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Still Making a Difference

Second Generation of the Ward Family Carries on Tradition of Leadership in Patient Care
By Susan Sample

Middle initials matter in the Ward family. "R" for rheumatology, "H" for hematology, people would say to distinguish John R. Ward, M.D., from his son John H. Ward, M.D., when both were on the School of Medicine faculty in the 1980s. "They used to ask him: 'Are you Dr. Ward's son?' Now they ask me: 'Are you Dr. Ward's father?'" said the 79-year-old physician, leaning back in a pale blue recliner, one of a matching pair in his Salt Lake family room. He smiled, then added, " - which is a wonderful question to be asked."

Passing down the physician's white coat from the shoulders of one generation to another isn't unusual. Sons and daughters often emulate their parents. But John H. isn't the only son, nor is medicine the only aspect of health care represented in this unique family of University of Utah graduates.

R. Scott Ward, Ph.D., P.T., is professor and director of the Division of Physical Therapy in the College of Health. Pamela Ward Proctor, R.N., B.S.N., is nurse manager of University of Utah Hospital's Emergency Department. John H. - "the 'H' is for Harris, my mom's maiden name" - is professor and chief of the Division of Oncology in the School of Medicine and medical director of the Huntsman Cancer Institute Clinics. Only the youngest son, James Alan, chose a career outside health care.

Their mother, Norma Harris Ward, R.N., a 1946 graduate of the College of Nursing, was night supervisor at the Salt Lake County General Hospital, where she met John R. ("R" for Robert), who'd just finished medical school. He founded and led the Division of Rheumatology for more than 30 years before retiring in 1993 as professor emeritus of internal medicine.

The leadership and values the parents modeled - and that their children have followed - are the kind that transformed a pioneering two-year medical school, a nursing education department, and a three-member pharmacy faculty into a renowned academic health sciences center in the last century. But that's not all that makes the Ward family unique. It's the characteristics each epitomizes, reflecting the best of what health-care professionals must continue to be in the new millennium: healers with compassion and intelligence.

"Let me tell you about John R.," said Carolee Moncur, Ph.D., P.T., professor and interim dean of the College of Health, who worked alongside the physician for many years in University Hospital's rheumatology clinic. "He was one of the earliest rheumatologists in this country, one of the leading ones, who built this program into an internationally known division.

"I've seen him as an academic physician mentoring students, a practicing physician treating patients, a leader conducting journal clubs, and as a presenter of papers at our national meetings. He's very insightful and asks good, important questions not only about issues, but also the impact of what we do on patients and their lives. He was always very caring.

"Scott was a student of mine," added Moncur, former chief of the Division of Physical Therapy. "Like his dad, he's very, very bright and very compassionate. Young John, Pam, they all have that caring attitude. And I don't think that can only be attributed to John. Norma is very much the same way."

H. James Williams, M.D., professor and former chief of the Division of Rheumatology, concurred. "John R. was dedicated to the medical profession. His patients loved him, and he took good care of them.

"The younger Wards all stayed at an academic institution, although financial incentives could be found outside. That comes from their dad," said Williams, who was a partner to John R. and an advisor to John H. "They're very dedicated, hard workers. But Norma gets a lot of credit for how good their kids are," he added. "John and I used to talk about that. She is a wonderful, charming person. Very patient, very supportive."

Courageous could be added to the list. In 1943, when Norma Harris was 18 years old, she told her parents she'd enlisted in the Cadet Nurse Corps and would move from San Bernardino, Calif., to Utah to study nursing at the U. "I just had always wanted to be a nurse. I never wanted to be anything else," she said. "I think they were pretty upset about me leaving home. I was the only daughter - I have three brothers - which makes it difficult for a dad, in particular," noted Norma, 77, who had been born in Payson, Utah. "But they encouraged us to get an education and do the best we could."

By the time she graduated in June 1946, World War II had ended and with it, her military obligation. Although her training at the College of Nursing had been "fabulous," she still wanted to learn more. "I just didn't feel fulfilled. If I was going to do it, I wanted to do it right. So I worked as evening supervisor at the county hospital and went to classes at the U in the day to finish a bachelor's degree in science."

John R. had grown up in Salt Lake City near 24th South and 6th East, a neighborhood many other influential citizens call home. His own childhood, though, was far from idyllic. His father died of pneumonia when he was 10 years old. "I was the oldest male and became a kind of surrogate dad - more than I would have chosen," said John R., who worked to help support his mother and four younger siblings. He graduated from South High School in 1941, then earned a bachelor's degree from the U. When he received his medical degree in 1946, his was only the fourth class to graduate from the four-year College of Medicine.

In retrospect, he wonders if he didn't choose medicine because of his family. "There was a lot of illness. A wonderful older sister of mine died of kidney disease soon after my dad, so we were around medicine and hospitals a lot. That makes an impression on a young boy."

He had just finished a 48-hour shift as an intern when he first saw Norma. "The nurses had a dining hall. You could go over late and have a sandwich and a cup of tea," said John R. "That's where we met, 10:30 at night."

"I just saw this good-looking young man," remembers Norma.

Dressed in traditional nursing "whites" - cap, dress, stockings and shoes - "she was beautiful," recalled John R. After they were married in 1948, "I remember her polishing those shoes every night."

Norma continued working at county general, supporting the couple while John R. finished his residency at a salary of $15 a month. He was chief resident in internal medicine when he was called to active duty in the Korean conflict in 1951. After fulfilling three months of medical field service training, he was stationed at Dugway Proving Ground, serving as chief of the Medical Investigation Division.

Research, though, was his passion. "From the day I went into medical school, I had wanted an academic career. Research seemed important, as well as seeing patients," said John R. His mentor, the late Maxwell M. Wintrobe, M.D., first chair of Utah's Department of Internal Medicine, wanted him to be a hematologist. "I wasn't eager about that," recalled John R. So Wintrobe gave him a choice of heading up one of three new divisions: gastroenterology, infectious diseases or rheumatology.

"This was about 1953. Cortisone had just been discovered, and it was very exciting. Rheumatology seemed like a challenging field at the time." After completing research fellowships in physiology and medicine at the U, he began a two-year term as a combined research fellow at Harvard Medical School and clinical fellow at Massachusetts General Hospital, focusing on arthritis.

By then, their family included 5-year-old John H. and 3-year-old Pam, both of whom had been born at Salt Lake County General. Norma had stopped working, but unpacked her whites when they moved to Boston. "It was such a prestigious place," she said of Massachusetts General, which, unlike Salt Lake, had intensive care units. Although she preferred the medical floors, she worked with iron lungs on the infectious diseases floor, drawing upon her extensive experience with them in Utah.

When she became pregnant with Scott, however, she quit. "It was the last large polio epidemic, and we thought she shouldn't be in a hospital," said John R., recalling how each week one of their neighbors would contract the disease.

Returning to Salt Lake City in 1957, John R. began as the sole faculty member and chief of the U's new Division of Rheumatology, with research grants totaling $50,000. By 1990, he headed a faculty of 10, who saw more than 11,000 patients and were involved in research funded by $2 million in grants. He also served as chair of the U Department of Preventive Medicine from 1966-70, earning a master's degree in public health from the University of California, Berkeley, during a sabbatical in 1967. He won accolades for his teaching - twice, he was named Professor of the Year by the medical school - and for his clinical expertise. He was the Utah Chapter of the Arthritis Foundation's Man of the Year in 1983 and received Salt Lake County Medical Society's Distinguished Physician's Award in 1984.

His reputation was not limited to Utah. In 1976, he established the Cooperative Systematic Studies of Rheumatic Diseases, a multi-institutional center for clinical drug studies funded through a contract with the National Institutes of Health. "These were large trials that established the efficacy of methotrexate, now considered the gold standard of treatment for arthritis," noted fellow rheumatologist H. James Williams, M.D.

Rheumatology clinics across the country participated in trials coordinated by the center, which John R. directed until 1993. When the producers of ABC's news program "20/20" asked rheumatologists whom they would recommend as an expert in medical therapies for rheumatoid arthritis, "the name that came up most often was Dr. Ward's," according to a 1988 press release announcing his appearance on the TV show.

Since his retirement, John R. enjoys football games, among other shows, on the big screen television in their family room. Once a month, though, the set's turned off when four generations of Wards gather for "Taco Sunday."

"It's just chaotic!" said Norma, who prepares ground meat for 50-60 tacos ahead of time - and obviously enjoys it. She began the tradition 20 years ago, when three of their four children were married the same year and she wondered, "How are we going to stay acquainted?"

A key ingredient of the meal is the recipe for "secret" taco sauce, which she brought from Southern California. Pam claims that "it's out of this world. There's a certain technique?it's not what you'd expect."

It certainly wasn't what her father expected when he first tasted it. "When I was courting my wife, her brother was living here," said John R. "Her parents found out she was going to marry a non-LDS, so they had him check me out. He invited Norma and me over for dinner, and served tacos. Who in Salt Lake City in 1948 had ever heard of tacos? I thought: what sort of crazy outfit am I getting into?"

Craziness can reign on Taco Sunday, when the month's birthdays and anniversaries are observed, and sundry activities can include drawing one of 37 names for Christmas gifts. Games figure in, too, with John H. and Pam playing a game of double solitaire that he describes as "more like a contact sport. We have a long history of competitiveness."

"Oh, Johnny's just gloating, because he's beaten me!" replied Pam. "But, if you look at the long-term average, I have more wins. He does, however," she said with a sigh, "have the long-standing Monopoly record."

"Dad taught me more about medicine than anyone else. He just has a way of treating patients," said John H., holding a black-and-white photo of his father from 1969, which sits on a bookshelf above his desk at the University's Huntsman Cancer Institute. "He's about the same age as I am now: not old but not young. He was at the peak of his powers: a thoughtful, compassionate physician. Everything I wanted to be?and hope that I am."

John H. never felt pressured to follow his father's career path. "I just think I always knew I would be a physician," said the 52-year-old chief of the medical school's Division of Oncology. "My parents never suggested it. It was never implied that it was something I should do." In fact, he laughs at how he rejected the only professional suggestion the elder Ward did give him: "He advised me to be a subspecialty surgeon."

After graduating from the U School of Medicine in 1976, John H. set out for Duke University Medical Center in North Carolina to fulfill an internship and residency in internal medicine. He received the Haskel Schiff Award as the outstanding medical resident. Initially, "hematology/oncology wasn't on my radar screen. I did three months of my residency in rheumatology, more to understand what my dad was doing than anything else.

"Then I discovered that I enjoyed looking at blood smears and treating leukemia patients. I could make a difference in their quality of surviving. It's a privilege working with cancer patients. It's hackneyed, but it's true: a lot of people show great courage in times of trial." Although his parents never said what to do, "it was understood that we'd make a difference," said John H. Oncology has provided him with that opportunity. "I remember a patient with acute leukemia. From my perspective as a physician, everything went wrong: side effects with drugs, the hospitalizations. When I told his wife I was sorry things hadn't gone more smoothly, she said, 'But you don't understand. The last year has meant so much. We've lived under the same roof, but it's like we've led two different lives. This past year has allowed us to become a couple.' Even if someone dies, you can make a difference."

Like his father, who was honored by a former patient with the Thomas E. and Rebecca D. Jeremy Presidential Endowed Chair for Arthritis Research, John H. recently was honored with one in his name: The Rodney H. and Carolyn H. Brady Presidential Endowed Chair in Hematology/Oncology. In the last 10 years, he also has been honored four times with one of the Department of Internal Medicine's Outstanding Teaching Awards and the 2002 Parkin Award for Outstanding Clinical Teacher in the School of Medicine.

"Medicine was such a part of our family and what we did," said Pam, 50, reflecting on influences during her childhood. Like her mother, she became a nurse. "But it was never suggested we go into medicine. It was just by example and respect.

"My mom was such a strong role model for me," she continued. "I always thought that nursing as a profession had value - to my family and to me as an individual. It's something I can contribute with. Part of what you choose as a career you hope makes you a better individual. Nursing had those qualities. It still does."

Honored last October as Nurse Manager of the Year by the Utah Emergency Nurses Association, Pam wasn't particularly enthralled at first working in University Hospital's emergency department in 1978. She'd preferred the medical intensive care unit, where "I knew every little detail about my patients and had total control. Then I got addicted.

"I'm challenged and stimulated every day," she explained, the tone and pace of her voice as animated as an ER. "The circumstances - the environment, the patients - are constantly changing. There's always an element of chaos. Patients don't come in with a diagnosis, but with something that has alarmed them. It's like detective work. You have to put so many things together for someone who is in crisis: synthesize it all and constantly re-evaluate in a brief moment."

Of course, not all patients who come to the ER are true emergencies. "Then," she noted, "you have a chance to teach them." And, sometimes, learn from them. "You see life change in a moment. You see how fragile life is and how you have to value it. The older I get, the more I realize that, boy, you don't have all the answers. It's very humbling."

From personal experiences, Pam knows how it feels to be vulnerable. Like all her brothers, Pam graduated from Granite High School in Salt Lake County. She enrolled at the U and, during her junior year in 1973, was married. When she graduated magna cum laude from the College of Nursing the next year, she was pregnant with her first daughter. She was divorced two years later when she was pregnant with her second daughter.

"In retrospect, it's surprising to see how everything fits together," said Pam. As a girl, she'd thought nursing offered her mother alternatives: "She could share her knowledge base with the community, teaching first aid. But if she had to support the family, she could." For nearly seven years, Pam was a single mother, supporting her own family not only as a hospital nurse, but also as a supervisor in the U.S. Army Reserve, then as an officer and chief nurse for the 151st U.S. Air Force Clinic in the Utah Air National Guard.

Her inspiration to join the military? "Two things. First, my father and brother's examples," she said. John R. retired in 1983 as a colonel in the Utah Air National Guard; John H. retired in 1997 as a lieutenant colonel. "And secondly," said Pam, "I had a desire to contribute to the welfare of the country?in a small way."

With too many variations of "Robert"already in their extended family and too many "Scott Wards" in the phone book, R. Scott Ward uses his first initial to "kind of" distinguish himself - "but it's not meant to be pretentious," he quickly added.

The only one born outside of Utah, and the only one who's left-handed, Scott shares his family's propensity for a career in health care. It wasn't a clear choice from childhood, however. "I was a normal college kid, not knowing what I wanted to do. I thought that, somehow, something magically would transpire and I'd come out being someone."

He considered political science as a major, then English and even law. Eventually, though, physical therapy won out, and Scott graduated with his bachelor's degree magna cum laude from the U in 1980. "I've tried to think: why physical therapy? I don't think there was an epiphany. Once I investigated and realized there was an opportunity to provide hands-on health care, it felt like the right choice.

"You interact with patients directly. It isn't like you give someone a pill for treatment. It's literally hands-on," said Scott, 47, director of the Division of Physical Therapy at the U College of Health. "You're working with people who have been devastated by disease and trauma. In some cases, they can't return to the way they were before. You help convince them - or they convince themselves, really - that whatever they can achieve is meaningful."

For three years, he had "an interesting mixed practice" as a physical therapist. He divided his time between inpatients in University Hospital's rehabilitation and burn units, and outpatients from a variety of departments, including oncology, dermatology, and surgery. When the U Intermountain Burn Center opened in 1984, he joined the staff as a full-time clinician and associate director of the burn therapy department.

There, his intellectual curiosity led to another opportunity. "I'd talk to surgeons, other physical therapists, and ask questions. For instance, patients had problems with sensations. Their scars were, and are, an ongoing issue, which is directly related to the burn injury. I'd ask, 'Well, gee, what about this?'

"Either they'd grown weary of me or were intrigued that I asked, but these colleagues encouraged me to go back to school," quipped Scott, who chose to study physiology, graduating with a doctorate in 1994.

He also began teaching physical therapy at the College of Health, climbing the ranks and garnering awards, including Outstanding Scholar and Outstanding Teacher. In 1994, he was honored as Physical Therapist of the Year by the Utah Chapter of the American Physical Therapy Association. In 1999, he won the distinguished Lucy Blair Service Award from the American Physical Therapy Association.

"I consider myself a pretty lucky guy. I never aspired to this position," acknowledged Scott. "The fact that I had the confidence to do this was modeled for me at some time.

"The wonderful thing about my parents is that they're very supportive, as long as you're striving to sustain yourself and make a contribution to society."

Caring for patients in crisis, whether they're suffering from cancer, emergency traumas, burns or chronic debilitating diseases like arthritis, requires total dedication - and sacrifice. That's a side of health care that James Alan saw growing up. Although he admires his older brothers' and sister's "amazing commitment" to their professions, he knew health care wasn't for him.

"The dinner table conversation often focused on highly technical terms that meant nothing to me," recalled Jim, 38, who was 12 years old when John H. was in medical school. Later, "Scott used me as a guinea pig when he was going through physical therapy and would practice on me."

Most poignant are his memories of Pam as a young nurse. "My sister would work endless hours in the ER. She'd stop by home, and I'd see her release all the emotions she kept bottled up at work - my mom would be there for her - then she'd wipe her eyes dry and go back."

He also saw the pressures his father faced. "Medicine as a career is so demanding," said Jim.

"There were a lot of missed concerts," agreed John H., who makes an effort to attend those of his 11-year-old twins. "But resentment? No. We understood."

"It's humbled me a lot for John, Pam, and Scott to have chosen health care, when it was a very consuming field for me," the retired physician acknowledged. "I was away from home a lot."

That's why the youngest Ward treasured the time he spent with his family at their cabin. In 1961, before Jim was born, the Wards had bought property on the upper Weber River with money John R. earned in the Utah Air National Guard.

"At the cabin, I had more of a relationship with my dad," said Jim. "He relaxed and was at peace, and really enjoyed life."

"It was a wonderful retreat," remembers John R. "I'd get up and cook bacon and sausage for everyone. The children would hike and wander. They'd fish. I'd hook it and let them land the fish. You felt like you were out in nature," he added, echoing a strong sentiment from his own childhood, when being a physician hadn't been his only dream. "I'd wanted to be either a forest ranger or a doctor."

John R. never mentioned that to Jim until a few years ago. Perhaps he didn't have to; he'd already passed on to his youngest son not only his love of nature but a career to which he'd aspired. Jim, 38, is an assistant fire management officer in fuels for the U.S. Forest Service in the Lolo National Forest in Montana. He, his wife, Laura, a fire management officer, and their three children live on five acres in Nine Mile Valley about 20 miles outside Missoula.

"My dad kept it a secret," said Jim, who graduated from Utah State University with a degree in forestry, "but he did tell me a story when I was a young pup. There was a fire scar on the other side of the canyon from our cabin. He and some of his buddies had helped fight it - what we call 'initial attack.' It's amazing," he said, reflecting on the power of a story. "Who knows how the subconscious works?"

Despite his professional and geographic distance from his family, Jim feels he's learned from them "an appreciation for the values of others" and "a sense of respect and willingness to accept others' careers. They've shown a real interest in what I do."

For Jim's wedding 10 years ago, John H. wrote a tribute to "my brother - Jim, James, Jamie - a decade-and-a-half my junior." "Our family had been defined by medicine: physicians, nurses, and a physical therapist. Jim, who often preferred the floor to his bed when young, sought a different - or the same? - path. He frequented the forests, tending to their vigor: nurturing, planting, saving trees. He fought battles in the corridors of nature instead of in the wonderful confusion of hospital halls."

Perhaps there's not much distinction, when what you do is practiced with passion. As John H. wrote, the youngest of the Wards is simply "a different kind of healer."

We always welcome your comments about the magazine. Address letters to: Editor, Health Sciences Report, Office of Public Affairs, University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, UT 84132. FAX: (801) 585-5188. E-mail: Susan.Sample@hsc.utah.edu.

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