On the University of Minnesota campus in Minneapolis, two names are emblazoned on different monuments about a hundred yards apart: Emilie Buchwald and Henry Buchwald. Married 52 years, they have given life to four daughters, thousands of patients, and more than a million books. Both have been publicly hailed as geniuses. And though thousands of students pass those monuments every day, most have no idea that because of Henry they might live longer and because of Emilie they have something more ennobling to read than the self-help hit He’s Just Not That Into You.
Henry is a surgeon, a professor, and a researcher at the University of Minnesota. He has been at the U since 1960, when he was discharged from Air Force duty as a flight surgeon. For his early work on surgical control of cholesterol, he was honored in 1991 on the floor of the U.S. Senate. For his current work in bariatric, or obesity, surgery—once pejoratively known as stomach stapling—the 74-year-old is internationally recognized as a leader, an advocate both for surgery’s use in battling the weight-gain epidemic and for obesity’s classification as a disease like any other.
Emilie is the founding editor of Milkweed Editions, a nonprofit press in Minneapolis that has long been recognized as one of the country’s leading literary publishers—an achievement that earned her the McKnight Foundation’s Distinguished Artist Award in 2002. Emilie left Milkweed three years ago when she thought Henry was going to retire. But Henry didn’t retire, so at age 71, she has begun a new venture: the Gryphon Press, which just a few months ago published the first two books in what she hopes will be a new niche in children’s literature—picture books that advocate a humane relationship with animals instead of dressing up the critters in ruffled frocks.
From most angles, surgery and publishing appear as disparate as, well, obesity and animals. But Emilie’s mission—to transform people through literature—is not so far from Henry’s. What could be more life-changing, after all, than shedding hundreds of pounds? Or more humane than adding years to a life? The Buchwalds have different means, but a similar end—leaving a better world than the one they were born into. And now, at the culmination of their careers, they are confronting two issues currently confounding the country.
ON A WEDNESDAY MORNING at the U of M Medical School, several dozen people are assembled in the surgical conference room. Nearly all of them are female and white. Several require wheelchairs. Sporting a preponderance of sweatpants, most do not look so different from the hospital workers outside the room or the pedestrians on the street. And they aren’t—according to the Centers for Disease Control and Prevention, two out of three American adults are just like them: overweight or obese.
Photo by Joe Treleven
This is an information session for people considering bariatric surgery, a variety of procedures that result in stomach reduction and, it is hoped, the eventual loss of a tremendous amount of weight. Henry and his colleagues hold these sessions at the U several times each month, drawing more and more attendees. The surgery’s popularity has ballooned more than 400 percent in this country during the last decade, with 12,775 procedures performed in 1998 and 600,000 surgeries estimated for 2011.
An extremely tan woman with tall boots and long, blonde hair—an employee of the U’s health center—opens the session with a discussion of post-surgery nutrition. She had the operation herself recently and shrank from a size 22 to 2. Someone asks whether she was worried about reaction to her choice to have the procedure. “You mean from the ‘normal’ population?” she responds. “I was super-paranoid.” The people in this room belong to a community of sorts, with its own lingo and a you’re-among-friends candor. The health worker, for instance, fields some casual criticism that not enough of the chairs in the room are “obesity-friendly”—that is, chairs with extra support and without armrests. “I was so waiting for someone to fall through the chairs,” she jokes.
Henry sweeps in, with a doctor’s hurried pace and distinguished air that belies the fact that he’s easily the smallest person in the room. Henry stands about 5-foot-5, with a bit of a hunch now, but his bedside manner is commanding, if compassionate. “He is a straight shooter,” wrote a past patient on a website where the formerly obese discuss bariatric surgeons. “I told him I was leaning toward the DS [duodenal-switch] procedure, and Dr. Buchwald’s response was, ‘Son, there is no leaning toward; it’s not like we can change our mind once we open you up.’ ” Another gushed, “He is a sweetie!” Speaking to the prospective patients, Henry is mostly blunt: “You have a disease,” he tells the group. “You overeat. You are hyper-metabolizers—you take in calories and convert them to fat. It’s the way you were born, just like hair color.”
Henry explains the differences between the three procedures he performs—gastric bypass (by far the most popular, in which the stomach is stapled to divide and shrink it), vertical banding (stomach stapling with the addition of a rubber ring to slow the flow of food into the stomach, holding it up long enough to make a person feel full), and the duodenal switch (in which part of the stomach is actually removed). While he has the body cavity open, Buchwald says, he’ll also take out the gall bladder if it has gallstones in it, and fix any hernias. “And if the ladies want their tubes tied, I can do that, too,” he quips.
Of course, there are risks. “You can die,” Buchwald tells his audience. Bariatric surgery has a mortality rate of less than half a percent—far better than cancer treatment, though still one in 200. About 80 percent of patients have excellent results. Some need a second surgery, and others “out-eat” the operation, continuing to pack in too many calories to benefit from the treatment.
To many, obesity surgery seems extreme. Even Henry, who has performed thousands of the procedures, equates it to attacking the problem with a hammer. “It’s a stupid way to treat this disease,” he says, “but it works.” He’ll argue, in fact, that it’s the only tool his profession has at the moment to help the morbidly obese, those for whom diets, drugs, and exercise work poorly if at all. He’s also quick to note that despite the surgery’s current boom, only 2 percent of those eligible for the surgery are having it done. “People say [the surgery] is out of hand, that we’re doing too much of it,” he says. “But would the American public tolerate treating just 2 percent of people with AIDS or cancer or diabetes?”
During the information session, Henry ticks off some of the problems associated with obesity: sleep apnea (in which people repeatedly stop breathing during sleep), diabetes, arthritis, gallstones, and many forms of cancer, including those of the breast, ovary, prostate, liver, and colon. “The sum total is that if you’re a woman you give up nine years of living, 12 for men,” he says. And then he lists obesity’s other evils: “Obesity isn’t fun. There is a social, marital, sexual prejudice.” The obese have more trouble finding work than other people, he says. “[Employers] think you’re unsightly. And you’re expensive—they don’t think you can do the same day’s work.” After obesity surgery, these associated problems often disappear along with the weight.
Around the room, there are plenty of nodding heads. For these people, obesity isn’t just a disease, it’s a stigma. And worse: “It’s the last socially permissible prejudice in America,” Henry says.
HENRY AND EMILIE experienced discrimination as soon as they were born to Jewish families in Vienna—Henry in 1932, Emilie in 1935. As children, they were running for their lives, fleeing the atrocities that would culminate in the Holocaust.
Photo by Joe Treleven
Henry arrived in the United States with his mother in 1938. His father was forced to wait, trapped by the U.S. quota system, which favored the emigrants of certain nations over others. In 1939, after several hazardous escapes from the Nazis, Henry’s father finally joined his family in New York City—at the same time Emilie and her parents arrived. In fact, they arrived on the same boat.
The families met years later, when they happened to rent vacation homes across the street from one another in the Catskills. Henry was then 17; Emilie not quite 14. Five years later, in 1954, they married. Over the next few years, Henry finished medical school at Columbia University, served in the Air Force, and accepted a residency at the University of Minnesota, which was then basking in the glow of having pioneered the world’s first open-heart surgery. Surgery did not have the negative connotation here that it did in New York. (“Smart ones go into medicine, dumb ones go into surgery—they’re technicians,” Henry recalls of the East Coast attitude then.) He also was enticed by the U’s policy of allowing residents to do research—a rare thing out East. Emilie, too, ended up at the U, teaching Shakespeare just as the English department was blossoming.
Life in Minnesota was an adjustment for a Jewish couple in a famously Lutheran land, though mostly a positive one. The day the Buchwalds arrived in Minneapolis, they accidentally drove into the Aquatennial parade, and a policeman pulled them over. Accustomed to brusque New York cops, they were pleasantly surprised when the officer simply asked if they wanted to park somewhere and enjoy the festivities. “We knew then that it would be very different living here,” Emilie recalls.
Eventually the couple moved to Edina, where they raised a family and still live today. So the story has a happy ending. But the Buchwalds have never forgotten how it started, in flight from evil.
Emilie channels her outrage at injustice into the issue of animal abuse, which she sees as indicative of larger societal values. She is fond of Mahatma Gandhi’s observation that “the greatness of a nation and its moral progress can be judged by the way its animals are treated.” “Do you treat other creatures as your equal or are you their conqueror?” she asks. An American Eskimo dog named Sam has the run of the Buchwalds’ lakeside home. But across America, the picture is more grim; the recent explosion in pet ownership has resulted in millions of dogs being bred in oppressively crowded conditions and millions more being given up, abandoned, or worse. Emilie acknowledges that some form of the strong taking advantage of the weak—the survival of the fittest—is endemic to all animals, including humans. She just doesn’t accept the instinct as unmalleable.
At a reading celebrating the release of Gryphon’s first two books (which she wrote under the name Daisy Bix), Emilie is surrounded by giant balloons shaped like dogs. She sits in the education room of the Animal Humane Society in Golden Valley, down the hall from a room full of cats, a wall of birds, and, on this day, a phalanx of rabbits hopping about. “Animals have a point of view, with a life that’s significant to them and to us,” she declares to the audience, who, like her, likely believe animals deserve better than they generally get. “Though sometimes,” Emilie continues, “I feel the whole weight of the culture is against us.” Children as young as 2 or 3, she notes, form groups with the sole purpose of excluding others. Instinct is a formidable foe.
If anyone can change people through words, it may be Emilie. First of all, she knows how to use them better than most: as a child in Queens, she would sit on her porch and read the dictionary; she published her first short story in Harper’s Bazaar at 23. And her optimism has always been matched by pragmatism. It was 1979, the last gasp of ’60s-style change-the-world idealism, when she and art director R. W. Scholes launched The Milkweed Chronicle, a magazine that combined visual art and literary writing. In the late 1980s, by which time the hippies had suited up for office jobs, she and Scholes phased out the magazine and created Milkweed Editions as a nonprofit literary press. Soon, Bill Holm was sending in a 300-page manuscript on box elder bugs (it was edited and published) and a Milkweed book by Carol Bly was being reviewed in the New York Times. Today, more than 1 million Milkweed books are out in the world.
But while Emilie obviously wanted Milkweed’s books to sell well, she never sought bestsellers (the press’s most popular book, Montana 1948, by Larry Watson, has sold some 380,000 copies). Instead, Emilie reached out to authors with something meaningful to say. From the beginning, she made room for nonfiction books she called “thistles” because they addressed prickly topics: Transforming a Rape Culture, Changing the Bully Who Rules the World, Toward the Livable City. For her efforts, she’s been celebrated like few other publishers. “Her commitment to contemporary literature and her dedication to providing American readers with writing that tackles the foremost issues of our time—during a period when more and more books are published but fewer and fewer matter—can only be described as heroic,” said the late Cliff Becker, then the literature director of the National Endowment for the Arts, when Emilie received the McKnight Distinguished Artist prize. Janisse Ray, whose memoir Ecology of a Cracker Childhood was published by Milkweed and won an American Book Award, has said, “Hers is a holy work.”
From the beginning, though, Emilie had the idea of publishing books about the relationship between animals and people—picture books that depict animals’ real lives as pets or wildlife. (“Do you want the butt-sniffing?” an illustrator asked recently, while working on At the Dog Park with Sam and Lucy. “Of course,” Emilie responded.) In the ’80s, Emilie incorporated the Gryphon Press, named for the mythological creatures known as protectors and symbols of integrity. But Emilie never had time to pursue this passion until she left Milkweed in 2003. Now she has titles slated through 2008.
Photo by Joe Treleven
She also has a slogan: “the voice of the voiceless.” It’s quite a calling, but then the Buchwalds’ success can be traced, in part, to an uncanny ability to remake themselves to meet their goals, as though they had no awareness of their limitations. There is no other explanation for how Emilie—once such a bookworm that her mom worried she would never have a social life—became the gregarious head of an organization. Or how Henry, a Brooklyn boy, came to enjoy saddling up in chaps, neckerchief, and a 10-gallon hat to ride horses, which he frequently does on vacations in Arizona.
“They’re both very strong believers that you can make your life what you want it to be, by and large,” says Jane Buchwald, the couple’s eldest daughter, “and if you set your mind to a mission, you will do what you need to do to transform yourself into that person who can accomplish that mission.”
HENRY’S FIRST TRANSFORMATION occurred on the streets of New York. After the move from Austria to Long Island, his family had little money and, at age 6, Henry worked on the docks unloading fish. But eventually, the family moved to Upper Manhattan, and where Henry fell in with a group of 12 boys who called themselves the Wolf Pack, a kind of club that fostered an interest not only in sports but music and books. They would play baseball together, then listen to Beethoven. The group instilled in Henry a lifelong love of learning.
Henry went on to the selective Bronx High School of Science, where he was a competitive swimmer and concertmaster of the orchestra. At Columbia College, he swam varsity and was class valedictorian. It was this mix of the physical and intellectual that would soon draw him to surgery and to the U’s research-oriented training program—a focus that has endured. “It was an opportunity to dispel ignorance and bring something about that would hopefully have some lasting benefit,” Henry says.
Soon after his arrival at the U, Henry received his own lab and began studying cholesterol. In the 1970s, he received the largest grant the National Institutes of Health had ever given for research initiated by an investigator (as opposed to a government contract), for the landmark POSCH trials that would occupy him for the better part of three decades and ultimately demonstrate that lowering cholesterol could reduce heart attacks and otherwise increase life expectancy. He also helped invent the first implantable infusion pump, a device that helps inject chemotherapy, insulin, pain killers, and other drugs into patients more efficiently.
Henry’s mentor, Dr. Richard Varco, performed the first-ever obesity operation in 1953, and it was almost inevitable that Henry would be pulled into the field. Varco, a world-renowned surgeon, had participated in the first open-heart operation and later developed the U’s transplant program. But in 1966, he was temporarily sidelined after an accident that cut a nerve. And so, when he spotted Henry in the hallway one day, he asked him to take over an upcoming obesity surgery. “His hand was in a cast,” Henry recalls. “He was waving it, saying, ‘I would do it if I could!’ And now here I am, 4,000 operations later.”
At the time, bariatric surgery had as much of a stigma as obesity itself; most surgeons wouldn’t touch it with a 10-foot scalpel. “It used to be the Rodney Dangerfield of surgery,” says Dr. Walter Pories, a pioneer in the field and a professor at East Carolina University. “How could you possibly want to deal with fat people? Those people are immoral gluttons, and gluttony’s one of the venal sins!” he says of the attitude then. At the time, the surgery often induced complications, and was so new that it wasn’t always clear who should or shouldn’t have the operation. “Its bad reputation was deserved,” Pories says.
But Pories and Buchwald carried on. “I developed an empathy for these poor people,” says Henry. “They have a disease, and there is no other disease that is treated with such disrepect. No one applies derision to people who have cancer or heart disease.”
Henry is convinced that obesity will experience a medical about-face the way ulcers have. Not so long ago, doctors believed ulcers were stress-induced and primarily occurred in anxiety-ridden mid-level executives. Now it’s known that ulcers are caused by a bacterial infection and could affect anyone. Henry suspects that the true causes of obesity may be similarly impersonal—a virus, even, that infects the hypothalamus and screws up the body’s sense of feeling full. “In 10 years, we may laugh at all this ideology of obesity,” he says. In the meantime, with the obesity epidemic linked to all manner of health concerns, bariatric surgery has suddenly become a savior. “First you don’t get no respect,” marvels Pories, “and now, in the last three or four years, we’ve become Mother Teresa.” For his part, Henry will continue to push for an understanding of both obesity and obesity surgery. “If you named maybe 10 international leaders [in bariatric surgery],” Pories says, “Henry would fall on any list that people in the field would make.”
But Henry has not been content to simply focus on obesity. He has begun work on a new quest: to understand how a measure of oxygen transport, the relative efficiency with which oxygen moves through the body, might redefine what it means to be healthy. He has discovered, for instance, that if you lower cholesterol, oxygen transport increases. And while it’s still unknown what the applications of measuring oxygen transport might be, Henry believes it could be anything from testing for the presence of heart disease to assessing overall health or even athletic potential.
This research began several decades ago, when he and others at the U built a device for measuring oxygen transport. Henry believes so strongly in its implications for patient well-being that he now funds some of the work himself. The Buchwalds, even in their seventies, seem like they’re just getting started. “It’s the Faustian spirit,” Henry says. “Always wanting to do something that goes into the future.”
Of course, the Buchwalds’ place in history is already assured, and for something bigger even than their individual achievements. On the U campus, you can stand between the monuments bearing the Buchwalds’ names, and, unable to read the specifics—to know that Emilie is etched in for her 2002 honorary doctorate or Henry for helping create the drug-infusion pump—you realize the details don’t matter. It is enough to know they have done something, and continue to do something, for the greater good. Or, as Emilie puts it, “To do something because you think it’s worth doing.” And not giving up. “It’s not even a work ethic,” Emilie says of her and Henry’s tirelessness. “It’s the ethic of continuing.”
Tim Gihring is senior writer at Minnesota Monthly.