Mayo Clinic, The: Faith - Hope - Science (2018)

[bunniefuu]

[Wind howling]

[People speaking indistinctly]

Man: "The sum total of medical knowledge is now

"so great and wide-spreading that it would be futile

"for any one man to assume that he has even a good

"working knowledge of any large part of the whole.

"The very necessities of the case are driving practitioners

"into cooperation.

"The best interest of the patient is the only interest

"to be considered, and in order that the sick may have

"the benefit of advancing knowledge, union of forces

is necessary."

Will Mayo.

[Loud thunder]

Narrator: On the early evening of August , ,

Will and Charlie Mayo, the young sons of a local doctor

in Rochester, Minnesota, were practicing eye surgery

on a sheep's head at a slaughterhouse

when the butchers urged them to go home immediately.

A powerful storm was coming.

[Loud thunder]

[Glass breaking]

[Bell tolling]

One of the worst tornadoes in Minnesota history tore through

the northern end of Rochester.

[Buildings collapsing]

[People crying]

Dr. William Worrall Mayo and his two sons treated scores

of the wounded in homes, offices, hotels,

even a dance hall.

Amidst the chaos, the elder Dr. Mayo asked to see

Mother Alfred of the nearby Sisters of St. Francis.

It was summer, vacation time at the convent school

she oversaw.

The students' rooms were empty, he said;

could they use the beds for the injured.

She agreed.

Afterwards, Mother Alfred told Dr. Mayo that she had received

a vision from God instructing her to build a hospital

in Rochester with Dr. Mayo as its director.

It would become, she believed, "world-renowned for its

medical arts."

Within a few years, Mother Alfred's vision--what people

would call "the miracle in the cornfield"--came true.

In one of the most unlikely of partnerships, and in one

of the most unlikely of places, the Mayos

and the Sisters of St. Francis

would end up creating what many believe is

the greatest medical center in the world.

Woman: I think that there is a reason so many people come

to Mayo Clinic and have been for so many years.

It has such a long history and such a good reputation.

Mayo was the right place to go and my parents

could see that, too.

When I first came, the history was powerful to me.

We read the description of how it was built after

the tornado.

There was a sense of support in the history and in

the beliefs that those nuns had had that carries on today,

not even in a religious sense, but just you feel supported by

that faith and hope.

Yeah.

Let me have that valve.

Man: I was a child growing up in the Midwest,

and the Mayo Clinic was a secular temple.

It was something that we could all be proud of even if we had

no association with it.

And it was there in Rochester, Minnesota, like it had

risen up out of the earth in some way.

Narrator: When William Worrall Mayo and his sons began

practicing medicine together in Rochester, Minnesota, a small

town miles southeast of Minneapolis, there were only

a handful of doctors in the whole county.

[Siren]

That -person practice has grown into an organization

employing more than , people, with campuses

in Florida and Arizona and affiliates all over the world.

For years, the Mayo Clinic has been confronting age-old

questions about our commitment to taking care of each other,

about the role of money and profit in medicine,

and about the very nature of healing itself.

Man: Imagine for a minute that you've been told that

the doctors don't know what's wrong with you

or can't help you.

And then imagine if you will that you contact Mayo Clinic

and Mayo Clinic says "We can help you."

Imagine what that does for that patient in terms of hope

and inspiration and opportunity going forward

for healing.

That's what this place is about.

[Second man speaking]

Narrator: Each year, more than a million patients arrive

at the Mayo Clinic from all states and countries.

During any given -hour period, there will be as

many as , patients,

, examinations and surgeries,

, lab specimens will be evaluated,

, diagnostic procedures will be conducted,

with radiologists able to read

the results and report back within minutes.

In an age when most doctors operate independently and are

financially rewarded for ordering a battery of tests

and procedures, every physician at the Mayo Clinic

is on salary, creating a culture that thrives

on collaboration.

Dr. Mayo had a simple philosophy he tried to impart

to his sons: "The needs of the patient come first."

They wouldn't treat diseases.

They would treat people,

and they would do it with the Sisters of St. Francis.

Man: Medicine is a science,

but how we interact is layered with all kinds of other issues--

all of which have to do with health.

And so if they don't have faith in the caregivers,

if that patient doesn't have hope, we're gonna have a lot

of trouble, you know, even attempting to make them better.

Faith, hope, and science-- those three things are

absolutely critical.

[Sea gulls crying]

Man: "My own religion has been to do all the good I could

to my fellow man, and as little harm as possible."

William Worrall Mayo.

Narrator: One day in , a -year-old aspiring doctor

named William Worrall Mayo went down to the docks

in Liverpool, England and got on a ship headed to America.

He had been born in to a middle-class family

near Manchester.

His father was a cabinetmaker who died when his son was

years old, leaving his wife with children to feed.

At , W.W., as he would be known,

became a tailor's apprentice, where he gained experience

with a needle and thread that would prove invaluable.

He was small, just '", wiry, and formal, with memorably

piercing blue-gray eyes.

One of his grandsons would describe him as "snap-tempered,"

"strange, ferocious, striving, and restless."

He had studied with the famous chemist John Dalton,

who promoted the theory that all matter is

composed of atoms.

Dalton was also a Quaker, and he instilled in W.W. Mayo

a commitment to the scientific method, to hard work, and to

social justice.

[Bells clanging]

When W.W. arrived in America, his first job was as a chemist

at Bellevue Hospital in New York City, where he saw the

full range of human suffering.

Man: Hospitals were places where the perception was,

that's where you go to die.

There really were almost no rules or regulations.

They weren't sterile places.

And there really weren't doctors, as we perceive

of them today.

There were no standards, in terms of education

for individuals that claimed they were doctors.

And also, there were a lot of quacks that toured the country

proclaiming cures for this disease or that disease.

Narrator: Determined to be a real doctor, W.W. enrolled

at the Indiana Medical College.

After graduating in , he married Louise Abigail Wright,

a -year-old strong-willed woman, who would become

his first assistant.

They moved to Lafayette, Indiana, where he opened

a practice in a small drugstore.

When W.W. contracted malaria, he left the mosquito-infested

marshes of Indiana, telling Louise he was going to

keep going, "until I get well or die."

By the time he arrived in St. Paul, Minnesota, he was well.

But wherever he traveled, there were either

too many doctors or not enough patients.

So for the next years, he worked as a surveyor,

riverboat pilot, newspaper publisher, and veterinarian.

[g*nf*re]

The Civil w*r brought Mayo's travels to an end.

At age , he was appointed examining surgeon

for a regional enrollment board on the edge

of the frontier in Rochester, Minnesota.

When Louise and their children caught up with him

in January of , she told him, "No more.

We're not moving again."

Although two of their children died in infancy, they would

eventually have two daughters and two sons, Will and Charlie,

whom they would raise "in medicine,"

the boys remembered, "like farm boys on a farm."

[g*nf*re]

While W.W. Mayo was trying to determine

who was fit to fight for the Union Army,

thousands of other doctors were

practicing on the b*ttlefield a medicine that was

almost medieval.

Most of them had never seen a b*llet wound, let alone

performed surgery.

Many sharpened their scalpels on their boots, carried

surgical tools in their pockets, and used their own saliva

to wet the silk used for sutures.

After the w*r, Mayo began to build a practice in Rochester,

and his reputation grew.

[Horse neighs]

He usually saw patients at his downtown office,

but in an emergency, he thought nothing of taking off

late at night in the middle of a snowstorm and driving his

horse and buggy at breakneck speeds to get to a patient's

log or sod home miles away.

He'd quickly determine the best place to operate,

then proceed to deliver a baby, set the bone of a farmer,

or amputate a leg ravaged by gangrene.

If the patient was poor, W.W. wouldn't charge him.

He also immersed himself in the latest medical journals,

and began contributing his own articles as his

expertise increased.

Mayo made several return trips to Bellevue Hospital, where he

attended lectures, observed operations and autopsies,

and marveled at its ambulance corps,

the first in New York City.

But he was most impressed with an imported German microscope

that cost $, a fortune.

When he returned to Rochester, he broached the subject

of mortgaging their house to pay for the new instrument.

Louise was loath to take on any more debt, but she thought

about it, and finally said,

"William, if it's of use to the people, let's do it."

Man: Mayo Clinic has a -plus- year history of investing

in new technology.

"Proton beam" sounds like this mystical term.

Why can protons revolutionize radiation therapy?

Because we avoid damaging normal, healthy tissues.

So who benefits?

Number one, it's patients in whom we're trying to avoid

critical areas--

for example, young patients with brain tumors.

[Machine beeping]

Woman: This doctor comes in and he pulls the chair over to

the bedside, sits down, and he says, "There's no easy way to

say this, but your daughter has a mass in her brain."

Get ready.

The neurosurgeons in Salt Lake City did an amazing job,

but, for me, I always knew that it wasn't just surgery.

Man: The proton beam, radiation is what brought us out to

the Mayo Clinic.

I said that I would go to India if that's the best place

my kid could be.

The Mayo Clinic is my India.

Things happen in life. People die.

The Mayo Clinic can't save everybody.

It's not magic.

And blasting my child's head for weeks while she's

trying to develop, you know, these cognitive and extremely

important pathways in her brain--that's just ludicrous.

But when we got to the Mayo and met with Dr. Keole, he said,

"Hey, you know what,

"I can't promise you anything, but we're gonna have

"a strategic plan on how to outmaneuver whatever adversary

you're looking at."

That was different. That was a big difference.

The Mayo Clinic didn't happen out of thin air.

And I know the Mayo Clinic has a reputation, but I didn't

understand what that was.

I'm not gonna know that until Abigail gets brain cancer.

Man: "When I was years old,

"Father was removing an ovarian tumor.

"He called me in, and I stood on a box and gave the chloroform,

"while Will, who was just years old,

helped with the operation."

Charlie Mayo.

Woman: From the time they were little boys,

when W.W. went to visit patients in the country,

Will and Charlie came along with their father in the buggy.

This buggy became a traveling schoolroom for the boys.

He encouraged the boys to observe, and then he would

pose problems.

Narrator: Will and Charlie began their medical careers

sweeping floors and washing windows

in their father's office.

Eventually, he would take them on house calls and let them

help care for patients.

At day's end, they would always sit together

and discuss what they had seen.

Louise also helped, assisting at surgeries, treating injuries,

and counseling patients who showed up when

her husband was away.

Charlie would later say, "The biggest thing Will and I

ever did was to pick the father and mother we had."

Both boys would eventually go on to medical school--

the older Will at the University of Michigan

and Charlie at Northwestern.

[Loud thunder]

[Wind whistling]

[Glass breaking, buildings collapsing]

[Bell tolling]

More than people died in the tornado that swept

through Rochester that summer day in and dozens more

were injured.

The Sisters of St. Francis had done what they could to help,

but afterwards, Mother Alfred knew they could have done more.

Then she had her vision of building a hospital--a place,

she insisted, that would be open to "all sick persons

"regardless of their color, sex, financial status,

or professed religion."

Mother Alfred was a -year-old nun who believed that

"the cause of suffering humanity knows no religion."

Dr. Mayo was a -year-old agnostic who, a newspaperman

remembered, "defended Darwin by the hour."

Both were stubborn and impetuous--

driven by a desire to serve.

Mayo was certain Mother Alfred would be unable to raise

the money.

She could buy the land she wanted just west of town

for $,,

but the building would cost at least $,.

But if she did succeed, he reluctantly agreed to lead

its medical staff and perform all his surgeries there while

still running his practice downtown.

Woman: He thought, "There's no way they're gonna raise ,."

And she was convinced.

She knew the sisters would

raise that money, and she would hold him to that.

Narrator: They shook on it.

Woman: Mother Alfred and William Worrall never drew up

any legal documents.

Their word and that handshake meant everything.

Narrator: For the next years, every agreement between

the Mayo Clinic and the Sisters of St. Francis

would be made that way.

Mother Alfred and the nuns set to work.

They saved every penny they could from tuitions

at their school.

They gave music lessons as well, embroidered linens,

chopped their own wood, made pillow cases out of flour sacks,

and ate the plainest of meals.

After long years, in August of ,

construction finally began.

Meanwhile, Will and Charlie, having both graduated from

medical school, were beginning to play a major role in their

father's practice.

They had become passionate advocates for a new procedure

developed by a Scottish surgeon named Joseph Lister,

based on the theory that germs caused infections.

Most American doctors were skeptical.

In , President James A. Garfield had died

not from his would-be assassin's b*llet,

but from his doctors' filthy, unwashed hands.

But the Mayos were convinced.

They designed and equipped the operating rooms for the new

hospital specifically to take advantage of the latest

innovations in sterilization.

There was an air of curiosity, an imagination, all the way

from the beginning of the-- of the history of the Clinic,

looking for new methods, new science, new techniques.

They were both forward-looking and conservative

at the same time.

Narrator: On September , ,

the day before the new facility was to officially open,

the Mayo brothers performed eye surgery

on a man from Olmsted County.

He was the very first patient admitted to Rochester's

brand-new hospital.

It was called St. Mary's.

Woman: So, with no more fanfare than just a blessing,

the hospital was open,

patient was admitted, had surgery,

and the only thing it says about him is he got well

and went home.

Narrator: From the outside, St. Mary's

was an impressive, modern-looking,

-story brick building.

But inside, the sisters who were responsible for taking

care of the patients, couldn't have asked for a harder test

of their faith.

Woman: They did the nursing. They did the laundry.

They did the cooking. They did the cleaning.

They did everything.

Oh, my. They got up at : and : and : in the morning.

They worked through the day and through

the night until the next night.

And a lot of times, they gave up their beds so that there

would be beds for patients.

Narrator: The nuns who lived and worked at St. Mary's

had trained as teachers, not nurses.

Edith Graham, a Rochester native who had completed

nursing school, joined the Mayos' downtown practice

on rd Street, but she ended up

spending most of her time a mile away at St. Mary's,

where she took care of patients and shared her

knowledge with the sisters.

Of the first surgeries performed by the Mayos at St. Mary's Hospital,

only patients died.

I have no idea how the Sisters took care of patients

with so little, but they made a way.

And that's one thing about being a nurse, you make a way

out of no way.

Woman: Two months before I went to the Mayo Clinic, I started

noticing that I had double vision,

so I scheduled an appointment to see the ophthalmologist.

As soon as they said, uh, something about melanoma,

we just were in shock

'cause all you think about is the worst.

Will I be able to stay pregnant?

Man: The same factors that are letting her baby grow are

allowing the cancer cells to grow as well.

I've seen these patients that are pregnant with melanomas.

Their cancer cells grow exuberantly.

Buck: Dr. Pulido basically sat down and told me that,

"Your life is at risk.

You really need to think about terminating."

That was very hard to hear.

What came in my head was, you know, "Is there another way?

"Can you just take my eye, please?

Just don't take my baby."

But he told us that he is good with the eyes.

He's not good with the babies.

But he already had the appointment scheduled

with the OB.

[Speaking indistinctly]

Woman: These are hard conversations to have.

Whenever you have a mother with a high-risk medical condition,

you need to have different providers

with different areas of expertise.

The impact of pregnancy on melanomas--I think a lot

of the data is conflicting.

At that point in time,

the options were still available for her

in spite of the pregnancy,

but the risk of metastases is there.

Melanoma's actually one of the most common cancers that can

spread, even to the fetus.

We reviewed what she wanted to do, and she was very clear

that she did not want to proceed with elective termination.

[Machine beeping]

Pulido: For her, we used a plaque.

It looks like a bottle cap, and you put radioactive seeds

within it, and then you sew this on the eye, so the gold

doesn't allow the radiation to come anywhere else

but into the eye.

Sometimes I deal with people that die.

[Voice breaking] I feel that the only way that I can give them hope...

is if I know in my heart of hearts

I'm trying to push the boundaries.

Now it's kind of a wait and see whether the melanoma cells

are responsive.

How are you?

Buck: We came to find out about my melanoma

and see if it shrank.

...chest X-ray's fine as well.

And the tumor is starting to shrink.

Fantastic! Ha ha ha!

Buck: My radiation worked.

And so now that the melanoma is shrinking, it's basically

dead now, which is very nice. Ha ha!

Pulido: It's pretty interesting that

the first case done at St. Mary's

was removal of an eye for an eye cancer.

[Hoof beats, horse neighs]

Narrator: Throughout the s,

as Will and Charlie Mayo took over

their father's practice, the brothers remained inseparable.

They walked to work together.

They made decisions together.

They built their first homes next to each other.

And they shared a bank account,

both signing checks

simply, "Dr. Mayo."

While they both performed all kinds of surgeries,

Charlie specialized in delicate operations

on the head and neck.

Will, like his father, focused on abdominal

and gynecological procedures.

Will was authoritative, clear-minded, visionary,

a perfectionist.

Charlie was more easy-going, less intimidating, friendly.

They had their disagreements, but never in public.

With them, it was never "I."

It was always, "My brother and I."

Will and Charlie, people in town said, were "married"

to the practice,

but like their father, they were also both married to

strong women.

Will's wife Hattie, who had grown up in Rochester with the

brothers, was shy and formal.

An artist, she mostly stayed out of medical affairs,

but would end up designing their houses and serving as

a hostess to doctors and dignitaries from all over

the world.

Charlie married Edith Graham, the nurse who was instructing

the sisters at St. Mary's.

She was the opposite of Hattie--feisty, outgoing,

and an integral part of the Mayos' practice.

Woman: "The first time Sister Joseph was asked to assist

"at examining a patient, she ran into a corner

"of the room and stood facing the wall, outraged

"and ashamed, because the man was naked.

"She told Nurse Edith it was impossible for her to be

"a nurse; she planned to transfer back to

"teaching immediately.

"But Edith convinced her to stay, and in less than years,

Sister Joseph was head of the hospital."

Narrator: Sister Joseph Dempsey was the second

in a long line of formidable women who would lead

St. Mary's Hospital, working closely with the Mayos,

but also maintaining the Sisters' independence

and their values.

She served as Dr. Will's main surgical assistant for years

and became so skilled that she would continue

with an operation when he turned away to explain

something to visiting doctors or students.

[Train whistle blows, engine chugging]

One cold morning, railroad workers in Waterville, Minnesota

removed a window from a passenger car

on the Minneapolis- St. Louis Line

so they could slide a stretcher in across two seats.

On it was -year-old Lucy Gray.

She was in great pain and had been feverish for almost

weeks.

Her parents were taking her to Rochester, Minnesota, where

they'd heard about some country doctors who were

having remarkable success.

A few hours later, she woke up in a dimly lit room at

St. Mary's Hospital, recovering from an emergency appendectomy

performed by Dr. Charlie.

Another hour, and it would have been too late.

But an infection set in.

There was another operation.

And then another.

She was not getting better.

The sisters held late-night prayers in their chapel.

The youngest nurse played with her day after day,

making a chain of paper rings, each ring representing a day

in the hospital, until they decorated the entire screen

behind her bed.

Lucy Gray lived to age .

She always gave the Mayo brothers and the Sisters' faith

equal credit for saving her life.

Man: For someone who is, I would say,

as nonreligious as Will Mayo was,

to refer to the spiritual as being so important

for the care of the patients and the good

of the Clinic to survive, I think just spoke volumes

about the Mayos' insights.

If we pay too much attention to the material nature

of what we do and ignore the spiritual,

we will amount to nothing as a clinic.

[Door creaks]

Woman: All of a sudden, your whole world done change on you.

When I got up, I couldn't hardly walk.

I was like shuffling my feet, losing my balance, and I was

like, "Wow, there's something going on with me, but what?"

I have no idea.

The neurologist doctor, he said,

"You have myositis, and there's no cure for it."

And when you have a doctor that tell you that, it seemed

like all hope is gone.

But I still don't feel like I have that right answer to

what's going on with me.

Somebody out there may have a different diagnosis for me.

I know people come from around the world to get into

the Mayo Clinic to get a second opinion.

So I called in January, but I couldn't get an appointment

because they wasn't accepting new patients at the time,

so the young lady told me, "Call back in December."

I didn't mention to her, but when I got off the phone,

I said, "Wow, I hope I be alive," you know,

'cause we talking about months.

During that time while I was waiting, I was going downhill,

but I never gave up hope.

Never.

And so when I got accepted in, that was my world.

It is a second opinion on my life.

I'm very excited.

I'm looking forward to it.

Man: "The people will demand,

"the medical profession must supply,

"adequate means for the proper care of patients,

"which means that individualism in medicine

can no longer exist."

Will Mayo.

Man: In the late th, early th century, medicine

was highly individualistic.

If you were a doctor, you held your skills close to the vest.

You were afraid of losing money or prestige or patients.

Trueman: That autonomous doctor brings to his practice and to

the service of his patients the knowledge and experience

he has alone.

He misses the opportunity to enrich that.

And when you're talking about healthcare and people's lives,

the value of somebody else's additional knowledge or experience

could mean the difference between life and death.

Narrator: By , the elder Dr. Mayo was years old.

His sons were confidently in charge.

He decided to step back from his practice, to indulge

in his other varied interests.

He became a Minnesota State Senator, loved to travel

and tinker with machinery.

[Horse neighs]

To handle the ever-increasing volume of new admissions

at St. Mary's, the Mayo brothers began to bring other doctors,

including a woman, into their rd Street practice

to examine and diagnose patients prior to surgery

at the Sisters' hospital.

The arrival of these specialists signaled something new

and fundamentally transforming--a collaborative

approach to medicine.

Aksamit: The concept of this multi-specialty, teamwork-based,

group practice for the good of a single patient

was maybe the greatest contribution that

the Mayo brothers brought to American medicine.

When I'm stuck with a patient, and I don't have the answer

for a particular patient,

I have no hesitation to share that patient with another

of my colleagues.

Man: I had a patient with a very unique condition.

And within minutes, I was able to speak to the various

sub-specialties that I needed to contact.

In private practice, it's really challenging to do that

for a lot of different reasons.

Man: Many times a patient would say, "I had to see multiple

"specialists, I couldn't get to the specialists as fast as I

"needed to, and no one was able to put it all together to give

me a diagnosis and a future plan of care."

Behind me and behind every other physician at Mayo Clinic,

we have , other physicians that can help you

take care of a problem that a patient has.

Brokaw: Several things stood out for me.

It wasn't just one, um, kind of A-personality doctor

looking after me.

It was a team, always.

It was always a team, there at my bedside.

Man: Teamwork is collective wisdom.

Nobody can know everything, and I think that's the beauty

of the group practice that the Mayo brothers

recognized early on.

Narrator: As the th century dawned,

there was as yet no formal medical center

in Rochester, Minnesota.

There was simply a small but unique group practice,

now on the second floor of the Masonic Building,

led by two surgeons and several associates,

affiliated with a hospital a mile down the road, run by

a small community of nuns.

Man: "Their hospital in the little prairie city

"of not more than , inhabitants has become

"a Mecca for surgeons!

"There is no other hospital on this side

"of the Atlantic in which so many important operations

are performed daily."

Narrator: After watching the Mayos operate,

a well-known Chicago physician reported to his colleagues

that the brothers were far more advanced than

most surgeons.

Patients had already been spreading the word

about the Mayo brothers for years.

Now more doctors began to travel to Rochester to

observe, learn, and even be treated themselves.

Eventually, Charlie had to design a custom platform

alongside the operating table, with slanting mirrors above it,

to accommodate the ever- increasing number of surgeons

who just wanted to see them work.

Woman: "Both men were entirely frank about their role,

"constantly telling visitors where they had picked up this good thing or that.

"Dr. Will would say, 'I used to do this differently,

"'but Moynihan showed me his method when he was here

"and it was better, so I use it now.'

"And Dr. Charlie--'The first time I tried this operation,

"'I got stuck at this point, but Dr. George Monk of Boston

was here, and he told me what to do.'"

Narrator: On most nights, visiting doctors

gathered at the "Surgeons' Club," where they discussed

what they had seen that day.

Increasingly, they began to refer to the place where they

had witnessed the brothers' extraordinary work as

"The Mayos' Clinic at St. Mary's."

Each year, one brother would take an extended educational "vacation"

to study different surgical techniques,

while the other remained at the practice.

Dr. Charlie and his wife Edith even attended surgeries

during their honeymoon.

And by the s, Dr. Will had witnessed procedures

by surgeons in every town in America and Canada

with a population of more than ,,

and had crossed the Atlantic times.

Boes: The Mayo brothers really developed their own continuing

medical education program.

If they heard about a new procedure, they would go

and see that physician, watch him do the new surgery,

learn the ins and outs of it, and then come back

and apply it to Mayo.

They took what others did, they applied it to a very

large number of patients, and really kind of perfected it.

And that part still goes on.

Woman: I was diagnosed with Ebstein's Anomaly when I was born.

It's a disease of the heart.

In my case, half the blood is sent in the wrong direction,

and that causes the heart to not function as efficiently.

I've had the same cardiologist almost my whole life.

The only reason we decided not to stay in North Carolina

for this surgery was because of Dr. Dearani's experience

with Ebstein's Anomaly.

[Door closes]

I'm Dr. Dearani. Nice to meet you. Hi.

Jenkins: My surgeon has only done Ebstein's Anomaly surgeries...

It probably would be appropriate for you...

but Dr. Dearani somehow has managed to do .

So the sheer numbers were just...unbelievable.

Dearani: We are a destination medical center treatment, which means

that there are many patients that will travel for answers.

With Anna, it was a surgeon who referred her to me--

one of my colleagues, a very, very good surgeon.

With Anna's case, she's an elite athlete, and the heart

is getting progressively enlarged.

Jenkins: The analogy Dr. Dearani gave me was with a spring.

Everything contracts, but that area sort of pooches out...

Jenkins: If you stretch a spring, which is what happens with athletics,

it'll bounce back.

But if you stretch a spring way too far, it gets stuck,

and that's what we don't want to happen.

I'm a little nervous,

although I don't think I'm as nervous as my parents are.

It would have been convenient to stay at home and to not

have flights and to be living out of a hotel room for a week.

And I know the recovery will be long,

but knowing that if my heart enlarges any more, I will not

be able to do any of the athletics I do,

maybe not even able to walk up the stairs anymore.

Man: You feel a great confidence in everyone here,

but you know they've stopped your daughter's heart, lowered

her body temperature, doing this intricate procedure.

You feel like you shouldn't be thinking about things like

how many sugars are in your coffee.

OK, we're all done...

Jenkins: My nurse just brought me a rock.

This is the rock she gave me, and it's shaped like a heart.

She said she brought it here to bring me peace.

Once my chest plate heals, - weeks down the road, I hope

to get back into rowing and join the team and not be

too far behind.

I think my heart is in a good place.

Narrator: In , the Mayo brothers hired a young doctor,

Henry Plummer, who had impressed them with his knowledge

of blood diseases.

They wanted to focus on surgery, but Plummer helped

convince them that better, more advanced lab

and diagnostic work would improve surgical outcomes

or perhaps make those surgeries unnecessary.

Plummer immediately began modernizing the Mayos' labs

and exploring ways to make all the patient information

they were gathering more accessible.

Man: "The highly scientific development of this

"mechanistic age had led perhaps to some loss

"in appreciation of the individuality of the patient

"and to trusting largely to the laboratories and outside

"agencies, which tended to make the patient not the hub

of the wheel, but a spoke."

Man: One of the things that the Mayos did very

successfully around the early s was that the patient

became the center, and the doctors orbited

around the patient.

They refocused the-- the circle of care.

Narrator: William Worrall Mayo

had kept long narratives about patients

on the back of ledger pages.

Later, his sons and the doctors who joined

the practice kept their own, separate

individual case notes.

Ziemer: Each physician would record the patient's information,

but then, when the patient came back, they might not have seen

the same physician, and so they didn't know what

the other physician had told the patient.

And so that was very difficult to know how to treat or move

forward with treatment.

Narrator: Henry Plummer was determined to standardize their records.

Mukherjee: The genius of Plummer's invention was to say,

"The heart does not live in the cardiologist's office.

"The lung doesn't live in the pulmonologist's office,

"The spine doesn't live in the orthopedist's office.

They're part of the same person."

So, really, to reflect that wholeness, uh, you needed to

have a medical record that was attached not to the doctor's

offices, but to the patient individually and not just

in one single moment of time, but through all time.

Plummer's invention eventually spread throughout the whole

nation and eventually spread through the world.

[Horse neighs]

Narrator: On July , ,

a -year-old housewife from British Columbia

arrived in Rochester with intense nerve pain,

fever, and chills.

The diagnosis was a gallbladder infection.

After a successful surgery, she went home.

For Henry Plummer and his new system,

she was patient number .

The Mayo brothers had also hired a pathologist named

Louis Wilson.

Dr. Will challenged him to develop a reliable way to tell

if a tissue was cancerous while the patient was still

on the operating table.

At the time, preparing tissue samples for analysis

took days.

Wilson developed an ingenious way to get specimens under

the microscope in less than minutes.

Dacy: On a bitter day in January ,

Dr. Wilson took the pathology specimen,

put it on the window sill, froze it,

and with a little bit of colored dye, assessed

in one stop whether or not the patient had cancer.

Man: Literally in a matter of minutes, he could go back

and tell the operating surgeon, "It's not a malignant tumor"

or "Yes, the margins of the edges of the tumor you've

"taken out don't show any tumor; you don't have to

operate further."

Mukherjee: That was really pioneered at the Mayo Clinic.

I mean, as an oncologist, as a cancer doctor, I can tell you

that that is so crucial to a patient.

Narrator: Dr. Wilson now insisted that his lab be situated next to

the operating room, a practice that continues to this day.

Man: Just a few feet from where we are right now, there's

a massive pathology lab with multiple technicians in there

freezing, cutting, staining slides, two pathologists

reading it--there's nothing like that anywhere in the world.

Woman: From the patient's standpoint,

it means that they come in,

they can undergo one operation to have their tumor removed,

and they can move past that day, and start moving on

with their lives.

Smoot: The speed with which we get people answers...

I know by the time I talk to the family

after the operation what we've done, if the margins are clear.

It's a great burden lifted off of them to--to hear

that immediately.

Boughey: Most institutions don't have the support of their

pathology department.

So a woman goes to the operating room to remove their

- or -centimeter cancer, and then that pathology report

may come back a week or two weeks after surgery.

"Well, the margin is positive, so we need to consider

a second operation."

Sometimes you have to do a third operation.

Man: Compared with the rest of the country, the likelihood

of a repeat operation is reduced by fourfold.

I don't know why it hasn't spread more widely.

[Train whistle blows]

[Bell clanging]

Narrator: The Mayos' almost mythical reputation meant

more patients.

More patients meant more diagnoses.

More diagnoses meant more surgeries.

More surgeries meant more nurses.

And all of it meant more hospital rooms.

There had already been additions to St. Mary's.

What had begun in as a small community hospital,

with only a dozen iron cots ready for patients, was now

one of the largest and most advanced surgical centers

in the United States, where more than , operations

were being performed each year.

Fye: A really stunning statistic that was published in --

there were more operations performed at St. Mary's Hospital

than there were performed at Johns Hopkins.

And that's when Rochester had a population of ,

and Baltimore had a population of half a million.

Narrator: Patients kept coming, now from all over the world.

Brokaw: I've sent people there.

You can always be assured to a man and a woman they would

come back like pilgrims who had been to the holy ground

and say, "I've never been in a place like that before."

That's why you have these metaphors of Lourdes,

of Mecca--people making their way across vast

distances, and that's how the public perceived it.

This was where you would go for that case that couldn't be

helped elsewhere.

Man: When you've been given the diagnosis of pancreatic cancer

in the back of your mind, you know it's a death sentence.

It's like being hit by a freight train, and all your

senses are gone--you can't hear anything over the noise

of the train, you can't feel anything.

Things start racing through your mind. You know, you're

years old and you have four kids at home, and then

you start looking...you start looking for answers--

you know, Internet, other physicians.

There's a lot of pessimism in the medical community

regarding pancreatic cancer.

And it was pretty clear. "Get your affairs in order."

You have two options, do nothing and die

or take a chance on living.

The choice is easy.

You just need a physician, a surgeon, that's willing

to have that same mindset.

Man: Mr. Schenk came to me with a very advanced pancreas cancer.

His tumor was essentially involving all the critical

major blood vessels in his abdomen.

By any standard definition,

he would never be a surgical candidate.

Schenk: The normal protocol for pancreatic cancer is to do

the surgery first, and then treat with chemotherapy.

The protocols here at Mayo are reversed from that,

and they're having much better results.

Truty: I do tend to take the patients that are

denied care elsewhere, being deemed "nonsurgical."

We're delivering specific therapies that are currently

available in the right dose--

knowing when to stop, when to move on to the next therapy.

And in the end, he ended up with an operation that's never

been done before... with an outstanding result.

It was met with a lot of skepticism.

That's the one thing that's always surprised me, at least

in medicine and even cancer in general--when you want to

bring a new viewpoint, there's a lot of pushback from people

that have been doing it a certain way for many decades.

[Sea gulls crying]

Schenk: Currently, I am in remission.

They can find no cancer in my body at this time.

I think Dr. Truty got it.

I've got another , years in front of me, for sure.

Here at Mayo, you are a person.

When no one else believed,

when no one else was giving me options,

Mark wouldn't give up.

If nothing else,

even if your time's limited,

you can walk away from Mayo with hope.

Woman: I think there are many things that really qualified

the Sisters to be nurses.

I think it was their empathetic approach to patient care,

it's the humility that they brought to their work

and how they worked with each other.

It was their Franciscan values, which we really carry

into the work that we do today.

Woman: Nursing would definitely be the frontline of medicine.

We are with the patients /.

We are monitoring them /.

And we're gonna be the first to try and make things better.

I know that the Sisters started it, and,

um, I think there's a sense of pride with that.

There'd be many nights when I would be leaving work at :,

: at night,

and Sister Generose would be rolling up her sleeves.

I remember Sister Vera walking the halls when she was

or , something like that.

Let's face it, we can't compete with the Sisters,

but if we could do that little fraction of what they've been

able to do, that yeah, wow, that would be an honor.

I would like to think that tradition can carry on.

Narrator: On November , ,

St. Mary's Hospital Training School for Nurses

opened its doors.

The curriculum combined lectures on anatomy,

physiology, and bacteriology, along with classes

in practical nursing and hygiene.

Students were required to attend at least autopsies.

One of the things that was taught to me by Sister Cashell,

who is one of the nuns here who I sat down with, she said

when she went through the nursing school, everyone was

taught to look at every patient like Jesus Christ.

Narrator: Evidence of the Sisters' faith and the Mayos'

generosity was everywhere.

When Dr. Will learned that a farmer had mortgaged his farm

to pay for his surgery, he not only returned the check,

he sent some extra money to help the family out

until the man recovered.

Fye: In small towns, the populace really had very little money,

often almost no money.

As the Mayo Practice grew, and more well-to-do patients

traveled to Rochester, they would see how much

an individual actually was capable of paying

and charge accordingly.

The individual, if they were well-to-do, should be able to

recognize that.

On the other hand, poorer patients who didn't have the

means, it wouldn't be that they would refuse to serve them.

They used the sort of principle of Robin Hood,

that they would take the fees that they got from the wealthy

individuals and they would sort of spread those over

and cover the cost of care for the poor.

Narrator: All along, the brothers maintained their

exhaustive schedules.

One visiting doctor claimed to have seen Dr. Charlie remove

a cataract, tonsils, and a goiter,

resect ribs after draining fluid from a patient's lung, perform

a complex surgery to reconnect the stomach and intestines,

treat a uterine abnormality, correct bowlegs, and cut off bunions--

all before going home for lunch.

Man: "The gracious privilege is not often accorded mortal man

"to live to witness the accomplishment,

"the culmination of his best wishes, his ideals.

"That this happiness had come to me after many days fills

my heart with deepest gratitude and peace."

Narrator: In , while trying to fix a machine

he had constructed to make ethanol from corn, W.W.'s hand was crushed.

His son Charlie had to amputate.

There were complications.

Infections set in.

His sons couldn't save him.

Dr. William Worrall Mayo, the doctor whose unorthodox

collaboration with the Sisters of St. Francis

had transformed the practice of medicine,

died on March , .

He was years old.

[Computer keyboard clicking]

Stevens: Healthcare systems gone a bit overboard by assuming that

consumerism and competition alone will somehow or other

clean up everything, and it hasn't.

And there's a great deal of frustration because of the way

in which health insurance is organized,

but the idealism is still there.

And I hope the age of consumerism in healthcare will

be followed by an age of idealism where organizations

feel that they have an obligation to do the very best,

no matter what the cost.

What we do kind of...

Feenstra: Healthcare is a customer service-based experience.

And I hate using the word "customer service" because it

makes it sound like I'm at Applebee's, you know, about

to tip the waitress.

We had a lot of different experiences with different

healthcare across the nation.

What blew me away about the Mayo experience was that it

showed me what was lacking in other places.

Keole: In Abby's case, we want to treat the cavity where

the tumor has been resected.

X-ray therapy, which is what .% of centers in this

country use, goes in through the patient, out the patient,

and exits on the other side.

Proton therapy is a charged particle. It'll go a set

distance in tissue, then stops on a dime.

And literally all the energy gets released right

at that point.

And that's how we k*ll the cancer.

We should be able to completely spare that area

of the brain that's the most important part of learning

in a child,

so we reduce the long-term complications.

We recognize there's a huge controversy over price.

Proton therapy is a $ million investment by Mayo Clinic.

Cost--it's an important topic, especially in today's

health economics environment, where our

healthcare costs are spiraling, but if protons

could be built and operated for the same exact cost as

X-ray therapy, we wouldn't even be having this

discussion today.

So at Mayo Clinic, we decided, we're gonna charge exactly the

same for proton therapy as we do for X-ray therapy.

We are gonna eat this cost.

Alyssa Feenstra: We go home from treatment, and she is a normal -month-old.

We are coming to an end, and I just--

I couldn't have asked for anything better for her.

I've never experienced healthcare in a team

like Abigail has.

Just watching her go through this, there's hope

for her future.

Narrator: By the time W.W. died in , it was clear that the Mayo

brothers' practice had outgrown its space

in the Masonic Temple, as well as the temporary offices they

had been renting around town.

They needed their own building.

The -story structure, designed by Henry Plummer,

opened on March , .

It stood on the site of W.W. and Louise's first home,

where Dr. Charlie had been born years earlier.

Etched in stone over the front entrance were the two words

that people had been using for years: "Mayo Clinic."

In addition to dozens of rooms for examinations, diagnostic

procedures, and outpatient surgeries, there were clinical

and research laboratories, a library, assembly hall,

pathology museum, and an artist's studio

to illustrate illnesses.

The medical records department alone took up rooms.

Man: "My brother and I had paid for our homes.

"Our clinic was on its feet.

"Patients kept coming.

"Our theories seemed to be working out.

"Money began to pile up.

"To us, it seemed to be more money than any two men

"had any right to have.

"That money seemed, somehow, like holy money to us.

"It had to go back into the service of the humanity

that had paid it to us."

Will Mayo.

Dacy: The brothers grew up in the Gilded Age.

Vast fortunes were being made,

but they had grown up seeing their father waive

or reduce his charges, they were inspired by

the Franciscan Sisters.

Dr. Will and Charlie believed, if you have certain skills,

abilities, resources, you hold them in trust

to give back to other people,

and they applied that through the profession of medicine.

Man: "My interest and my brother's interest

"is to train men for the service of humanity.

"What can I do with one pair of hands?

"But if I can train or pairs of hands, I have

"implanted ideals and scientific spirit in many who

in endless chains will carry on the same endeavor."

Narrator: In February , the Mayo brothers endowed the

Mayo Foundation for Medical Education and Research

with the University of Minnesota.

Their goal was to set a higher standard for training

medical specialists.

It ultimately made Mayo one of the largest centers

of graduate medical education in the world.

Greene: Education is core to Mayo's being.

Will and Charlie, they invested heavily in it.

It's the premise on which the future of Mayo will lie,

because we're trying to embody that level of teamwork and all

that we do for every young person that decides to get

an education here,

when they see the future and see something that they can build

that's greater than what they've inherited.

Man: "The great contribution we can make is to prepare the

"oncoming generations to think that they can and will

think for themselves."

Charlie Mayo.

[g*nf*re, men shouting]

[Whistle blowing]

Narrator: After the United States entered the Great w*r

in , a "Mayo Unit" was set up in France near

the Belgian border, where they cared for more than , soldiers.

Those left behind in Rochester struggled under

the increased workload.

Things got worse when the Spanish influenza broke out

in the fall of .

It ultimately k*lled millions more than had died

in the World w*r.

Dr. Charlie himself developed a serious case of pneumonia

and Dr. Will had jaundice so severe that he suspected

it was liver cancer.

Both survived, but the experiences made them even

more aware of the need to prepare for a time when they

could no longer lead their clinic.

On October , , having set aside enough to support their

families, Dr. Will, Dr. Charlie, and their wives transferred

a significant portion of their personal savings, along

with all Mayo Clinic assets and future earnings,

to a trust called the Mayo Properties Association.

They further stipulated that, from then on, all proceeds

beyond operating expenses would go to "education,

research, and patient care."

Woman: They wanted to make sure that they turned over all the

assets to the greater good.

If it remained privately owned, money would become part

of the dynamics and take away from what the mission was.

The family had to let go of the authority it had

over the practice.

That meant all generations would also forfeit that,

and if they would have a place in the institution,

it would be earned.

Narrator: From then on, the Clinic would be run by a Board

of Governors, comprised almost entirely of Mayo doctors.

"We have in this way," Dr. Will said, "established

a medical democracy."

The Mayos also insisted that they, their partners, and all

future Mayo physicians would be on salary and would not

profit personally from the proceeds of the practice.

Boes: Will and Charlie's idea about putting the faculty members

on salaries was brilliant in many ways.

In private practice, it's a fee-for-service situation,

so if you see more patients, you make more money.

That leads some physicians to see more patients in a day,

and that leads to them being able to spend less time

with the patient.

The Mayo physicians, they were gonna get paid the same

whether they ordered the test or not,

whether they referred the patient for surgery or not.

We choose to be here because we value this teamwork

and this environment over our own compensation.

This place tends to select people

who want to have that type of teamwork.

Man: Doctors that are at the very top of their profession,

they could be anywhere, and yet

they've decided to stay with Mayo.

There are people there who could be making times

the amount of money that they're making at Mayo,

but they're devoted to their profession and their

science of medicine and healing people.

Noseworthy: There will never be a decision made about patient care that

benefits the physician.

It's always about the patient.

That helps us keep pure our decisions going forward,

that the collective whole is better than the sum

from any individual.

At Mayo Clinic, you are never alone in your efforts to find

an answer to that patient's problem.

Narrator: By , only a quarter of the medical

staff at the Mayo Clinic were surgeons.

The rest were physicians and scientists who not only

examined and diagnosed patients, but also now

researched the underlying causes of disease in order to

improve surgical outcomes and develop

non-surgical treatments.

It was the rapidly growing field of internal medicine,

and the Mayo Clinic was at the forefront.

Henry Plummer and Walter Boothby's discovery in

of how to treat enlarged thyroid glands with iodine

before surgery greatly reduced mortality rates.

Dr. Albert Broders had made a major contribution to cancer

diagnosis by developing a technique for grading tumors

based on how likely the mutated cells were to spread.

In , Dr. Russell Wilder and colleagues

conducted one of the earliest clinical trials of insulin.

Within a year, more than , diabetic patients

in the United States were being successfully treated.

Man: In many institutions, there are researchers and there are

clinicians, and they can both be excellent, but there are

very few, uh, institutions where they both come together.

Man: To be both a physician and scientist, if we can identify

disease at its purest form, we'll be able to, in a very

minimally invasive way, dramatically change the life

course of an individual.

Sierra: Atta has been doing some innovative work, in cardiac

regeneration in regards to heart failure.

And that is what we've also used as our bridge to work

in my field, which is in orthopedics.

We take cells from an individual and also try

to regenerate bone.

Boughey: I've enjoyed some research on evaluating the role

of surgery, in particular surgery of the lymph nodes,

in terms of patients with breast cancer.

I think Mayo Clinic has been dedicated to research since

the founders themselves were.

The Mayo brothers wrote about the possible role of germs

in cancer.

And that's come to be true.

Behfar: Will and Charlie, setting up the concept of investigation

as part of your practice, created a culture at Mayo

right from its origins.

If we have a careful consideration of the patients'

welfare in mind, and if we show scientifically

the evidence for our discovery, then it's

an irrefutable finding.

That's when true innovation occurs in medicine.

[Orchestra playing]

Man: First time I noticed something was not quite right,

the rehearsal started, and I started drawing a very

slow bow, and for the first time ever, I noticed a little

tiny shake in my bow arm,

the arm that needs to have

absolute, perfect control.

And as a musician, that's when you start panicking.

I must have gone to about different doctors,

and no one could really come up with an answer.

I considered the possibility this was the end of my career.

He started to play his violin, and it was clear

that he couldn't play.

And he said, "Can you help me with this?"

Frisch: Dr. Lee, he said to me,

"I've been working on a technique that

involves drilling a hole in your head."

I had one reaction: "No one is ever drilling

a hole in my head."

But after three months of the tremor getting worse and worse,

someone drilling a hole in my head maybe wasn't such

a bad idea.

Lee: Deep Brain Stimulation--

it's a technique where we can target

anywhere in the brain with an electrode and stimulate that

area of the brain, and what we find, amazingly, is that

our patients with tremor, we can actually make

those symptoms go away.

Frisch: I was fully awake, and you have to be, because

they needed me to play violin during the surgery.

[Plays shaky notes]

Lee: OK, very clearly he has a tremor.

Frisch: Dr. Lee inserted the first lead, and I started to play...

[Playing steadier notes]

and the tremor was much better,

but only much better.

Lee: Roger, what do you think?

It wasn't good enough to play professionally.

Lee: You actually--you still have a little bit of tremor left,

but you're right, it is better. Great.

The question is, whether we should insert that second lead.

Lee: OK.

Frisch: They inserted the second lead,

and I drew a bow and it was perfectly steady.

[Playing strong, steady notes]

They give me this little control switch, which I always

think is like a garage door opener, but I can actually

turn myself on and off.

[Beep]

It says I'm off now, and it's that simple, and if you wait

about seconds, then it really does kick in almost--

almost right away.

[Playing jarring, scraping-sounding notes]

And as hard as I try, that's as smooth as I get,

and you can see the bow just shaking,

just me holding it.

[Beeps twice]

So I--now I'm back on again.

And wait about seconds...

[Playing classical music perfectly]

Lee: What we often say in the lab, "Patients are waiting."

And so we have to discover the new cures...today,

that we're on a mission to help the patient in a timely fashion.

This is not a theoretical academic exercise that we're

trying to do.

We want the cure because we see the patient

suffering today.

[Dalai Lama speaking]

[Train whistle blowing]

When the patients really started an influx to the community,

they saw that there was a need for additional hotels,

for restaurants to dine in, and the community

really embraced Mayo Clinic.

Brokaw: It's where it is, in Minnesota, and it reflects

the values and it absorbs the values of Minnesota.

Aksamit: This Midwestern ethic drove the people around the clinic

and the hospital to take care of the people,

give of themselves, sometimes at great personal sacrifice,

to make it an excellent place.

Noseworthy: It's the person who opens the door, it's the person who

meets them in the hallways, it's the person who says,

"You look lost. Can I help you find your way?"

It's the desk attendant, it's the secretary, it's

the custodian--it's pervasive.

Narrator: By the mid-twenties, more than , patients were arriving

at the Mayo Clinic every year.

In response, St. Mary's built an impressive new

surgical pavilion.

At the same time, local businessman John Kahler

constructed several innovative hotel-hospitals that could

accommodate the massive influx of patients

and their families.

Eventually, Kahler's healthcare facilities would

evolve into a new non-profit hospital called

Rochester Methodist.

The Mayo Clinic was overwhelmed, too.

Henry Plummer agreed to oversee yet another

expansion project.

Completed in , the $ million, -story

Plummer building was the tallest in the state.

Constructed of limestone and brick, it featured marble from

France, Germany, and Italy; hand-carved ornamental designs;

two solid bronze doors; and an -ton, -bell carillon.

[Bells ringing]

Plummer devised an ingenious series of lifts to

automatically deliver medical records to designated floors

before patients arrived for their appointments.

He also developed an array of signal lights outside the

exam rooms so nurses could track the status

of every appointment.

There was even a system of pneumatic tubes to send

medical records and specimens between the Mayo Clinic

and St. Mary's Hospital a mile away.

Mukherjee: The Mayo Clinic is an engineering wonder.

If you go to the Mayo, you all of a sudden find this highly

integrated and engineered system,

like a well-oiled machine, and it comes from Plummer's

vision and the Mayos' vision.

It comes from the idea that

all these pieces, uh, which were spread out,

are part of the same clockwork.

Man: "Medicine is both an art and a science,

and both make appeal to the true physician."

Charlie Mayo.

Dacy: The Mayos insisted on a degree

of distinction in Mayo Clinic buildings.

For many patients, this will be their encounter

with beautiful architecture and design and art.

It's so important to put them in a frame of mind of healing.

Fast-forward to Cesar Pelli, the designer

of the Gonda building.

He said, "Healing begins when you walk in the door.

"Before you ever see your doctor, you have this sense,

I've come to a good place."

We have the piano in the lobby. We have performances.

All this is part of the healing mission of Mayo.

[Playing classical music]

Narrator: But for all its innovation and success, The Mayo Clinic is

not a perfect place.

Access is problematic.

Diseases are relentless, their cures elusive.

Mistakes are made.

Patients are misdiagnosed.

Treatments fail.

People die.

Truty: Every physician has a personal private cemetery

in the back of their minds.

It's a graveyard of all their previous patients that they

failed, and it's a place that we all go to to reflect upon,

upon our shortcomings and we try to decide, how do we improve upon this?

Rhodes: Sometimes the body is unexplainable,

and those times really eat at me.

We have to guard against the illusion of greatness.

We have to earn our greatness every day.

I have personal stories of failure.

I have institutional stories of failure.

We have to speak about those openly.

Narrator: Occasionally, Mayo's emphasis on putting the patient first

has led to decisions in direct conflict with its

original values.

Although the Clinic welcomed patients of all races

and regularly invited minority doctors as distinguished guests,

they, as at most hospitals across the country,

were not allowed to treat white patients, who might not

be comfortable with a black doctor.

There wouldn't be an African- American physician on staff

until .

Wald: It's a challenging point in our history that we have

to acknowledge.

That was the decision that was made because that was

the culture of our time.

The decisions that we make, yes, are ultimately

about the patients, but if you're not serving the staff

the same way, then you ultimately don't serve those patients.

We just have to learn from things that we've done

in the past, and get to a new point for our future.

Kelly: Here I am.

I don't know if it's gonna be the same diagnosis, that I

have myositis, or it might be something else, but, um,

I'm hopeful.

The tips of my fingers...

Kelly: The discussion with Dr. Kennelly,

she listened to what I was saying.

So, I go to him, like, every months.

Kelly: I hadn't had that in the past.

It was, like, here...

I mean, she took her time with me.

She didn't rush me.

She explained everything to me.

And--and were you just getting progressively worse?

Kennelly: Inclusion body myositis is a category of muscle disorders

that are thought to be inflammatory.

OK.

It's a tough one because it's kind of creepy-crawly.

It doesn't come on like gangbusters.

It sneaks up on people.

And don't let me push your head back.

Kelly: I noticed that they was on the ball of doing different

stuff, you know, checking my blood, doing stuff that I felt

like I should have had done in the beginning at a early stage,

and it wasn't done like that.

I come here, and they-- they on the ball

of boom, boom, boom, boom, doing this.

minutes--I'm on the road driving home, and Dr. Kennelly

called me and she said, "I got your test results back."

I said, "You got my test results back?"

Because normally when you take blood work, it takes a couple

weeks before you can get your results back.

And she said, "Well, it does look like you have diabetes."

And she said, "Have they ever told you your white cells

was high?"

Kennelly: The blood work was important,

and her white blood cell count is markedly elevated.

And then another thing...

Kennelly: For Mrs. Kelly, I'm asking for the hematologist to see her,

and I'm asking for the endocrinology department

to see her.

I think we will be able to give her a definitive answer.

I'm still most suspicious that she has

this inclusion body myositis,

but it's possible that the elevated white blood cell count

could be affecting her muscles.

[Man speaking indistinctly]

That has potentially

nothing to do with her muscle disease...

Now, interestingly enough...

but it might.

They found that your white count is high.

May be indication for a low-grade leukemia.

Mm-hmm.

One that sometimes is associated with these

muscle inflammatory processes.

So we may have the cause...

Kelly: Leukemia. That was not something that I thought was gonna be told to me.

It was-- it was devastating.

It's quite likely that she may had had it at least

for or years or could be even longer.

Cranial cell leukemia had been associated

with this inclusion body myositis,

so we approached her condition with some chemotherapy

directed to the leukemia and another medication directed

to the myositis.

Kelly: I went for weeks,

and I felt like it worked in the beginning.

Then my husband lost his job,

and I wasn't able to continue to go to the Mayo Clinic

'cause I lost my insurance.

And so I had to seek other places.

What other option do you have?

Trying to get in to see someone, it's a--

it's a battle, you know?

Who wants for somebody like me to come in,

and I got all these problems?

The main thing come out their mouth,

"How would you like to pay for this?" you know.

Things cost money,

and the Mayo Clinic, it's not free.

But if I was able to continue treatments, I felt like

the Mayo Clinic was my hope to help me.

Colon-Otero: I visited with her after she had lost her insurance

and was able to examine her and determine

where we stood with her treatment.

And her condition doesn't seem to have improved

that much at this point.

Kelly: You know, sometime it doesn't work like you want it to

in the beginning.

I got weaker.

But he looked me dead in my eye.

He said, "You can live a long life.

You can live a long life with leukemia."

So all hope is not gone.

They did all they could do for me.

I thank them from the bottom of my heart to give me answers

to what I was looking for.

You know, you just have to move on.

That's what I'm trying to do now.

I know in the beginning it was gonna be a journey, and it

still is a journey, and hey, it's still going.

Narrator: One day in ,

Dr. Will arrived at his office and told

his secretary that he'd just performed his last operation.

He had developed a slight tremor in his hands.

When she protested, he explained, "I want to stop

while I'm still good."

Meanwhile, Dr. Charlie's son, who was known as Dr. Chuck,

had received his medical degree and was looking forward

to working with his father, just as young Charlie and Will

had worked side by side with their father.

Man: "I had been dreaming for years of being his first assistant,

"amazing and impressing him with my skill.

"I thought, I suppose, that it would draw us together.

But fate gave me only that one morning to prove myself."

Narrator: On Dr. Chuck's very first day as surgical assistant,

his father suffered a dizzy spell.

It turned out to be the first of a series of minor strokes.

Dr. Charlie's surgical days were over, too.

Weivoda: I think the Mayos thought about the future all the time.

I don't think they ever looked back over their shoulder.

I think it was always,

"I'll deal with what I've got in front of me,

"but how do I face the next thing,

and what is the next thing?"

Man, on radio: My friends, I want to talk for a few minutes

with the people of the United States about...

...tell you what has been done in the last...

Narrator: The Great Depression tested the Mayo Clinic

as no other event.

Doctors and staff accepted pay cuts to minimize layoffs.

The Clinic printed "Mayo money" in case employees

needed help paying for rent and food.

No one was turned away because of their inability to pay,

but the number of patients seeking treatment

fell dramatically.

At St. Mary's, the situation was even more precarious.

But having made vows of poverty,

the Sisters knew how to adapt.

They raised turkeys and chickens, harvested acres

of fruits and vegetables, and pasteurized almost

a quarter of a million gallons of milk a year, which they not

only used to feed their patients, but also shared

with the many needy people who were arriving at their door

begging for food.

The reduced patient loads during the Depression did give

doctors time to do experiments they had been putting off.

Edward Kendall and Philip Hench began work that would

lead to the discovery of cortisone, for which they

would be awarded a Nobel Prize.

Dr. Hugh Butt discovered that Vitamin K could save the lives

of patients with jaundice.

And Dr. John Lundy established one of the nation's first

blood banks.

[Cheering and applause]

On Wednesday, August th, , with temperatures

in the s, , people-- times the city's population--

gathered along Broadway to see

President Franklin Roosevelt ride with Dr. Will

and Dr. Charlie from the train station through town.

FDR had come to present the Mayos with an award from the

American Legion in honor of their service to the country,

which included providing free care to World w*r I veterans.

During his visit, Roosevelt laid a wreath at the grave

of W.W. Mayo and stopped at St. Mary's

where Sister Joseph Dempsey came alongside his car

and clasped the President's hands.

The town had been preparing for weeks.

A portable stage with a hidden ramp had been built

so the President could reach the platform without the crowd

seeing the metal braces on his legs, crippled by polio.

His -minute tribute to the Mayo brothers was broadcast

on radio throughout the country.

Roosevelt: I hope that the people of Minnesota and of Rochester

will not feel limited in their pride of possession,

when the nation which I have the honor to represent claims

the right to call Dr. Will and Dr. Charlie

by the good word of "neighbor."

[Cheering and applause]

Woman: "Dear Dr. Markovic...

"I think it's clear that I'm reaching the end of my road.

"Our gratitude to you and the Mayo Clinic is beyond words.

"You always have believed in me and my future,

"despite the unbearable odds that have been against us.

"You gave me the gift of time, of months of life that I

"otherwise wouldn't have had.

"Countless times, you gave my family and I hope

"when we had none.

"You are an inspiration and a godsend to your patients.

"Your favorite patient,

Claire Richards."

McCain: I can't tell you how important

the care and concern and the affection

that the people at Mayo treated me with

had such a beneficial effect on my health.

I realize that all of this time of ours

comes to an end.

They've been very straight with me, and they've told me the odds

and they've told me exactly what they're doing.

And, uh, that's-- that's so important.

It's so important because then you can plan

what time you have left.

Narrator: Will and Charlie Mayo now spent much of the winter

in side-by-side adobe houses they had built

in Tucson, Arizona.

At A.M. every morning, they would meet at Charlie's house

to review news from the Clinic.

"Well, well," Charlie once said, "This is quite

"a comedown for us, Will.

They're doing better now that we're away."

In , the Mayo Clinic officially treated its

one-millionth patient,

but there would be little else to celebrate.

Sister Joseph, the resourceful year-old leader

of St. Mary's Hospital for decades, had retired.

She could still be found visiting patients at St. Mary's,

particularly children, the poor, and alcoholics.

But early that next Spring, she came down with pneumonia

and died on March , ,

surrounded by her Franciscan Sisters.

In April, Dr. Will began having stomach pains.

An X-ray showed it was cancer.

The man who had operated on so many abdominal tumors

now had a tumor of his own removed by a Mayo surgical team.

Will seemed to be recovering, but then his brother Charlie

came down with a serious case of pneumonia.

Man: "Granddaddy was sitting straight up in a high-back

"rose-colored chair.

"His glasses had slipped low on his nose,

"and his mouth allowed soft air to escape.

"Granny was leaning over him.

"'Isn't he beautiful?' she said.

"'Isn't he the most handsome man?'

"I asked her what she was doing.

"She said she was memorizing his face

"'in case he leaves me first.

I want to remember what he looks like.'"

Narrator: Dr. Charlie died on May , .

Man: "Not long after Father died, Uncle Will noted

"with professional interest that he was

"becoming jaundiced.

"He diagnosed it at once as metastasis in his liver.

"He went about his death in the same practical, crisp manner,

"with no self-pity.

"He summoned the family. 'I've had a good life,

"'and this is all right.

"'I'm not going to have any further medication except some

"'morphine for the pain.

I'll say good-bye to you now.'"

Narrator: On July th, Dr. Will died.

Noseworthy: It must have been a tremendously solemn time

at Mayo Clinic

to lose those three-- those three leaders.

An awful lot of people believed that when the Mayo brothers died

that the clinic would go into decline,

and it didn't.

Others believed that as change occurred in society

that the need for the Mayo Clinic and its success would

go into decline, and none of that happened.

The clinic has grown and has flourished long after

the Mayo brothers left this earth.

[Machine beeping]

Woman: Over years, I have seen different doctors,

and I have been admitted times at my local hospital.

And no diagnosis.

My liver was failing, and then it went to my kidneys and to

my lungs, and then it went to my heart.

I have been revived times.

I always felt like I was passed on from one doctor to another.

They did not know what was wrong.

They kept me alive, but they never gave me

any kind of hope.

They said I would not make it past .

Man: You might see a lung doctor, and you have to go see

a kidney doctor somewhere else, but for Shannon,

she's thinking, "It should be one thing that's linking

"these things together, and I'm not sure anyone's

really got that yet."

I think most physicians are well-meaning, honestly, and they

want to try to work within these systems, but it's

difficult when everything is so fragmented.

This is the healthcare system in the U.S.

that we're running into as patients.

Leon: Dr. Niewold was the start of my hope.

I had many, many tests, and the consultation

between me and him lasted about hours.

I just told him what was wrong and all my symptoms.

He sent me back to the waiting room...

and minutes later,

exactly minutes, he called me back

and gave me a diagnosis--

Lupus.

Between and years and no diagnosis,

and minutes with Dr. Niewold.

It was like a total miracle.

Niewold: The pace of medical knowledge isn't gonna slow down, and I

think it does take more of a distributed mindset to be able

to handle all of that and apply it to patient care.

[Klaxon sounds]

[g*nf*re]

[Men shouting indistinctly]

Narrator: The Mayo Clinic sponsored several medical teams during

the Second World w*r, including one

in the Philippines.

Led by Charlie's son Dr. Chuck, it built hospitals

in the jungle, where they treated both Allied

and Japanese soldiers.

In the new Medical Sciences Building, a top-secret

Aeromedical Unit developed an inflatable "G-suit" that

protected Allied pilots from blacking out on steep dives.

The Aeromedical Unit had cost the Mayo Clinic $ million.

They charged the United States government

$..

In the years ahead, Mayo doctors and nurses would

help assemble MASH units for the Korean w*r, devise plans

to deal with potential mass casualties during the Cold w*r,

and, after /, developed a rapid test

to diagnose anthrax.

Mayo doctors also used the first CT scanner

in the country, pioneered the use of computers in operating rooms,

performed the first series of successful surgeries

using a heart-lung bypass machine, developed one

of the first combined liver-heart transplant programs,

and the Mayo Clinic has helped the medical community

accelerate the pace of stem cell, gene-based,

and other individualized therapies.

Man: "The greatest asset of a nation is the health of its people.

"The medical profession can be the greatest factor for good

"in America.

"Our failures as a profession are the failures

"of individualism, the result of competitive medicine.

[Gavel banging]

It must be done by collective effort."

Will Mayo.

Narrator: The biggest challenge facing the Mayo Clinic,

and every other hospital and doctor

in America, would be the question of cost

and delivery of health-care.

For more than years, as the country argued over

what it owed its citizens, the Mayo Clinic would struggle

to remain true to the values W.W. had instilled

in his sons.

Stevens: With Medicare and Medicaid, everybody was to have

good health insurance.

Well, that didn't actually work out as planned.

There was supposed to be health

maintenance organizations,

and that didn't work well.

There was supposed to be regional health planning,

and that didn't work.

Most recently, we've had this consumer-oriented movement--

competition will bring down costs, we'll make it

more efficient.

Well, that hasn't worked.

Brokaw: It's appalling how little they know in Washington

about how it really works.

The most important thing that our lawmakers can learn from

the Mayo Clinic system is it's the team effort, that everybody

is involved, not just in the treatment, not just

in the diagnosis, but also in the system

and how it operates, trying to keep cost down.

Citizens of the United States expect and deserve

a sustainable, high-quality health care system that brings

innovation and research to their needs when they need it.

Stevens: One of the messages from Mayo's history is that you

can be entrepreneurial and competitive and idealistic

and put the patient first all at the same time.

And that is the message now that leaders of these

organizations all across the country are trying to tackle.

Wald: We're not trying to solve healthcare.

We're trying to do it.

From a healthcare professional's perspective,

this is medicine.

This is what it was supposed to be.

We'll do what's in the best interest of the patient,

and the rest of it will fall into place.

Mukherjee: The Mayo is on a historic pedestal,

but it needs to be maintained, not just dusted

like a sculpture on a pedestal, but really maintained in a way

that the physiology of the institution remains active

and viable and vital.

It's an island of excellent medical care,

and that has its problems.

How to translate that model into extremely diverse

communities has remained a huge challenge.

Narrator: In , St. Mary's Hospital,

the Mayo Clinic, and Rochester Methodist Hospital

merged as an integrated center

of medicine with total assets of $ billion.

Gervais: At the time when we were merging, the lawyer wanted

a copy of our contract with the Mayo clinic, and I said,

"Well, I'm sorry, we don't have a contract with the Mayo Clinic."

He said, "Oh, you must have a contract someplace."

And I said, "No, we have never had a contract

with the Mayo Clinic."

He said, "Well... how do you function?

How do you get along?"

And I said, "Well, I'm not being facetious, but if there

"is a problem, the departments concerned about it get together,

"they discuss possible solutions,

"they decide what is the best solution,

and both parties set about doing it."

And he looked at me and he said, "You just destroyed

a profession."

I said, "Good."

Man: "We know who we are with the Sisters,

but we don't know who we'd be without them."

Narrator: The Mayo Clinic, which started

in a frontier doctor's office in a small Minnesota town,

would go on to create medical centers in Jacksonville, Florida,

and Scottsdale, Arizona,

the regional Mayo Clinic Health System,

the Mayo Clinic College of Medicine and Science,

and a worldwide network of like-minded hospitals,

all dedicated to working together to find new ways

to perfect the Mayos' belief that the needs

of the patient must always come first.

Weivoda: I don't think it's a miracle in the cornfield.

I think it's what humanity should be,

where people do the right thing, not because they're

looking for money, not because they're looking for fame

or glory, but they do the right thing.

Truty: People need to have the Mayo Clinic.

They require that we exist.

They need a place like this in America, in the United States,

that offers hope where sometimes hope isn't offered elsewhere.

Mukherjee: I think what the Mayo does is not peddle hope.

What it peddles is excellence.

Hope is a consequence of excellent delivery

of medical care, and integration is

a consequence of being able to be the most thoughtful,

the most excellent, the most incisive in medicine.

Dacy: A lot of people have a sense that the Mayos

are with us today,

so they don't feel remote to us at all.

And we have a sense that whatever we're doing, maybe

they're looking over our shoulder, and that keeps us

on our game.

Man: "I look through a half-opened door into the future,

"full of interest, intriguing beyond my power to describe,

"but with a full understanding that it is for each generation

"to solve its own problems and that no man has the wisdom

to guide or control the next generation."

Will Mayo.