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March 31, 2011

Community profile: Tucson, Arizona

Eric Sipos, MD, and his family in Tucson, Ariz.

Eric Sipos, MD, and his family in Tucson, Ariz.

The following account is essentially true, according to the Arizona History Museum in Tucson. In 1880, when the railroad finally reached the booming city of 7,007 inhabitants, Mayor Bob Leatherwood was so proud that he sent a telegram to the pope in Rome, rejoicing that Tucson was now connected with the Christian world. Who would think that His Holiness, thousands of miles away, would respond? Thanks to a few of the mayor’s wise-guy friends, he did - sort of.

The telegram the friends concocted read, in part: "Congratulations…but where the hell is Tucson?"

Not a question that ever occurred to internist and pulmonologist David Engelsberg, M.D., but southern Arizona’s biggest city did seem far, far away to a born-and-bred New Yorker. "When I was a kid," he says, "I thought this was a place where they had cowboys."

Then, with a degree from the University of Kentucky College of Medicine, he signed on for training at the University of Arizona, arrived in town "and immediately hated the place."

But things changed. "After I spent my first year in a pulmonary fellowship, I got to like the place, and after two years I didn’t want to leave. And I guess I still don’t want to leave." In fact, "We don’t intend to move after I retire."

The many perks of Tucson, Arizona

He lists several reasons for staying. First, the obvious: The weather is "absolutely fantastic." Because of the almost perpetual sun, Tucson is "a great place for doing outdoor sports. I hike, play tennis, fish and ski. We have all of that stuff in and immediately surrounding the city."

Second: "Tucson is a real community and a unique community."

Third: "I like the medical community. It’s collegial."

Engelsberg currently cares for patients at St. Joseph’s Hospital, part of the Carondelet Health Network.

Fourth: "I like the informality of the town. …I like the fact (here) that I haven’t worn a tie in two or three years. And I’m still considered well-dressed enough to go anyplace in town."

"I think the constant sun exposure is good for your psyche and your work ethic," said Rainer Gruessner, MD.

Fifth, and most pertinent in his field: "Tucson has good leadership in medicine. The university is an excellent place to get trained or retrained or educated. I think they set a lot of standards and guidelines. You can always get a second opinion there. If I really need a top chemotherapy opinion, I’ll send a patient to the university."

As chairman of the surgery department at the UA College of Medicine, Rainer Gruessner, M.D., exemplifies the quality and scope of treatment and research there. Although directing a department of about 60 surgeons and 80 residents limits his actual OR time, he continues to treat patients with pancreatic and liver cancer, plus doing "all kinds of abdominal transplants."

His "stock in trade" includes bowel transplants and complex resections of liver and pancreatic tumors, but one of the most unusual procedures he recalls was "a multi-organ transplant in a little kid 1 year old where we transplanted the liver and the intestine and the pancreas." Another: "(In an adult) we removed a pancreas and isolated the insulin-producing cells and gave them back to him so that he wouldn’t become diabetic."

Gruessner’s road to the Southwest was long, both in terms of distance and training.

After medical school, residency and advanced training in his native Germany, he accepted a fellowship in transplantation surgery at the University of Minnesota in 1987, where he spent most of the next 20 years, eventually becoming vice-chair of the Department of Surgery. Then "I looked at different chairmanship positions, and this was the one where I thought I could make the greatest impact. That is why I came to Arizona. The atmosphere that I found here in terms of support for my specific practice area, both on the hospital side, the practice side and the university side, was just right."

Like Engelsberg, he found serendipities that enhanced his decision - low humidity, gorgeous landscape, easy access to spots like the Grand Canyon. In short, "I think the constant sun exposure is good for your psyche and your work ethic."

The history of Tucson

Ancient bones, spear tips and other artifacts have tipped off archaeologists to prehistoric civilizations.

By the time Spanish troops and missionaries arrived, Pima villagers were cultivating crops along the riverbanks.

The newcomers began developing their own brand of civilization, starting with the missionary Padre Eusebio Francisco Kino, who established the mission church of San Xavier del Bac. Now, a newer congregation, the Tohono O’odham people, lives in the area and worships at the church, the remarkable "White Dove of the Desert."

Today, Hispanic flavor is especially prevalent in the Presidio Historic District, site of the original fort. The area is home to Old Town Artisans, a square block of shops and cafes within a charming courtyard. Nearby, the Tucson Museum of Art and Historic Block is a complex of modern building and five vintage homes used as adjunct exhibit spaces. Exhibits often reflect a Hispanic influence.

The Tucson water story

El-Tour-de-Tucson

Nine thousand cyclists tackle El Tour de Tucson each November with courses from 109 miles to a children’s fun ride.

From the time of Spanish rule until Tucson’s appealing climate began to attract thousands of newcomers, groundwater, supplemented by monsoon downpours in fall, fulfilled community needs. Today, a million area residents rely on a canal system linked to the Colorado River. With current usage as a yardstick, according to Fernando Molina, a Tucson Water spokesman, "we have supplies at least until 2020 or 2022. Then we’ll have to look for a new source."

In the meantime, city government and local organizations are promoting conservation practices. One group, Tucson Clean & Beautiful, Inc. (TCB), has started programs for green energy, waste reduction, recycling and city beautification.

One of its most successful programs is Trees for Tucson. For $8 each, citizens, schools and neighborhood organizations can buy desert-friendly mesquite, paloverde, desert willow and ironwood trees. The program coordinator, Rani Olson, ticks off the many advantages, including carbon dioxide absorption, shade to conserve energy, trapping air pollutants and controlling stormwater runoff. The response, she says, has been phenomenal.

A tree-filled memorial garden, El Paseo de los Arboles (The Pathway of the Trees), now covers the banks of the old Santa Cruz River where Pima staples of beans, maize, squash, melons and wheat once grew. The garden’s popularity, says Olson, has spawned other specialty groves, including a children’s memorial park complete with playground, sports and picnic areas, plus a memorial wall and garden.

Besides its renowned medical research program, the University of Arizona is well known for work in many other areas, including water technology. Currently, its Water Resources Research Center is involved in researching such issues as safety for universal use of reclaimed water, the study of pharmaceuticals and pathogens in water, landscape trees requiring the least water, and improving water company planning to reduce its own impact on the environment.

Prosperity in the desert

Tucson-Courthouse-Dome

Construction on the Pima County Courthouse started in 1928 and features a ceramic-tiled dome. Now it’s on the Register of Historic Places.

Ironically, Tucsonans in 1885 regarded a territorial insane asylum as more of a plum than a university when the territorial government was allocating public facilities to various towns. Without a single high school in the Arizona territory, what good would a college be?

Little could they foresee the prestige and economic bonanza that the University of Arizona would bring. Statewide, today’s economic impact is some $2 billion. Much of its research has spawned thriving businesses. As a web "motto" has it, "We partner with industry so that innovative ideas become thriving enterprises."

Year-round blue skies made Tucson a must-go-to location decades ago for the U.S. Air Force, which in turn lured aerospace companies. The largest, Raytheon Missile Systems, is now the city’s number-one private employer. More recently, the almost-perpetual sunshine has attracted solar energy companies.

Fifteen major space exploration corporations round out an industry spurred by the Phoenix Mars Mission launched by the NASA-operated Lunar and Planetary Laboratory at the U of A.

The innovative mix also includes at least a hundred bioscience companies, many of whose employees are graduates of some 20 life science programs at the university and Pima Community College.

Opportunities for physicians in Tucson

Among all of southern Arizona’s private employers, the third largest is actually a medical organization, the Carondelet Health Network. The Tucson component includes St. Mary’s Hospital, St. Joseph’s Hospital, Carondelet Heart & Vascular Institute, mammography and imaging centers. Its medical group offices are located across southern Arizona.

Eric Sipos, M.D., a neurosurgeon with Western Neurosurgery, Ltd. and affiliated with St. Joseph’s, was especially attracted to Carondelet by its physicians’ "unique relationship with the administration."

Born in France, Sipos came to the U.S. to study at Johns Hopkins University, first in its School of Arts and Sciences, then the School of Medicine, followed by internship, residency, advanced training and, finally, as assistant chief of service. U.S. Army service in San Antonio introduced him to the Southwest.

With civilian life on the horizon, he recalls, "I specifically looked in this part of the world to find a job. I found a great group of well-trained neurosurgeons who share a philosophy similar to mine in terms of patient care (and other areas), so I was a good fit."

At the hospital, "The relationship we have with the administration is unique, (extending to) a very collaborative working relationship with the hospital, the network and executive team."

Even more satisfying, he and his colleagues were heavily involved in every aspect of designing the ICU, the ward for neurology patients and the ORs for a recently opened neurological institute, of which he is now the medical director. "We created a very state-of-the-art, unique surgical suite that’s the first of its kind anywhere in the world," he says. "Since then, surgical teams from all over the place, even Australia and Brazil, have been coming here to tour the facility and consider whether what we did here is appropriate for their programs."

For him and his colleagues, probably the most important aspect is that the suite "integrates all the different technologies we use in neurosurgery so that they work together seamlessly."

An innovative feature is "an interactive CT scan that serves two ORs and is mounted so that it can be moved on tracks and can scan a patient during surgery in one room and then be moved to the other room. It’s pretty revolutionary to get that kind of real-time data during surgery. We’ve seen improvements in surgical results that are very tangible."

Sipos has also been pleased with Tucson’s "small-town feel."

"Shopping and in restaurants, you run into people you know. You don’t have the sense of anonymity that you have on the East Coast." The quality of restaurants has also impressed him.

City institutions, especially schools, have been another pleasant surprise. "Our kids are in public schools, and they are thriving," he says. "They have an advanced curriculum. They’re challenged, but they also have fun and participate in wonderful extracurricular activities."

The Carondelet network in Tucson has seen - and weathered - many changes since St. Mary’s Hospital opened with 12 beds in April 1880, a month after the arrival of the Southern Pacific Railroad. After a number of expansions and relocations through the years, St. Mary’s and St. Joseph’s (opened in 1961) have a combined 927 beds. Over the years, treatment focuses have shifted from tuberculosis to wounded soldiers to influenza to polio.

As the city’s population multiplied, so did its health services, including area "firsts," such as Arizona’s first open-heart surgery in 1959, a small burn care unit in 1969 and a hospice in 1980. Through its various facilities, it offers a "continuum of care" for patients, from home calls to outpatient, inpatient and long-term care. Innovative strategies have been developed to retain workers, and the network has received awards for "exemplary practice in recruitment, flexible work opportunities and rehiring of retirees."

Arizona’s early reputation as a wonder-cure location for tuberculosis and other pulmonary ailments led to a number of clinics for hopeful sufferers from the north. That’s how Tucson Medical Center got its start, opening in 1927 as the Desert Sanatorium. In 1944 it transitioned into a full-service hospital, now, according to its website, one of the 300 largest in the U.S.

"We are by far the favorite place for delivering babies, some 6,000 a year, in Southern Arizona," says spokesman Mike Letson. "Sometimes the count is well over 7,000." Falling in line with that statistic, he adds, "By 2015, we’ll have an all-new pediatric area, bringing all pediatric services into the 21st century." The reason: TMC’s $120 million redevelopment plans.

Its executives have used their ingenuity to solve previous problems, such as a nurse shortage of five to 10 years ago. They started an on-campus education program for employees to upgrade their skills. Today, on-site courses are conducted at a nearby training facility complete with a lab setup and practice robots. More recently, TMC has partnered with a magnet high school focusing on healthcare.

Interestingly, as in the lexicon of many U.S. hospitals, today’s Northwest Medical Center was founded as a satellite of El Dorado Hospital, which itself would later become Tucson Medical Center. You could say the "new kid on the block" received a baptism of water. Two weeks after its 1983 opening, Tucson experienced the worst flooding in recorded history. NMC was the only healthcare center not crippled by inundated bridges. Since then, its medical corps has multiplied from 50 to 700-plus physicians with 300 beds. It has added a freestanding Women’s Center, three urgent care facilities and physician group and "center of excellence" citations for its bariatric program and women’s imaging department. It has achieved "Gold Seal" status for its total knee and hip replacements.

In 2009, it became number one in Tucson for cardiac "door-to-balloon" speed. A year later, it was first in the area to use Breast-Specific Gamma Imaging (BSGI). It’s about an hour-long process, but the patient can be seated for that duration and endure only a slight breast compression. The major advantage, though, is administration of a tracing agent that is absorbed more quickly by cancer cells, which show up as dark spots. A second advantage: diagnosis is almost immediate.

No matter how satisfying life and work in any location can be, no city is completely free of flaws. For Engelsberg, the pluses have obviously outweighed the minuses, but he feels that "medical incomes are significantly less than 120 miles up the road - and significantly less than our colleagues in Texas and California."

In those states, malpractice insurance costs are "significantly lower. If (your attitude is), ’I’m looking to make the big bucks and make as much as I can, and then I’ll retire at age 45,’ that would be a bad reason to come here," he says.

On a more personal note, he adds, "I don’t mean to sound like Tennessee Williams, but it is a long, hot summer. My wife and I take at least two vacations of a week or 10 days to break it up."

But he always comes back.

Get out and play in Tucson’s sunshine

Recreational opportunities in Tucson range from the grand and awe-inspiring to the very tiny, with many "in-betweens." And, not surprisingly, the nearly perpetual sunny environment has inspired more than a few popular activities.

The "tiny," and also the newest attraction, is The Mini-Time Machine. This is not Doc Brown’s "Back to the Future" contraption, but a museum of miniatures displaying some 275 mini-houses, "room boxes" and "enchanting collectibles" from the collection started in the 1930s by Patricia Arnell. Accompanying stories and histories are as captivating as the intricately reproduced castles, snow villages, shops and furniture arranged in specialized areas.

Tucson-Golf

Golf addicts can find plenty of courses in the city and surrounding areas.

Desert Odyssey

Meanwhile, nature’s grandeur waits outside. Not one, but five mountain ranges surround the area - the Santa Catalinas, Rincons, Santa Ritas, Tucsons and Tortolitas. One eastern transplant, Robert Lefko, revels in their "purple mountain majesty" and says they could have been the inspiration for "America the Beautiful." The more practical application is that the mountains offer bountiful hiking opportunities.

Mt. Lemmon in the Santa Catalinas is by far the most popular, even for non-hikers, who can drive a winding road to the top. Winter snows create big business for the mountaintop ski resort. One veteran hiker, Sara Willsey, also recommends venues including Saguaro National Park (both east and west locations), and for those willing to drive an hour or two, the stunning array of rock formations at the Chiricahua National Monument.

Golf addicts can find plenty of courses in the city and surrounding areas. Stables and resorts offer horseback riding, and there are shooting, rock climbing and ballooning opportunities for the more skilled and/or adventurous.

Cycling tops the popularity charts for many Tucsonans, including Eric Sipos, M.D., who cycles year-round. In November, the city makes way for throngs of riders in El Tour de Tucson, America’s answer to the Tour de France.

Unfortunately for baseball aficionados, major league teams have abandoned their Tucson spring training facilities in recent years, mostly to join the crowd in Phoenix, which now boasts 15 winter resident teams. Dedicated fans of pro baseball, basketball and football can make weekend or day trips to Phoenix to enjoy all three, but thanks to the University of Arizona, there’s no dearth of amateur sports, including football, baseball, tennis, men’s and women’s basketball, women’s soccer and volleyball.

The region’s skies have spawned the increasingly popular Tucson Amateur Astronomy Association, whose members meet at observatories, hear lectures, learn viewing techniques and, of course, watch the stars.

Museums abound, but probably the most spectacular is the Pima Air & Space Museum. From "75 airplanes and a tin shack," it’s grown to encompass 80 acres showcasing more than 300 aircraft - from the world’s smallest, "Bumble Bee," to the huge "Super Guppy." The number and variety of specialty government and warplanes are almost beyond belief. The museum also offers bus tours of the boneyard at Davis-Monthan Air Force Base, which houses more than 4,400 retired aircraft.

There’s no better way to develop a deeper sense of kinship with Tucson’s special environment than spending time in some of its unique "showcases," such as the two

Chiricahua National Monument

Chiricahua National Monument

sections of the Saguaro National Park, the mostly outdoor Arizona-Sonora Desert Museum (one indoor exhibit demonstrates the striking differences among deserts of the world), Sabino Canyon (daily tourist shuttle tours), Tucson Botanical Gardens and Tohono Chul Park, where a pleasant tearoom lunch can be interspersed with viewing nature trails and specialty gardens

Culture vultures can find almost any kind of entertainment important to them, including symphony, opera, ballet, professional and amateur theater, Broadway road shows, chamber music and jazz.

As for cowboys, they’re still on the landscape, in a Hollywood kind of way. Since 1939, Old Tucson Studios has been the set for hundreds of movies and TV shoot-’em-up shows. Visitors can check out dozens of buildings and exhibits, not to mention the real excitement - gunfights, stunt shows and dance-hall musicals.

And perhaps shake hands with a real live Hollywood cowpoke.



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