CITIZEN KOOP : Former Surgeon General’s New Shingle Could Read: ‘America’s Family Doctor’

In uniform, in federal service, C. Everett Koop was a bearded bear in shoulder boards and braid.

In retirement, Koop wears two-piece suits and oversized bow ties and lapel pins, and they make the man appear smaller, less forbidding.

In his transition from title to person, home is no longer red-brick government quarters. Koop, like ordinary folk, has a new, huge mortgage on a small house in Maryland.

The beard stays. It never has been a statement of Amish beliefs, as often suggested, because Koop is Presbyterian. He grew the beard years ago to camouflage multiple chins. How many? “Triple chins,” he admits. “But I haven’t looked lately. I’m not sure I can feel them anymore.”

As surgeon general and leader of the 7,000-member Public Health Service, C. Everett Koop preached high health and balanced diet. As civilian practice, Chick Koop eats marbled steaks, likes his martinis dry and his macadamia nuts dipped in Cool Whip.

“Darn good genes,” Koop explains. “My cholesterol level is right on the border between normal and abnormal, but what you probably don’t know and the country doesn’t know, is that . . . at the age of 73, it doesn’t matter what my cholesterol level is as far as predicting my heart attack.

“I think the worst thing about the cholesterol effort in this country is that it has frightened about 30 million (senior) people that don’t have to be frightened at all.”

So the Koop candor hasn’t surrendered, the insights aren’t retired and the mind remains open for his new business--as America’s family doctor. Or Dutch uncle.

“I want to be seen as an opinion maker,” he says.

Koop was in California recently making those opinions for audiences in San Diego, San Francisco and Los Angeles and to those “wanting to know what I thought because of who I was, rather than the title I used to have.

“So I am very pleased to see news reports, headlines and magazine things talking about C. Everett Koop and not talking about the former surgeon general.”

Koop is writing his memoirs. He will be host of five prime-time television health specials for NBC and produce videotapes that may do for individual health habits what Jane Fonda has done for thighs.

He was in Paris last week to receive an anti-smoking award and warn Europeans about their tobacco problems. He continues to visit AIDS patients in hospices, to lecture students in universities and offer free advice to the curious who still allow him no privacy in waiting rooms, on airplanes or riding the New York subway.

And for the first time since leaving his federal post in July, Koop is talking to the media--but only to interviewers selected by the Beverly Hills agent he now shares with Gerald and Betty Ford, Donald Regan, Alexander Haig and Bill Cosby.

“I have to be very careful not to be overexposed,” he said. “If I accepted what is offered, with radio and with television, you would see me every day and I don’t think I could last six months.

“I am approaching the limit of what people can take in the way of ‘don’t.’ You must remember that all my messages begin: ‘Don’t.’ ”

In this new life, there might even be a bluffer, tougher Koop. He always was direct. But in government service, he said, “there is a kind of an in-built, inborn restraint. I don’t do that (government service) anymore. I can be as outspoken as I wish.”

So here is Koop on abortion, a procedure he adamantly opposes: “I’m absolutely disgusted with the rhetoric and the bashing that one side does against the other. I think they have both forgotten, in a sense, what their first love was.”

On the lighter side, on Betty, the woman he married 51 years ago: “My wife is the world’s greatest non-accumulator of worldly goods. She should have been a nun.”

On smoking, from a man who quit his comfortable pipes 15 years ago: “I am making a plea for the European Common Market to fight smoking as a continent and not piecemeal as countries.”

Of his conflicting images as blusterer and humanitarian, as moral dictator and compassionate healer: “I’m all the good things.”

On AIDS: “Everything that turns up confirms heterosexual spread, numerically and geographically . . . most recent estimates are that there will be, in the year 2000, a hundred million people who are HIV positive.”

On the media that took years to warm to Koop: “I view the line between veneration and ridicule that the press can give you as a very narrow knife edge.”

On the past eight years when he became the most visible, the most controversial and, say even former detractors, the most effective surgeon general in the 119-year history of the Public Health Service: “I’m bloodied and scarred.

“But the veneer of approval and accolades has really removed any sense of bitterness I had about those first nine months (of nomination hearings). For the entire second Reagan term, really since October, 1986, when I put out the AIDS report, the acceptance and the appreciation that seems to come from the public has been very gratifying.”

And on the Holiday Inn in Torrance where he stayed before speaking to the South Bay Center for the Arts at El Camino College: “They actually put me in a smoking room.”

Had things gone a little differently 10 months ago, Koop might very well have rated the presidential suite wherever he stayed.

His second term was nearing its end and not even a personal appeal from President Bush would have persuaded him to remain in office.

“As surgeon general I had done it,” he remembered. “I was still to some people a new voice but in another year, I wouldn’t have been . . . and I think you need a new voice.”

But Koop did want a Cabinet post as Secretary of Health and Human Services. He made it known. A medical lobby (“probably as potent an affair as ever existed”) formed. Bush appointed Louis W. Sullivan, president of the school of medicine at Morehouse College, Atlanta, to the Cabinet.

“There are a lot of reasons why I am not secretary,” Koop said. “I am too outspoken and independence is viewed by some people around the President as not being a team player. I think they wanted to have a minority.”

Above all, Koop thinks he was tripped by his Washington record of never politicizing medical and personal opinions.

“I think when you sit at a cabinet meeting with the President and he says: ‘Chick, next week when you appear before so-and-so, the Administration position has to be . . .,’ then I might have to say: ‘Well, I can’t go.’ ”

Koop denied Washington rumors that he was angry at being passed over.

“Friends had asked: But how will you feel if you don’t get it,” Koop continued. “I said: I’ll be disappointed for a few days and happy for the rest of my life.”

Happiness for Koop is the pace of being on the road for two weeks of every month, the pressure of 51 speaking engagements (“that’s a misnomer . . . you usually speak once, teach a class, perhaps go and talk to a high school on AIDS or smoking”) since July--and now the unique challenge of building a third career at the start of his eighth decade.

Last week, between flights, Koop was home for only a few hours. He usually sees three films a year and they are in-flight movies. Most days are 14-hour sprints starting at 5 a.m with 10 minutes of prayer. Koop once went to bed at 2 a.m., slept until 7 a.m. and spent two days apologizing to his secretary for oversleeping.

“I have never been a rester,” he says.

He also needs the money, Koop says, for two sons, a daughter and seven grandchildren. He can’t build their inheritance on a federal pension. So, to cover his penchant for speaking for nothing “to any place where the message counts, where I will reach people who will reach others,” he charges richer organizations $25,000 an appearance.

The doctor has always treated himself this harshly.

He was attending Dartmouth at the age of 16 and decided to specialize in pediatric surgery because there were only six such physicians in the nation. Doctors were reluctant to anesthetize babies. Surgery on infants was virtually unknown.

“I was keenly aware that kids weren’t getting a fair shake in surgery, that they were falling through the cracks,” Koop said.

He closed those gaps with pioneer surgeries on babies with birth defects and by establishing the nation’s first neonatal intensive care unit at Philadelphia’s prestigious Children’s Hospital.

Siamese twins, several sets, were brought to Koop for separation. And if a tiny patient died, Koop often would deliver the eulogy.

Fellow doctors idolized this 200-pound ex-football player with the fingers of a watchmaker.

“He was the forefather of pediatric surgery . . . one of the best surgeons I’ve ever seen,” says Dr. Louise Schnaufer, associate professor of pediatric surgery at the University of Pennsylvania School of Medicine.

Yet some criticized Koop, the devout Christian, for co-mingling science and religion by praying at a child’s bedside. Koop’s retort was typically pungent: “I have found there are very few atheists among the parents of dying children.”

It was perhaps inevitable that he would become a pro-life devotee.

He wrote two books on the subject, lectured nationwide and his message was that legal abortion could track to “the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen.”

When Koop was nominated Surgeon General in 1981, liberal voices were unanimous that President Reagan only wanted this pro-lifer to support his own anti-abortion posture.

The hostilities of nomination lasted nine months. Koop was insulted as “Dr. Kook,” his family was “crushed.”

As he remembers it now: “Think how you would feel if you had been the darling of a city like Philadelphia, preeminent in your specialty and considered to be one of its founders, its sage.

“And all of a sudden you’re an absolute bum. Even in the city that nurtured you, there are cartoons showing you as a two-headed monster.”

Nobody, he said, saw him as a physician and public servant unwilling to compromise ethics for political ideology.

“What the press missed totally, was that on the second day I was in Washington, I voluntarily went to the Secretary of Health and said: ‘Mr. Secretary, I just want you to know, in case you are asked, it is not my intention to use this job as a pulpit for pro-life causes.’

“I was mislabeled and misunderstood. It took successive press conferences where I called a spade a spade and did not succumb to pressure from either side (of the abortion question), for the press to begin to appreciate me.”

Yet abortion remained his albatross. It flew again this year when President Reagan promised right-to-life organizations a report on the psychological harm to women who had abortions. Koop’s “report” was a five-page letter stating that such evidence did not exist.

This time, it was his former allies, the conservative right-to-lifers, who crucified Koop. Howard Phillips, chairman of the Conservative Caucus, said that if the surgeon general “couldn’t act on what he believed to be correct, he should have resigned.”

The irony, says Koop, is that he most certainly was acting on what he believed to be correct.

“The President,” he explained, “was led to believe that I would produce a document for him that would be very effective actually in reversing Roe vs. Wade,” the landmark Supreme Court decision legalizing abortion. “But the health of women who had abortions has never been an issue. It is the morality of whether or not you are destroying a person.”

In retrospect, he sees a dangerous message in continuing efforts to prove psychological damage of abortion.

“It is a subterfuge and I think a kind of admission of defeat on the part of the pro-life people,” he said. “If in midstream, they suddenly shift their emphasis to the health of mothers, they must have forgotten why they got into this (abortion issue) in the beginning.”

He remains opposed to abortion, but not to contraception. He is concerned with life. “But I don’t think that if you prevent a sperm and an egg from meeting in some way, that you are upsetting life.”

In 1982, Koop wrote his rigid indictment of cigarette smoking, focusing exclusively on its connection with a dozen cancers. He proposed a smoke-free America by the year 2000, called for tougher health warnings on cigarette packs--and was vilified by cigarette companies, their lobbies, their legislators and the governor of North Carolina.

Today, the cigarette habit continues to decline and Koop thinks his smoke-free society may not be a pipe dream. Looking back, he presumes the crusade will be considered among the highest triumphs of public health.

“I called upon the citizens of the country to do it and they did it,” he said. “We had 80 ordinances against smoking in 50 states at that time. It is now over 480 and that is (an example of) militant nonsmokers getting on the stick.

“Yesterday, in Greensboro, N.C., they voted for restriction on smoking in the city. That is unbelievable. That is the home of the tobacco companies.”

Three years ago, Koop numbed but educated the nation with his report on AIDS. He researched it alone, talking for months to researchers, gay activists and sufferers. He wrote it alone, all 26 drafts, at a stand-up desk in the basement of his home.

In graphic language and with stark definitions, Koop called for sex education at grade-school level and condoms for those who could not practice abstinence.

Ultraconservative author and activist Phyllis Schlafly accused Koop of promoting immorality.

David Baltimore, a Nobel Prize-winning biologist and chairman of a National Academy of Sciences task force on AIDS, told an interviewer at the time that history will remember Koop “as a hero, the one person in the Administration who attempted to act positively and decisively.”

Koop remembers the period as a test of his loyalty to President Reagan and “the toughest time in my life . . . when the country was demanding that the President say and do something about AIDS.”

At press conferences, his AIDS report would be lauded.

Then came questions about Administration inaction.

“My retort was: ‘I thought you said you liked what I did. Well, I am the Administration. I am the person doing AIDS right now. You don’t ask the President to talk about diarrhea or cholera. Why should he talk about AIDS?’ ”

So at some “personal discomfort,” Koop said, he defended President Reagan “for not using the dirty word. I had looked forward to Mr. Bush being quite different. But he hasn’t said a word either.”

Koop remains concerned by those who deny the heterosexual spread of AIDS.

“It stands to reason that if AIDS has been in Africa as long as it has been and its transmission now is largely heterosexual, it is going to be (like that) here eventually,” he said. “The second thing that bothers me is the projection for the world by the end of the century.”

World Health Organization statistics, he said, indicate that 100 million people will be testing HIV positive 10 years from now.

“If that is the case, and if you stopped it (AIDS) then,” Koop said, “you would (still) have the deaths of 100 million people.”

These thoughts and fears are the stuff of the book he is writing, not a biography, he says, but memoirs of the Washington years where his motivation never shifted--but where allegiances changed around him as times, labels, causes and people changed.

Now there are new causes.

He wants a fresh emphasis on the wellness of America through citizen adoption of preventive health measures.

“If we spent one third of the effort on preventing things from happening that we do on trying to cure or repair them, we would be way ahead,” he said. “Estimates say that the years you gain, the premature deaths that you postpone . . . you get about 70% of those from prevention and about 15% from repair.”

The payoff for a 45-year-old starting now, he said, will be a reduced need for medical repair in later years.

For 20 years from now, Koop continued, health-care resources for the elderly “are going to be scarce . . . there are going to be so many people over 65 that the gravy is going to be very thin as far as medical care of the conventional sort is concerned.”

The health-care gospel according to Koop is simple:

* Don’t smoke.

* Drink only in moderation.

* Exercise proportionate to age.

* Avoid stress.

* Choose an appropriate diet.

Koop’s television specials, his book, the speeches and interviews will be conduits, he said, to the commercial videotapes that “I am just aching to do . . . health videos directed at people like you to buy for your mother.

“There are three one-way tickets to nursing homes that don’t have to be. Fractured hips. Diabetic amputations. Incontinence. And I have a good answer to all three.”

Yet if it all ended today--with a repeat of a heart attack suffered in his 50s, with a worsening of the arthritis he suffers, with a recurrence of the spinal canal closure that left him a temporary paraplegic in 1987--there remain many treasures in the past and present of Charles Everett Koop.

Chick and Betty Koop did lose a son, David Charles Everett, a 20-year-old junior at Dartmouth who was killed in a New Hampshire climbing accident in 1968. But there is Allen, 45, a history professor; Norman, 43, a Presbyterian minister, and Elizabeth Thompson, 38, a homemaker, and all their children. There was remoteness and much separation in those early years, said Koop. But today’s family meetings--especially when the Koops attend Norman’s church--are perpetual Thanksgiving.

Koop’s opinions have been described as Commandments and his delivery and presence close to Moses. He says, mischievously, that he is not uncomfortable with that image.

He keeps contact with hundreds of his 100,000 former patients, now productive adults. Especially Paul Sweeney, born 24 years and 56 operations ago with multiple defects. Three surgeons refused to operate on the baby. Koop said he would. Last year, Sweeney graduated from West Chester State College in Pennsylvania and is headed for law school.

Part of that large legend is that in 1983, when Sweeney was facing his final operation, Surgeon General Koop flew to Philadelphia and, in full uniform, wheeled Sweeney to the operating room.

About that uniform.

It is the official wear of the Public Health Service and gave Koop the rank equivalent of three-star general. He insisted on wearing it in the office, he said, as “a pure morale builder” for a lightly regarded organization that eventually developed “into what they were supposed to be, a quasi-military, uniformed, unarmed service.”

That uniform, white ducks in summer, navy blue in winter, became a symbol of Koop.

“The other day I was at a meeting,” Koop said. “One of the curators of the Smithsonian said: ‘I’d like your uniform.’ ”