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Hutter an artist in the world of cells

Prominent pathologist dreamed of becoming a psychiatrist

By Mark Bloom
MedPage Today Editor in Chief

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Hutter: "The greatest thrill I ever had was to learn more."

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LIVINGSTON, New Jersey (MedPage Today) -- Growing up in Yonkers, New York, a blue-collar suburb that borders the Bronx, Robert V.P. Hutter dreamed from the time he was 10 than he would become a great psychiatrist. He didn't.

Instead he became one of the world's most prominent pathologists, a specialist in the diagnosis of breast cancer. By the time he retired a few years ago, he had earned every honor pathology has to bestow.

He served for a year as president of the American Cancer Society, and for several years he was editor of the journal Cancer.

He did all this while reigning as chairman of the Department of Pathology at St. Barnabas Hospital in Livingston, New Jersey, which, because of him, became a magnet for talented young pathologists.

"I came because of Bob," said his longtime colleague and successor, Dr. Robert Rickert.

But it was a long road from Yonkers to medical school for Hutter. First of all, his family had no money to send him to college. So Hutter won a football scholarship to Syracuse University, a two-way athlete in the era just after World War II.

Though you wouldn't guess it by the slim physique he possesses now in his retirement days, Hutter was a middle linebacker and an offensive guard. On the other hand, Syracuse wasn't the football powerhouse that is today.

Scholarship athletes were given a room in the stadium about the size of a folding bed and a small desk, and he got his meals. Meanwhile, Hutter was a premed student.

"Needless to say, I was the only premedical student in the stadium dorm," he recalls. "So I was the only one trying to study."

All went well until the middle of Hutter's sophomore year. He separated his shoulder during a game and couldn't play any more. No play, no scholarship. No scholarship, no college.

But the Syracuse coaching staff saw something in the brainy young man and offered to keep him on scholarship if he would coach the freshmen team.

Many of the freshmen players, back from the war, were several years older than Hutter. But Hutter was a success, and his coaching career got him through college financially.

He had one other hurdle. He discovered at the end of his sophomore year that his faculty adviser despised athletes and was trying to sabotage him with extra courses beyond the university requirements.

As a first-year medical student Hutter tried to keep his dual life going, but within a week the dean called him in. Make a choice, he was told: medicine or coaching.

"I never knew how he found out I was coaching," Hutter recalled.

Now what? Hutter got a job in the university teaching hospital. His assignment: Call a doctor if someone needed one.

"At least I had a place to sleep and a couple of meals," he said.

To earn money in the summers he worked as a waiter at a Long Island resort from 7 a.m. to 10 p.m., seven days a week, from the day the school year ended till the day the new school year began.

All the while, Hutter retained his dreams of psychiatry. But in his second year, the chairman of pathology, like the football coaches, also saw something in the young man.

"He called me in and asked me to do some research with him," Hutter said. "No one else in the class was asked, and I was excited. We did some research together, and the papers were published in international journals."

Psychiatry lost a budding star and pathology gained one.

From Syracuse medical school, Hutter did training at Yale University in Connecticut and Memorial Sloan-Kettering Cancer Center in New York, and his financial situation was little improved.

At Yale, when his mother-in-law visited him and his new wife, Ruth, she took one look at the couple's apartment, and said to her daughter, "I thought you married a doctor."

But then, and throughout his career, money was never paramount.

"Learning excited me," he said. "Good basic learning, research and publishing papers on things that hadn't been done before. The greatest thrill I ever had was to learn more. I never thought of money; it was learning discovery that excited me."

That, of course, and his beloved German shepherds, his three children (two physicians), and nine grandchildren, with whom he is enjoying his retirement.

One of his daughters, Dr. Randi Hutter Epstein, a medical journalist, recalls how her father, by then a world renowned breast cancer pathologist, talked for hours on the phone with patients and never charged.

"He was brutally honest with patients, with their prognoses, and they appreciated his honesty," she said. "He was like an old-time family practitioner. He would say, 'How can I charge? They have breast cancer.' "

It was Hutter who was co-author of a now-classic paper published in the mid-1970s that proved for the first time the relationship between breast cancer findings and mammography. The research compared mammography and pathological findings, a finding still cited.

His career goal was to make sure he and the pathologists who served under him got it right.

"We wanted to be certain that we have identified the right thing, to interpret it right so that the right therapy is given," he said.

"You give the surgeons a diagnosis, and that's what they base their therapy on. That was my concern. It was very important to me that we do the best we can so that what we are saying to the surgeons is correct."

Those decisions were often made on the basis of what is called a frozen section, a slide or series of slides sent to pathology from the operating room. The pathologists have about 10 minutes to sort out the swirl of red and blue cells on the slide.

Hutter was an artist. Often he could tell what was going on even before his hit the microscope.

"He would hold up a slide, and before he put it up to the microscope, he would have a good educated guess with his naked eye at what he was going to look at," Epstein said. "He could see the pattern before he put it in the microscope."

Said Hutter: "In the beginning, I learned to recognize what was known. But as I got more knowledge, I was able to identify things that hadn't been recognized before, and relating the significance of what I saw to therapy."

"He had a very keen eye," his daughter added. "If a bulldozer came and knocked over our house, he wouldn't have noticed. But on the cellular level, invisible to the human eye, he could see it."

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