Teachers are the underpinnings of a successful society. Equally essential are doctors. The very few who are both, who combine education with practical medical experience to teach others to become skilled physicians, offer a combination of heart and intellect that nurtures the growth of a nation.
When Phillip Fulkerson graduated from Ohio State in the spring of 1967, he had earned a doctor of medicine degree and immediately faced a fork in the road of life. “I could have done my internship and then started a residency somewhere while waiting for a draft notice, or I could have told Uncle Sam what year I wanted to start military service,” he explained.
Only it wasn’t that simple. His wife, Carolyn, a teacher, had left her job to care for their infant daughter. His internship paid only $5,000 a year; they were barely solvent. Fulkerson elected to enter active duty after completing his internship and one year of a residency in internal medicine. That decision brought him $10,000 a year until he entered active duty.
He went on active duty as a medical corps captain in October 1969. A brief course in how to be an army officer preceded an assignment to Vietnam. He left his home in Dayton, Ohio, on Thanksgiving morning and headed for the war.
Unlike most army doctors in Vietnam, Fulkerson divided his tour among four very different duty stations. “I reported to the Second Army Surgical Hospital in Lai Khe, a 1969 version of Hawkeye Pierce’s beloved 4077th MASH,” Fulkerson recalled. “The entire facility was three operating rooms, an ER, preop, several postop wards, a lab, an X-ray, and a pharmacy, plus supporting infrastructure. It was designed to be transportable by two CH-47 Chinook helicopters.”
Fulkerson was assigned as the hospital internist. “I saw far more time in the OR as first assistant to the orthopedic surgeon and on one of the three general surgery teams,” he recalled. He donned his stethoscope only to diagnose and treat a GI with leukemia, an elderly Vietnamese woman with heart failure, and an ARVN soldier with an advanced case of pneumococcal sepsis. “That was all I had to keep my brain from decaying,” he said.
Not that working with severely wounded men was boring. “I came into the ER one day, and medics were putting a tube down this guy’s throat to help him breathe, and there was a towel over his head,” Fulkerson recalled. “I took the towel off and there was his brain—he had only half a skull. That image remained with me.”
On another occasion, he worked on the driver of an armored personnel carrier who had struck a mine. “It blew his feet back up his legs a couple of inches. When you have long bone trauma—bone marrow is loaded with fat—that fat can get into the veins. If it migrates through the veins and it goes to the lungs, it causes a terrible mess. He had great trauma of the long bones of the ankle and lower leg. I was operating with an orthopedic surgeon. We couldn’t fix much of his problem, but we could clean it up and stabilize it. Then he had a fat embolism and lost consciousness. His temperature soared and his oxygen fell. We transferred him to the evacuation hospital sooner than planned because he was on a ventilator and we only had one of those—we couldn’t have it tied up. So we had to bag him and send him down to the Ninety-Third Evac in a helicopter.”
Fulkerson and a medic accompanied the patient to the evacuation hospital on an air ambulance, then headed back to their own hospital on a helicopter gunship. “I noticed we were off course,” he recalled. “Next thing I saw was a bunch of helicopters circling around us, including a couple of Cobras and a light observation helicopter. My medic suddenly put on his helmet and grabbed his rifle. Sitting there with my baseball cap and no weapon, I asked him what was going on.”
The medic said a helicopter had gone down, and their bird was going to land and take care of the pilots. “So we went in, and there was a helicopter on its side and another that had landed near it,” Fulkerson recalled. “The medic jumped off the helicopter before we landed, and I went with him. Then he jumped back on the helicopter and it took off. I was a little upset, but there I was, so I examined the downed pilots. Then we got them onto the other helicopter and took off. I thought that was pretty high drama,” he said.
Fulkerson’s next duty station was the Sixth Convalescent Hospital, which was near the beautiful white-sand beaches of Cam Ranh Bay. This facility cared for soldiers with injuries or illnesses that were expected to heal or significantly improve over several weeks, after which they could return to duty. Fulkerson provided postacute care to patients with malaria, infectious mono-nucleosis, hepatitis, and so forth. “It was a very nice job in a picturesque setting,” he recalled.
Next, Fulkerson became the battalion surgeon of the Fifth Battalion, Seventh Cavalry, First Cavalry Division at Firebase Neal on a Cambodian hilltop surrounded by thick jungle. “I was the primary care doctor for about twelve hundred men, including about six hundred in active combat,” he recalled. Fulkerson treated mostly malaria or hepatitis cases; wounded men were flown directly to a hospital.
When he wasn’t at his aid station, Fulkerson hitched rides on Hueys flying resupply missions to make house calls to the troops in the jungle. He once also hiked to a Montagnard village and held sick call.
Fulkerson’s final duty assignment was as the commanding officer of Alfa Medical Clearing Company at Bien Hoa, also a First Cavalry unit. “My duties were mostly administrative, with a little politics thrown in to keep things interesting,” he said. Medical clearing companies were intended to provide secondary medical care for patients referred by battalion aid stations. “In fact, seriously ill or wounded patients were usually medevaced directly from the battlefield to evacuation hospitals.”
When he returned to civilian life, Fulkerson completed his residency in internal medicine at Ohio State, and then he was granted a two-year fellowship in cardiology there. Until he retired in 2004, he was an associate professor of medicine, teaching cardiology to students, interns, and residents at medical schools in Ohio, Wisconsin, and Illinois. As he gained seniority, he also served in administrative positions.
But his passion was teaching. Between 1985 and 1988 he was a part-time student at Ohio State’s College of Education, completing all the coursework for a master’s but foregoing the thesis required for the degree.
“People like me do research, sometimes with another doctor,” Fulkerson explained. “They think together and plot data and write papers together. But one of those people is primarily a researcher and the other is a clinician,” he said.
“A medical school is a three-legged stool: research, teaching, and patient care. Most physicians do some of each, but the rock stars of medical schools, the full professors, are the researchers who bring in millions of dollars from research grants.”
That’s not Fulkerson’s strength. He said, “In my heyday at Ohio State, I was on service four months a year. I was the doctor taking care of all the patients on one particular service. I had an intern, a resident, four medical students, and sometimes a pharmacy person or a cardiology fellow with us. We would make rounds. My job was to take the best possible and most humane care of the patients. At Ohio State, we often got the very sickest of the sick.”
At the same time he was doing that, Fulkerson was teaching. “I taught students, interns, and residents. I took that very seriously. I devoted two hours a day to teaching. As we made the rounds, visiting each of my patients in turn, a student presented the case to the group, sometimes sitting in a classroom and at other times in the hallway. I would ask pertinent questions about, for example, the patient’s family history.
“If we were presenting a case in the hall, I’d go see the patient with this group of five or six people. We’d walk in and I’d introduce myself. Often I had seen the patient the night before and completed his physical. I had to get it right for the patient. I had to take the patient’s history and do a physical exam. Often it was written on the chart as well for the students to see.
“I educated interns and residents more in the afternoons. We would have our set of labs without students and we would talk about patient management issues,” Fulkerson continued. “What drug? What dosage? What’s the next care? What’s the discharge date? Case management is a cutting-edge kind of thing that students don’t need to be bothered with. They need to know the science of what’s going on, because management will change by the time they get out of medical school and out of their training. But the basic science of a heart attack will not. So students must learn how to take a history and do a physical and relate that to the science of medicine. All that education was going on when I was on the ward.
“I spent a lot of time with patients; that was my primary responsibility. I couldn’t screw that up. If patients don’t trust me, then they won’t tell me everything, stuff that may be critically important. So I spend a lot of time taking that history, talking to the patient, talking to the family. Every day I spoke to the family and the patient about what’s going on, what we’re learning, and what our treatment plans are.”
When he was on that monthlong rotation, at any given time Fulkerson was responsible for the care of eight to twenty-four patients. To handle that caseload and spend adequate time with his students, interns, and residents, he was in the hospital by six o’clock every morning. Often he returned home as late as 11:00 p.m.
“If six patients came in overnight through the ER, that was six people I had to meet and do a complete history and physical that morning,” he explained. His patients suffered from heart failure, heart attacks, and breathing troubles. Fulkerson is a pioneer in the use of echocardiography. “It was then brand new. So I had to learn it along with the rest of the world,” he added.
The amount of time Fulkerson spent with students and patients was not the norm. “I spent more time with students teaching and more time with patients earning trust than most physicians in my situation,” he said.
Fulkerson’s approach to teaching medicine, if not unique, was at least highly innovative. Medical schools across the world have taught in much the same manner since at least the eighteenth century, placing great emphasis on lectures.
“I was big into curriculum, learning theory, and educational theory,” he explained. “I don’t believe teachers can impart things to students. They can only sequence and present things so students can learn. I believe most learning in medical school takes place between 8:00 p.m. and 2:00 a.m. when the student is home, reading their book, studying their lecture notes, and making the material concrete in their mind. They have to internalize the material and come up with understandings of what it means. And you can’t do that in a lecture for 250 kids. Most of them are with you only 30 percent of the time. Their minds wander.
“I believe education has two parts,” he added. “There’s teaching and there’s learning. Your job as a teacher is to provide appropriate learning activities so the student can actually get it done.”
After giving a few lectures to sophomores, Fulkerson was put in charge of the sophomore cardiology unit. “Instead of lecturing in the afternoon, we had small group activities. I had them interpret chest X-rays with a teacher present to help them understand the principles of X-rays and what the X-ray means. We spent the afternoon reviewing six X-rays. Another day we reviewed EKGs,” Fulkerson explained.
“One of the most fun and interesting things I did in sophomore cardiology was to buy sixty-five beef hearts, one for every three students,” he recalled. “I wrote a manual on beef heart dissection, including both anatomy and pathology. Students had their anatomy dissection tools and a beef heart, which is the size of a football. A human heart is about the size of a softball. With greater scale, a student can actually see the smaller features of the heart. These hearts were fresh-frozen instead of embalmed in formalin, so they retain their color and flexibility, whereas an embalmed heart is blurry and stiff. They learned a great deal about cardiology from that exercise,” he concluded.
Fulkerson was subsequently promoted to head the whole second year of the Ohio State medical school. “I did that for about eight years, and I made all those other units get out of the lecture hall in the afternoon and develop small group learning,” he said. In that manner he revolutionized the second year of medical school toward learning instead of teaching.
Phillip Fulkerson retired from medicine in 2004, but he did not stop teaching. For the last fifteen years, he has spent much of his time tutoring elementary school students in the Rockford, Illinois, school system. He set up tutoring programs, involving members of his church to staff six half-hour morning tutoring sessions to provide ninety minutes of one-on-one instruction each week to twenty-four students in kindergarten and first and second grade. He describes these personalized one-on-one sessions as being particularly effective for students who start school with limited previous exposure to the learning process, often kids from homes that had no books. Each student’s classroom teacher sets forth specific goals for each student.
In addition, Fulkerson’s wife, Carolyn, and a few like-minded friends launched a scholarship endowment program, the Dayton Foundation, for graduates of Belmont High in Dayton, his hometown. They created two separate endowments. One offers $500 annual grants to students pursuing vocational or job skills training at a Dayton community college. The other offers an annual grant of $1,000 to students pursuing a degree in teaching, psychology, sociology, nursing, or another medical field. The Fulkersons intend to continue raising money to increase the number and value of these scholarships. Thus far the Dayton Foundation has dispensed $1.7 million for 2017, 2018, and 2019 and has accumulated an endowment of $70,000 for future scholarships.