Delos M. "Toby" Cosgrove arrived at the Cleveland Clinic in 1975 as an "incredibly poor" 34-year-old dreaming of a life as a cardiac surgeon. "Heart surgery was the astronaut corps of health care," he says. He had $3,000 in his bank account, left over from running an Air Force hospital in Vietnam, where he had won the Bronze Star. All his earthly belongings, including a Chevy Vega that was too flimsy to tow, fit in the back of a U-Haul. During his first year someone was shot dead at the clinic's front door. The bank in the basement was robbed.