Dallas Walker was a 20 year old diabetic dwarf, who came to Duke Medical Center in the spring of 1979 for treatment of his diabetes that was out of control. His local doctors had tried their best, but were unable to manage his diabetes and they were aware that he was deteriorating rapidly. His health was failing and they didn’t know what to do.
I was a fourth year medical student who was taking advanced internal medicine as an elective when I met Dallas. He was one of my first assigned patients. As a fourth year student, I was supposed to function like an intern, except I would only see one new patient every other day. On the other hand, I was responsible for that patient, and I was the one who ordered everything and literally cared for the patient. Everyone was at my disposal; interns, residents, professors, consultants, the library, and anyone else I wished to contact. But the patient’s welfare was my responsibility. This was a lot of responsibility for that stage in my medical development, and I took it very seriously. Quite frankly, it was daunting.
Nonetheless, once I met this 20 year old, five foot tall man, who looked only about 12 years old, I began to understand why they called him a diabetic dwarf. He apparently was discovered to have diabetes at age five, but likely had it for a few years prior to that. It was not controlled during the ensuing years, and the disease process literally stunted his growth. He wound up a dwarf, who looked like a child. But that was not all. As with diabetes in general, if it is not controlled, many serious health effects can result. By the time he presented to Duke, he had failing kidneys, was losing protein in his urine, had severely swollen legs up to his thighs, was having fragile blood vessels rupture in the back of his eyes, causing loss of vision and he had hypertension that could not be controlled. This angelic appearing 20 year-old was a complete mess. As you might imagine, this was a great case and a severely intimidating case all at the same time. Dallas had as many problems as two or three typical Duke patients, and he had the most inexperienced person on the medical team assigned to him. But it turned out that this was the best choice he could have made, if he had had the choice to make.
After a thorough work up, all of the consultants that I could think of were called to help me with this case. There was an endocrinologist, nephrologist, cardiologist, and ophthalmologist that were consulted. They all scrutinized this unique case and did their best, but one week later, poor Dallas was not much improved. He appeared a bloated, puffy, short boy, with failing eyesight and kidney function, as well as diabetes that was out of control. He was so challenging that the chief of the endocrinology department was brought by, but, alas, to no avail. Dallas was not improving. It seemed impossible to me that this patient was not getting better at Duke Hospital, something I didn’t even imagine could actually happen.
This was all quite troubling, and as I walked pensively through the hospital hallways, I ran into a former professor, Dr. Frank Neelon, and I told him about my dilemma with Dallas. I had also read some short work by Dr. Eugene Stead about the nephrotic syndrome (which Dallas had), and I wanted to know what Dr. Neelon thought. There was mention that this could be cured by the Rice Diet, and I had no idea what that was or how to implement it. “Could it work?” I asked. Dr. Neelon, who in his inimitable way, said “why don’t you go down to the basement of the Blue Zone and find Dr. Stead, and ask him yourself.”
Dr. Stead was the former chief of the Department of Medicine for 20 years, before he relinquished that position. By the time I was about to meet him, he was a professor emeritus, relegated to an office in the far corner of the basement of the hospital. Dr. Stead, by the way, had a reputation of being a very difficult task master, and an extremely intimidating person to the medical staff and students. All the stories about him propagated fear. He would grill students and young doctors to tears, especially if he could find any faults in their presentation or their care of the patients. That was the word on the wards, anyway. Suffice it to say, that I believed all the hearsay, and was intimidated at the prospects of speaking with Dr. Stead.
Nonetheless, I had no choice. I reread the pamphlet Dr. Stead had written on the role of the Rice Diet in treating the nephrotic syndrome. When I felt I was ready, I marched down to the basement and found a non-descript office in the corner-most part of the Blue Zone. I entered a secretary’s office, and an elderly, gray-haired, pleasant lady asked what my business was. “I’d like to speak with Dr. Stead,” I replied. She looked me over, and deliberately stated, “Dr. Stead is only here two days a week. He will be back tomorrow, why don’t you come back at 1pm?”
I felt like I was Dorothy at the great gate to Oz, and the guard at the door had just said, “the wizard is not in today, come back tomorrow.” And that was exactly what I did.
The next day, at precisely 1pm, I hurried into the office of Dr. Stead, and after a short wait, I was ushered into his unassuming office.
“What brings you to my office?” he queried. “I don’t get many young visitors these days.”
I slowly relayed the story about how the entire medical staff and I were failing to cure this poor diabetic dwarf from the back woods of North Carolina, and I wanted to know whether the Rice Diet he had written about would help Dallas.
Dr. Stead looked me over, and asked me a few questions to see if I had really read his essay. Then, when satisfied, he said, “Why don’t I take a look at this young man with you? You can present the case at the bedside.” I had heard that he was the main originator of the bedside presentations that was the hallmark of all medical presentations at Duke. “When can we do this?” I asked. “Let’s go right now,” he responded, and off we went to Long Ward, to Dallas’ bedside, and I presented his case in full. Then Dr. Stead asked him a few questions and perused his chart. After a short while, it appeared that he was satisfied that we were not doing a good job in his overall care (despite a great effort), and he said that he thought the Rice Diet might be very beneficial, but it could only be implemented by one man, Dr. Walter Kempner. And right there, Dr. Stead picked up a phone and spoke to “Wally,” and asked if he would let me tell him about Dallas and decide if he could help us. They agreed to meet the following morning. We all convened at the “Rice House” the following morning, and I presented the case yet another time to a short, slight, balding man with delicate features, but eyes that looked inside you. He had on his signature uniform: light blue blazer, white shirt—with top button open—white slacks, and white shoes. He had a commanding presence, despite his short, delicate stature. He was a man used to assuming authority, used to giving orders. It was all apparent, even to me, a naïve medical student.
After hearing the case, he listened to Dr. Stead relay how this patient would in fact have no means of paying for the Rice Diet Program, and he wanted to know if it could be provided gratis.
Dr. Kempner was silent. He looked at both of us, and after a long silence, he said (in a heavy German accent), “and why should I treat this patient for free?” I certainly had no answer, but Dr. Stead said, “Well, you know, Walter, that I would do it if I could, but you already know that I failed at that when I set up a Rice Diet at the Department of Medicine many years ago. We couldn’t get the results that you do, so we quit. You would have to do it, if this boy is to get better. Can’t you make him a charity case?”
Dr. Kempner seemed to like the way Dr. Stead had put that “charity case,” and his eyes lit up, and began to sparkle. “I could do it, but how would that help this medical student?” he said, glancing at me. “How will he learn anything about the diet?” He looked at Dr. Stead, and then Dr. Stead looked at me. “Why don’t you have him come here every day to see what you do here, and he can help to care for Dallas with you. This way he will learn something. In addition, he will come to see me every week, and report on Dallas’ status to keep me informed.” They had a deal.
Suddenly, I had been given more time on the job, all without pay. But as it turned out, it was “the road less traveled, and that which made all the difference.” It was the defining moment in my medical career, although I didn’t know it at the time. I thought it was neat how this was all unfolding, but the 7am meetings at the Rice House seven days a week (on Saturday and Sunday as well) seemed onerous. After a full 50-60 hour week on the wards, I had to get up very early to get to the Rice House so I could see what happened there. Dr. Kempner seemed pleased to have me there, and introduced me to all the patients. Dallas seemed quite a bit better when I saw him again, after only a few days on the new diet. Every weekend for the next eight weeks, I spent 2-3 hours at the rice house, starting at 7am. I really hated getting up early, but after a few weeks, I actually looked forward to the early morning jaunts to see how the patients were doing. Dallas was thriving. After a few weeks, he had lost a lot of his extra fluid, his kidneys were improving, as was his eyesight. The hypertension was getting under good control, as was his diabetes. This was truly amazing. This thin, well-dressed man, who wore the same uniform daily, was able to heal Dallas outside the hospital, whereas “all the king’s men” at Duke Hospital “couldn’t put Dallas back together again.” This was intriguing! Dr. Kempner was one of those larger-than-life men, that were able to throw themselves into their work 100%, and because he believed in what he was doing, he had better results than anyone expected.
At the end of two months, Dallas had been taken off of all medication, except for his insulin. That dosage, however, was lower than when he first presented at Duke. He felt the best he had in the past few years, and he was longing to get home. I have not had any follow-up with Dallas over the years, but if he was able to stick to some of what he learned at the Rice House, he certainly would have been much better off than he would have without the time spent with Dr. Kempner.
For me, as a malleable medical student, this was an unbelievable experience. I had witnessed a miraculous recovery in a very low tech setting. By the end of the 1970s, high tech was the future of medicine, and we were all mesmerized by its flashing lights, CT scans, endoscopic and surgical instrument, cardiac catheterizations, and angioplasties. Each specialty had its explosion in the technological arena, and new drugs had begun pouring forth like running water. It was a time to forgo the past and move on. Nobody at Duke Medical Center would think of not treating a patient with hypertension with one of the new anti-hypertensives that had exploded onto the market. Diabetics were being tightly controlled with more surveillance, but when they had bleeding in the back of their eyes, like Dallas, they were sent to the Ophthalmologist to begin YAG laser treatments to try to seal those leaky blood vessels. If their kidneys began to fail, they were observed, and the nephrologists (kidney doctors) waited until they might need dialysis or a kidney transplant. In the meantime, they received supplemental medications. If the patients had heart failure or coronary artery disease, they received a number of medications and, perhaps, angioplasty or surgery. I was amazed at how few of these specialties were trying to treat the core problem and, therefore, remove the need for all these medications and high tech procedures.
I felt as if I had been present at Mt. Sinai when the Ten Commandments were given to the Israelites. The Rice Diet had been, quite simply, miraculous. Why weren’t we using it across town, at the University, in our fair city of Durham? Dr. Kempner was right here in Durham, so why had I never heard his name mentioned? Why weren’t there a number of students and interns at the Rice House every day to see the miracles that were occurring on a daily basis? All these questions bounced around in my brain, and it didn’t make sense. Why was such a resource like Dr. Kempner going unused right here at Duke University? Let me return to answer this question in a short while.
If the Dallas Walker story was an anomaly, then I would have easily understood how this simplistic, backward program would be shunned by the premier medical program at Duke Medical Center. It was no anomaly. Forget about all the miraculous results that had been obtained in the past, I wanted to see what was happening today. Dr. Kempner obliged. He took me by the wrist, which was his way, and stopped patient after patient, and made them tell me their story. After a while, I saw the repetitive themes, spoken by different patients, again and again. To them, he was an eccentric, charismatic genius who had helped them turn their lives around, from desperation to hope. Most of them were grossly overweight and had benefited in an immediately visible fashion by shedding pounds of “excess baggage,” as Dr. Kempner liked to put it. He would ask each of the patients, mostly middle-aged or older, if they were able to carry more baggage now when traveling, than when they were young. They would invariably respond, “I could carry much more when I was young.” Then he would ask, “So why are you carrying all this extra baggage with you now?” They would nod, agreeing that they needed to do more work and lose more weight.
After the weight loss, there was the new sense of well-being and increased energy that they all displayed, and the shorter medicine lists, as most had been able to stop many of their previously-taken medications. This shorter medication list by itself made them feel healthier! Then they could walk further, stay up later in the evening, forgo their naps, and were, in a word, more “productive.” The high blood pressure was normalizing, the cholesterol and triglyceride levels were lower, the blood sugars were better. Then there were the scores of miracle stories:
There was the thin diabetic man, who was not as bad off as Dallas, but by age 50 was losing his eye sight. As any of us would be, he was desperate. So he came to Durham to eat rice and fruit. Over 4-6 weeks, he went from being almost legally blind to being able to read the newspaper and pass his driving test. He was a believer, and in his eyes, Dr. Kempner was a saint.
There was the CEO of one of the main jean companies, who had severe obesity and heart failure. After a month on the program, he was breathing better, walking a mile and not having any chest pains, which were even occurring after walking across the room one month earlier.
There was also a prominent businessman, who had severe hypertension that had been poorly-controlled for years, resulting in the onset of kidney failure. If it got much worse, he was notified by his doctors that he would have to be on dialysis. That was his wake up call. He investigated and decided to come see Dr. Kempner. In 4-6 weeks, he had decreased his blood pressure, had gotten off of most of his BP medicines, and his kidney failure was returning to normal. It would take a few more months, but he had been shown the miracle of the Rice Diet, and would not need dialysis. He became a disciple of Dr. Kempner.
There were more stories just like these, and there were many others just there to lose weight—apparently something they had not been able to do on their own or even in a group or with their doctors.