Life After Surgery: Layton "Bing" Rikkers

My name is Layton “Bing” Rikkers. I was a University of Utah general surgery resident from 1970 through 1976 and then a member of the surgery faculty from 1977 until 1984. However, my odyssey towards a surgical career began several years earlier. What follows are brief descriptions of that career, so positively impacted by my years at the University of Utah and my more recent delightful years of “life after surgery.”

I grew up in a small town in Wisconsin and attended the University of Wisconsin-Madison for my undergraduate bachelor’s degree. The combination of my major in zoology, my love of the life sciences, and an older and very influential brother who was passionately interested in medicine led me to the decision to apply for medical school. The most significant happening during my four years in Madison was meeting my lifetime partner, DeeDee. After dating for two years, we decided to marry soon after graduation and have remained so now for 58 years. We did not look at medical school as simply furthering my education but rather as an adventure we could experience together. The password of the 1960s was independence, and we decided that we would move as far away from our families as possible for medical school. I was accepted at Stanford University, and we spent our honeymoon traveling to Palo Alto, California, after our August wedding.

My initial and rather naïve plan for a career in medicine consisted of finishing medical school, obtaining the necessary residency training for family medicine, and then returning to a small town in Wisconsin as a family doctor. This superficially thought-out plan lasted -3 days. At Stanford Medical School, we were required to purchase our own microscope for our histology and pathology courses.  In searching for the best buy of a used microscope, I was told there was a fourth-year student working in a nearby laboratory who had one for sale. I poked my head in the door and saw several people in scrub attire doing a heart transplant on a dog. They invited me to put on scrubs and join them. I was fascinated by what I saw. The following morning, and for the next four years, I replaced this graduating student in Dr. Norman Shumway’s heart transplant laboratory. This abrupt and serendipitous decision led me to experience not only surgery but also academic surgery three days before my first medical school class. Destiny declared that I was to become an academic surgeon.

One of the many visitors to our heart transplantation laboratory was Dr. Keith Reemtsma who was chair of surgery at the University of Utah. My plan at that time was to obtain a general surgery residency away from Stanford and then return to become a cardiac surgeon under Dr. Shumway. Dr. Reemtsma encouraged me to apply for the surgery residency at University of Utah, which I did. I was accepted and then began my surgical training in 1970. Dr. Reemtsma left Utah to become chair at Columbia University one year after my arrival and was replaced by Dr. Frank Moody, who became my mentor and guide into a career in academic surgery. 

The 12 years I spent at the University of Utah were fulfilling and memorable. I received outstanding training in surgery from numerous excellent role models, Frank Moody, Ralph Richards, Gary Maxwell, Dom Albo, Fred Chang, Hal Harmon, and John Dixon to name a few.  During a year in the research laboratory with Dr. Moody, my interests moved from the heart to the liver. This new focus led me to two one-year fellowships in liver disease, one in London, England with Dame Sheila Sherlock, an eminent hepatologist, and the second at Emory University with Dr. W. Dean Warren, the father of the distal splenorenal shunt and, like Dr. Moody, a leader in American academic surgery. 

Now, hopefully fully trained, I returned to Utah in 1970 to become a full-time staff member in the Department of Surgery. I spent seven years on the faculty during which I obtained research funding to begin my independent investigative career, developed an active hepatobiliary/pancreas surgery practice, and gained valuable administrative experience as general surgery residency program director and then acting chief of general surgery during my final year after Dr. Moody had moved to the University of Texas-Houston. Our children grew up in Utah and the state’s natural resources provided many happy family hours of skiing and hiking the numerous mountain trails. These recreational activities, begun in Utah, were central to our family vacations for years to come after we left Utah. DeeDee and I owe a great debt of gratitude to our Utah years that established such a firm base for our family and for my career in surgery. 

In 1984, we left Salt Lake City for Omaha, Nebraska where I had accepted the position of Chair of Surgery at the University of Nebraska Medical Center. Still “wet behind the ears” in administrative skills, I fortunately inherited a small department that grew during the ensuing 12 years along with my capabilities of managing it. A strong focus on liver disease in the Department of Medicine was a key factor in my decision to move to Nebraska. Bud Shaw, who had trained in liver transplantation at the University of Pittsburgh after completing the Utah surgery residency, was my first recruitment to the faculty. Bud initiated a highly successful liver transplant program that put the Nebraska Department of Surgery on the map. Another Utah residency graduate, Bob Stratta, joined us a few years later. My Utah connection continued to serve me well and contribute to any success I experienced for a long time after I had left Salt Lake City. 

Our family never lost its love for the mountains. After moving to Omaha, and then later to Madison, Wisconsin, we traveled each year to Steamboat Springs for a ski vacation. Steamboat rather than Salt Lake City was chosen because of its closer proximity to Omaha and to Madison. We loved the community of Steamboat and eventually bought a vacation home so we could spend several months rather than a week or two in the mountains during our retirement. Because of the high cost of a ski vacation that they could not afford, this home became a magnet for our children and grandchildren, a key unifying stimulus for our family life. 

Our final stop in my surgery career was Madison, Wisconsin where I assumed the Chair of Surgery at the University of Wisconsin in 1996. Madison is the city where DeeDee grew up and where we had met at the University of Wisconsin 30 years earlier. However, this was not the main draw in accepting the position that was being offered. Rather the Department of Surgery had been well developed under my predecessor, and my challenge was to subspecialize the various divisions and enhance the department’s research and education portfolios. That I was now closer to my beloved Green Bay Packers was the cherry on top. My 12 years as chair allowed me to work with incredibly talented people who consistently pushed the department toward excellence. 

In 2007, two years before my retirement as an active surgeon, Bud Shaw invited DeeDee and me to present our perspectives on retirement at one of his Sundance retreats. Although I had not yet retired, we had thought a good deal about it. We proposed that a long-lived surgeon’s life could be divided into three phases, each 33 years in length. Phase 1 is the many years of education required to become a surgeon, phase 2 is the active years of working as a surgeon, and phase 3 is the hopefully delightful years of retirement. Whereas thoughtful and meticulous planning is usually put into preparing for phases 1 and 2, preparation for phase 3 is often ignored until the time it occurs, and, even then, financial planning is emphasized and how newly acquired leisure hours are to be spent is often ignored. The result can be a less-than-satisfying retirement. 

I often do some of my best thinking during periods of exercise. Whenever I thought of something that I wished to do or to accomplish, but did not have time for, I would interrupt my exercise (often biking) and write the thought down on my Palm Pilot, the precursor of the smartphone.

[Figure 1: My list of possible retirement activities]

RETIREMENT:

1. Photography
2. Biking
3. Hiking
4. Skiing
5. Kayaking
6. Canoeing
7. Great Courses
8. UW, Union, SB Courses
9. Golf
10. Bird Watching
11. Sailing
12. Fly Fishing
13. Meditation
14. Philanthropy
15. Spirituality
16. Musical Lessons
17. Theater
18. Model Building
19. Elderhostel
20. Archery
21. Woodworking
22. Referee
23. Boy Scouts
24. Model Trains
25. Tennis
26. Regional Trips
27. Rowing
28. Writing
29. Greenhouse - bonsai, cactus, orchids
30. Gardening
31. Coaching
32. Madison Friends of International Students
33. Surgical History

My goal was to participate in several of these activities when my retirement years arrived. Over time during phase 2, I accumulated a list of 33 activities. These ranged from kayaking to model building and from photography to writing. Well before the time came, I was to some degree planning my retirement. I highly recommend this approach to all who are in phase 2. After several years of retirement, I have been able to mark sixteen of these potential avocations off my to-do list. Several of them continue as ongoing activities that I thoroughly enjoy and I am not yet done with 19 years still left in phase 3 (assuming a life span of 99 years!). 

I thankfully retired in stages. A sudden and complete termination of all of my career activities would probably have been difficult for me. I stepped down as chair of surgery at age 65 and ended my clinical practice 10 months later. I left the department to not interfere in any way with my successor, who then hired me back at 10% time one year later to mentor young faculty and residents. I continued two rather major editorial responsibilities for an additional 10 years. Except for some leadership involvement in two national surgical societies that did not require a major time commitment, I have been completely retired since 2018.

After freeing myself from administrative and clinical responsibilities, my first objective in partial retirement was to write a history of our Department of Surgery which had been founded in 1924. I enlisted a co-author, Dr. Lou Bernhardt, who was attached to the department in various ways for nearly 2/3 of its 90-year existence. The result was a 232-page book, ”Promoting Excellence: The University of Wisconsin Department of Surgery: 1924-2012” that was published in 2013. 

We have been blessed with homes in three beautiful natural settings: the mountains in Utah and Colorado, a protected nature conservancy in Nebraska, and on the shore of a 10,000-acre lake in Wisconsin.