Alpha Omega Alpha Honor Medical Society SPRING 2018 THE PHAROS of Alpha Omega Alpha honor medical society SPRING 2018 Alpha Omega Alpha Honor Medical Society “Be Worthy to Serve the Suffering” Founded by William W. Root in 1902 Editor Richard L. Byyny, MD Officers and Directors at Large Eve Higginbotham, SM, MD President Managing Editor Dee Martinez Philadelphia, Pennsylvania Alan G. Robinson, MD Art Director and Illustrator Jim M’Guinness President Elect Los Angeles, California Designer Erica Aitken Joseph W. Stubbs, MD, MACP Immediate Past President Albany, Georgia Wiley Souba, Jr., MD, DSc, MBA Editorial Board Secretary-Treasurer Hanover, New Hampshire Robert G. Atnip, MD, FACS, RPVI Jeremiah A. Barondess, MD James G. Gamble, MD, PhD C. Ronald Mackenzie, MD Hershey, Pennsylvania New York, New York Stanford, California New York, New York Holly J. Humphrey, MD David A. Bennahum, MD Michael Gerber, MD Philip A. Mackowiak, MD Chicago, Illinois Albuquerque, New Mexico Denver, Colorado Baltimore, Maryland Richard B. Gunderman, MD, PhD John A. Benson, Jr., MD Dean G. Gianakos, MD Ashley Mann, MD Portland, Oregon Lynchburg, Virginia Kansas City, Kansas Indianapolis, Indiana Richard Bronson, MD Jean D. Gray, MD J. Joseph Marr, MD Sheryl Pfeil, MD Stony Brook, New York Halifax, Nova Scotia Broomfield, Colorado Columbus, Ohio John C.M. Brust, MD Richard B. Gunderman, MD, PhD Aaron McGuffin, MD John Tooker, MD, MBA New York, New York Indianapolis, Indiana Huntington, West Virginia Philadelphia, Pennsylvania Charles S. Bryan, MD Lara Hazelton, MD Stephen J. McPhee, MD Steven A. Wartman, MD, PhD Columbia, South Carolina Halifax, Nova Scotia San Francisco, California Washington, DC Robert A. Chase, MD David B. Hellmann, MD Janice Townley Moore Peterborough, New Hampshire Baltimore, Maryland Young Harris, Georgia Lynn M. Cleary, MD Pascal J. Imperato, MD, MPH&TM Francis A. Neelon, MD Medical Organization Director Syacuse, New York Brooklyn, NY Durham, North Carolina Atul Grover, MD Fredric L. Coe, MD Therese Jones, PhD Douglas S. Paauw, MD, MACP Association of American Medical Colleges Chicago, Illinois Aurora, Colorado Seattle, Washington Washington DC Jack Coulehan, MD John A. Kastor, MD John S. Sergent, MD Stony Brook, New York Baltimore, Maryland Nashville, Tennessee Councilor Directors Gregory Davis, MD Henry Langhorne, MD Jan van Eys, PhD, MD Regina Gandour-Edwards, MD Lexington, Kentucky Pensacola, Florida Nashville, Tennessee University of California Davis School of Medicine Lawrence L. Faltz, MD Jenna Le, MD Abraham Verghese, MD, DSc J. Mark Kinzie, MD Larchmont, New York New York, New York (Hon.) Oregon Health and Science University School Joseph J. Fins, MD Michael D. Lockshin, MD Stanford, California of Medicine New York, New York New York, New York Steven A. Wartman, MD, PhD Kahtleen F. Ryan, MD Faith T. Fitzgerald, MD Jerome Lowenstein, MD Washington, DC Drexel University School of Medicine Sacramento, California New York, New York Gerald Weissmann, MD Coordinator, Residency Initiatives Lester D. Friedman, PhD Kenneth M. Ludmerer, MD New York, New York Geneva, New York St. Louis, Missouri Suzann Pershing, MD Stanford University Student Directors www.alphaomegaalpha.org Jeremy T. Bolin Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine Manuscripts being prepared for The Pharos should be typed double-spaced and conform to the format outlined Samantha Dizon in the manuscript submission guidelines appearing on our website: www.alphaomegaalpha.org/contributors.html. University of Maryland School of Medicine Editorial material should be sent to Richard L. Byyny, MD, Editor, The Pharos, 12635 E. Montview Blvd, Suite 270, Aurora, CO 80045. E-mail: [email protected]. Sean Christensen, MSIV Requests for reprints of individual articles should be forwarded directly to the authors. University of South Carolina School of Medicine The Pharos of Alpha Omega Alpha Honor Medical Society (ISSN 0031-7179) is published quarterly by Alpha Omega Alpha Honor Medical Society, 12635 E. Montview Blvd, Suite 270, Aurora, CO 80045, and printed by The Ovid Bell Press, Inc., Fulton, Missouri 65251. Periodicals postage paid at the post office at Aurora, Colorado, and at additional mailing offices. Copyright © 2017, by Alpha Omega Alpha Honor Medical Society. The contents Administrative Office of The Pharos can only be reproduced with the written permission of the editor or managing editor. (ISSN 0031- Richard L. Byyny, MD 7179). Executive Director Circulation information: The Pharos is sent to all dues-paying members of Alpha Omega Alpha at no additional Aurora, Colorado cost. All correspondence relating to circulation should be directed to Ms. Dee Martinez, 12635 E. Montview Blvd, 12635 E. Montview Blvd, Suite 270, Aurora, CO 80045 Suite 270, Aurora, CO 80045. E-mail: [email protected]. Telephone: (720) 859-4149 POSTMASTER: Change service requested: Alpha Omega Alpha Honor Medical Society, 12635 E. E-mail: [email protected] Montview Blvd, Suite 270, Aurora, CO 80045. 2 Editorial I The joy in caring Richard L. Byyny, MD, FACP 9 Feathers and files Slavena Salve Nissan 10 Leonardo at 500: A lesson in creativity Salvatore Mangione, MD 19 The organ donor’s gift Samuel Cohen-Tanugi, MD 22 You don’t know Jack Jonathan M. Bekisz, MD 25 Back in the day: A roman á clef Gordon Green, MD, MPH 29 Secondary intention Brian W. Christman, MD 30 Sir Arthur Conan Doyle: The physician behind Sherlock Holmes Stacy J. Kim, MD 36 The Sick Child: Artistic perceptions of mortal illness in children Don K. Nakayama, MD, MBA 43 Developing foundational principles for teaching and education for a school of medicine Joseph Cofrancesco Jr., MD, MPH, FACP; Roy C. Ziegelstein, MD, MACP; David B. Hellmann, MD, MACP 47 The living dead: Interactions between the living and the dead in Spring 2018 Spring • clinical practice Robert W. Putsch, III, MD 55 Book reviews 58 Medicine on the big and small screen: Manchester by the Sea and Three Billboards Outside of Ebbing, Missouri 62 2017 honor roll of donors 81 Coffee shop Volume 81 Number 2 Number 81 Volume Raymond C. Roy, MD, PhD • Corrections In the Autumn 2017 issue, the article “Astonished Harvest” incorrectly identified Dr. William Carlos Williams as being AΩA. This was incorrect. We apologize for any confusion or inconvenience this may have caused. The Pharos In the Winter 2018 issue, the article “Update on the Aliki Initiative at year 10: Changing the culture of IN THIS ISSUE medicine to know our patients as individuals,” should have listed Drs. Laura Hanyok and Janet Record as co-first authors. The joy in caring Richard L. Byyny, MD, FACP Time, sympathy, and understanding must be lavishly is characterized by emotional exhaustion, depersonalization dispensed, but the reward is to be found in that personal (treating patients, students, and colleagues in a cynical way), bond which forms the greatest satisfaction of the practice and reduced feelings of work-related personal and profes- of medicine. One of the essential qualities of the clinician sional accomplishment. It has been associated with reduced is interest in humanity, for the secret of the care of the or poor job performance, clinical illness, cognitive impair- patient is in caring for the patient. ment, mental errors, lack of attention and concentration, absenteeism, and thoughts of quitting or changing one’s job —Dr. Francis W. Peabody and/or occupation. The total cost of recruiting a physician (AΩA, Harvard Medical School, 1906)1 can be $90,000, with the lost revenue for that physician be- tween $500,000 and $1 million. Turnover begets more turn- he joy in the care of the patient is in caring for over, and those left behind are managing increased stress.4 the patient. Jack Coulehan, MD (AΩA, Emory It is estimated that more than 50 percent of physicians University, 1974), wrote: in the United States have at least one symptom of burn- T out.15 Typical symptoms include headaches, insomnia, The rapid progress in medicine has indeed yielded an tension, anger, and closed thinking. Symptoms of depres- astonishing harvest of improvements in our patients’ sion with altered mood, distorted behavior, and sleep dis- health…Medical practice provides a rich opportunity to turbance can be experienced during extreme instances of experience empathy, hope, solidarity, compassion, and burnout. Cognitive impairments in memory and attention self-healing. Our profession gives us privileged access can occur as well as behavioral effects associated with ab- to deep bonds of humanity we share with our patients. sences, time missed from work, and thoughts of quitting. Traditionally, physicians have considered this fulfillment The ICD-10 includes burnout under problems related to one of the chief rewards of our profession.2 life-management difficulty with clinical manifestations similar to, and often consistent with, clinical depression. And, Sir William Osler said: A gratifying profession Nothing will sustain you more potently than the power to I presented a lecture on hypertension to community recognize in your humdrum routine…the poetry of the physicians in the 1980s, and at the evening’s dinner most ordinary man, of the plain, toil-worn woman, with their of the older men were commiserating about the negative loves and their joys, their sorrows, and their griefs.3 changes in medicine, medical care, hospitals, and patients. One younger woman was eating and not participating in Medicine continues to make tremendous improvements the conversation, so I engaged her and asked what she in science, diagnostics, technology, and treatments, which thought about the current state of medicine. She was clearly are better for patient care and outcomes. However, a 32-year-old obstetrician/gynecologist, and said, “You more physicians report dissatisfaction with the profes- know, I don’t remember the good old days. I am an excel- sion, and many report suffering from burnout. Perhaps all lent physician and surgeon, and provide excellent care physicians who have given of themselves for their patients for my patients.