The Brills – Making a Difference
There are many influences that may lead one into the field of medicine, but one deep motivation is our family commitment to make a contribution or basically make a difference. There are two basic principles which were inculcated in us through our parents influence and also by my father’s Dad; whatever you choose to do, first, be the best at what you do and, secondly, make a difference.
My dad, Thomas M. Brill, M.D., knew that he wanted to be a physician since primary school. His father was a chemical engineer and introduced dad to medicine at a young age through his physician friends. Dad graduated from high school early skipping a year, graduated from college in three years and then graduated from Medical School in three years (accelerated program during Word War II). He was an M.D. at 23 years of age with his degree from the University of Michigan. My mother was a Gainesville native and after graduating from college, she visited her brother, Dr. Marvin Kokomoor (at that time married to Mable), who was a senior medical student at Michigan and a friend and colleague of dad’s. Mom and dad met through a blind date and became engaged ten days later. As history notes, that brought the second pediatrician to Gainesville, Dad (1949) and, subsequently, Dr. Kokomoor (1952) along with their young families. By virtue of longevity Dad is the senior physician in Alachua County anteceding all others.
Like so many of Dad’s contemporaries, he was called to active duty as a Naval medical officer in 1946, and was in Hawaii when I was born in Gainesville. When the war ended that year he was placed on inactive duty and returned to his residency. In 1952 his practice was interrupted during the Korean war when he was again called to active duty for two years (as in “M.A.S.H.”!)
Dad was well respected by his peers and participated in the founding of the medical school at the University of Florida. He served on the clinical staff from its inception. To this day many of his greatest friends were pioneers including Richard T. Smith, MD (Dick) and Gerold L. Schiebler, MD (Jerry). Dad helped establish the Well Baby Clinic for indigent children. He was also the first allergist in Gainesville completing an allergy fellowship at the University of Michigan and was the first board certified private practicing physician in allergy with Dick Smith being the first board certified allergist at the University of Florida. Not only was he always in the forefront of knowledge and giving excellent quality medical care to patients, he also had and still has a humorous personality and a happy disposition to match. He also was very calming to patients in times of stress. In and outside the field of medicine, he always listened intently, understanding different points of view and always respecting them. He commanded respect in a very subtle way and when he spoke, he was like the E. F. Hutton commercial, “When he speaks everyone listens”. If the saying, “cream rises to the top,” is true, he is definitely the cream as he rose to the top in almost every organization of which he was a member. for example, President of the ACMS, President of the Florida Pediatric Society, President of the Florida Society of Allergy and Immunology, President of the Rotary Club of Gainesville, Captain of the Quarterback Club, served four years on the Board of Medical Examiners for the State of Florida, served on the board of a local bank and, subsequently, as a board member of a major bank in New York.
As an example of Dad’s significant influence on individuals, our housekeeper had two sons, Bud and Hubert Wingate. They were graduates from Lincoln High School and this was at the time of segregation. They were older than us and frequently visited our parents. This was a time when they were excelling academically and Dad was helping them financially with their academic pursuits. One became a doctor (MD) and the other became a pharmacist. This was through their contact with Dad in the medical field and they reached these goals with his assistance. What pressure on us kids to equal such an academic achievement and by our housekeeper’s sons!
My Mother, Gretchen, was his right hand and she was a major driving force facilitating not only his success but the success of our entire family. As the daughter of the head of the mathematics department at the University of Florida she was very academic. A story told to me by dad fairly recently (to my mother’s chagrin), she was called to the President’s office when she was a college freshman and thinking she was in some type of trouble, she was surprised that he told her that she scored the highest on the I.Q. exam in the entire freshman class and that he expected great things from her. To her this was awful because she did not want people to expect great things from her; what pressure! However, she did graduate with honors and was accepted in graduate school at Yale, which was interrupted by a rendezvous with dad and so instead of a graduate degree she attained her MRS degree. She is very talented in many ways including being an artist and she can write in such a humorous way that even Irma Bombeck would envy. She could paint and sketch with skill. She was a sketch artist and could do fashion illustration and also paintings. One of my favorite paintings stands today in their home which is an antebellum home in Texas. She also painted a series of nude paintings that were actually quite tastefully done in the style of a Dutch Master painter (after all she is of German-Dutch decent). I confiscated them and hung them in my bachelor pad bathroom when in medical school and residency and even several years after marriage. Invariably, I would get a comment from a guest who would notice the signature at the bottom of the paintings and they would ask “who was G. Brill?” My response was, “That’s my mother”, only to watch their jaws drop! I wonder if this didn’t teach me body shape and form for a plastic surgery career. With her personality and love of people and certainly enjoying and entertaining others, she was an excellent compliment to dad and a mother who brought out the best in her kids.
Judy was a very accomplished older sister. She was very popular and was the GHS Homecoming Queen, second runner up Miss University of Florida, and the KA Rose riding in the Homecoming parade. Growing up, we three boys referred to her as the “upstairs mother”. She kept us organized, dressed and downstairs for school and accomplished this in such a pleasant way that I can’t recall having an argument with her (only among boys). She married James F. Lang, a young practicing attorney while she was in college and she went on to complete her Masters degree at the University of Florida in rehabilitation counseling and worked for the State of Florida . Jim was also a graduate with honors from the University of Florida and Florida Law School. Incidentally, he was one of four contestants who represented the University of Florida on the television show, College Bowl (Allen Luden as the announcer).
The Guardian Ad Litem Program was incubated and formulated through meetings in my physician office under the guidance and leadership of Carol Zegel, Jeanne Singer, JD, Randy Caton, DDS, and others. I provided materials for the printing of guidelines and manuals. Eventually, this program grew with the help of State Representative Jon Mills, Speaker of the House, passing legislation for funding. The leadership of Audrey Schiebler (wife of Dr. Jerry Schiebler) also helped statewide growth and the program has now been adopted by many other states. Our sister, Judy also participated as a guardian representing the welfare of many children in Alachua County.
We three sons entered into medical fields but we were not influenced in the way you might expect. In our early years we would sit at the dinner table every evening along with mother and our sister, Judy, after dad came home from work (usually late and we were starving) with the phone mounted on the wall next to his chair. Dinner conversation was regularly interrupted by him answering a phone call from his answering service and he would proceed practicing medicine at the dinner table. We got half the conversation “what color was the stool?” “how many times did he vomit and what color was it?” With comic brothers and humorous sister, exaggerated conversations were completed followed by much laughter. The subject matter didn’t seem to affect our appetites – only the laughter which made our sides ache. Also, as children we would ride in the car with him when he made house calls ($3.00 office visit, $4.00 house call) and when waiting for his return with his black doctor bag, we could imagine what disease he was treating (filth, pestilence and disease of all sorts). We would wait in the waiting room at AGH when he was making rounds and sit by the telephone operator (Lily Tomlin – wearing the headset and working the plugs). With emergency room visits, long hours, and our horrid imagery of the sick, who wanted to become a doctor!
For me, I started in college interested in engineering as my grandfather was a Chemical Engineer. I definitely was not going to be a doctor and take care of a bunch of sick people! But with knowledge gained from an academic perspective, opinions slowly changed. I went from chemical engineering to a biological chemical field in chemistry and after four years at the University of Florida, I was accepted in the first dual MD-PHD program offered in pharmacology at the University of Miami with visions of a career in drug research. However, during my third year of medical school, rotating through surgery, a grand rounds presentation was given by Dr. Ralph Millard, Head of the Division of Plastic Surgery, which was standing room only. I understood why it was so crowded because of the magnificent slide presentation showing solutions to difficult reconstruction problems and the creativity involved in solving almost impossible situations to help patients with significant life altering deformities. He proved to me that Humpty Dumpty could be put back together again and that you could make a silk purse out of a sow’s ear. I didn’t know anything about plastic surgery until then, but being somewhat artistic and creative myself, (probably inherent from my parent’s) I made a significant direction change and completed general surgery and then plastic surgery instead of pursuing the pharmacological research and the PHD degree. At the end of that year, Dr. Warren, Chief of Surgery at Miami left to become the Chief of Surgery at Emory and brought with him Dr. Josh Jurkiewicz (Dr. J.) from the University of Florida. Dr. J. founded the Division of Plastic Surgery and served as a General Surgeon and Pediatric Surgeon when at Florida. He became the Chief of Plastic Surgery at Emory. He was also great friends with Dr. Millard who told me that he was the best plastic surgeon in the United States. Interestingly enough, my parents were good friends were Dr. J. and his wife Dee and Dad was their children’s pediatrician. Fortunately, I was accepted in the residency program at Emory and completed my plastic surgery residency in his program. While at Florida, Dr. J. performed the first Jejunal Freeflap for head and neck reconstruction, publishing a series of three cases. Drawings of this publication have been framed and displayed in the library at the University of Florida. He revolutionized plastic surgery not only by his own innovations but by training many innovative surgeons. Leonard Furlow was one of Dr. J’s early residents and created the method now known as the Furlow palate repair for cleft lip and palate. Many others pioneered innovative procedures such as the latissmus dorsi back flap and the TRAM flap for breast reconstruction, multiple myocutaneous flaps and free flaps which culminated in thousands of publications and many textbooks. I was very fortunate to participate in these pioneering endeavors –making a difference!
My younger brother by sevens years, Robert (Boonie), also did not want to be a physician at an early age as dad. He went from Westwood Middle School to Deerfield Academy, one of the top three prep schools in the nation where he excelled both academically and also in sports, particularly diving and swimming. He was an all American swimmer and third place in diving in the North East Competition. He entered Vanderbilt changing his sports interest to soccer and was the only freshman on the varsity squad. Being the youngest and having two older brothers, he was very competitive and tried anything. He was fearless. Unfortunately, he broke every extremity more than once and was a veteran orthopedic patient. When I was practicing in Gainesville and he was in medical school at Florida, he broke his arm again and was treated by Dr. Thomas Moore. I saw Tom in the surgeon’s lounge at AGH and asked him about Boonie. Tom said, “Yes, Boonie came in for his annual fracture”.
When he was at Vanderbuilt, I was a Surgery Resident at Emory University and he came to visit. I was on call at Grady Memorial Hospital. He put on scrubs and spent the entire weekend shadowing me and saw a plethora of pathology, trauma, and surgery including orthopedic surgery. This was his turning point. It was a view of medicine from a different vantage point. It was not a world of vomit and diarrhea and certainly better than being an orthopedic patient! He subsequently became an orthopedist with a long career in orthopedics in Ocala. He was particularly interested in joint replacement and was one of the first in Ocala to bring in new innovative techniques. As to his sense of humor his practice was “Knees R US” in Ocala.
My brother, Eric, also had no interest in treating a bunch of sick people. He hated to be sick and he would not come near anyone who was sick – self preservation! To this day, even when visiting in the hospital, he will let anybody else open the door for him or touch elevator buttons and won’t touch anything that might transmit a disease. He is a bonafide genuine germaphobe and is proud of it! Not being interested in medicine, he majored in accounting (FL) and law (FL) and attained a masters degree in tax law (Boston). His professional life started as a CPA in Jacksonville with a prestigious firm and was then hired as the head of the financial and legal department of an oil company. He was promoted to Executive Vice President and was flying in private jets from continent to continent making business deals for sums of money that have more digits than I could comprehend. While he was working as an executive, I was still a lowly paid surgery resident and wondered who was smarter. He was already earning a salary greater than I would ever expect to earn even as a physician. So much travel kept him away from family so he resigned and started his own company in North Carolina which he subsequently sold. In Gainesville he helped several physicians and others with financial matters in improving management including me. Joe Cauthen, MD, and Larry Smith, MD, and Eric convened in the conference room at my office and founded FIPA. He became the CEO of FIPA with the main state office in the downtown Seagle building. This was a state organization. Eric made multiple presentations to medical societies throughout South Florida. He acquired expertise and knowledge in medical law, contractual relationships with insurance companies, experience in negotiating with insurance companies, and even forming surgery centers.
When Eric was waiting in the doctor’s lounge to talk with Dr. Joe Cauthen, he struck up a conversation with Dr. Clinton Bush. Dr. Bush had a brainstorm idea of bringing the multiple groups of Orthopedists together in one major group and ultimately building their own Orthopedic Center. Clinton had been interviewing multiple people from all over the country to find someone who had enough knowledge and expertise to make it happen. After talking with Eric about his experience and knowledge, Clinton was convinced that Eric was the guy for the job. Eric told him he wasn’t interested multiple times but, eventually, he made him an offer he couldn’t refuse. Eric then pursued the job of bringing a network of physicians together to agree in creating The Orthopedic Institute (TOI) and building an office building and a surgery center. According to Eric, the job was “equivalent to herding cats.” However, he formalized the relationship in the formation of a group and presented the plans in a meeting with all of the physicians and to his surprise, there was unanimous agreement. Therefore, with Eric as the CEO that brainstorm idea became the Orthopedic Institute (TOI) which now amasses a staff of 300 including 19 Orthopedists, 3 Plastic Surgeons, and a Neurosurgeon. After the Orthopedic Institute opened and was successful, they also opened branch offices in Ocala, Alachua, and Lake City delivering state of the art medical care with efficiency and quality outcomes. The University of Florida subsequently built their Orthopedic Center making Gainesville premier in this arena second to none in this country.
When I first began practice in Gainesville, after finishing Dr. Jurkiewicz’ program, I brought many innovative concepts and ideas that had not yet been formulated or applied in this area or most areas in the country. For example, breast reconstruction was not readily accepted at that time. General surgeons did not recommend breast reconstruction as they thought this may interfere with the detection of a reoccurrence and affect long term survival. At first, breast reconstruction was performed after no reoccurrences were noted for five years after a mastectomy. Now immediate skin sparing reconstruction is performed when appropriate. Breast reconstruction was aggressively advanced by Dr. J’s group with many innovative techniques. The latissimus dorsi myocutaneous flap was a new innovation at that program and I presented this to the University of Florida at the invitation of Dr. Hal Bingham, past Chief of Plastic Surgery and many such operations followed both at Shands and in private practice. In the year following my completing residency, Dr. J’s program developed the TRAM flap reconstruction (using the lower abdominal tissue for breast reconstruction and performing an abdominoplasty for closure). Before this was reported and published Dr. Furlow performed the first such operation in Florida at NFRMC and probably the first outside Dr. J’s program. I performed the second and this technique has since been perfected with the addition of microvascular techniques under the leadership of Dr. Brent Seagle, MD, current Chief of Plastic Surgery at UF, and also recently perfected by Jason Rosenberg, MD, at The Orthopedic Institute (TOI).
A plethora of myocutaneous flaps and muscle flaps that were innovations from Dr. J’s program were now being applied and were formerly not available for advancement of patient care. I knew a gentleman who worked at the “Gas Well” on 13th Street when I was in High School (cars were serviced in those days) and he had a chronic draining leg wound with osteomyelitis for over 30 years. He became a patient of mine and I performed debridement and closure with a myocutaneous flap. This patient was completely healed using this new technique. He was the first in a series of four similar patients who had been treated for chronic wounds for 30 to 45 years and now they too were completely healed using this operation. Open heart wounds with infected and necrotic sternum were referred to me and subsequently to other plastic surgeons for care. These were life threatening complications now being treated with muscle and myocutaneous flaps created by Dr. J’s group utilizing flap repair and having almost total success and patient survival.
The VAC wound closure system, an innovation of a plastic surgeon from the University of Michigan, was brought to Gainesville for the first time by me to be used at NFRMC. It was an uphill battle to have this instituted. With the help of Tom Lemaire, PT, then head of the rehabilitation center, this eventually became instituted for the treatment of patients with complicated wounds which were referred to me but also for many other patients through the physical therapy department. This then spread to AGH and then to Shands and is now standard worldwide including being used in the military. Tom Lemaire now works for KCI (VAC system parent company) in the North Florida region and claims that I made his career! Now I’m participating in a new wound study from Innovative Technologies Inc., which has shown significant promise in treating wound complications including MRSA. Infections have been successfully healed in a matter of days rather than weeks, including treating infections of implantable devices in plastic surgery, neurosurgery, and orthopedics without removing the implants. This is an innovation by Dr. Paul Rucinski, MD, (TOI in Ocala) and others.
Being in the forefront of medical knowledge, technology, and innovation is not unique in Gainesville. It is actually almost common place! New ideas are openly accepted as opposed to other rigid medical communities. With the creativity and innovation in a myriad of specialties and with a strong town-grown relationship, this community has advanced the medical knowledge and treatment modalities more than any area in this country. New methods, devices (patents), and medical companies have evolved. The Brills are very fortunate to be part of this community and to have been able to make a contribution.
With the outstanding example of our father and mother and the desire to “make a difference,” now you know how a kamikaze daredevil, a germaphobe, and one who does not want to take care of a bunch of sick people all became doctors and a CEO in the delivery of health care.
Roger T. Brill, M.D., F.A.C.S. offers breast augmentation surgery in:
