL Oh sure. But if I had a “management style,” I never knew it. My concern was for the medical staff to provide the best medical care to all our patients in the framework of Dr. Schweitzer’s philosophy of “Reverence for Life” and Dr. Mellon’s mandate to implement it. Gwen Mellon, The Lovely Miss Pete, and I had a great working relationship. It was a privilege.

PM I guess we can’t talk about Larry Mellon without talking about Gwen Mellon. Could you share a few memories of her?

FL Well, she was also an activist. And if I thought that some physical change might be made somewhere around the place and if she bought into it, phew, practically before I had finished talking a wall would come down. But of course, that wall didn’t come down unless we were both sure that Larry would approve of it, and if there was any doubt in Gwen’s mind she would say, “I’ll have to ask Larry.”

PM Now after he passed away, she decided to stay on. Were you surprised by that?

FL Oh no. She’d be up to it. She was tough. She could have run General Motors. You know, if she had a handbook, she could take one of those diesel generators apart. Gwen Mellon was a fantastic woman.

FL She was like many pediatricians, extremely devoted to her children and her patients. You could do anything you wanted to Skeets, but “Don’t touch my children!” She was devoted to her children and an outstanding doctor and a great dancer too. At Halloween she’d dress up in the most ridiculous costumes.

FL Well, there was a time when she was running her clinics too late, until 11 pm. Everyone had the utmost respect for Skeets, but the late hours put people under pressure. Other staff members were getting restive, so we had a problem. It got to Larry and he said, “We got to do something about Skeets.” He didn’t tell me what to do, mind you. That was another thing about Larry, he didn’t interfere.

FL I finally had a talk with myself: “Look, she’s a Quaker and you’re a Quaker; why don’t you try the Quaker approach?” So I went over to her cement-block house and, as it happened, we were sitting in one of her small rooms. She sat in one corner, I sat in this corner, just like a couple of boxers. I gave her my pitch, a quid pro quo, and then I said to myself, I’m going to sit this out. So we sat and we sat, for thirty minutes exactly, without speaking. Then I got up and said, “Well, see ya.” She got up and she said, “See ya.” That was the end of the interview.

PM Are you saying you communicated in a kind of mental telepathy? Without a lot of talk?

FL Not sure what happened. But slowly, ever so slowly, the clinics began to get smaller. I can’t remember how long it took, but I noticed a change and was happy, so I just left it alone.

FL Not quite. A few months after this episode, I was called to come to her screening clinic, the one she conducted with Mrs. Mellon on the front steps. “Doctor Marshall wants to see you on the front steps,” the messenger said. I went right away and she was in the midst of screening when she turned to me and said, “All right, Frank, dammit. What do you want me to do about this?” She had one of those classic marasmicpatients, skin peeling off, conjunctivitis of the worst kind, and a perforated cornea. She kind of dragged her like a wet towel over her arms and put the question to me again: “What do you think about this?” She wanted us to take this kid in and not turn him away. Her point was that if I didn’t want her to run the clinic for as many as needed it, what was the alternative?

PM You’ve been quoted as saying that your motivation to go to HAS was to avoid changing storm windows.

PM Could you elaborate on that, and, by the way, wouldn’t it have been easier to have changed a few storm windows?

FL Well, that comment came about after a reporter from the National Review or the Wall Street Journal got permission from Larry to spend almost a week at HAS, which was a big mistake. This guy went around interviewing everybody and when he asked me about my service there, I said, “Oh, I came down here because I got tired of changing storm windows.” Well, when the paper came out, I was quoted in it.

PM Now you were Medical Director for nine years, 1964-1973. Why did you stay so long and how did you avoid burnout?

FL Well, I guess the answer is that I was having the time of my life because I was doing what I liked best – I was being a real doctor.

PM I’ve heard that before from doctors who’ve worked at HAS. It seems to be a place where people get to really practice medicine the way they want to.

FL Yes, that’s one of the big attractions. No insurance forms, no lawyers, just a long stream of sick patients who need your help. And you can give them that help because the equipment and the drugs are there, and the whole atmosphere is dedicated to saving people’s health and lives. There you are! That’s heaven for a doctor!

FL Because of the family. We had three older daughters, and two that were about to go to college.

PM So you were there with your wife and two younger children, and they were in their teens when you came back?

FL Yes. Monny homeschooled them in Haiti, and that’s not so easy to do. But they had a great time. They had a wonderful time: We all did.

PM I understand it was Monny Lepreau, your wife, and who worked with PeggyRea SP? in Pittsburgh to do physician recruitment. That was an important contribution of hers. And I’m told that the three of you--you and Monny and Peggy--brought quite a few people to Haiti who’ve become really important people in the HAS story: Bill Meffert, Ralph Greco, John Judson, Stephen Stein, and so many others from Yale who remain in awe of you. What’s the secret to successful recruiting?

FL Well, I never took a doctor unless I had a second opinion of him from somebody I knew in the States. An extreme example of this would be Rick Kueneman. He was not a doctor, but we needed a pretty smart guy to run the fluorescent microscope – for the rapid diagnosis of tuberculosis. The job required some technical skill and smarts. Well, he came from Idaho and he sounded good. I didn’t know anything about Idaho, except that I had a classmate in Idaho, a guy named Dr. Miguel. I contacted Kueneman; I wanted him to interview with Dr. Miguel. It turned out that the interview was 500 miles away, and Kueneman never let me forget it!

PM You’ve talked about problem-solving, like the situation with Skeets Marshall, but how did you approach the supervision of young physicians who were raring to go, to do medicine?

FL There are all kinds of stories to tell. As far as the surgeons and I were concerned, we were all in this together. We were all learning new things. I had a skeleton beside me once when I was trying to fix up a broken back and an anatomy book and a book on orthopedics. What it came down to was the resident and I and a skeleton and a book fixed this guy up. He walked out of the hospital.

PM Looking back on all this, the time at HAS and your life as a physician, what do you think your lasting contribution has been?

FL I think probably it was a highpoint for me to contribute to the careers of these Yale surgeons who came down.

PM When you say “contribute,” do you mean that you gave them a learning experience?

FL Yes. I’d get a fellow who could handle most things and I’d stay at the clinic; I’d work up the cases, do the history and the physical, get the basic laboratory work, and send them over to Dr. Greco or whoever was over in the OR, and he’d do the operation. Well, that made them feel like they were at the Mayo Clinic. They’d say to themselves, “Hey, the chief is out there doing these physicals. Boy, that’s great. All I have to do is do the operation.” Well, that approach instilled a lot of loyalty and faith and confidence and everything else in them.

PM Would you say that empowering and respecting others, students and colleagues, would be true beyond HAS? Because you also taught at Brown University Medical School for many years.

FL I lived 25 miles away from Brown, but I always had Brown medical students with me. I saw a lot of them. I was also running a Catholic home for terminal cancer patients, but I always had students. And in my office here in Westbrook, my students always interviewed my patients first, and the patients knew that.