Duke GI Oral History: Ian Taylor, MD, PhD

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Transcript

Dr. Rodger Liddle: Ian, this is a real pleasure for me to have you here. This is a treat to me, brings back a lot of memories, so thanks for coming back to Duke.

I wanted to sort of ask a couple of questions. We're trying to get an idea as to how the Duke GI Division has grown over the years and you clearly have a unique perspective. Many people think that Duke is an older institution than it really is, but I was wondering whether you thought that having fellow Maltier as the division chief who was here for over 20 years as division chief. And he was only the second division chief here at Duke, you're the third GI Division chief. Did you have some sense as to the history of this when you came here?

Dr. Ian Taylor: Yeah, I'd done a little bit of homework before I came out to interview, I knew I was the third, if I came I would be the third divisional director. Julian Ruffin who had done some pretty important work in Celiac Disease had been the first, and then Maltier with his interest in bile and bath salts. So I realize that its a little unusual for a medical school with such a rich reputation, a national reputation to be young in terms of even American history, certainly by British history. And coming from England I was immediately attracted by the architecture, certainly gave you the impression that this was a school that could've been built in the time of Oxford and Cambridge, but obviously wasn't, but you know it's a very young school. So I was fully aware it was a new school but it had developed a reputation, a clinical reputation that was really first class and along side that education and research were equally important so I was cognizant of the fact that I was coming to a first rate institution when I interviewed here.

Dr. Liddle: Yeah. Now you and June had been in California for a number of years before coming here.

Dr. Taylor: Mm-hmm (affirmative).

Dr. Liddle: And a lot of people once they go to California never want to come back. What was it that really attracted you to Duke?

Dr. Taylor: June and I both love California, I know you love California too. UCLA had been unbelievably good to me and good to my career, it sort of salvaged my career because unbeknownst to me, when I was sent to the states by Lord Gregory in Liverpool it was to escape the academic acts of manufacture, who was the Minister of Education at the time. And she was about to sack 10% of the university faculty. And I would've been the most junior faculty member in physiology in Liverpool and I would've been fired.

Dr. Liddle: Wow.

Dr. Taylor:  Just after gaining my PHD.

Dr. Liddle: I never knew that.

Dr. Taylor: I know, a lot of people don't. But it was one of the things I learned about mentorship. Lord Gregory called me and said "I think you need to go to the states." Hell fire, what have I done? [inaudible 00:05:22]

I thought the world of Lord Gregory and he was very kind to me. I was the first MD investigator that he ever had in his lab, he only accepted PHDs before then. But he knew that my career was over if I stayed in Liverpool. So I land in LA, not a cloud in the sky, it's beautiful. Just left Liverpool cold, damp, and miserable. I think I'd died and gone to heaven.

So I wasn't used to the American system as I did a years research before I went to the GI Fellowship. And in England you get told what project your gonna be one, at [] you can do whatever you want. So I'm finishing up some papers in my PHD and everyones telling me what to do and I'm thinking that's strange.

So I went to see John Walsh, and I said to John Walsh, I said "John, I'm here for a year, id like to do as much as I can, what do you want me to work on?" And I remember to this day this puzzled look came over John and he said "You're not here for a year." He said. "You're here for three years. You're doing a years research and then you're in the GI Fellowship." I never interviewed for the GI Fellowship. But Gregory had been senior fellow in [] lab when Mort Grossman was a junior fellow in Chicago. And he rang Mort and said "He's got some talent, and if he doesn't leave the country, his career is over. Will you take him in? And I think he can probably come back in two or three years."

So unbeknownst to me these two guys saved my career.

Dr. Liddle: Wow.

Dr. Taylor:  It's had a permanent effect on the way I feel about them for sure. You know that. [inaudible 00:07:25]

So leaving UCLA was very difficult for me because you sort of think you're deserting the people that saved you. The real reason I came to Duke, I knew it was a great institution. And that the real reason is Joe Greenfield. And he is extremely honest, you know he said, well I can't really say what he really said. He emphasized to me that the division was small and that he wanted it to grow, and that he was willing to invest both in faculty and in facilities to make it grow. Because of my previous experience working for people I could trust, I felt an immediate trust in Dr. Greenfield and everything I heard about his was you could go to the bank on what Dr. Greenfield says. Which is not necessarily true in academic medicine. So I felt there was a real opportunity to grow something here. And that if I was gonna take that leap of faith this was the place to be. Great institution with a GI division that had good people in it, but have never really grown to its full capacity or its full potential.

Dr. Liddle: Yeah, I was gonna ask you what the state of the GI division was when you came?

Dr. Taylor:  Well, there were really only a handful of faculty basically, and the two PDC physicians, John Garber and Mike McLeod, they were really the entral GI guys, they were it. Just two PDC physicians, who were very good docs but its a pretty small group of people, two people, for an institution like Duke. Paul Kimber, one of the best hepatologists I've ever met. One hepatologist, Steve Quarf at the VA, very good bath salt investigator, and Charles Mansback, who shortly after I arrived announced he was moving to Memphis to become Chief of GI at Memphis.

So basically there was a handful of physicians and basically three people in a way that did the majority of the work. And GI Fellowship was in a strange position because it had trouble recruiting into the second year, so they only recruited two fellows; Joe Greenfield had convinced Scott Brasier and one other Duke resident to join the first year, promising there would be a chief and things would change, so we had this strange situation of having two senior fellows and four first year fellows. So that meant one group of fellows was doing every other night and the others were one in four so halfway through the year actually promoted Scott Braiser early, put him into the third year to even up the rotation.They had to do a lot of things that first year to make things work basically.

Dr. Liddle: Wow. What was your strategy for recruiting? It sounds like Dr. Mansfield sort of gave you the charge to grow the GI division

Dr. Taylor: Yeah he gave me resources. I'd already told him that the one thing I thought they needed was because I knew it was important for Duke to have a very good clinical operation. If you could put together a very goo clinical operation you would get support for the research and the educational elements. But if you were never successful in growing the clinical operation, you would never be looked upon as a successful division. So, the endoscopic facilities were pretty primitive and Joe agreed to build a new endoscopy unit. They sort of bridged between two outcroppings overlooking Duke Gardens, so we built the new endoscopy unit.

That put a lot of pressure on me to fill that endoscopy unit. So to this day I do not know who told me, but somebody told me at DPW that Peter Cotton was in Georgia and that there's a possibility he might move to the states permanently. So I ring Peter, and I've never met Peter before, even though we're both from England. But I did know the game, the Great Manufacture decided to save money, she was gonna join medical schools together, that have been separate medical schools for hundreds of years. So she put together schools that hated each other. She made the chiefs dual chiefs, which is never a good thing to do.

I sort of heard through the rumor mill from my friends in England that there's a big problem there. People are very unhappy with what she's doing. And so I ring Peter in Georgia and say "Heard a rumor you might be interested in moving to the states. Would you be interested in looking at Duke?" And I could tell from the tone of his voice this was probably the 20th he'd had with somebody saying "Come and look at the job." And I could tell I wasn't getting anywhere too fast so I just said "Well, could you ask your friends about Duke? And then I'll ring you back in a week and we can talk again."

So Peter, I rang him back in a week and I said "Well did you ask your friends in Georgia about Duke?" And he said "Yes, yes I did." And I said "Well what did they say?" He said "All I got were "oohs" and "ahhs.""

I'm thinking. I knew he was a golfer, so I talk to John Garber

Dr. Liddle: Play that card, huh?

Dr. Taylor: Yeah, I was playing any card. I could tell this was a key recruitment.

So I said to John Garber "Could you get him a round of golf on Hope Valley while he's here?"

And John Garber says "Well I can do better than that, I can get him a round of golf on Pinehurst." Which meant nothing to me, I'm a lethal golfer, they warn old ladies and dogs when I go out on the golf course.

So I ring Peter and he's setting up his itinerary to visit and I said "John Garber says he can get you a round of golf at Pinehurst." There's this silence. And then Peter said "You don't mean Pinehurst #2 do you?" I had no idea, but I thought I gotta say "yes."

If John Garber didn't say Pinehurst #2, I'm paying for Pinehurst #2. So I said "Yes, I'm pretty sure that's what John Garber said." And the rest is history.

So Peter was a key recruitment. He wasn't my first clinical recruitment. My first clinical recruitment was Joanne Alsen.

Dr. Liddle: She was at Michigan at the time.

Dr. Taylor: Michigan at the time. And she had personal reasons for wanting to leave and Tachiamado was the chief of Michigan, and he rang me and said "She's terrific." If she has to leave not because of any problem with her appointment. I don't want to go into details of why she needed to leave. They said she'd be a great clinician to pick up.

Dr. Liddle: And she was from here?

Dr. Taylor: Yeah, absolutely. This was where she was from initially. So she was my first recruit. And I'm actually very proud of the fact she then became the first African American women to be tenured in the School of Medicine. In fact she was only the second woman I believe to achieve that.

Dr. Taylor: Okay, so, we've a few key clinical recruitments, a clinical practice just took off. It was very interesting, even although we started to establish a reputation and a diagnostic and therapeutic endoscopy obviously with Peter and the people that came with Peter. Our biggest group growth was in non-endoscopic GI and so I became very important that we maintain John Garber, Mike McCullough. You know they were great physicians. But the growth was huge and we could hardly keep up with the growth. But once the clinical operations started to take off, then I could start to focus on the research side of things. So, recruiting yourself, from U.C. San Francisco or Greg Fitz from U.C. San Francisco. I mention, I had a role in recruiting to Ted Pappas, so we needed a good GI surgeon too because of all the stuff that was coming out of the GI division. There were good surgeons here but Ted was a key component of the growth of the GI division even although he was in the department of surgery. Jonathan Covenant from Wash. U. who I think coming to Duke resurrected his career too and he did very well here.

Tom Geddes, Steven, yeah. So Greg was a doubler in a way because he had both a great scientist and somebody ... and of a hepatologist which we were lacking. So, the whole strategy was to develop the core of faculty ... that I had to recruit that core faculty because the numbers were just not here and then I knew that once we had quality faculty here, we could grow the rest of the division out of our own fellowship. So people like Stan Branch, who's key was one of the fellows and we cultivated Stan from fellowship to become faculty. I recruit ... I knew with the growth of the clinical operation having an outcomes group would be important so we'd recruited Don Provancale from UNC and Jane Onkin came up through our fellowship and she joined the outcomes group. Dave Whitcomb would be another example. As I mentioned in the lecture, he was gonna go into endocrinology and then found out, well, the new chiefs a GI endocrinologist and Roger Little's an endocrinologist so he suddenly saw that he could have a home in GI. So he was somebody that grew up through the fellowship program.

So I can't remember the exact numbers, but we went from being a handful of faculty ... I think we ended up with something like 26 fellows and over 30 faculty within a relatively short time. And key to that was that Joe ... I didn't think Joe ever realized how well we would really do ... he gave us the endoscopy unit so that the technical fees ... we had to hire our own people but both the professional and technical fees stayed within the division so I ran something like 15 fellows off the endoscopy unit. I'm not sure Joe ever realized that but it was ... that was also key to the success. We controlled our own ... financially controlled our own endoscopy unit. But everybody was pleased with GI because we were feeding general surgery and so nobody was complaining. I remember I got a bit up too ... I love Joe Greenfield and I'm looking forward to seeing him this afternoon. And I guess I got a bit big-headed because I was, I guess, I was really proud of what I'd done. But Joe had always said that, you know, the taxation would be kept at a certain level, and that whatever we made above that, we could grow the division. And then, I think, Joe never realized how much money we would make. So he said, "I'm gonna have to raise the departmental tax."

I very foolishly argued this, because he had been so good to me, it was something I regret to this day. But it did annoy him because he's been so generous to me. And he always called me in but at this meeting he started to call me "Tato" which I knew was bad. So he said, "You know, Tato, I recruited you to give me a division of gastroenterology, not a bloody department." But we mended that bridge and he was so supportive. I could never have done what I did without Joe Greenfield.

Again, it just reinforced to me that you've gotta work with good people. I've learned in other institutions that that's not always the case and you just have to be prepared to say, "I'm not working with the person like this," but I would've gone to battle for Joe Greenfield. He was that sorta person and then he was the reason, he really was the reason that I left California. I would've been happy staying at UCLA but I knew this was a very honest man who had big plans for GI and he was gonna support me. And the division was so small, that there was only one way to go. Growth was the only possibility. You can't get much smaller than 2 gastroenterologists, and one hepatologist, and one researcher. So it was a job that I felt that I couldn't fail at. I don't ... I think you and I are a lot alike in some respects, and I may be pulling my persona on you, but I think we tend to be driven somewhat by ambition.

But for me, a major driving force, and maybe I'm being too honest here, is the fear of failure. So going from UCLA where I was very successful in a limited role as a faculty member, I was the acting chief when Jim Myer was on sabbatical, but this would be my first leadership role and I wanted to be certain that I wasn't gonna fail. And I felt with Joe Greenfield, and the status at the GI division at the time, with good faculty but just too small of faculty and a weak fellowship at the time, although that's to say there were two Duke residents in the first year so that was a good sign that Joe would help sort of advise Duke residents to join the fellowship which he did. So he was key, and I knew he was key when I interviewed and I couldn't have achieved what I achieved without him.

Dr. Liddle: Yeah, that's wonderful. That's a wonderful attribute about Dr. Greenfield.

Dr. Taylor: Yeah, he's a remarkable man.

Dr. Liddle: What would you say was the biggest challenge you had coming here?

Dr. Taylor: I knew the biggest challenge was going to be ensuring we had a first class clinical operation. Duke's unique in its culture, and if you don't have a good clinical operation, you're not successful. You can have the best research operation, you can have the best educational programs but if you don't provide a good clinical service, if you don't care for patients in an exemplary manner, you would not be counted as successful at Duke. And that's not true at all premier institutions. Some institutions live on research and their clinical care is okay but may not be stellar. But at Duke, you have to have a stellar clinical operation. So I knew I had a limited time to develop the clinical operation, and as I mentioned in my lecture, there's a lot of luck in life, and let's just say, to this day, I can't remember who told me about Peter Cotton.

Dr. Liddle:  Interesting.

Dr. Taylor:  I should send that person a case of champagne. This has been key to my success at Duke and he was key to my success at MUSC. And once I have the clinical operation taken care of, then I could start to focus on areas that to me were very important to have a really good clinical division, you had to have good researchers, and you had to have terrific education. Now you can have good education with a good clinical operation, but it limits the opportunities for the fellows so I think the fellows have to have the opportunity that if they want to be clinicians, that's fine, if they want to be clinical researchers, that's fine, or if they want to be good basic scientists looking at clinical problems, they need that opportunity too. So the challenge was to develop that core faculty in all the areas that make a good academic division but key to that was making sure we had a stellar clinical operation.

Dr. Liddle: What did you enjoy most about the position?

Dr. Taylor: I found in all the jobs that I've been in from an administrative point of view, that the most fun is growing things. If you look at my career, and I warned you that this would be the case, that I would be about eight years at every job that I was in, and I told her this when we got married.

Dr. Liddle: You didn't tell me that when you recruited me.

Dr. Taylor: No, and I didn't tell anybody I recruited that. The reason for that was because it's a lot of fun growing something. I got the most satisfaction from growing this division, from recruiting good people, and being able to say I took a division that was unrecognized nationally, and I'm not a great believer in U.S. News and World Report but we were never in the top ten in U.S. News and World report, and within a few years, we were in the top ten of U.S. News and World Report, and we still are. That reputation is still there and you can argue that it's an unscientific entity and you shouldn't pay attention to it, but patients pay attention to it. And doctors pay attention to it. So, whether it's right or wrong, that was important. So I found that holding ... once I've grown and Joe had a clear idea of how big we should become, I don't think we ever have wanted us to outgrow cardiology which I understood too.

And then holding things together is ten times, 100 times more work, and a fraction of the fun. So I found out, really at Duke, because I'd not been in an administrative position, to advance that I'd have to move. So I told June, that if you really want to go up in the ranks, you ... I didn't know it was gonna be eight years but I found out at Duke, eight years is about the right time for me because I've sort of achieved all that I'm gonna achieve. And if you've done the job right, whoever you report to, has to move on to whatever the next division is or the next department they have to build up. It's ... you can't continually grow one department or one division, but then, and this isn't just Duke, but you know, you get into situation where faculty will come here, and they'd complain about this whatever, and you think, if you had any idea of all the things that I do on a daily basis. So, it just wasn't as much fun holding it together, and I got a huge kick on growing it.

I can't explain it. It was so fulfilling to be able to say, "I really made a difference," at an institution like Duke University. That's pretty remarkable. And it was interesting when I ... and this may be off your question a little bit but when I left Duke, I was starting to get office of chairs positions. I remember I looked at Pittsburgh, and I looked at MSUC, but again, I went to Joe Greenfield, and I say to Joe Greenfield, "if I'm gonna become a chair, this is probably the time to do it given the people that have expressed interest in me." So I said, "What do you think about these various jobs?"

And he said, "Well, Pittsburgh's a great institution, so prestigious but that sort of difference are you going to be able to make at Pittsburgh, it's already up there." And then he said, "MSUC is sleepy but they got a new president who was the first Republican Governor of South Carolina and a Cabinet Minister in Reagan's, and had a magical touch for raising money. Jim Edwards was unbelievable in terms of getting money. And Late McCurdy who I greatly respect and love, and was really good to me was the new dean, and Joe's a southerner. So he said, "You'd have a lot more fun in South Carolina than you would in Pittsburgh."

And it was the same thing, MSUC, the time I went down there was a little bit sleepy, but it's grown unbelievably. It's a state institution, it's come a long way in a short time, and so it's almost addictive to go to an institution and take something and really make a difference. So, that's what I got my kicks from. But once, I've grown it, trying to hold it together was no where near the fun that building it was.

Dr. Liddle: What would you say your greatest accomplishments were, here at Duke?

Dr. Taylor: I would say it lay in the people I recruited because that was the key to the success. It wasn't me, per se, it was my ability to convince people who're just like yourself that Duke was a place to come. So to see people of your quality, Greg Fitz's quality, Peter's quality, Joanne's quality, to sort of take that leap of faith and come to Duke ... convincing people to do that, you are picking up sticks, you are moving your family, that's a lot of things to do, and people were coming from good institutions so ... and then on top of that, the ability to see an amazing improvement in the fellowship program and the quality of the fellows we attracted. They've populated GI divisions all over the country. So, I would say I am proud of the fact that Duke GI division, to this day, is counted as one of the best GI divisions in the country, and holds that reputation. So whatever was built, the foundation was strong enough that it could maintain that reputation. You know sometimes you build something and then it collapses immediately.

But I think the fact there were good people there, the fact that I left ... didn't make a lot of difference. This whole nucleus of what made the division great was already here. So, I'm proud of that, but I think I'm more proud of the people that I recruited, both the people who stayed here and did good things, and the people who went on to work on becoming the chief of GI at Pittsburgh, and becoming a leading figure in inherited pancreatitis, and then Greg going on to Colorado to become the Chief of GI and become the dean and provost at South Western.

So having people go and be ambassadors for the division was important, but it was equally as important that good people stay in the division because if everybody had left, then the whole thing would go back to what it was before. So the fact that people came here and enjoyed both the university environment, and the environment ... the living environment for families, which is important, so people were comfortable staying, that ensured that what I've helped build didn't collapse as soon as I left, which would have negated eight years of my life. So, I think both of those things were important, the people, the people who left and were good ambassadors, and the people that stayed and ensured the quality of this division was maintained, which it has been, so, I'm proud of that.

Dr. Liddle: Let me take you back to when you came, because that was in 1986, is that when you arrived?

Dr. Taylor: Mm-hmm (affirmative)

Dr. Liddle: What was Durham like in 1986?

Dr. Taylor: I wondered what the hell I got into. I think it was worth it for June because I was busy at work and-

Dr. Liddle: And she'd come in from Los Angeles.

Dr. Taylor: And she's coming from Los Angeles and I told you this story, but I think it reflects ... I wanted to build co-adhesion in the division, so for me, the Christmas Party was a very important event. It brought the faculty together. It brought the fellows together in a social setting and we had some really good parties. Robin, Maryn, Kate ... she did some of the best food, and gastroenterologists love food. So, I remember and I told you this story but it might be interesting for the people who hear it, I remember sending June out to get the alcohol for the party. So I gave her my ... credit cards, that's part of story, she took off with our credit cards on the car, had to find an ABC store, which she found was downtown. So she comes back eventually after a long time, totally frazzled, and she said, "I drove around downtown Durham, there's nothing there other than one-way streets."

There's ... nobody's there, there's nobody walking the streets, I'm driving around trying to find this ABC store. There's no traffic, I can't ask anybody. I've been driving around for a long time and I eventually find it. I go in, I pick up all this alcohol that you told me to pick up that we needed," not a substantial amount of alcohol, it was going to be a Christmas party with a lot of people. And she said, "I get to the sales person and hand him a credit card, and he says, "We don't accept credit cards here, we only take cash."" So she says, "What? You only take cash? I've never heard of that." In L.A. or San Francisco, you'd go into a grocery store and buy alcohol, so she says, "Well, where's the ATM machine?"

So he says, gives her instr- ... so she's back in the one way streets again trying to find the ATM, which she eventually gets. She gets the cash, comes back to the ABC store, and she's got her crate of alcohol in her grocery cart, goes up to the same cashier and says, "I've got the cash now. I'll pay for it and leave." He says, "Well that's a bit tricky. You're over your limit, you know." So she says, "What? I'm over my limit?" He says, "Yeah, you're only allowed to carry a certain amount of limit in the car. And you're way over your limit." So she said, "Well, I've got a party and what am I gonna do?"

He said, "Well, I can give you a transportation certificate so this will give you permission to go straight home with this amount of alcohol. If you're stopped by the police, you show them this, and you have to promise me you're not gonna cross straight at the state lines." So she comes home and she says to me, "What the hell have you done to me?"

So that was our first introduction, and seeing it today, it's totally different. Restaurants, it's exciting, it was like a desert when we came here, everything was on the periphery of Durham and everything revolved ... everything in our world revolved around the university. There was no downtown. The big thing I remember was the construction of Durham Bull Stadium and going to see the darn bulls but it was, coming from L.A., you were on the moon, from a living sort of condition. It was so, so different. It took ... but it was worth for June I think, and me. I was busy working but she had to deal with the issues of "You took me away from L.A. that I love, the beaches of Santa Monica, in a place that just has one-way streets." There's no other reason to have one way streets. So that was interesting.

Dr. Liddle: Add that to your ability to recruit into that environment, right?

Dr. Taylor: Yeah, yeah.

Dr. Liddle: Yeah. Before we finish, is there anything that you would like to ... I'm not sure exactly what's going to happen to this recording but it's going to be saved in some capacity. Is there anything that you would like to say, or thoughts that you think would be important for others to remember at some time in the future?

Dr. Taylor: Well, I think I'm very grateful for what Joe Greenfield did for me and for coming to Duke. This sort of ... it was very important and crucial move for me, even though I joke about coming to Durham. It was the best move I could have made if I was gonna become a divisional director. So, I'll always be grateful for the opportunity that Jude gave me. And I'll always be proud of what was achieved here. And I think for people that might be a stage in their career where they are thinking about things, I think the most important thing is not necessarily the environment that you move into. The most important thing is that you find good people and by good people, I don't just mean good clinicians and researchers, I mean good people, honest people, people that you like, because then you have a personal interest in their success too, which I think it's important for people to know that you're just not interested in them because they enhance the division. You are interested in them as people. So, the faculty and fellows you recruit, I think you have to have a genuine interest in their future and what's gonna happen to them.

I think that grew out of the fact that I had special people that looked after me. You know that story I told you about Rod Gregory, I don't tell that story very often because it was probably illegal that they put me in the GI fellowship into [crosstalk 00:28:03]. Pissed off most, well maybe ... can we take that word out? It will annoy most fellows with all the struggles they have, to get into a fellowship that ... but they saved my career and I think I've paid them back but what I did at UCLA, I think I did well at UCLA, and I think I did a ... and I'm not trying to be big-headed. I think I did a great job at Duke.

I think I did a great job with the Department of Medicine at MSUC and it's a very different place from the one that it was when I arrived, and I'm very proud of what happened at Tulane after Katrina, and the fact that I resigned. I lot of people didn't know why I resigned after Katrina, but it was over a disagreement. The president of the university called for final exigency which allows him to terminate tenured/ non-tenured faculty. So we had a fundamental argument about the number of faculty that he wanted to terminate. So to me, these were people that lost their houses and were ... lost their livelihood, and he wanted to terminate them. So, I remember June was back in Houston, and I ring ... they called me back from this meeting to tell me that Price Waterhouse ... we were going to have to fire another 75 faculty. I said, "Well, I just sent around a letter with my signature and the Senior Vice President, saying everybody was safe, and I passed it past the president." And he called me, senior vice president calls me at five in the afternoon and says we gotta fire another 75. I said, "I just sent them a letter saying their all safe, that's the end of it. I can't suddenly undo that." I said, "Can I think about it overnight?"

I needed to call June, we had two kids in college, we just dropped Kevin off at USC, one of the most expensive universities in the country, and I've potentially got no job. So I ring June, and I said, I explained what had happened, and I said, "I think I'm gonna have to resign. I can't fire people I just said they were safe in writing and they want me to fire another 75 faculty who've moved to Houston at my request to keep the school going." And I will always be forever grateful to her, this pregnant, poor ... and I thought she was going to say "Bite your lip, you know what are you doing?"

But she said to me, "You've gotta do what you've gotta do." And so I resigned that night. But I'm both proud of the fact that we were able to move the school to Houston, that every student graduated on time, every resident graduated on time, and the students invited me back for their graduation, and gave me the Gold Humanism Award, which meant a lot to me.

Dr. Liddle: Yeah, that's wonderful.

Dr. Taylor: But equally important to ... and I know you know this, to recruiting good faculty is marrying the right person. This ... I could have not lived with myself if I hadn't resigned over that issue. I don't know if I would have had the guts to do that without the fact that a lot of people had made sacrifices for me during that time ... during my time and my development. And I've worked with really good people with really good ethics. I didn't know what the hell I was gonna do, this leaving in the midst of a tragedy like that, I thought I was never gonna get a job. We were talking about retiring to Florida at that time, and then it turns out that John Larose had been the chancellor at Tulane and he had similar troubles with the person I had troubles with who I won't mention.

So I interviewed with him and off ... spent the whole hour talking about both our times at Tulane but I think the ability to work with very good people who have very good ethics is really important. And know when you are in a situation where that's not the case, and you have to be out of that situation, and I was Duke ... Joe Greenfield, as I mentioned, he was the reason I came. I loved working for that man. I loved working for Joe Greenfield.

Dr. Liddle: Personally Ian, I'd like to say that I ... one of the reasons that I came here ... well, the reason I came here was because of you, and that you made the GI division a very welcoming place. I always felt that you genuinely cared about me and our family. It made all the difference in the world for me personally. So it certainly reflects what you just expressed about the importance of those personal relationships in making an environment that is productive, allows people to be productive but really makes it all worthwhile. So, I want to thank you for that.

Dr. Taylor: Well, I appreciate you saying that because I think that feeling of family was important to me too, that I was passing on all the kindness that had been shown to me in my career. And I realized that makes a hell of a lot of difference if people really feel that you care about them, it makes them more productive, it makes them better colleagues, it just makes the environment a very great environment to work in.

Dr. Liddle:  Well thanks very much. This was a wonderful opportunity to-

Dr. Taylor:  My pleasure. It's great to be back, and it's great to be back with you too.

Dr. Liddle: Yeah, thanks.

Dr. Taylor: Thanks.