A Doctor Prescribes Hard Truth: C. EVERETT KOOP

He is, by Washington standards, a little strange. First, there is the uniform draped with gold braid he insists on wearing. Before he became famous, it prompted people at airports to pile him with baggage and ask what time the flight was leaving. Then there is the big, clunky hearing aid that he takes out and fusses with right in the middle of a conversation, as if it were a pipe, and the canvas tote he uses as a briefcase, and his habit of loudly cracking his knuckles. On top of that there are the Old Testament beard and the preacher’s voice that make him seem like Moses come down again from Mount Sinai to deliver commandments 11 through 20. Smoking? It’s an addiction that will kill you. Sex? Only in marriage. AIDS? The best preventive device is a monogamous relationship; the second best, a condom. Deformed newborns? Save them. Sex education? In the earliest grade possible.

You name it, Surgeon General C. Everett Koop has an opinion, which he will give you with great certainty at high speed. There has never been a Surgeon General like him, not even Luther Terry, who slapped warnings on cigarette packs 24 years ago. It’s a fair guess that Terry was never air-kissed by Elizabeth Taylor, the butt of jokes in Johnny Carson’s monologue, was never a visitor to the set of Golden Girls, and never lectured Hollywood producers about showing safe sex in their programs. Antismoking is a small part of Koop’s crusade; AIDS, child abuse, domestic violence, pornography, old people, drunk driving and Baby Doe regulations made Koop one of the most visible officials in Washington. Now at airports people offer to carry his bags.

The 13th Surgeon General, whose second term runs through the end of the year, almost never got a chance to don a uniform. When Koop, a retired pediatric surgeon, and his wife Betty moved to Georgetown in early 1981 to await his confirmation, they became proof of the old saw that if you want a friend in Washington, buy a dog. The process, expected to take a few days, turned into nine nightmarish months of name-calling and personal attacks, as liberals stalled his confirmation. He was called a right-wing crank, a prolife nut, a religious zealot, inexperienced, Dr. Unqualified (the New York Times), scary (California Congressman Henry Waxman) and Dr. Kook. The intensity of the attacks was fueled by prochoice advocates who feared his opposition to abortion. In addition to being the author of several books, Koop was known for an antiabortion film he produced in which a thousand black and white dolls were scattered over the salt wastes of the Dead Sea to represent millions of aborted fetuses. Koop, who became an evangelical Presbyterian in his 30s, explains his views against abortion and against withholding food and medical care from congenitally deformed newborns simply: “If you had led my life, you would understand.” As a pediatric surgeon for 33 years, Koop saved many ^ babies no bigger than his hand. In the course of treating 100,000 patients, Koop saw many so-called difficult cases become happy and productive children. One of these was Paul Sweeney, born in 1965 with twisted intestines, facial deformities and a cleft palate. Koop operated on him 37 times. For the final operation by another surgeon in 1983, Koop returned to Philadelphia in full dress uniform to wheel his former patient into the operating room. Sweeney recently graduated from West Chester University in Pennsylvania.

Accustomed to the godlike treatment accorded surgeons, Koop was stunned by the viciousness of Washington, which has neither gods nor heroes. Every day he would go to his temporary office on the seventh floor at the Department of Health and Human Services. Every day the phone wouldn’t ring. His wife, uprooted from Philadelphia, waited in their small sublet wondering whether to unpack. One day Koop returned to find tears rolling down her face, a critical newspaper article on her lap. He considered leaving, but Betty persuaded him to stay. The two had been through a lot — long years of medical school, Koop’s fractured vertebra and stomach surgery and, worst of all, the death of a son — and they stuck it out. Finally, in November 1981, he was confirmed by a Republican-controlled Senate.

Koop was expected to be a figurehead like most Surgeons General, with little authority and few staff or duties, but he quickly shook things up. He insisted that the commissioned corps of public-health officers wear uniforms. Then the 6-ft. 1-in., 210-lb. doctor, whose taste for red meat and martinis keeps him from losing his paunch, pronounced the U.S. a country of fatsoes who would have to give up cholesterol in favor of fiber. When Koop found out that the tobacco companies had fought hardest over the years against the Government’s calling nicotine addictive, he stated high up in his Surgeon General’s report that nicotine is addictive. “They absolutely hated it,” he gloats. He said the companies’ claims that science cannot say with certainty that tobacco causes cancer were “flat-footed lies” and that sending cigarettes to the Third World was “the export of death, disease and disability.”

He is not above gimmicks. Pushing his slogan “A Smoke-Free Society by the Year 2000,” he adopted a kindergarten class whose students pledged not to start smoking (“Like Communists,” he says, “you have to get them when they’re young”), and everywhere he goes he hands out buttons saying THE SURGEON GENERAL PERSONALLY ASKED ME TO QUIT.

But Koop might have remained just another bureaucrat if it had not been for AIDS. As the disease grew to near epidemic proportions, the Administration had to do something. Conservatives breathed a sigh of relief when in 1986 the President handed the job to the Fundamentalist Christian Surgeon General.

After getting assurances that he would be the sole author of the report, Koop took to the task with an open mind, consulting Government experts like the National Institutes of Health’s Dr. Anthony Fauci and inviting more than 25 groups, from gay activists to the Southern Baptist Convention, to his office. He wrote 26 drafts at the stand-up desk in the basement of the brick house he rents on the campus of the NIH. He numbered the copies he took to a meeting at the White House and collected all of them to prevent leaks. The next day, Oct. 22, 1986, he released the report at a packed press conference; 16 million copies of the report and 107 million copies of an AIDS pamphlet are in print.

Administration conservatives were stunned by the report’s candor. They were particularly outraged that he did not preach abstinence alone and refer euphemistically to body fluids rather than semen. “The White House doesn’t like the C word. But if you don’t talk about condoms, people are going to die. So I talk.” Liberals were amazed that Koop had produced a reasoned report with such compassion for homosexuals, whom he had once called antifamily. Phyllis Schlafly, who said the report sounded as if it had been edited by a gay-rights group, lashed out against Koop and led a campaign against him. Her efforts culminated in the boycott of a dinner in honor of Koop and persuaded two presidential candidates, Representative Jack Kemp and Senator Robert Dole, to pull out as sponsors of it.

Koop says no one should be surprised, that the report is consistent with his moral view that you can hate sin but love the sinner. “I am the Surgeon General, not the chaplain, of all the people, and that includes homosexuals,” he says. He outraged conservatives again in January. Although opposed to abortion morally, Koop concluded, following an 18-month study undertaken after President Reagan promised right-to-life leaders a report, that the evidence just wasn’t there to condemn the practice as psychologically harmful.

Despite his success in Washington, Koop’s real calling is medicine. By the time he was five, he knew he wanted to be a doctor like his uncle. At 15, he ! would take the subway on weekends from Brooklyn to Columbia-Presbyterian Hospital in Manhattan, pinch a white lab coat, and take a seat in the balcony of the operating room, transfixed for hours by amputations and appendectomies. Back home, while his father was at the office, he would persuade his mother to help her precocious only child round up stray cats and dump them into a sterile trash can with an ether-soaked sponge so that he could perform exploratory surgery. He brags that he never lost a cat.

Not your normal teenage pastimes, but Koop managed to avoid being the science nerd with a slide rule in his back pocket. He was on the wrestling, football and baseball teams, editor of the school paper and president of the student council. He went on to Dartmouth and Cornell University Medical College, completing his training at the University of Pennsylvania in 1947. He surprised many people when he decided to specialize in pediatric surgery, a decidedly low-rent field in those days, when the real brains were going into neurosurgery. “Children weren’t getting a fair shake in surgery, getting giant incisions like their grandfathers’ and being sewn up like a football when a tiny hole would do,” he recalls. “I saw the chance to make a difference.” There were about five such surgeons in the country at the time (there are close to 500 now), and Koop’s training consisted of going to Boston Children’s Hospital and peering over the shoulders of surgeons there, much as he did at Columbia when an adolescent.

Back in Philadelphia, Koop quickly became known as a tireless and dedicated doctor. When a peptic ulcer threatened to keep him out of surgery for months, he treated himself at night, filling an IV bottle with milk and clamping it onto the bedpost. With the help of his wife, then pregnant with their first child, he would thread a tube through his nose and down his throat so the liquid could drip into his stomach while he slept. More than once, the jury- rigged system failed, and the Koops woke up in a soaked bed.

Koop was named surgeon in chief at Children’s Hospital of Philadelphia in 1948. There he perfected techniques for correcting undescended testicles and undeveloped esophaguses, skills that he compares to threading together two wet noodles at the bottom of an ice-cream cone with your eyes closed. His first brush with fame came when he separated Siamese twins joined at the abdomen and pelvis. He established the country’s first neonatal unit. Noted for his speed — he did hernias in six minutes (he has done more than 10,000) — he used the time saved to counsel parents and make house calls on terminally ill patients he thought were better off at home. Dr. Judah Folkman, a professor at Harvard Medical School who trained under Koop, says, “I remain in awe. He was beloved at that hospital, worrying over patients as if they were his own children.” To criticism that he tinged his medicine with religion, Koop says, “There are no atheists at the bedside of a dying child.”

Koop learned this firsthand in 1968, when his youngest son David, a junior at Dartmouth, fell to his death in a mountain-climbing accident. “I thought I knew what parents went through, but I had no idea,” he says. “I felt bone- crushing grief.” For months he got such a lump in his throat talking to parents that he had to cut his discussions short.

Koop and his wife, the daughter of a Connecticut country doctor for whom a punishing dawn-to-midnight schedule was normal, have three other grown children and seven grandchildren. The Koops recently celebrated their 50th wedding anniversary aboard the QE2.

Whatever happens when his term is up in 1990, Koop will stay in Washington, which has made its peace with him. His most vociferous enemies have admitted they were wrong about him. Most of the friends he lost in making the ethically correct — not politically correct — decision on AIDS have come back. The city that worships at the gray altar of ambiguity found there was room for a man of black and white.