DHMC department directors often joke that they know when Varnum has been making rounds. "We always knew, as administrators," says Susan Reeves, vice president for operations, "because we would get e-mails or notes saying, 'Gee, I was in this area last night and they were concerned about X. Could you look into this, make the improvement, and then follow up with me?'" Then, Reeves adds, "within three or four days, you'll get another note [asking], 'So, what have you found out so far?'"

Reeves also recalls, when she was a nursing supervisor in the late 1980s, making night rounds with Varnum at Raven House, a 16-bed dermatology inpatient unit across from the old Hanover MHMH. The nurses told Varnum that the streetlights were out in front of the building and that they felt unsafe as they came in to work. "Within 24 hours," says Reeves, "the streetlights were repaired."

From his earliest days at MHMH, Varnum earned a reputation as a man of action. "He said he would do something, and he did it!" recalls John Hennessey, his voice rising in astonishment. Hennessey, the former dean of Dartmouth's Tuck School of Business, was chair of the MHMH board of trustees when Varnum was hired. "He said he would talk to somebody, and he did it!" continues Hennessey. "And then he would let me know promptly. That was before e-mail—long before e-mail. He would call me or write me a note."

Having never worked for a board before coming to MHMH, Varnum had much to learn about the intricacies of board-CEO relationships. Hennessey helped guide him through that process. For example, "he had to learn what to do when individual trustees seemed to be crossing the line," says Hennessey. "He had to protect his turf. . . . But it was not always clear. There are a lot of ambiguities in this business."

When Varnum arrived on the job in the late 1970s, Dartmouth-Hitchcock Medical Center—as a composite institution—was in its infancy. It had been established officially in 1973, when the Medical School was transformed from a two-year feeder school into an M.D.-granting

From his earliest days at MHMH, Varnum earned a reputation as a man of action. "He said he would do something, and he did it!" recalls John Hennessey, his voice rising in astonishment. "He said he would talk to somebody, and he did it! And then he would let me know promptly."

institution. Composed of Dartmouth Medical School; Mary Hitchcock Memorial Hospital; the Hitchcock Clinic; and the VA Hospital in White River Junction, Vt., the Medical Center was still an evolving concept in 1978 when Varnum was hired. Reconciling operational and philosophical differences and priorities among four organizations wasn't easy.

"It was a very tense time, with a great deal of uncertainty," remembers Dr. James Strickler, who was dean of the Medical School from 1973 to 1981. "When Jim [Varnum] came, he was, for me, a breath of fresh air," recalls Strickler, "because he had come from a university hospital."

From 1973 to 1978, Varnum was the head administrator at one of two hospitals affiliated with the University of Washington. Before that, he'd worked for 10 years at University of Wisconsin