Dr. Norman Schatz

Great Conversations Section Editors: Meagan D. Seay, DO Rachel Calix, MD Dr. Norman Schatz FIG. 1. Norman Schatz (right) and Steven Galetta (left) at dinner during American Academy of Neurology 2019. L aura Balcer (LB): We want to welcome Dr. Norman Schatz, and we are honored to have him here (Figs. 1– 3). He is actually the first neurologist to become a neuroophthalmologist. I thought we’d start with one question to get things rolling. And that is, “Why did you become a neuro-ophthalmologist as a neurologist?” You were one of the first. Norman Schatz (NS): Well, it has a little depth to the answer. It really starts with my interest in neurology and how that came about. That was a passion because my father was paraparetic. From the day I was born until I was in my midteens, he progressively worsened. There was an interest as to why this man was in pain, didn’t have a bladder that worked, couldn’t get out of a wheelchair, and drove his automobile with hand controls. By the way, I learned to drive with hand controls in my car. LB: Okay. NS: And that was quite a stimulus. Then another fateful thing happened, and that is, when I was 22, I had bilateral Seay et al: J Neuro-Ophthalmol 2020; 40: e65-e73 optic neuritis and lost my vision. I came under the care of an ophthalmologist doing neuro-ophthalmology who put me on IV Adrenocorticotropic hormone daily for a year. That led me to being admitted to a psychiatric hospital for 2 years. LB: Oh my goodness. NS: I came out of that and came to fulfill my dreams as a neurologist when I went to Wills Eye Hospital, part of Thomas Jefferson University. Bernard Alpers, who was the program director of neurology and also the program director of Wills Eye Hospital’s consulting, took me into the residency. I realized that during that period of time, of all the things in neurology that I had a grasp of, neuroophthalmology, which I was doing so much of, I had no information about. So I was motivated to go on to try to figure that out. I then applied to work with Lawton Smith at the University of Miami and spent a year with him. I returned to Jefferson to help out at Wills. There were wonderful people at Jeff during my residency. Nathan e65 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations FIG. 2. Norman Schatz (right) and Steven Galetta (left) after Grand Rounds at NYU in 2019. Schlessinger was a neuro-ophthalmologist who approached things in a way from that generation where neuroophthalmology and psychiatry were intertwined. He brought to my attention a different approach to neuroophthalmology. All our patients with blepharospasm got electro-shock therapy because they were in Freudian denial of sexual activity and kept their eyes closed. I had to go up to watch these people getting electric shock therapy, and it looked to me like they had an organic disease that was a movement disorder that was very disturbing. It opened my eyes and made me question classic teaching. NS: And so that chapter went by—of the optic neuritis and the MS, and the steroids—and then not knowing what tomorrow would bring. Seeing the psychiatric aspect brought in by Nathan Schlessinger put me on the path of combining neurological thinking about human behavior. And then I looked for a program. Lawton Smith seemed to fulfill many of my further education needs. LB: Can I ask you, how was your experience with Dr. Lawton Smith important for your clinical skills? NS: Lawton Smith was the show master and he was really a promotional spiritual leader. He was spiritual in his biblical thinking, he was certainly spiritual as a teacher. He certainly had enough gimmicks to reinforce your knowledge. He would make tapes so that medical students could e66 FIG. 3. Norman Schatz and Steven Galetta at visit to NYU Grossman School of Medicine in July 2019. listen to his teachings in their cars on their way to work. He recorded me and would say: “I have Dr. Schatz here, the world’s expert in syphilis. He’s going to tell us all about the Argyll Robertson pupil.” LB: No pressure. [laughter] NS: And he’s taking what I say and putting it in people’s cars all over the country. LB: Simple. NS: And it really was effective in conveying, “You can learn, you can get information, and you also can go out and teach, and you can do something where people will understand.” And that became my goal and I felt, I’ve got to do this thing. Then it evolved because we had a companionship of the Ron Burdes, the Joel Glasers, the Neil Millers, the great people that began to appear, and then Tom Carlow gathering them together with Bill Hoyt and forming this society. It began almost like having coffee klatches, we would meet and say, “I’ve got something better than yours.” [chuckle] NS: And everybody went to their own corners and said, “I’m going to bring in another case.” LB: That’s fantastic. NS: And one of my great experiences was when John Guy went to Gainesville, and he had been one of my fellows, one of my early fellows, and set up cases for me to Seay et al: J Neuro-Ophthalmol 2020; 40: e65-e73 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations discuss, and he called it 10 Cases with Schatz, stamped in the program. And then they would present 10 placards and I would discuss them. John had the right idea. The thing that has reinforced my interest has always been the students that have come my way, what they’ve done, how they’ve done, and how they’ve glorified my achievements. LB: Yeah, that’s great. LB: You had related earlier that Dr. Smith really made it possible for you to be first fellow who is a neurologist. Can you tell us a little bit about that? NS: Well, that was a wonderful thing. We can’t say that there weren’t neurologists because there were many—like Morris Bender was a New York–based neurologist with an interest in neuro-ophthalmology doing eye movements and recording and discussing them. NS: Bender was from Mount Sinai in New York. He would come down to Philadelphia when I was a resident, and he would come into the room and he’d say, “What kind of case is this? Nickel and dime, cheap stuff.” He was firm in his opinions, saying, “We’re not going to operate on this subdural. We’ll sit at the bedside and watch him get better, and everybody keep your hands off.” This was an innovative time. We didn’t have computed tomography (CT). As Lawton Smith said, “We had air, fire, and water.” Air was pneumoencephalogram, fire was angiography, and water was spinal fluid examination. I added phrenology because you feel the bumps on the person’s head, and that was what you could do in our time. After I finished my residency, CT scan became available. I was at Jefferson Medical University on the committee to try to select CT scanning. What an adventure that was. I did the review of everything available. Jefferson selected a CT scan and I said, “You only get shadows and I’m not quite happy with that.” And then we got our first pictures, and we could only see shadows. Suddenly, you noticed there was a dichotomy between your clinical thoughts and what this CT scan said, and you knew they were wrong because we did our learning from brain cutting, and they hadn’t caught up with us yet. Well, you know where they’ve gone now. We don’t have to cut brains anymore. We don’t have to do anything. All we have to do is get the right slice and know what you’re looking for. LB: That’s amazing. NS: You do have to have the answer first. It makes looking at it much easier. LB: I see. NS: So I don’t think we’ve lost anything by our accomplishments. In fact, it’s made it more difficult for the clinician because the clinician who doesn’t know the answer before he asks the question doesn’t get anywhere. LB: Right, because one of Steve Galetta’s main questions is, how did you master anatomy so well? You are the master of that. NS: That’s an interesting story. When I finished college, I was looking for something to do before attending medical school at Hahnemann Medical College. Ray Truex was the Seay et al: J Neuro-Ophthalmol 2020; 40: e65-e73 neuroanatomist there, and he put me to work in the laboratory to first dissect the whale’s heart bundle of His. LB: Oh, how big is a whale’s heart? NS: Maybe as big as a small car. We were working with the whale’s heart. That was a very interesting time. My roommate at that time became Dr. Facial Nerve, Mark May, who was at the University of Pittsburgh. NS: And of course, you couldn’t get past Pittsburgh without getting your seventh nerve decompressed with Dr. Facial Nerve. He was a sportsman and a big swimmer and had a different temperament. He also worked in Truex’s laboratory. He was injecting arteries and getting casts of them while I was looking at nerve fibers and seeing what they were doing. It was kind of an interesting combination. Then we got assigned our cadavers. We went into Truex’s cadaver laboratory, and this is a true story. Mark’s cadaver was an obese 350 pounds—you can’t learn any anatomy on something when you find adipose tissue. My cadaver was fantastic. There were 5 students at every cadaver. Well, I became the meticulous dissector because we had the body that you could see everything. It became so fascinating to me. Until then, my interests had really nothing to do with mechanics but now I had some structure to put things on. That fit together with what I wanted to do. LB: That’s fantastic. NS: My interest in anatomy led me to my interest in CT scanning. When CT came out, I thought I better learn everything. Then I took physics courses at the University of Pennsylvania with a radiology resident, Dr. Robert Grossman. At Penn, GE’s MRI was going to be the next tool to look at anatomy. I got on the committee to look at the MRI and said, I better learn this and take the physics courses with them. I had the background of anatomy, I had the background of brain cutting with that wonderful program at Jefferson. The neuropathologist there, Dr. Richard Berry, was fantastic. And when he would bring out brain cutting, every one of us would have to have an opinion before he cut a brain. LB: That’s very good. NS: When MRI came about, everybody had an opinion, and you had to know the answer before you looked at the film. LB: That’s how you learned neuroanatomy so well. NS: That’s how I learned neuroanatomy. LB: We were talking about how he became a neuroophthalmologist as a neurologist and how Dr. Smith was so influential. And it sounds like from what you were saying, you have really developed the characteristics of a teacher that you had, modeling on in part of Dr. Smith and others you’ve admired, and you really. NS: Incorporated them into me. LB: Yeah, you just bring the aspects of a great teacher. NS: I didn’t convert, though. LB: Right. Okay, great. [chuckle] e67 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations LB: You did not convert, either way. [laughter] Steve Galetta (SG): But you did go to various dinners, right? NS: That’s an interesting story in itself because. I was making $3,000 as a fellow in Miami. Because I had 3 kids, and because feeding them was difficult, Rhoda and I used to go to the Bible classes where we could get free sandwiches. LB: Great. [laughter] You got the sandwiches for your kids. [laughter] LB: Before we started recording today, we talked about some interesting meetings with Dr. Smith. But I think all of these things make for a wonderful, colorful relationship. Can you tell us about you and Dr. Joel Glaser and your special relationship? NS: What I might tell you about is when I arrived in neurology with my chairman, Bernard Alpers. He had written his book which was the gold standard—or one of the gold standards of neurology other than the European greats. He always took a third-year resident on his service. The third-year residents by that time were going to Europe to do electives, et cetera, and he selected me, as a first-year resident, to go on service. He made rounds at 6:00 in the morning. We had to be there at 4:00 AM. When he came into the room, we had to roll a pillow under the knees of the patient, hand him the hammer, he would hit the knees. And we would go, “Oh,” in admiration. We had worked up 5 patients the night before, all admissions stat and with the toughest neurologic problems, you know this story. NS: I presented to him at 6:00 in the morning and he said, “Tell me about this patient.” I said, “She is a 63year-old Caucasian woman, married. And she has a movement disorder where she is making myoclonic movements in her arms. She’s confused, she cannot do serial subtractions. She has a disoriented attitude.” And so he said, “Well, what is that?” And I said, “She throws her hands up and jumps.” I kept repeating this description. Five minutes in he said, “Did you ever hear of Creutzfeldt–Jakob disease?” [chuckle] NS: This is my first week. Of course, I said no. And he said, “You are the dumbest person I’ve ever met.” LB: Yeah. Are you a resident or a medical student? Oh my goodness. [chuckle] NS: I was a resident, but I was just finished obstetrics during my internship. [laughter] NS: I said, “Come on now.” He then fired me. I went out. I called Joe White, who was the chairman of the residency program. He said, “Oh, please don’t worry.” He said, “We’ll get it straightened out.” A week went by, I was coming into the library, and I called Dr. Alpers’ office. He wouldn’t talk to me, wouldn’t take my calls. And I said, e68 “I don’t know what to do.” Finally, a month later, Joe White said to me, “You’re going to go into the neuropathology laboratory with Dick Berry.” So I said, “Well, that’s funny.” So I called Alpers’ office disguised as one of his recently discharged patients. I said, “This is Mr. Colin. I was recently discharged. I want to speak.” His secretary said, “I’ll put you through right now.” [laughter] NS: I said. LB: I love it. NS: “Doctor. Professor Alpers, this is Schatz.” LB: Oh, amazing. NS: “If you don’t think I can be a clinical neurologist, why don’t you take the courage and fire me. I am not going to the neuropathology laboratory. You think about it.” I hung up. [laughter] LB: He’s a man of courage. NS: So, Joe White. I said to Joe, “What should I do?” he said, “Don’t worry, don’t worry.” Finally, they said you’re banished to Philadelphia General Hospital (PGH). Now Philadelphia General Hospital had 4 services. Penn had 20 beds. Jefferson had 20 beds. Hahnemann had 10 beds, and Women’s Medical School had 10 beds. And there were 60 beds in neurology at PGH. And the patients had been there for a long time—they were old demented patients. Since I got there a month after things started, they didn’t know who I was. So when they asked, they said they’re expecting the new chief. I said, “That’s me.” [laughter] NS: Now this is a true story. [laughter] NS: I get an office, phone, and a secretary. LB: No way. NS: I said, “What am I going to do?” I said “I’m used to getting up at 4 in the morning. I’ll go, make rounds on all the in-patients because my patients were not challenging.” I went to medical wards and found the “TB meningitis.” I went to all areas and transferred the interesting patients to my service. They had been sending their patients to the Penn service. [laughter] NS: Well, the head of the Penn service was Wilmer Anderson. NS: He was a neurologist, head of the Penn service at PGH. He was supposed to be doing all in-patient consults, but the residents were sending them to me. This is an important thing to know. So I would make consults on thousands of patients because they would go directly to me because they knew I was available. The head of the Hahnemann service was Don Baxter and we had no conflict but Dr. Anderson found out my game. Finally, I was caught—6 months into it, running the service. LB: That’s pretty good. Seay et al: J Neuro-Ophthalmol 2020; 40: e65-e73 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations NS: Anderson brought me to the Medical Director office of PGH, the head of service. NS: They said “What are you doing, you’re seeing consults?” I said, “What is the charge? Doing good medicine?” And they said “No, I think it would be a little bit fairer if you at least saved some consults for Dr. Anderson.” So I made the deal that Anderson would get every other consult and we would discuss what he wanted. That was another escape on my part. Alpers would come to Philadelphia General once a month and I would present to him. He came to me about a year into my PGH rotation and he said, “You know, Schatz, Dr. Louis Weiner, Dr. Elliott Mancall, and Dr. Lawrence McHenry tell me you’re the best resident we’ve ever had.” NS: And he said, “Schatz, I know you’re a shit and you know you’re a shit. Will you come back on my service?” And I said to Alpers, “Not yet.” I said, “2 years in PGH,” and I spent my next year after that with Dr. Alpers as his resident. LB: No wonder they wanted you to be a neuroophthalmologist because you’d already been so much. NS: Well neurology was my love, and. SG: Did you guys get into how neuro-ophthalmology came to be? NS: We’re there. SG: Oh yeah. LB: No we talked a bit about it, but I think Dr. Schatz told more before the recording was on, but he was talking about meeting Dr. Lawton Smith. [laughter] Prem Subramanian (PS): Oh you’re waiting for that Lawton Smith, that whole funny story about. SG: About the dueling neurology fellows. [laughter] NS: It was arranged that I would interview with Dr. Smith at Johns Hopkins during their alumni day. The evening that I was to see him, Lawton called me and said that he was having dinner with the “big dogs,” and he informed me that the he wouldn’t be seeing me that night and indicated that he wouldn’t be interviewing me. At about 8 PM, there was a message for me at the desk. It indicated that I could have breakfast with Lawton at 7 AM and that I should come to his room in the morning. I met him at his room and we went down to breakfast. At the table, there was Professor Frank Walsh, Professor David Cogan, William Hoyt, and J Lawton Smith. As I sat at the table, there were some back and forth comments and without being interviewed, Lawton mentioned that I would be his fellow. Seeing that I was somewhat confused, Hoyt leaned over and said “At dinner last night Lawton spoke about you and he said, you know I have a neurologist who wants to interview with me. Dr. Cogan says you can’t train a neurologist, Dr. Walsh says you can’t train a neurologist. I told Lawton that I was accepting my first neurologist this year and he said, “Mine will be better than yours.” Thus gave birth to my career in neuro-ophthalmology. Seay et al: J Neuro-Ophthalmol 2020; 40: e65-e73 LB: His was Daroff, right? Dr. Daroff? NS: No, his first was not Daroff. It was a fellow who became a neurosurgeon. NS: Then I came back to Philadelphia and Lawton did something very nice for me when I left. He invited me back every year to his January course and I gave lectures and was on the panels with Lawton, with Hoyt, and with Glaser, and then I’ll tell you how I met Glaser. LB: Yeah. NS: Lawton would call me when I left and say, “I’m going to Caracas to examine people with yaws and pinta.” Lawton thought that perhaps he could make a serum to prevent syphilis because yaws and pinta was a spirochete that crossreacted. So we went down, I examined 50 Amazon indigenous people, did the neurologics on them, did mental status examinations on every single one of them. And all the other ophthalmologists looked at one little eye. I had to do the entire examination. Now, the article was published and even the pilot who took the monkeys back to the States that we injected got a better place on the article than I did (1). [laughter] LB: Yeah, so you were talking about your relationship with Dr. Glaser and how you met. NS: It’s interesting. I was in Miami, I had 3 kids and a wife, and I met Glaser. He was a first-year resident in ophthalmology. And he was brilliant, and he had information. And when you were there your first time looking at the eye with all these people that are in their residencies for ophthalmology, you realize you’d better stay close to somebody who could tell you when you touched the eye you’re not going to hurt it, you’re not going to perforate it. Glaser really protected me and made me feel more comfortable with the examination of the eye. For me it was like “Swimming to Cambodia” going through the taboos of touching the eye. NS: Spalding Gray. SG: Correct. NS: He gave a wonderful monologue. Somebody told him he had a cataract and described what they would have to do with a needle. So he went searching for noninvasive treatments throughout the world. He ended up in China with an acupuncturist who came to him with a needle to put it into somewhere in his scalp and he ran out of there and decided to get his cataract operated. His monologues had a crescendo to them, and if you’ve never listened to his “Swimming to Cambodia” it is something worth listening to. It was inspirational when I found Glaser, and I realized that he was somebody that could coach me through my work, and he became my balance and I loved his humor, I loved his intellect, and I loved his smile and his moment. I was disappointed when he left me too early because he was a dear friend from 1965 until he died in 1998. We did everything together. SG: No, you drove in together, right? I mean, you would come in that little Flintstone mobile. [laughter] NS: Oh my god. e69 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations LB: One of those little zip cars? SG: It was a car that Glaser could pick up, and me and Schatz used to get in. NS: Have you heard the stories about that? So, I would come down for the. SG: Winter right? NS: Winter holiday neuro-ophthalmology course that Lawton Smith was giving. And Glaser would pick me up at the airport in his Alfa Romeo. SG: It was the tiniest car. NS: And he was a big man, so only one of us could get in the car. [laughter] NS: When I would come off the plane, he would be out there. On one occasion my plane was 2 hours late because of the snow, Glaser met me and over the loudspeaker we heard, “Will the owner of a red Alfa Romeo..” We arrived at the car to find 4 cops around the car ready to have it towed. He said, “What do we do now?” SG: Stick with me, right? NS: I said, “Stick with me.” I faked a seizure and neurologic problems. No one knew what to say. [laughter] NS: The police gave us an escort to the hospital. [laughter] NS: Glaser said then, “So that’s what life’s about with Schatz.” LB: That’s hilarious. NS: So it was the 2 of us participating in the Academy course in neuro with Ron Burde. I think it was the most successful primary course in neuro-ophthalmology for 15 years running at the Academy. Ron was a compulsive. And I would always tell Glaser, “We should go 15 minutes late. Let the conference start without us. Then they’ll really want us.” So, Ron would be pacing up and down the halls and say, “Where are they?” And we would come in . PS: Nothing ever changed. LB: That’s great. PS: Nothing ever changed. You guys would roll in at 10 or 11 o’clock for clinic. LB: Yeah. NS: And Glaser did that with everything. He did arrange for us to go on mercy missions to foreign countries to teach and do things. He’s got an eye to do—take eyelashes out or something—and I was going to do teaching. And he said, “We’ll go to Jamaica.” I said, “Uhh, I don’t know anything about.” He’s been there a lot, many times. He’s lived with Rastas in tree houses. So, I get to the airport in Jamaica and Glaser’s not there. I call him, he’s at home. I said, “What do you mean? You made the connection, we’re going to see your friends here, we’re going to give lectures.” He said, “Didn’t you know a hurricane is coming in?” I said, “Well. What do you mean? Don’t tell me you’re not coming.” NS: Sure enough, the hurricane came in. We could only lecture on the plane. Half the island was swept away, and e70 Glaser was sitting at home having matzah balls. You have to love a man to tolerate some of his stuff. I was in Philadelphia, he was down in Miami. I had returned to join the faculty of Jefferson. Alpers had retired, and Richard Chambers took over the Department of Neurology, and I was his neuro-ophthalmologist. On the first day, Chambers informed me, “There is no such thing as neuro-ophthalmology.” NS: I had one friend at Jefferson and that was Tom Duane, chairman of ophthalmology. He took me under his wing. Tom Duane was the head of the American Academy of Ophthalmology. He was a dear man and a wonderful friend and a wonderful mentor. He had me seeing my patients in the ophthalmology clinic. And he said to me, “I’m very interested in neuro-ophthalmology, any time you have something good, I’m in the next room.” He was doing his manuscripts and writing his book. One day, I had a patient with voluntary proptosis who could voluntarily push his eyes out of the orbits. He was a little proptotic to begin with and I asked Tom, “Would you please look at this guy. He’s got an interesting problem.” I told the patient, “When Dr. Duane puts his hands on your head, you pop your eye out.” So, Tom Duane walked in and he touched the guy. The guy prolapsed his eye to his cheek and Tom Duane said, “Oh my!” The lid closed behind the right eye. [laughter] LB: Oh my word. NS: Needless to say, Dr. Duane put up with a lot with me and even defended me against Dr. Chambers. Dr. Chambers was not very tolerant of me and wanted to end my career. Fortunately, Duane took me into the Department of Ophthalmology. SG: Talk about the Zee paper. NS: As Steve will tell you I kept quoting the Zee paper. Little did I know all of the residents in neurology were trying to find the paper that I made up. It never existed but the students would bring in all the other literature they could find on the subject and we all benefited. SG: So, were you the first neurologist that was housed in the Department of Ophthalmology? NS: I sure was. SG: And so, that’s a breakthrough for the many neurologists that. NS: I was with Dr. Alpers in my third year as a neurology resident, psychiatrists were taking neurology boards and they asked me to teach them. So I was teaching psychiatrists to take the neurology boards. Alpers found out and he said to me, “I understand you’re teaching neurology to psychiatrists.” I said, “Yes.” He said “If you’re teaching already you don’t need the residency, you can leave.” And he was a principled man who said that your job is to learn everything about neurology you can. And anything over and above that. Of course, he also told us that we couldn’t take anything from the drug companies that was gratuitous— Seay et al: J Neuro-Ophthalmol 2020; 40: e65-e73 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations those red hammer tomahawks and the pills [laughter]. Even if you ordered a blood sugar, he would say “Why did you do that? You’d better justify every last thing.” LB: Sure. NS: So it was another world. We didn’t have button B that gave you all the instructions. PS: You had your own board experiences that we don’t have any oral boards anymore in neurology for good reason. [laughter] I don’t know if you want to tell that story. NS: I will tell the story. So I went off to take my boards. It was at the same time that I was called to take my physical to serve in the armed forces. Daroff was going to Vietnam to be in the front lines, and I was a coward. So I took my boards—I had completed the writtens and then had to take 2 days of oral examinations. NS: I had 2 hours of psychiatry to do. First hour of psychiatry, they gave me a schizophrenic and I said, “He has hallucinations and this and that.” The second hour was in theory of psychiatry. The examiner asked, “Tell me, what are the recent advances in psychiatry?” And I said, “Well, there is operant conditioning,” and I went on to say, “Of course now they’re discovering about serotonin and depression and they’re also measuring serotonin levels, the new serotonin reuptake inhibiting drugs have come up.” In spite of my answers, he kept asking, “what are the new advances in psychiatry?” So we went through about 5 of these and I did everything from behavior modification to punitive to electric shock therapy. And finally, he said to me, “What are they?” and I said “There are no new discoveries in psychiatry. And it’s obvious we’re not getting along.” [laughter] LB: Oh man. NS: I said, “So I don’t think we should continue.” I left the room. Three weeks later, the mail came. I was expecting something from the neurology boards and the draft board and I was so nervous. I got home from work and it was 12:42 PM on a Saturday. SG: Wow. NS: Rhoda, my wife, said “Your special delivery letter came.” I said, “I have to go get it.” She says “It’s locked in the safe.” I went to the post office, I banged on the door, I finally convinced the guy this was a matter of life and death. He gave me the envelope and I went back to the house. This is a true story. My wife and kids are standing there, I open the envelope and it said, “You’re 4F.” My classification for getting in the military. So that was the good news. The bad news came a week later—that I flunked one hour of psychiatry, which was called theoretical psychiatry. What that meant was that I had to take 2 hours of psychiatry separately to complete the examination. NS: I got all the psychiatry journals and I spent a month reading. I was scheduled to take the boards at Mount Sinai with a psychiatrist. I arrived at his New York office and he said “Oh, you’re a neurologist, aren’t you?” I said “Yeah.” He said, “And you’re doing neuro-ophthalmology?” I said, Seay et al: J Neuro-Ophthalmol 2020; 40: e65-e73 “Yeah, that’s my interest.” He said “Oh. What do you like to do?” I said, “I’ll do anything you like to do.” [laughter] NS: He surprised me by saying, “Let’s go have coffee and you can get out of here.” [laughter] NS: I got my credit for 2 hours and fulfilled my requirements for board certification. So that was a wonderful story. Then when I came back to Wills, it was very exciting because Nathan Schlesinger was in charge of the Wills group. He gave me 3 days a week at Wills to see clinic patients. I didn’t generate any money, but I took over the clinics there, and he was there with me. Half of the patients got admitted to the neurology service. When they got admitted they formed one of the neuro-ophthalmology services at Penn. Twenty patients, one-third of all the neurology patients. SG: Yeah. We had a separate neuro-ophthalmology service at Penn. NS: You have a separate neuro-ophthalmology service at Penn. LB: Yes. NS: Dr. Asbury suggested I take over the Spiller service and that began the neuro-ophthalmology service for Penn Neuro. SG: There were just 2 services. It was a service for everything and neuro-ophthalmology. NS: And the neuro-ophthalmology service. And the residents would say, “Oh here comes another dump from Schatz.” NS: Wills rocket. SG: It was a Wills rocket. NS: We admitted everything because we didn’t have the way to workup patients. And these things were emergencies. LB: Yeah, they still are. NS: Yes. NS: So that was very exciting because I tumbled into a very responsible position. One of the early trainees was Dave Kaufman who came through to take an elective. He was a medical student and the next thing I heard was that he was going into neuro-ophthalmology to become a neuroophthalmologist, and he blamed me. NS: The Wills Neuro-Ophthalmology Service became more demanding. I was seeking help. I drove with my family in an recreational vehicle to Myrtle Beach. Glaser told me there was a neurologist there who finished his training but now was in the armed forces. That young man was Dr. James Corbett. He had completed his training with Hoyt and with Glaser and was ready to defend our country. But I needed his help to defend against my ignorance. Dr. Schlesinger agreed to have 2 neurologists, Dr. James Corbett and Dr. Linda Orr, to form the neuro-ophthalmology program at Wills Eye Hospital. Both of them, after helping create Wills Eye Neuro-Ophthalmology, left for their careers in e71 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations Oklahoma (Orr) and the University of Iowa and then the University of Mississippi (Corbett). Glaser came to my aid again and suggested Dr. Peter Savino who had finished his fellowship at Bascom Palmer with Glaser. He joined me in the neuro-ophthalmology program at Wills as a full associate. NS: In 1977, Tulay Kansu came aboard. She was one of my first fellows—a neurologist from Temple University and she became the Dean of Women’s Medicine at Ankara University, Turkey. And that same year was Robert Osher who went on to a career as a cataract surgeon. Ed Norton called me and said, “Could you take this young man, we’ve accepted him for next year, but I wonder if he could spend some time with you?” There was a wonderful story about Osher as a fellow. Everything Savino would tell him he would come to me and say, “Is that correct?” You know that can get under the skin of a fellow associate. And Osher could do it in a way that was impossible. So, that was the first group, and then came Walter Cobb, Jan Hilliker, Sue Benes, Roy Beck, Tom Bosley, John Guy, Mark Moster, Craig Smith, Mitch Drucker.. I know I’m forgetting some—but you can imagine what a group of brilliant minds we had. SG: You were starting. That’s when you really went fulltime at Bascom Palmer. NS: I had to leave Philadelphia because of illness and I joined the staff at Bascom. I had left my mark of contamination at Wills and now went on to Bascom Palmer and that was a fun group to contaminate. [chuckle] When I got there, there’s a wonderful story to tell. NS: I was there and Glaser was leaving for Israel. His wife, Irena, was pregnant with their first child. They had gotten some of Lawton’s evangelical spirit and Irena became a Hasidic Jew, from her Eastern European Orthodox Catholic roots. And they went to Israel to bond and have their child. The fellow got stuck with me. The fellow, Ed Buckley, was with me for 6 months. Joel returned and the ophthalmology residents had a dinner to welcome him back and to say goodbye to me. Everybody was in tuxedos. NS: Ed Norton, tuxedoed, wives and guests, and everybody. And Buckley got up to give the toast. He said, “I came here to do my fellowship with Smith and Glaser. I was Glaser’s select fellow for the year. What did I find? Schatz.” He said, “I was quite disappointed but you know, I have to tell you, anybody who’s with Schatz for a month, begins to talk like Schatz. And anybody that has been with him for 2 months, begins to think like Schatz. And anybody who’s been with him for 3 months, begins to look like Schatz.” And everybody in the room took glasses and a mustache and the big nose, put them on and I have the picture of Ed Norton with the whole crowd. LB: That sounds like fun. NS: And Buckley said, “And that’s what I got stuck with.” [laughter] e72 NS: So Glaser came back. And for 5 years I was just a volunteer at Bascom. The Penn group allowed me to leave Penn. Everybody wanted to get rid of me. [chuckle] NS: And the secret was I was good enough when I was leaving they’d say “Thank God he’s gone” and when I came back, they would say, “Oh, it’s so good to have you back.” SG: Absolutely. [chuckle] NS: I found the perfect balance of what to do. SG: So what’s the secret of keeping your enthusiasm for neuro-ophthalmology? It’s unparalleled. Where does that fire come from? NS: I think the fire is that I’ve always thought that I was a fake. And that I always got my gift from my students when I realized that they were getting a message. Sort of like a preacher in a church who asks for donations. The donations in the basket get thrown up in the air. And the preacher would say, “God will take what he wants. I’ll take the rest.” And that was what I did. I took my students and said, “My students will take what they want and I’ll take the rest.” The students kept coming and that was the gift that I took. Can you imagine? SG: Fantastic. LB: That’s amazing. You talked about being a character. Prem asked a question, “Is there a real Norman Schatz hiding underneath the Schatz character or are they inextricably merged now?” NS: I don’t think there is a hidden me. Remember, you don’t get there without insight and facing yourself in your mirror. LB: I have a question. Has the way residents and medical students learn changed over the years in your view point? Or is it just a matter of style? Or have we changed? NS: Now, I can’t say anything in my clinic without somebody taking out their phone and typing it, almost immediately. LB: Google it, right? NS: Googling, and. I’m always pleased when I get it right. NS: And if I get it wrong, I’m even pleased then because then I have information and we all learn something. So from my standpoint, the interactive nature of the student is my gift. But that’s what I had with all my students. They knew that I was real and they were real. LB: There’s no replacing that, no. NS: There was never a separation between which side of the discussion you were on. SG: You always made it so much fun. And it’s somewhat sad that there’s the iPhone to look it up now because the struggle of trying to find the information was part of the education. NS: Absolutely, absolutely. Students would go home and look for days. LB: The library. Go to that basement library thing where the shelves move. Seay et al: J Neuro-Ophthalmol 2020; 40: e65-e73 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Great Conversations PS: That’s right, you’d go to look something up, and you’d read the page next to it, instead, and find out something new. LB: Penn Library, remember that place? NS: Oh my goodness. Well. LB: If you had to pick a biggest accomplishment among many, what would you say? NS: The toughest challenge was the Hoyt Lecture at the American Academy of Ophthalmology—I was nervous as can be but very satisfied after it was over. But the biggest satisfaction for me was every time a new student came along who went on to show his or her brilliance and became accomplished. And I’m missing that now because I don’t have the same influence. LB: Do you miss teaching the neuro-ophthalmology community? NS: I thought that when I retired I should at least get stud fees. [laughter] SG: I mean you are a legend, on and off the field. LB: Definitely a legend. NS: I must say, one of the great thrills of my life was having the sophisticated neurology residents of my time say, “I saw Schatz on South Street, and we need somebody out every weekend to see if we can get a Schatz sighting.” And then there were the neurology dinners at the famous estate. SG: The Wharton Sinkler estate. NS: The Wharton Sinkler estate. You couldn’t even get in there without a tie and a jacket. And I would always tell after-dinner jokes that sometimes were a little off-color. Art Asbury would put up with everything, handle it with a little style. NS: And when Don Silberberg took over he would get very nervous. SG: You didn’t get banned. NS: Don Silberberg was so nervous but it didn’t change my behavior. LB: Tell us about social events you hosted for the Bascom residents. PS: Yeah, you used to take good care of them. NS: Oh, well, you know, when I got there I had been recovering from my 5 vessel open heart surgery. I was recovering by running 3 miles on the beach and finally got myself into some sort of shape. I was trying to establish my role at Bascom. The group of residents that I found was fantastic. They had a place called “The Shack” and with their misguided encouragement, I sponsored toga parties with 200 of our favorite friends. SG: Did you guys talk about NANOS, and how that got started? NS: Well, it’s a remarkable thing the way NANOS started. Tom Carlow was running a ski meeting. Hoyt would attend every ski meeting no matter where it was and he would even go every year to retina ski meetings in Vail and present papers that Seay et al: J Neuro-Ophthalmol 2020; 40: e65-e73 had interest for the retinal docs. He would present neuroretinitis, anything that related to retina. He persisted consistently in doing that for about 20 years. He loved to ski. NS: Joe Bicknell was the chairman of the Neurology Department at the University of New Mexico and was a certified cross-country skier who knew everything about the hills and got us to the best ski resorts. And Tom ran the beginning meetings where he invited his friends and he had trained with Glaser, so Glaser was there. He knew me because I was Glaser’s buddy. He got Hoyt and Daroff, who had trained with Hoyt, and Lou Dell’Osso. And that was the crew. Then we had a visiting professor as if we were doing Walsh’s Saturday morning conference and called it the Rocky Mountain Neuro-Ophthalmology Meeting. Joe Cannon who used to fly from village to village doing cataract surgeries for Native Americans—he was always there. And then we began to accumulate a list of people and with Tom Carlow’s engineering and Hoyt support and Glaser’s, Daroff’s and Ronny Burdes’s support, it took off to become NANOS. LB: Wow, that’s great. Initially, it was just one day or several days? NS: It was 2 days, and it was papers, and everybody brought their best case, and Lawton never attended. LB: Interesting. NS: Hoyt and Smith were major competitors and this was Hoyt’s stage to perform on. Smith performed in December in Miami. SG: And it was the Miami. LB: So the winter meeting in Miami was pretty nice. NS: Everything was an offspring of that and the New Mexico meeting. Look what’s happened to the North American Neuro-Ophthalmology Society. LB: I know, 700-some attendees. I was just reading the news that was going in the September issue. NS: Yeah, incredible, wonderful. So I am selfishly very proud of being part of that group that started it. I would like to think my legacy is the students I’ve trained. They gave me the credibility that I never could have achieved by myself. Meagan D. Seay, DO Kathleen B. Digre, MD Departments of Ophthalmology and Neurology, University of Utah Moran Eye Center, Salt Lake City, Utah Steven L. Galetta, MD Departments of Neurology and Ophthalmology, New York University Grossman School of Medicine, New York, New York REFERENCE 1. Smith JL, David NJ, Indgin S, Israel CW, Levine BM, Justice J Jr, McCrary JA III, Medina R, Paez P, Santana E, Sarkar M, Schatz NJ, Spitzer ML, Spitzer WO, Walter EK. Neuro-ophthalmological study of late yaws and pinta. II. The Caracas project. Br J Vener Dis. 1971;47:226–251. e73 Copyright © North American Neuro-Ophthalmology Society. 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