On the five floors below him, he tells visitors, there are more severely disabled people than in any comparable building in the world. Rusk's 150 inpatients and the 250 who regularly visit its clinics are counting on Dr. Rusk to give them a better life. They are amputees and victims of strokes, spinal-cord injury, congenital disorders, and neuromuscular diseases. In the institute therapy rooms, they learn to overcome their disabilities by combining what muscle power remains with artificial limbs, braces and electronic aids—and not least by having the courage to follow the often harsh, painful regimes that Rusk's staff of 80 prescribes.
Rusk was introduced to medicine at the age of 11 in Brookfield, Mo. He was an errand boy who also scrubbed up the operating room, a remodeled kitchen in the frame house that was his town's first hospital.
He began medical training at the University of Missouri and completed it at the University of Pennsylvania. On campus he sold his blood by the pint to pay for weekend trips to date a welfare caseworker in New York, Gladys Houx. They were married a few weeks after he hung up his shingle as an internist in St. Louis 50 years ago.
In his 1972 autobiography, A World to Care for, Rusk tells about a lawyer friend who "went bad under anesthesia" during an appendectomy. "I was terribly frightened, and I stood there at the operating table thinking about his wife and three children as I watched him sink. Fortunately, he recovered, but the experience made me very sensitive about recommending surgery."
Over the years Rusk has often scolded the medical community. He once wrote that he could not understand doctors who refused to make house calls. One critic replied: "I could have made house calls on Joe Kennedy too—if I thought it meant $25,000 for the institute I ran." For Rusk, however, those visits may have seemed more social than medical. "If your friends need you," he says, "then you simply have to go." Such lofty manner, plus Rusk's envied genius at raising money and promoting his own projects, has made it fairly easy to find doctors who are not 100 percent fans.
Undaunted, Rusk has always gone his own way. Though he was 40 and had three children and was well beyond the draft age, he enlisted in the Army Air Corps a few months after Pearl Harbor and was made chief of medical services at Jefferson Barracks outside St. Louis. One of Rusk's first decisions there was to release patients who had normal temperatures and who felt good enough to play blackjack in the hospital sunroom. In less than two days almost all of them were back in the hospital. They had recovered from their injuries or sicknesses, but psychologically they were not ready to face active duty.
Watching them return led to the discovery of what Rusk calls medical responsibility's third phase. The first is prevention. The second is care. The third takes a patient from the bed back to the job. "It's what happens after the fever is down and the stitches are out," Rusk says. "If you only care for the disability and don't make some kind of life for them, they turn to you and say, 'You saved my life. For what?' " Rusk tells them: for a life as close as the doctor can manage to what it was before the illness or injury.
Rusk was commanding officer of the Army Air Corps convalescent training division during World War II, and when he describes what he has been up to since then he sounds like an old bomber pilot reviewing his campaign ribbons. "I went on a mission to Vietnam for President Johnson in 1967, and I went on my first Korean mission for Eisenhower in 1953," he says. Rusk was at the Potsdam conference in 1945 with fellow Missourian Harry Truman, the President whom the doctor has felt closest to and with whom he shared an aversion for the pushups, knee bends and jogging of body cultists. "I get my exercise being pallbearer at my exercising friends' funerals," says Rusk.
His toughest White House assignment from John Kennedy was to treat the President's father after the elderly Kennedy had been partially paralyzed and left speechless (and irascible) by a stroke. "They asked why I didn't teach him to write. Well, I told them Mr. Kennedy hadn't written anything but his name on a check for years and anyone who thought a man with a fuse as short as his could be taught to write was mistaken. He didn't even like the brace we made for him."
Rusk's success at rehabilitating wartime casualties earned him a Distinguished Service Medal and gave him the idea of carrying on with rehabilitation when he was mustered back into civilian life. The publisher of the New York Times, Arthur Hays Sulzberger, enlisted him to write a weekly column to tell readers how the wartime advances in medicine and especially rehabilitation could be put to peacetime use. Simultaneously, New York University took Rusk on as its chief of rehabilitation, but in the postwar building shortage it could not provide him with a place of his own to work his wonders. That is when Rusk began shifting his energies from the practice of medicine to the art of fund-raising. His articles in the Times made him well known, and through the years many prominent social figures have supported the institute and other Rusk projects with a generosity that was the envy of the medical world.
In those early years, when Rusk was not appealing for money or diagnosing patients, he would drop by the corner of 34th Street and First Avenue to watch his institute go up. It opened for patients early in 1951, and since then Rusk has grown so busy with administrative duties that he has had less and less time to serve as a doctor.
Sixty percent of the institute's patients nowadays are from the New York area, and the rest from all over the world. "We don't see any ordinary cases here anymore," Rusk says. "We get only the tough ones—and that is as it should be."
Many of the other cases are treated by doctors Rusk has trained. At least 50 Rusk students head up rehabilitation departments at the best medical schools and hospitals throughout the world.
"Here I'm quite like a college president," he says. "I'm responsible for the standards of service, the teaching, the research—everything. If I didn't sweat my heart out to raise money, we would be in deep financial trouble."
Not all that sweat yields results. After the institute helped a son of the late John Paul Getty recover from car crash injuries, Rusk anticipated a formidable expression of gratitude when the billionaire came to lunch. It was a dry hole, however. The institute's list of donors that year included the Getty name only because he had made a gift to the hospital of the wheelchair used by his son.
Rusk is fiercely honest with the disabled who flock to the institute for help. "Take the man who called me this morning," he begins. "Both legs were off above the knees when he had a stroke that paralyzed him on one side. I told him that he'll never be an ambulator. We can make him comfortable in a wheelchair, and we can teach him to meet the needs of daily living, but this is not the age of miracles."
Rusk then goes on, sounding as if it might be. "I spent a lot of time with IBM on an electric arm operating with brainwaves that worked pretty good, but it was so complicated you had to have an engineer to go with it. We are now providing amputees with prosthetic arms that operate with impulses from the brain through the nerves to the stump. The signal current is stepped up 50,000 times and operates the artificial hand through a miniature, solid-state electronic device. At night, the batteries that power the hand can be charged by plugging them into a wall outlet.
"And we've got things from the space program, of course. One of them is a pressure suit, a kind of coverall. When inflated it takes the place of braces, holding the patient erect and enabling him to walk with crutches."
There is help available, too, for those with no muscle power at all. They can travel in a wheelchair by blowing or sucking on a strawlike control. Indeed, the institute has developed a whole range of electronic devices that can be activated by a patient's breath.
Rusk likes to stress another positive advance in rehabilitation since his private hospital opened. "Now the acceptance of disabled people is totally different than it was 25 years ago," he says. "Employers know that the disabled, if properly trained, are good workers with a better production rate, lower accident and absentee rates, and the turnover among them is 10 times less. We are not asking that the disabled start at the head of the employment line. But we do feel they have a right to start at the same place as the normal. And anytime in this country the so-called normal can't compete with the disabled, then we had better give it back to the Indians."
He was gazing out at the river and sounding a bit out of sorts. "There are times when I wish I were back in St. Louis again," he says, "but there were times then when I wished I didn't have to face 40 patients."
He thought for a moment and then said, almost wistfully, "You know, I haven't practiced medicine for so long that unless it were a lifesaving situation I wouldn't attempt it."
A few weeks ago the World Rehabilitation Fund honored Rusk at a Waldorf-Astoria dinner. At $150 a plate, the event raised $300,000. More than half of it is going to Rusk's projects. He sent the celebrants home with some plain eloquence about his feelings for his patients. "The awful thing is," he said, "when you are poor and crippled and can't get off your knees and look the world in the face, it does something to your spirit deep inside. And if you can walk and look your fellow man in the eye, it is a different world."
As everybody stood to cheer, one listener summed up Howard Rusk. "He's the greatest con man in medicine. Thank God, he's benevolent."
"I'm a cross between the old family doctor, Billy Graham and Lydia Pinkham," the big ruddy man from Missouri says. "I'm selling the wine of rehabilitation on an international market." It is not a bad shot at self-description for Dr. Howard A. Rusk. Whatever else, he is also the 75-year-old boss sitting in the corner office with the river view at New York University Medical Center's Institute of Rehabilitation Medicine.