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Publication Date: Wednesday, March 20, 2002

The seventh Dr. Lee

By Marion Softky

Almanac Staff Writer

'What keeps me going to work is what occurs with the patient. That's the only thing that really stands the test of time."

This basic doctor's credo _ plus drive, skill and energy _ have led Dr. Rich Lee of Skyline to the darnedest places.

It was a patient, entrepreneur and Everest climber, Charles Corfield, who researched high-altitude medicine with Dr. Lee, and brought him along as team physician on the 1999 Everest trip that determined Mount Everest was 7 feet higher than previously thought. "He was my guinea pig," chuckles Dr. Lee in the living room of his Skyline home overlooking Devil's Canyon and the Pacific Ocean.

Another patient, an Indian businessman, persuaded Dr. Lee to organize an expedition of doctors and nurses to India to rebuild spines and nerves damaged by the earthquake that flattened Gujarat in western India, on January 26, 2001.

Two months later _ thanks in great part to Dr. Lee's contacts, organizational talents, and hard work _ 11 doctors and six nurses were doing state-of-the-art spinal and neurological surgery in a public hospital in Ahmedabad. Working with Indian colleagues, several teams performed 35 sophisticated surgeries in five days, says Dr. Lee.

When he's not off on adventures or missions of mercy, Dr. Lee is an assistant professor of clinical medicine at Stanford. He sees patients for primary care in Stanford's family practice program, where he does everything from delivering babies to mentoring students and residents in the clinic.

"In my practice I try to get to know my patients _ to know their interests and gain their trust," he says. "It's a joy to give someone unexpected hope, or unexpected relief."

Dr. Lee follows a line of pioneering physicians who helped shape modern medicine on the Peninsula and in the country. His grandfather was the legendary Dr. Russel Lee, who co-founded the Palo Alto Clinic, which was revolutionary in its time. All of Dr. Russel Lee's five children _ Richard, Peter, Philip, and Hewey Lee, and Margot Paulsen _ were also prominent physicians and community leaders. "I come from a long line of agitators," quips Rich Lee.

As of now, Dr. Rich Lee is the last physician in the dynasty, the only one of Russel Lee's 21 grandchildren to get his medical degree. "I'm the last of the Mohicans," he says.

Will his sons, Russel, 11, and Philip, 8, some day be doctors? "Given the politics and economics of health care today, and how busy I am, probably not," Dr. Lee replies.

Now Dr. Lee lives in a house he and his wife, Janet, largely designed and built themselves on a knoll with a spectacular view. Keeping them company are a dog, a cat, a horse, a goat, a donkey, two emus, and assorted wildlife.

Here he applies his experience in wilderness medicine to helping victims of accidents. He is an active participant in the new program to train Skyline residents in first aid and emergency response. The first Community Emergency Response Team (CERT) class graduated 24 residents in November; a second class will be given this spring.
Local hazards

Dr. Lee gestures down from his deck, recalling a particularly difficult middle-of-the-night rescue. A man walked off a waterfall in Devil's Canyon far below during a lunar eclipse. He bashed the back of his head and suffered brain damage.

Dr. Lee scrambled down the steep slope at 1 a.m. to help a rescue team from the California Division of Forestry. They secured the man, who was fighting his rescuers, and hauled him up the steep trail to safety. He has fully recovered, says Dr. Lee.

In a career where he has dealt with lots of death and injury, Dr. Lee says he hasn't seen anything worse than the crashes and accidents in the Skyline area. "Here, right in my own back yard," he says, "it's not just vehicles, it's mountain bikes, hikers, climbers; I've treated brain injuries and gunshot wounds _ self-inflicted."
On the compound

The Lee compound _ originally some 600 acres across Los Trancos Road from what is now Portola Valley _ must have been a glorious place to grow up.

Dr. Russel and Dorothy Lee, their children, and 21 grandchildren lived in five households on Boronda Farm, a spread of hills, valleys and streams that used to include Foothills Park. "Most holidays, we had big family gatherings with my grandfather," Dr. Lee recalls. "Politics and medicine were always big topics discussed enthusiastically _ plus limericks and warped humor."

History knows Dr. Russel Lee as an innovator who introduced group practice to Palo Alto in the 1920s, when medicine was supposed to be practiced by individual family doctors on their own. The clinic was attacked as socialist medicine, and labeled as a "Medical Soviet" by the American Medical Association.

"The Palo Alto Clinic was the first multi-specialty group practice west of the Mississippi," says Dr. Lee. "My grandfather was a strong advocate of pre-paid medical care. He was also one of the architects of Medicare. He was an adviser to President Kennedy on preventive medicine. He was never afraid to break out of the mold."

Dr. Lee also cherishes more personal memories. "Grampy was a brilliant prankster with a wry and lewd sense of humor," he recalls. "Grandmother was quiet and strong and kept him grounded.

"She was more of an anchor than he ever realized," Dr. Lee muses. "She anchored the whole family."

His grandmother also got him involved in nature and introduced him to great nature writers and photographers such as Ansel Adams and Jacques Cousteau.

Rich Lee is the son of Dr. Richard Lee, an obstetrician-gynecologist who has delivered thousands of local babies. He is retired and still lives on what is left of Boronda Farm. Dr. Hewey Lee still lives there, too. While Dr. Philip Lee now lives in Palo Alto, he sees his brothers almost every day, says Rich.

Young Rich wasn't pushed into medicine by his overwhelming family. "It was my calling," he says.

He attended Corte Madera School, and the former Portola Valley School, and graduated from Gunn High School in Palo Alto. After graduating from the University of California at Berkeley, he attended medical school at Michigan State University's special program on the Upper Peninsula.

Here he got hands-on training, like an apprenticeship; practicing alongside doctors in the community. "You learned to practice medicine with common sense where resources are limited, but you still have technology," Dr. Lee says. "It suited my active learning style."
Hands on outdoors

Dr. Rich Lee is a hands-on kind of guy, and a passionate outdoorsman with a taste for adventure.

As a teenager, he became involved in his father's passion for sports cars and car racing, and began learning emergency medicine. "I grew up being his mechanic," he says, adding, "Actually, car racing is very safe. I encounter more trauma commuting back and forth to work."

By age 16, Rich had become an emergency medical technician, and began doing mountain rescue in Yosemite National Park. "It was a real maturing process for me," he says. "A lot of it was body recovery. I lost six friends in one year."

Dr. Lee also became an enthusiastic mountain biker, slalom kayaker, backcountry skier, and rock climber.

Bungee-jumping? "No. I've fallen 120 feet rock climbing and been caught by a rope; it's a lot less comfortable," he replies. "I'd rather sky-dive than bungee-jump. I'd rather fly a hang glider than either."

It was on a cross-country skiing blind date that Dr. Lee met scientific programmer and model Janet Carr. During their 22 years of marriage she has been a national champion bike racer, and won a second place in three-day eventing at Pebble Beach, on Cabernet, a horse her husband acquired for $80.

Russel and Philip are already eager climbers and cross-country skiers. They also do downhill skiing, but do telemark turns, their father says. "Their heels are free."
Everest

When Dr. Lee got to Mount Everest base camp at 17,500 feet, his friend Charles Corfield was coughing when he should have been climbing.

Dr. Lee, who prides himself on being prepared for things other people may not think of, gave him a new asthma medicine that hadn't been used before for high-altitude problems. Mr. Corfield got well and made the summit; it was his first success after trying every year since 1996.

On the 1999 U.S. Millennium Expedition, sponsored by the National Geographic Society and Boston Museum of Science, the climbers used global positioning technology to find that Everest was 29,035 feet, instead of the previously measured 29,028.

Dr. Lee's role was far less glamorous. After studying high-altitude medicine with Mr. Corfield for several years, and doctoring him by e-mail on previous expeditions, he had a list of problems and a pack of medications. "We endeavored to solve common problems _ why people don't eat, how to prevent the cough that ruins everybody's day and their climb," he says.

Everest base camp in 1999 was quite a scene. With 14 expeditions, it was also a reunion of survivors of the disastrous expeditions of 1996, when a number of people died.

Dr. Lee found himself helping people from other camps who had problems they weren't prepared for. One woman had profound hypothyroid, but didn't think to increase her medication. "I was the only doctor in base camp who had thyroid medicine," Dr. Lee says. "Everyone knows what to bring for what they expect; they forget other problems that can arise."

Dr. Lee never got high up the mountain, although he admits sneaking part way up the Khumbu ice fall. He sums up, "Everest is primarily judgment and luck and some conditioning."
Gujarat

Another of Dr. Lee's patients, Dr. Deven Verma, and his daughter enlisted him to organize a medical relief expedition to Gujarat after a January 2001 earthquake killed 30,000 people. "He asked if I could come up with a project and lead it. He wanted to involve expertise at Stanford," says Dr. Lee.

The logistics were awesome. Preparations involved enlisting a team of doctors and nurses, arranging visas, vaccinations, airline flights half way around the world, packing equipment and medications, and _ most important of all _ identifying a feasible project.

Stanford neurosurgeon Dr. Daniel Kim headed the surgical team and helped recruit others, including pediatric surgeon Dr. Baird Smith, and two surgeons from India, plus six surgical nurses from Stanford. "We all worked together so well," says Dr. Lee.

The project they focused on was rebuilding spines and repairing nerve damage _ injuries with long-term consequences. "Loss of mobility affects quality of life and productivity. People can't walk or stand or use a limb."

Dr. Lee persuaded other suppliers to donate medicines and equipment. Johnson & Johnson gave cases of titanium rods, screws and plates that surgeons could use to rebuild spines from the inside. What wasn't used, they left in the civil hospital for future use.

The Indian team members helped make sure the civil hospital in Ahmedabad really needed their help and could make good use of their time treating patients. By the time they arrived, the hospital, under the direction of Dr. Anhil Chadha, had already chosen patients and organized their records.

"We arrived at Ahmedabad at 8 a.m. By noon we were doing surgery," says Dr. Lee.

Dr. Baird Smith gives credit to Dr. Lee and his enthusiasm for the success of the venture. "He was able to organize a large group of people, and keep them happy, so good things got done," he says.

For five days, the teams operated almost continuously, bringing state-of-the-art techniques and equipment to a huge government hospital that served only India's poorest. In the evenings and between surgeries, they gave seminars and trained their Indian colleagues in new procedures.

The public hospital itself was an eye-opener. Over 5,000 patients competed for 2,500 beds in the complex, which sprawled over 11 acres. By contrast, Stanford Hospital has 500 beds, says Dr. Lee.

On the next to last day, President Bill Clinton stopped by and held a baby, who had been operated on by Dr. Smith.

Dr. Lee has only praise for the civil hospital and its staff. "They did amazing things with few resources," he says. "I challenge any hospital in America to do as much with as little."

Now the people who shared the suffering of the people of Gujarat just last year are appalled at the new violence. "It's horrendous. It's tragic," says Dr. Lee. "The place was peaceful; everybody was getting along. Now they're killing each other."
What next

Not one to sit at home, Dr. Lee is trying to choose between three new projects.

He'd like to go back to India to help burn victims from the Hindu-Muslim riots. "Long-term, I'd like to do CERT-type training in Gujarat to help improve community health in daily and disaster situations," he says.

Alternatively, Dr. Lee would like to become involved in a community health project in northern Afghanistan. "I'd particularly like to help women with resources, education, and improvising solutions to problems," he says.

Closer to home, the perennial agitator wants to juggle the health system to improve primary care at the point of contact between doctor and patient. "I'd like to bring health care back to being a service rather than a commodity," he concludes. "Precious little is being done to enhance what happens at the point of care. That's what's getting lost in the mix."