A Surgeon General's Warnings
CT's editor-at-large probes the feelings and aspirations of one of the nation's most colorful surgeons general, C. Everett Koop, who died yesterday. This article originally appeared in the November 3, 1989, issue of Christianity Today, shortly after Koop resigned as Surgeon General. Yancey had profiled Koop in the previous issue.
How did you get nominated for the post of surgeon general in the first place?
I doubt we'll ever know. Ronald Reagan had read my books Whatever Happened to the Human Race? and The Right to Live, the Right to Die. In his typically unorthodox political style, he went to his pastor at Bel Air Presbyterian Church, Don Moomaw, and asked him to get a sense from around the country of what Koop's peers thought of him. Almost immediately I started getting calls from my friends saying the President was interested in me.
You have said that as a surgeon you used to pray over specific procedures and that you had a sense of God being involved in your work. Did you feel anything similar during your time as surgeon general?
Oh, yes. I have frequently said that I could not have been a pediatric surgeon if I thought when I walked into the operating room that I was in complete control of what was going to happen. And when the surgeon general post came up (I had never sought public office), I believed that God plucked me out of Philadelphia and dumped me in Washington. I used to ask him a lot of questions about it! During the agonizing nine months of the nomination process, I would stare at the Bible on my desk, trying to understand what had happened. Looking back now, I thank the Lord for the great opportunity.
I am not a great prayer. But I go to work with the attitude that says, God, you're sovereign. You've given me a mind and I want you to use it today. if I start to do anything against what you want, stop me just like that [snaps his fingers]. I simply acknowledge my relationship to him.
When did you become a Christian?
I was raised in a Christian home, but with no idea what it meant. For a while I went to the Baptist Church of the Redeemer without knowing what a redeemer was. One Sunday morning I walked into the balcony of Philadelphia's Tenth Presbyterian Church out of obligation to a nurse who had babysat for us. Right away I was impressed with Barney [Donald Grey Barnhouse], who had the most arresting voice and personal style.
That night he was speaking from Hebrews about Jesus being a priest after the order of Melchizedek. As a child I had lived across the street from a church, where on Saturday nights I could watch the priest play poker and drink whiskey out of a bottle until he vomited out the window. It puzzled me that Jesus should be called a priest.
So at first, wondering if this guy Barnhouse was off his rocker, I went back in order to prove him wrong. And I consider this a real miracle: Although I was the only pediatric surgeon within 400 miles, I never had a true emergency that kept me from attending church morning and evening. The day came, and I can't tell you how or when, that I realized I was inside the fold rather than outside.
Is there one "cutting edge" issue of the Christian life for you?
For me, the challenge of the Christian life is to be theologically pure but also service oriented. I do not believe in the social gospel, but I very much believe that the gospel demands social action. The aids crisis is an example, and the response of the church has sometimes disturbed me. I sit at the bedsides of patients dying of aids. They remind me of kittens, so sick and so weak that they open their mouths to cry and no sound comes out. How can you not put your arm around that kind of person and offer support? Instead, to say, "God is punishing them and I support God's punishment"—that attitude is what makes me so mad.
You got a lot of criticism from conservatives during your term as surgeon general. Do you still bear scars?
After the aids report came out, under pressure from Phyllis Schlafly, all but one of the Republican presidential candidates boycotted a dinner in my honor: Rep. Jack Kemp, Gov. Pierre DuPont, Sent. Robert Dole. Only George Bush refused to boycott. Interestingly enough, Sen. Jesse Helms, despite our differences, didn't join the boycott. Jack Kemp was the moist disappointing, because the week before he had stood on the steps of Washington's Fourth Presbyterian Church and warmly shook my hand and told me how much he appreciated all I was doing.
I can understand the problems that allegiance to someone like me might create for a politician. But if someone who felt he had to take a public stand had called up and said, "Chick, these are days of tough politics for me," I would have understood it.
Later, over the abortion issue, Cal Thomas wrote that the country would have been better off with an atheist in this job. That kind of criticism affects me in a strange way. I don't like to go to church anymore—he happens to go to the same church as I do.
In the controversy over the aids report, was there a question of your being "soft" on the gay issues?
It was never expressed to me that way. As I've often said, the large part of this nation considers sodomy to be legally and spiritually wrong. And so do I.
Yet I know that some of the people who persist in leading their flocks astray on the aids issue do so out of homophobia. Really, we need a new word. Homophobia has to do with more than just fear. These people combine fear with an unbelievable hatred for homosexuals. I've had conversations with people who, if they could, would push a button and get rid of homosexuals by any means whatsoever.
You use a word like sodomy, and yet the gay community almost reveres you. Do you have any explanation?
In Boston this year I spoke to 12,000 gay people, and they kept chanting, "Koop! Koop! Koop! Koop!" They give unbelievable support, in spite of what I say about their practices. I guess it's because I'm the person who came out and said, I'm the surgeon general of all the people and I'll meet them where they are. In addition, I've asked for compassion for them, and for volunteers to go and care for them.
You use the slogan "Love the sinner; hate the sin." Was that pattern instinctive for you?
Well, let's say it has always been my theology. But many times you have theology but no specific opportunity to put it into practice. When the aids example came along, my obligation seemed pretty clear. I viewed the lifestyle with a certain revulsion, but as a health officer I had to look upon aids patients primarily as sick people. On the same principle, if a fat lady enters the hospital with a gall bladder attack, you can't refuse her treatment on the basis of her lack of discipline in eating.
You say your views on homosexuality have not changed. What about abortion?
There was so much misunderstanding on that issue. Last week a woman came running up to me and said, "Oh, Doctor Koop, I'm so pleased that you've turned your position on abortion." And I said, "Madam, you have misunderstood me completely. I have not turned my position on abortion: I just refuse to be dishonest with statistics, that's all." I think doctors and scientist appreciated my position [that there was not enough statistical evidence to prove the harmful effects of abortion on the mother], but many prolifers were very upset.
I keep telling prolife people, such as Harold O. J. Brown, "You have been magnificent in the fight against abortion by making it a moral issue, with the life of the fetus as the primary concern. Don't shift the grounds of the argument. If you have to shift to the health of the mother and the other side perceives that you've had to shift your base, you've lost it."
It's been reported that you recommended abortion for women who are pregnant with an aids-infected fetus. True?
Never. No. That issue is the kind of thing that always comes up in a question-and-answer period. I read my speeches verbatim because I know how the press can distort. In this case, the question arose in a discussion of a clinic in Baltimore where something like 29 percent of the pregnant women were found to be HIV-positive. Did I think those women should have abortions? I answered, No, I'm opposed to abortion. In the follow-up discussion I said that although I could never and would never advise an individual woman to have an abortion, if she requested counseling on the pros and cons of abortion, I thought she was entitled to it.
Only a third of women who are hiv-positive produce a baby with aids. And I've said for the record that I wouldn't even recommend abortion for Tay-Sachs disease, which is 100 percent fatal for the youngster. So why would I possibly recommend abortion for aids when you have 60 or 70 percent of these children coming out okay?
You often defend yourself by claiming that the press distorted your position.
I do because it's true. Selective reporting happens wherever I go. In a lecture, I never recommend the use of condoms until I've gone through the litany of reasons for abstinence and monogamy. Then I approach condoms by saying, If you don't listen to those two good health messages, then you've got to protect yourself. The headlines, however, will always read, "Koop Recommends Condoms," and won't mention abstinence or monogamy. One problem is that the people who write the headlines aren't the ones who write the story. Headline writers don't think "Koop Recommends Abstinence" is news, but "Koop Recommends Condoms" is.
I don't want to beat on Harold O. J. Brown, an old friend, but he was vehement in his disapproval of me over the abortion letter. When Time misrepresented me, he said, "Chick, how can you let Time magazine say that?" What do you mean how can I let Time magazine say that? But what can you do, except write a letter to the editor? A cover story in Newsweek had me ordering a double Scotch just before I went to bed—something I never do. I wrote a letter of protest to the editor, which they printed, but how many remember that letter? People just remember me ordering the Scotch.
To give some balance here, who stuck by you throughout the various controversies?
Popular support is what allowed me to survive politically. It was fascinating to watch from where I sat, because I could see the administration conservatives gathering forces, getting ready to strike. But just when they thought they had enough ammunition, my personal popularity would edge up a bit.
As surgeon general I always felt general approval and appreciation from the public. The issues I tended to address were issues that affect individual people, and the public heard them discussed in a frank, honest way. The mailroom of the White House is the pulse of the nation. The next best mailroom was mine. Only about one in a hundred letters took me to task; most were positive.
I also got some supportive letters from unexpected sources. For example, I must have gotten 20 letters from Southern Baptist ministers. That denomination was one of the groups I interviewed before writing the aids report commissioned by the President in 1986. I've never seen such babes in the woods. They had never heard of the kinds of sexual practices I was talking about.
One day in my office I very gently tried to explain what the problems were, to tell them what bathhouse sex was like, for example. They didn't know whether to scream and run, or to cry, or to bury their faces.
But they came around, and proved very supportive. I said, If you are so worried about your kids getting sex education—and I understand why you would be—why can't you, a denominational of 26 million people, write your own curriculum? Nine months later they invited me down to talk about aids, and to help launch that curriculum.
Some of the prolife people have said you've really missed the influence of Francis Schaeffer in the last few years. If he had been alive during your term, do you think he would have understood your various decisions?
I think so. I had been his son Franky's doctor, so I knew the family well. Francis was a very open-minded guy, and I loved to talk things out with him. I remember a call from the Mayo Clinic when we discussed his cancer and the wonderful opportunities he was having in Rochester. I said, "Francis, isn't it remarkable that in the sovereignty of God, before the foundation of the world, when God planned for you to come down with lymphosarcoma, he planned that it would take place in the Mayo Clinic, in order that you, in distress, could witness there to your faith in Christ?" He nearly exploded, telling me it was Satan, not God, who had sent the cancer. I said, "Well, Francis, you're just mixed up on one thing, and that is that God controls Satan, too."
I believe Francis would have understood me. I should say, though, that I had a phone call from a very distressed Edith Schaeffer in the midst of the abortion controversy. She asked if I had changed my position on abortion, and I assured her I had not.
Do you look back on the Whatever Happened film and lecture series with pride?
Yes, I do. There are certain conversations I expect to take place everywhere I go. Someone will come up to me and tell me I operated on them when they were three days old. Someone else will come up and say, I owe you a debt of gratitude—I was never concerned about human-life issues until I heard you speak with Francis Schaeffer. That's important to me, because the lecture series was a kind of sacrifice: after that 18 months I never went back to the intensity of surgery that I had had before.
I love the thing that was most precious to me in my professional life. Yet I think it was a very important statement to make at that time.
For eight years you have been sitting on the other side of the desk from the lobbyists. Do you have advice for people who want to affect the laws in this country? How could they do a more effective job?
What bothered me most, as I reflect, was the lack of scholarship by Christians—as if they felt that by leaning on a theological principle they didn't have to be very accurate with the facts.
People talk about knee-jerk liberals. The liberals have no corner on that market; I've learned there are also knee-jerk conservatives. Christians should be involved in politics, and use their Christian principles and ethics in that process. But they shouldn't jump over the process and voice their beliefs as the only possible outcome.
One of the problems with the prolife movement, for instance, is that they are 100-percenters. Historically it is true that if the prolife movement had sat down with the prochoice people in, say, 1970 or 1972, we might have ended up with abortion for a defective child, in cases of rape or incest, and to save the life of the mother, and nothing more. That would have saved 97 percent of the abortions since then. Ninety-seven percent of 15 million is a lot.
Often, when you were explaining your actions to religious leaders, you would say, "I am the surgeon general, not the chaplain general." Now that you're out of office, will that platform change?
Yes, it will. I will tackle issues that are not considered kosher for a government official to discuss. For example, I have concluded that adolescent sexual behavior will not change strictly by appealing to fear of consequences: "You may get a sexually transmitted disease or get pregnant." Teenagers are risk takers by nature; they don't like admonitions that begin with "Don't," and they don't think of serious health problems as applying to them.
I met a person from a behavioral institute in Switzerland who said, "We consider ourselves to be failures in changing the behavior of adolescents on the basis of education. What is your experienced?" I said, "The same as yours." He asked, "What is the answer?" I said we have to call in the authority of the Higher Power: We've got to call in morality and make a stronger case for ethics; and we have to return to religion.
Are you saying you'll take up the banner of sexual fidelity?
I think I have to. Because of my credibility, I have a marvelous opportunity to bring whole segments of this country around to a little different point of view. It would be wonderful to bring up a whole generation of preteenagers who are not sexually active and who are committed to sexual fidelity. But you don't do that in your very first lecture out of office. You take them a little bit of the way, gradually. I don't want to lose the pulpit I fought so hard to gain.
Your personal image—the beard, the uniform, and so on—played a big part in your gaining that "pulpit." How consciously did you go about fashioning your image?
I would love to be able to say, Koop stood back and looked at his challenge and he decided this, this, and that. The truth is, Koop stumbled into all these things. No doubt my beard is important to the image that grew up. But I grew this beard as a lark when I went with my son Norman to Israel for two weeks. They night before we came home he shaved off his beard and kept his mustache; I shaved off my mustache and kept my beard. We did it just to shock our families. A few days later, when I looked at a picture of myself taken in Naples before I started growing a beard, I realized I had three chins! And I didn't have them with a beard.
As for the uniform, it was deliberate effort to try to raise the morale of 6,000 Public Service employees.
Do you ever feel as though you've lost control of your own life, being so much in the public eye?
As surgeon general, I had to learn the very fine line between exposure by the press and overexposure. I nearly crossed that line a couple of times in office. I had said, Don't, Don't, Don't on issues like tobacco, drinking, and nutrition. The most sensitive barometer in the country is editorial cartoons, and I started getting a flood of cartoons, all with the theme of Dr. Nag. So I cancelled my next three press conferences and remained silent for about eight weeks, even though there were other issues I wanted to address: radon, fluoride, et cetera. I could have lost my constituency then.
Now that I'm retired, the main effect is simply public recognition. I avoid restaurants and order room service a lot. Nobody's ever nasty; it's just that I feel embarrassed when I walk into a big restaurant and I see everyone stop with their spoons halfway to their mouths, and then as I walk between tables I hear words like Kook, general, surgeon. And then there are people who come up and say, "You mean to tell me the surgeon general is eating an olive!" I answer, "Well, if you look as well and feel as well when you're 73, give me a call!"
There were a lot of rumors about your "abrupt" departure.
Everybody knows that I wanted to be secretary of Health and Human Services. I said, that if I didn't get it I'd be disappointed for a few days, but happy about it for the rest of my life. And that's how it turned out. Now I realize I can accomplish more in the private sector than would be possible as secretary.
Are you ever going to tell the behind-the-scenes story?
Yes. I have a book of memoirs under contract with Random House. It won't be a kiss-and-tell book, but it will tell the truth.
Did you leave office with a bittersweet taste, or did you feel it was time?
It was time. And the more I see the opportunities out there, the more I realize it was time. I have absolutely no bitterness about the early days in Washington nor about not being appointed to the secretary's job. The things I can do in the future are legion. In fact, this is the first time in my life that I've ever been sorry I'm as old as I am. I don't know how much time I've got—I hope three to five years, at least.
You'll stay in Washington?
Yes. I want to continue the role I've had with the public. I think I have their trust. I hope they see me as a credible individual who has never lied to them, and I would like to continue to serve by writing, by speaking, and through the medium of television.