June 2019 – Donald Brown

Throughout his adolescence, Donald Brown, MS, MD, had the privilege of having many different role models, but none had as large an impact on his initial career choice as his Explorer Scout leader, John Tyrell.

As a young boy growing up in Manchester, Iowa, Brown first found his love for science while working at his backdoor neighbor’s pharmacy. Although Brown was not interested in the business aspect of pharmacy, the practice of pharmacy inspired him to begin looking for similar scientific careers. He even wrote a letter to Iowa State University inquiring about their chemical engineering program, only to receive a picture of men building a small liquor distillery as a response. It was that Scout leader John Tyrell, himself a physician, who inspired Brown to study pre-medicine at the University of Iowa.

“I saw John having a lot of fun. I didn’t realize that some of the fun was related to his medical practice, and a lot of it had to do with his civic involvement,” Brown said. “Here’s a doctor who wants to spend his time with Explorer Scouts. Why would you do that? It was because he wanted us to grow up to be productive citizens.”

Three degrees from Iowa
Brown expected himself to eventually change his mind and go in another direction. But by the time he stopped to take a breath, he says, he was already a cardiologist.

“Your next goal is always the Western civilization test next week or the chemistry test or the whatever. You just take each day, not thinking, ‘Am I still on the right track?’ And then it kind of worked out,” Brown said.

Brown is somewhat of a unique case, receiving his Bachelor’s and both graduate degrees all from Iowa. Because of his academic success, Brown received a full tuition scholarship to medical school from Iowa. As a sophomore in medical school, he became a teaching assistant in the Anatomy Department and in that role developed a course in neuroanatomy for occupational therapists. From such experiences, his appreciation for mentorship and teaching began to develop.

In the early 1960s, Adel Afifi, MD, emeritus professor of Neurology, became his research advisor and later a colleague and dear friend. “I was sitting one day and this very nice gentleman walks into the lab where I’m cutting up rat brains or something and his name was Dr. Adel Afifi,” Brown said. Afifi credits this encounter as the beginning of a 58-year friendship between the two physicians and their families.

“To Don, medicine is a calling. A mission, not a business, practiced and taught along the Oslerian and Hippocratic models. Management and standard of practice protocols are guides, not decision-makers,” Afifi said. “The medical decisions and recommendations are made jointly by him and the patient.”

According to Afifi, Brown treats his patients as people seeking counsel rather than clients and speaks to them rather than the computer screen.

“Afifi is a most compassionate man and an exceptional scholar. He’s written more books than I’ve ever read. I learned a lot from him about life and about the world,” said Brown.

In fact, Afifi’s guidance and passion for neurology influenced Brown, who already had a working knowledge of the brain, to consider entering Afifi’s field of study. However, Brown found himself enrolled in a cardiology elective instead. “It became obvious that cardiology just made more sense for me,” Brown said. Although he appreciated that both neurology and cardiology placed a primacy on physical exams and history, cardiology reigned superior.

Following his MS in anatomy and his MD, Brown completed internal medicine training and a cardiology fellowship at Strong Memorial Hospital at the University of Rochester in New York.  “I will always be so very appreciative of the training there that emphasized the bedside skills of obtaining a meaningful medical history and a skillful physical examination coupled with well-thought-out clinical reasoning.

“It was always a choice, but my heart belongs in cardiology. I’ve since told students, ‘If you know what your capabilities are and you know what your passion is, marry those two, and then go in that direction and it’ll all work out well,’” Brown said.

A teacher develops
After Brown finished his fellowship in cardiology, he served as a cardiologist at the Naval Aerospace Medical Research Lab and Institute for two years in Pensacola, Florida. There he spent most of his time reviewing EKGs and screening pilot candidates. Brown also was fortunate to be involved in two research projects on SkyLab, one of the first studies of the effects of extended outer space exposure on the human body.

After Florida, Brown’s sights turned back to Iowa and the growing Internal Medicine department, where he hoped to obtain a teaching position. “I really liked patients and I really liked teaching more than anything,” Brown said. “I can’t explain precisely my love for teaching. You have an immediate feeling that somebody has been changed in a positive way.”

François Abboud, MD, was then Chief of Cardiology, still a few years shy of becoming Chair of Internal Medicine. Brown sent Abboud a letter with his application and asked him for a teaching job, but at the time, Brown said, there was no such thing. The tenure track in academic medicine involved teaching as well as clinical care but it also required significant involvement in research. Brown said, “I’m sure Dr. Abboud just chuckled and thought ‘this kid’s going to take a lot of work.’”

Abboud still has the letter almost 50 years later, and it serves as a symbol of their student-mentor relationship and friendship. “He came,” Abboud said, “and for 30 years I had the privilege of serving as his Chief of Cardiology and for the past 16 years as his most ardent admirer for his masterful, inspirational dedication to teaching of several generations of medical students.”

In 1973, Abboud gave Brown the opportunity to teach the cardiology elective for seniors, a course Brown’s been teaching ever since. Shortly after that, Abboud recommended that Brown take charge of a class called Introduction to Clinical Medicine. Brown taught that class for more than 20 years, with the “fantastic” assistance of Sandra Schuldt.

“Since his arrival in 1973, his performance as a teacher has been superlative by any standard,” Abboud continued. “He is the kind of teacher who not only makes you a more skilled physician, but makes you a better and more caring, empathetic person as well. He has pursued his calling for teaching with selfless devotion and not as a means for career advancement or a desire for high academic visibility.”

Training beyond the classroom
In addition to growing as an instructor, Brown became interested in new techniques, such as digoxin blood level measurement and advanced cardiac life support (ACLS). At the time, the American Heart Association had just developed a program for ACLS certification. From about 1979 to 1985, Brown was a member of the state faculty for ACLS and toured districts in Iowa, certifying new instructors. Brown had support in this from the Emergency Medical Services Learning Research Center (EMSLRC), University of Iowa Hospitals & Clinics, and the Iowa chapter of the American Heart Association, among many others.

With Ken Stults of EMSLRC, Brown would later publish in nationally respected journals the idea of basic emergency technicians using defibrillators and automatic defibrillators. “The major part that brought me joy was seeing the local physicians and nurses and paramedics and realizing the teamwork that goes on, which is perfectly obvious in any hospital setting,” Brown said.

“Throughout my career, participating in the educational programs for physician assistants and medical students, nurses, and residents and cardiology fellows was always a major source of joy and accomplishment,” Brown said. Brown received the Carver College of Medicine’s Teacher of the Year award on multiple occasions as well as the John Thomas Milleman and Milleman Family Teacher of the Year awards.

History and science merge as humanism
During his free time, Brown reads history books on Western civilization and American history. He started the habit when he was a resident at Strong Memorial. “I would go home and couldn’t get to sleep. Somebody had given me Winston Churchill’s history of the Second World War. It’s five volumes of every telegram he ever got from Roosevelt. I started reading those knowing that they would put me to sleep,” Brown said. But the curiosity for information has persisted.

Brown also enjoys traveling for a similar reason. “Especially if it’s international, I like to travel with guides who can tell me things, information about the area or the events that happened there.”

Brown still places a primacy on human connection with the people he encounters, developing friendships with his patients and trainees. And that list of friends has only grown. “I’m now teaching the children of the people I taught previously.”

As one of his lifelong friends, Afifi is grateful for Brown. When Afifi was faced with a significant heart valve problem and needed to travel to Mayo Clinic, he did not have anyone to drive him and Brown volunteered. Afifi said Brown told him, “You walked miles with me through my life, the least I can do is drive you and walk you through this at Mayo.”

“If this gesture is not humanism, what is?” Afifi asked. “If this is not noble character, what is? My family and I feel blessed to know Don and his family. They have become members of our family. We are forever indebted to them for their love and caring.”

Although Brown views all his patients as friends, it makes saying goodbye one of the toughest parts of his job. “People influence you every day. You just have to keep your heart and mind open to how they are changing you.”