Alpha Omega Alpha Honor Medical Society SPRING 2016

THE PHAROS of Alpha Omega Alpha honor medical society SPRING 2016

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 Robert G. Atnip, MD President Managing Editors Debbie Lancaster and Dee Martinez Hershey, Pennsylvania Joseph W. Stubbs, MD Art Director and Illustrator Jim M’Guinness President-Elect Albany, Georgia Designer Erica Aitken Douglas S. Paauw, MD Immediate Past President Seattle, Washington In memoriam Wiley Souba, Jr., MD, DSc, MBA Robert J. Glaser, MD, Editor Emeritus Secretary-Treasurer Helen H. Glaser, MD, Associate and Managing Editor Hanover, New Hampshire Eve J. Higginbotham, SM, MD Philadelphia, Pennsylvania Editorial Board Holly J. Humphrey, MD Chicago, Illinois Jeremiah A. Barondess, MD Lester D. Friedman, PhD Philip A. Mackowiak, MD Richard B. Gunderman, MD, PhD New York, New York Geneva, New York Baltimore, Maryland Indianapolis, Indiana David A. Bennahum, MD James G. Gamble, MD, PhD Ashley Mann, MD Sheryl Pfeil, MD Albuquerque, New Mexico Stanford, California Kansas City, Kansas Columbus, Ohio John A. Benson, Jr., MD Dean G. Gianakos, MD J. Joseph Marr, MD Alan G. Robinson, MD Portland, Oregon Lynchburg, Virginia Broomfeld, Colorado Los Angeles, California Richard Bronson, MD Jean D. Gray, MD Aaron McGuffn, MD Stony Brook, New York Halifax, Nova Scotia Huntington, West Virginia John Tooker, MD, MBA John C.M. Brust, MD Lara Hazelton, MD Stephen J. McPhee, MD Philadelphia, Pennsylvania New York, New York Halifax, Nova Scotia San Francisco, California Steven A. Wartman, MD, PhD Charles S. Bryan, MD David B. Hellmann, MD Janice Townley Moore Washington, DC Columbia, South Carolina Baltimore, Maryland Young Harris, Georgia Francis A. Neelon, MD Robert A. Chase, MD Pascal James Imperato, MD Medical Organization Director Peterborough, New Hampshire Brooklyn, New York Durham, North Carolina Griffin P. Rodgers, MD, MBA Therese Jones, PhD Bonnie Salomon, MD Henry N. Claman, MD National Institute of Diabetes and Digestive and Denver, Colorado Aurora, Colorado Deerfeld, Illinois Kidney Diseases, National Institutes of Health Lynn M. Cleary, MD John A. Kastor, MD John S. Sergent, MD Bethesda, Maryland Syacuse, New York Baltimore, Maryland Nashville, Tennessee Clement B. Sledge, MD Fredric L. Coe, MD Henry Langhorne, MD Marblehead, Massachussetts Chicago, Illinois Pensacola, Florida Councilor Directors Jan van Eys, PhD, MD Jenna Le, MD Regina Gandour-Edwards, MD Jack Coulehan, MD Nashville, Tennessee Stony Brook, New York New York, New York University of California, Davis, School of Abraham Verghese, MD, DSc (Hon.) Medicine Lawrence L. Faltz, MD Michael D. Lockshin, MD Stanford, California Larchmont, New York New York, New York Steven A. Wartman, MD, PhD Charles Griffith III, MD, MSPH Joseph J. Fins, MD Jerome Lowenstein, MD Washington, DC University of Kentucky College of Medicine New York, New York New York, New York David Watts, MD Mark J. Mendelsohn, MD Faith T. Fitzgerald, MD Kenneth M. Ludmerer, MD Mill Valley, California University of Virginia School of Medicine Sacramento, California St. Louis, Missouri Gerald Weissmann, MD Daniel Foster, MD C. Ronald Mackenzie, MD New York, New York Dallas, Texas New York, New York Coordinator, Residency Initiatives Suzann Pershing, MD Stanford University

www.alphaomegaalpha.org Student Directors 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 in the manuscript submission guidelines appearing on our website: www.alphaomegaalpha.org/contributors.html. Editorial material should be sent Richard Latuska, MD to Richard L. Byyny, MD, Editor, The Pharos, 525 Middlefield Road, Suite 130, Menlo Park, California 94025. E-mail: thepharos@ Vanderbilt University School of Medicine alphaomegaalpha.org. Laura Tisch, MD Requests for reprints of individual articles should be forwarded directly to the authors. Medical College of Wisconsin The Pharos of Alpha Omega Alpha Honor Medical Society (ISSN 0031-7179) is published quarterly by Alpha Omega Alpha Honor Medical Society, 525 Middlefield Road, Suite 130, Menlo Park, California 94025, and printed by The Ovid Bell Press, Inc., Fulton, Missouri 65251. Periodicals postage paid at the post office at Menlo Park, California, and at additional mailing offices. Copyright Administrative Ofﬁce © 2016, by Alpha Omega Alpha Honor Medical Society. The contents of The Pharos can only be reproduced with the written Richard L. Byyny, MD permission of the editor or managing editor. (ISSN 0031-7179). Executive Director Circulation information: The Pharos is sent to all dues-paying members of Alpha Omega Alpha at no additional cost. All Menlo Park, California correspondence relating to circulation should be directed to Ms. Dee Martinez, 525 Middlefield Road, Suite 130, Menlo Park, California 94025. E-mail: [email protected]. 525 Middlefeld Road, Suite 130 Menlo Park, California 94025 POSTMASTER: Change service requested: Alpha Omega Alpha Honor Medical Society, 525 Middlefield Road, Suite 130, Telephone: (650) 329-0291 Menlo Park, CA 94025. Fax: (650) 329-1618 E-mail: [email protected] INThe Pharos • Volume THIS 79 Number 2 • Spring 2016 ISSUE

81 Ill Us donors of 64 2015Honor roll and reflections 56 Reviews tothe editor 54 Letters you, Dr.52 Thank Dans 49 theoath: 43 Breaking 40 39 Inan instant 31 26 20 12 10 9Confession 2

Editorial I Au revoir Medicine in the movies: floor daughter on our bedroom midwife: to student medical From Paul Klee of the works as seenthrough illness: chronic of time a in Art the King’s Touch England in Reformation Macbeth: Shakespeare’s The uses medical of oaths in the twenty-first century The Harlem assassination attempt on Martin Luther King, Jr. Richard L. Byyny,Richard L. MD, FACP Antonia Palisano D.Lester Friedman Taylor Brooks R. Lowder Kevin Maya Armstrong Grace Prince, MD Netter BrayFleta Matthew Iles-Shih, MD, MPH; andJohn Stull, MD, MPH Ralph S. Crawshaw, MD; Byron Foster,A. MD, MPH; MD, Nakayama, MBA K. Don Jennifer Hu toaloyal friend andcolleague

s Time matters in caring for patients Time matters Why physicians torture It’s An insight into politics, religion, and and politics, religion, into insight An still alive: alive: The effects systemic of sclerosis The day I delivered my Victor Frankenstein

Time matters in caring for patients Twenty minutes isn’t enough

Richard L. Byyny, MD, FACP

The good physician knows his patients through and for-profit medical organizations. This results in inadequate through, and his knowledge is bought dearly. Time, sym- time for doctors with patients, and the healing power of the pathy, and understanding must be lavishly dispensed, but doctor-patient relationship is often impaired or forgotten. the reward is to be found in that personal bond which Peter Dans, MD, wrote, forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in When the AMA [American Medical Association] agreed humanity, for the secret of the care of the patient is in car- to drop its opposition to Medicare and Medicaid in the ing for the patient. 1960s, it exacted a promise that the new laws would incor- Francis W. Peabody1 porate its “usual, customary, and reasonable” fee system. This paid disproportionately for hospital visits, surgery, espite rapidly developing new technologies and ad- and technologic procedures for treating acute illness, as vancements in medicine, how we actually care for our opposed to office visits for maintenance treatment of patientsD continues to be our most important professional chronic illnesses or for prevention. The legislation also responsibility. The care of the patient is based on what each accommodated hospitals by agreeing to pay all their costs patient needs; what is most important for each patient and plus 2 percent. This favored the development and use of family; and what patients and their families need to un- costly technology and instrumentation in larger and more derstand to cope with their health, illnesses, and suffering. complex institutions. Medical care, once considered a The qualities that we physicians bring to our patients “cottage industry” became “corporatized,” or in the words and society are many, but most important, we need to be of Arnold Relman, MD, editor of the prestigious New present and engaged with our patients as individuals. The England Journal of Medicine, a “new medical-industrial doctor-patient relationship remains the core of our profes- complex.” No longer could the profession’s ethos be set by sional responsibility, and our profession. Sir William Osler a Hippocrates, Sir William Osler, or the few distinguished wrote, “the good physician treats the disease; the great leaders and institutions that dominated it until the 1950s.3 physician treats the patient who has the disease.” 2 We have made incredible progress in diagnosing, pre- The most important way to improve patient care venting, and treating diseases which has reduced deaths through the doctor-patient relationship is to increase the and extended the life expectancy to an age never before amount and quality of time for the doctor to spend with seen in history. Yet, many factors introduced by our third- his/her patient in the clinic or office. party payer system and the corporatization and busines- sification of medicine adversely affect the doctor-patient What doctors and patients need is more time, not more relationship. Patient care has become increasingly imper- technology. sonal, hurried, and commercialized. Doctors and the way —Malcolm Gladwell4 we practice medicine are controlled by insurance companies, corporations, health maintenance organizations, and

2 The Pharos/Spring 2016 David Sipress/The New Yorker Collection/The Cartoon Bank

Many organizations and insurance companies pur- the patient is a distinct human interaction that is set apart posefully limit or decrease doctor-patient time, and align by its sovereign confidential nature which includes a thor- financial incentives for doctors with the plan’s commit- ough physical examination; discussions of disability and ment to greater profit, and other goals that are unrelated death that directly relate to the patient; diagnostic tests to those of doctors or patients. Time limitations must be and therapeutic interventions with which the physician addressed and recognized as a critical requirement in the is directly or indirectly involved; and an atmosphere of care of patients. The doctor-patient relationship in which respect for individual dignity. It is characterized by trust, a history, clinical examination, thoughtful communication, compassion, humanism, professionalism, and high moral diagnostic reasoning, diagnoses and plans, and medical and and ethical standards.5 other caring interventions are made, remains the keystone of care. Effective doctor-patient communication cannot be Much stands in the way accomplished in a strict, time-limited, fifteen- or twenty- Limiting the time spent with patients while increasing minute appointment. the “efficiency” and “productivity” of the interaction—the Dr. William Watts Parmley observed that the care of assembly line approach—often destroys any meaningful

The Pharos/Spring 2016 3 Time matters

doctor-patient relationship. For many physicians who are increase reimbursement, administrative responsibilities, tied to a computer and the electronic health record, it practice controls, charting, working with the electronic becomes easier and more “efficient” to spend their lim- health record, ordering tests, writing prescriptions, order- ited time with the patient entering information into the ing consultations, attenuating litigation risks, and a mul- computer, and ordering tests and consults (see The Pharos titude of other diversions and responsibilities that restrict Summer 2015 editorial “The tragedy of the electronic face-to-face care of the patient. All of these activities must health record” pp 2–5). This makes the actual one-on-one be completed in a time-limited fifteen- to twenty-minute time for the patient and doctor even more constricted, and patient appointment. often is very frustrating for the patient. Limitation of time also contributes to dissatisfaction as well as physician burn- Assembly lines are not possible out. Sufficient time to care for patients and help them—and The business model of an assembly line approach to their families—to care for themselves is what patients, patient care completely ignores the fact that there is no av- especially those with chronic diseases and socioeconomic erage patient with the same design, problem, cause, and ef- influences, need most. fect. People are not mass produced, all from the same mold Studies have demonstrated an association between with uniformly engineered parts and systems. Our current shorter visits and increased rates of medication prescrib- standard ignores the individuality of each patient, and the ing, as well as increased risk factors for inappropriate time needed to address his/her health, and medical issues. prescribing.6 In addition, shorter visit length and patient As Gladwell stated, “What my mother needs is a doctor perceptions of rushed doctors who spend less time with who knows her and someone who can understand her.” 4 them has been associated with an increase in malpractice The reasons for inadequate one-on-one time between claims and a predictor of outcomes in malpractice claims.7 physicians and their patients are mired in the complexities One of the primary sources of physician satisfaction is of an evolving payment system. patient relationships, with the primary source of dissatis- Taking into account the amazing advances in science; faction being “time pressure.” 8 There is a direct correlation medical technology; diagnostic testing and interventions; between higher physician satisfaction and higher quality and myriad different medications, with new ones coming of care when physicians explain the treatment plan to the out everyday, logic would dictate that the time allotted patient, and pay attention to psychosocial aspects of the for patient visits should be much longer. These wonder- patient’s care. This also results in more moderate prescrip- ful advances in medicine have provided us with patients tion rates.9 who are living longer—often into their 80s, 90s, and even In a 2009 report, Lizner, et al., found that 53 of physi- 100s—and who have multiple chronic medical and psycho- cians complained about time pressure during office visits. logical issues. However, the business aspects of caring for The time pressure was associated with low job satisfaction, the patient haven’t kept up, and, if anything, have adversely stress, burnout, and intent to leave the practice of medicine affected patient care. all together.10 In the current business model, the physician’s time be- The history of billing and coding comes a constrainable resource to accommodate greater To further understand the evolution in the care of the patient volume for increasing revenue, often at the doctor’s patient related to time and reimbursement we must re- expense of working longer hours. The total patient load or view the creation of the relative value unit (RVU) set by schedule has not actually decreased. However, the physi- Medicaid, and the Current Procedural Terminology (CPT) cian now spends time on distractions—interacting with in- set by, and copyright protected by, the American Medical surance companies, staff motivation to decrease costs and Association.

4 The Pharos/Spring 2016 Historically in America, usual, customary, and reason- for the doctor-patient relationship wasn’t included. able was the standard used to establish health care prices.10 The Harvard-based team decided to utilize dimen- W. A. Glaser, MD, once noted that “paying the doctor is sions of complexity, including judgment, skill, physical inherently political.”11 Over time, politics related to pub- effort, and stress due to risk. Specialty groups argued for lic expenditure on health care have involved working out relative weighting since the fees would determine income. conflicts of interest between the payers for health care and Eventually, they decided to weight the time, practice the medical profession—including the interests of medical costs consumed, difficulty, and skill for each procedure. specialties and special interest groups. This has been evolv- However, the data and information to accomplish this did ing for more than fifty years. not, and does not, exist. Originally, the American health care delivery system, The major constraint was budget neutrality, which per- consisting primarily of a country doctor and a local hos- petuated the historical income differentials by specialty. pital, was developed based on charging customary, pre- The enactment of the relative value system (RVS) was an vailing, and reasonable rates. The basic principles were imperfect political process because it was designed as a to maximize professional freedom and minimize conflicts Medicare-only method of paying doctors rather than a with payers. comprehensive health insurance system. Medicare payment was very contentious when it was In 1992, Medicare changed the way it pays for physicians’ implemented in 1965. Doctors could accept the Medicare services by establishing a standardized physician payment payment, or they could bill the patient the difference be- schedule configured on a resource-based relative value tween their charges and what they received from Medicare. scale (RBRVS). Payments for services are determined by In the 1980s, it was clear that change was needed. Fee the resource costs needed to provide the particular service. schedules were reviewed and updated based on finan- The cost of providing each service has three components: cial value and negotiations with payers for cost controls. physician work, practice expense, and professional liability However, the attempt to have competitive markets deter- insurance. Payments are then calculated by multiplying the mine pricing of services resulted in fee schedules no longer combined costs of a service by a conversion factor, which being published, and many organizations that had fee is a monetary amount that is determined by the Centers schedules eliminated them. for Medicare and Medicaid Services. The physician work In 1985, politicians with some input from medical or- component accounts for, on average, 48 of the total rela- ganizations decided to replace the customary, prevailing, tive value for each service. and reasonable charge system with a formula reimburse- The factors used to determine physician work include ment system. A team from the Harvard School of Public the average time it takes to perform the service (whatever Health, the American Medical Association, and several average is for patients suffering from acute and chronic ill- specialty groups were charged with developing a medical nesses); the technical skill and physical effort; the required reimbursement system to provide fee-for-service utilizing mental effort and judgment; and stress due to the potential fee schedules. However, they were constrained because it risk to the patient. The practice expense accounts for an is easy to measure time for visits and procedures, but very average of 48 of the total relative value for each service difficult to measure complexity and difficulty of the patient based on a resource-based practice expense relative value and their maladies independent of time. for each CPT code at the site of service. The professional This extremely intelligent group forgot a very important liability insurance RVU accounts for 4 of the total relative factor when developing their new system—“Not everything value for each service. that counts can be counted, and not everything that can be CPT codes are a list of descriptive terms, guidelines, counted counts,” as noted by Cameron and Einstein. Time and identifying codes for reporting medical services and

The Pharos/Spring 2016 5 Time matters

procedures designed to provide a uniform language that medically necessary.” Only what Medicare considers the describes medical, surgical and diagnostic services to bill necessary direct services for the condition of the patient at and inform third party payers. There is a defined code for the time of the visit can be used in determining the level all health care visits and procedures—office visit; hospital of an E/M code. Time spent reviewing medical records, visit; home visit; nursing home or facility visit; surgery; talking with other providers, documenting the encounter labor and delivery; office procedures; tests; as well as the without the patient present cannot be considered and physician’s “cognitive work. “ reimbursed. There are thousands of CPT codes, which, combined Physician time can only be charged for prolonged ser- with the Resource-Based Relative Value Scale (RBRVS), vices after a minimum of thirty minutes beyond the typical value physician services using RVUs. time listed in the highest code set. Medicare allows for Evaluation and management codes (E/M)—the process charges for each thirty minutes over the initial time if it by which physician-patient encounters are translated into is documented in the medical record. Also, the additional CPT codes—are defined by the service provided for the time charges must be face-to-face time with patients, not patient and include patient type (new or established; set- other work related to the care of the patient. ting of service) office, hospital, emergency department, In addition, the physician payment plan has not estab- nursing facility; level of evaluation and management service lished uniform charges by geography, community, or within performed. They relate to history, which includes chief specialties. Data continues to demonstrate that the same complaint, history of present illness, review of systems and “procedure” can vary dramatically within the same com- past/family/social history, and examination and medical munity or region. decision-making. These are then categorized by the level for each component. Doctor vs. car mechanic—who gives more time? Confused yet? Let’s compare taking your car to a me- Billing Codes, Charges, and the Medical Bill chanic with going to the doctor for a medical problem. In CPT C0de + ICD10 Code + Charges/Fees = Medical Bill both situations you have to wait for an appointment unless it is an emergency. However, almost no routine automobile CPT Description Physician Facility Malpractice Total service lasts only fifteen to twenty minutes; but a routine Code E & M Portion Portion physical examination with a doctor is supposed to fit into 99202 New patient 0.88 0.31 0.05 1.24 that time frame. office visit Consider the average middle-aged man with hyperten- Medicare pays $36.879/RVU x 1.24 = $45.73 (physician’s compensation sion and high cholesterol who drives a 2011 Volvo. The for the new patient office visit regular maintenance schedule for his car is every 10,000 Note: In Medicare contracts, private insurers pay $55/RVU for evaulation and miles. According to a J.D. Power and Associates 2013 U.S. management, and $70/RVU for procedures. Payers reduce payments for 12 secondary CPT codes. Customer Service Index (CSI) Study, car owners visit a dealer service department an average of 2.6 times per year.

This means that the aforementioned man will most likely This is an extremely complex system not necessarily see his doctor twice a year for a total of forty minutes, and related to the care of the patient, good decision-making, his car mechanic three times a year, usually for at least an or outcomes. hour or two each time. He will be spending more time with Medicare allows only for the medically necessary por- his car mechanic than face-to-face with his doctor. tion of the visit, even if patient care requires more time The human body is much more complex than a car’s and effort for patient interactions that are considered “not engine. Humans have millions of interactive parts that have

6 The Pharos/Spring 2016 evolved over long periods of time, and are not designed by reasoning is prone to bias, errors in diagnosis, and pre- engineers and built by factory workers with the goal of hav- mature closure of the reasoning process. ing all of them come off the assembly line exactly the same. Analytical reasoning is a complex and time consum- Choices with car repairs are different from an individual’s ing process that requires reasoning with incomplete data, health and quality of life. It would be nice if patients could memory, assimilating new information, and excellent hu- spend as much time with their doctors—or more—than man communication. Excellent analytical reasoning is slow, they do with their car mechanics. deliberate, sequential, systematic, reflective, laborious, and uses many different cognitive pathways to diagnose com- The medical value to the patient plex cases and clinical problems. It is used to arrive at the The medical value to the patient of a service is not con- best or correct diagnosis, and to prevent bias and diagnos- sidered in how much is paid for the service. There is no tic errors. Adequate time is essential for the physician to financial remuneration to the physician for spending time think and reason about a patient, the illness, suffering, and on outcomes and improving health. The focus is purely worries. Time, mindful adaptability, attention to detail, and on providing services in a specified time allotment with information on past events, are integral to the physician’s no consideration of effectiveness or elegance. There is no role using clinical intelligence, experience and conversation recognition that an “average” patient doesn’t exist. in reasoning on behalf of the patient. The physician needs The strict fifteen- to twenty-minute patient visit means the time to conduct analytical reasoning in every patient physicians frequently spend too little time with their pa- encounter to ensure the best outcomes for all involved. tients to understand them and their suffering, to converse, Lack of adequate time results in the inability to consider assess, reason, and communicate with their patients. all the available information and use analytical reasoning Extra time for doctors with their patients has been shown to reach the most accurate diagnosis. In a study conducted to contribute to better outcomes, fewer complications, by Evans, et al., of 750 patients in a primary care clinic, 98 better overall patient health, decreased emergency room had at least one expectation before the medical visit —in- visits, and fewer hospitalizations. A patient coming to formation on their diagnosis and prognosis. Failure to ad- see a physician rightly wants the visit to take as long as dress diagnosis and prognosis was the most common cause reasonably required. of unmet patient expectations. Patients who received the The shortened time allotment assumes that every symp- information they were seeking experienced better symptom can easily and quickly be translated into a problem tom relief and functional outcomes.13 with a simple answer and solution. A hurried, task oriented Simply put, patients want a personal relationship with patient visit doesn’t address the numbers and complex is- their doctor, good communication, empathy—and time. sues of patients or the caring and humanism of the doctor- patient relationship. It’s time for a new system Physicians are taught to use clinical reasoning and logi- After twenty-four years of physician billing and com- cal deduction through evolving dialogue that is critical to pensation using CPT codes and RVUs, which is based on understanding, responding, and adapting as part of the care an impression of what average patients need in a visit, we provided. Clinical reasoning involves nonanalytical reason- need to review and revamp the system to improve access ing combined with analytical reasoning. and quality. Nonanalytical reasoning uses rapid, unconscious pat- The Centers for Medicare and Medicaid Services (CMS) tern recognition based on stored knowledge of examples is making small steps to modify the payment system. or “algorithms.” It is rapid, intuitive, simple, and usual Starting just this year, they began covering advance care in routine and uncomplicated patients. Nonanalytical planning—discussions that physicians have with their

The Pharos/Spring 2016 7 Time matters

patients regarding end-of-life care and patient prefer- . Osler W. BrainyQuote.com. Available at http://www. ences—as a separate billable service.14 This is definitely a brainyquote.com/quotes/quotes/w/williamosl.html. step in the right direction, but not enough. CMS needs to . Dans P. Doctors in the Movies: Boil the Water and Just revolutionize the entire compensation system and develop Say Aah! Medi-Ed Press ; xx a completely new payment system that would reflect the . Topol EJ. Malcolm Gladwell: Future Docs Need More cost to the doctor of providing quality care with better Time, Not Technology. Medscape  Aug . http://www. results. medscape.com/viewarticle/. A new payment system would recognize that adequate . Parmaley W. The decline of the doctor-patient rela- time for the doctor with the patient is fundamental; that tionship. J Am Coll Cardiol  Jul; (): -. human beings are amazingly complex and more than the . Davidson W, Molloy DW, Somers G, Bedard M. Rela- sum of their cells, organs, and diseases. tion between physician characteristics and prescribing in A new payment system would take into account that elderly people in New Brunswick. Can Med Assoc J ; today’s patients usually do not have isolated problems, but :-. come with two, three, or more health issues that are not . Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel interconnected. And, that these patients and their families RM. Physician-patient communications: the relationship are worried and suffering. with malpractice claims among primary care physicians and Physician payment reform requires national political surgeons. JAMA ; :-. leadership and a recognition that the time has come for . Mawardi BH. Satisfaction, dissatisfaction, and causes change. In the over-studied and over-documented field of stress in medical practice. JAMA ; :-. of health care finance, legal and administrative mecha- . Grol R, Mokkink H, Smits A, et al. Workload and job nisms need to be drafted and introduced quickly for satisfaction of general practitioners and the quality of patient urgent reform. care. Fam Pract ; :-. We must develop a new, twenty-first century physi- . Linzer M, Manwell LB, Williams ES, et al. Working cian payment system for the care of patients that allows conditions in primary care: physician reactions and care the physician and patient the ability to manage their quality. Ann Int Med  Jul ;  ():-. health, suffering, and illnesses in a time period that rec- . Glaser WA. The politics of paying American physi- ognizes and accommodates today’s changing health care cians. Health Aff  Fall;  (): -. environment. . Power JD and Associates. U.S. Customer Service Physicians must lead, and have a central role in, the Index (CSI) Study.  Mar . Available at http://autos.jd- process of devising, designing, approving and implement- power.com/press-releases/-us-customer-service-index- ing a new medical care payment system. Any new system csi-study. must be considerate of the costs to individuals and society. . Evans JS, Handley, Bacon AM. Reasoning under time This new system must put the patient first, and rev- pressure. A study of causal conditional inference. Exp Psy- enue and profit second. chol ; (): -. . The Henry J. Kaiser Family Foundation.  FAQs: References Medicare’s Role in End-of-Life Care.  Nov . Available . Peabody FW. The Care of the Patient. JAMA at http://kff.org/medicare/fact-sheet/-faqs-medicares-role- , : . in-end-of-life-care/.

8 The Pharos/Spring 2016 Confessions

Today I held your heart. I put my fingers around your vessels. I washed until they glowed and your blood shook out in so many shades of rust. And, yes, it’s true, only the other morning I broke your spine. I shivered at your bony ridges, the color of so many whitened trees in winter. Afterwards, I carved into your wrinkles until I found that startled dark pink, and I uncurled your stiff fingers to lay my thumb on your palm, your tendons drawn under the weak October light. I want you to know that this is beautiful— your barrel chest and wasted thighs, your singing neck and painted nails, even the crusts on your skin and the hair on your upper lip. I want you to know that of those who have held you close, I have held you closer, my hands cradled around your brain or pressed warm against your ribs. In the end, I want you to know how we smell you on our skins as we walk to the locker room, how we undress, our backs turned in modesty, covering our secrets— what we are naked and on the inside— your body reflected in all of ours, no perfect mirror but enough to make us nervous, so awed and almost fearful at the quiet pulse within us.

Jennifer Hu

Ms. Hu is a member of the Class of 2018 at University of Rochester School of Medicine and Dentistry. Her poem won first prize in the 2015 Pharos Poetry Competition. Ms. Hu’s e-mail address is: [email protected]. Illustration by Erica Aitken.

The Pharos/Winter 2016 9 Erica Aitken Au revoir to a loyal friend and colleague

t is with a heavy heart that we are saying goodbye immeasurable. Her legacy will live on in our hearts Ito our dear friend and colleague Debbie Lancaster. and in the work we continue to do to support our After twenty years of dedicated service to Alpha members and chapters, and further the mission of Omega Alpha and The Pharos, Debbie has decided AΩA. Debbie has laid the groundwork to ensure to retire. AΩA’s continued success and advancement Over the years, Debbie has worked hard to uphold Thank you, Debbie, for your dedication, commit- the prestige and quality of The Pharos as a one-of- ment and indefatigable devotion. We wish you the a-kind, prestigious publication read by thousands very best in your retirement! across the country and around the world. She has thoroughly enjoyed working with the authors and the Editorial Board. She has always been a stickler Richard L. Byyny, MD, FACP, Executive Director for correct references, and enjoyed searching for the Erica Aitken, The Pharos Graphic Designer perfect piece of art to draw out a story’s essence. She Jane Kimball, Director of Membership Services has worked tirelessly to ensure the unique beauty of and Communications Officer the publication, its articles and illustrations. Laura Kimball, Administrative Assistant Not only the Managing Editor of The Pharos, Bill Nichols, Assistant Treasurer to the Board of Debbie has worn many hats during her tenure at Directors AΩA. She has done nearly every job in the office. She Dee Martinez, Chief of Staff, and The Pharos is an outstanding problem-solver, negotiator, office Managing Editor manager, technical consultant, programs manager, Jim M’Guinness, The Pharos Creative Director fundraiser, writer and editor. Susan Mullaney, Database Technologist The debt of gratitude we owe Debbie is Barbara Prince, Controller

10 The Pharos/Spring 2016 Jim M’Guinness

Laura Aitken

The Pharos/Spring 2016 11 12 The Pharos/Spring 2016 The Harlem assassination attempt on Martin Luther King, Jr.

Don K. Nakayama, MD, MBA

The author (AΩA, University of California, San Francisco, Doctors treat a VIP differently out of deference to their 1977) is in practice in pediatric surgery in Pensacola, wealth and celebrity, and often to the patient’s detriment. Florida. Much of the information in this article can be In King’s case, in spite of the urgency to deal with his found in Hugh Pearson’s When Harlem Nearly Killed King: injury, the staff at Harlem Hospital delayed surgery to The 1958 Stabbing of Dr. Martin Luther King, Jr.1 wait for Director of Surgery Aubré de Lambert Maynard (1901–1999) to show up. Such alterations to the standards n September 20, 1958, in a Harlem department of care may be yet another hazard of fame. store, a mentally ill black woman stabbed Martin Maynard claimed to have performed King’s surgery, OLuther King, Jr. (1929–1968), in the chest with relating all the details of the operation and never failing a letter opener. The tip of the knife only a fraction of to emphasize the harrowing location of the tip of the an inch away from his aorta, he narrowly missed death. blade. But while the description of the position of the The momentous events in the civil rights movement in knife was true, Maynard’s account was a fabrication. It the decade that followed, including his assassination in is generously seen today as an odd delusion of a self- Memphis in 1968, eclipsed the memory of the earlier important surgeon desperate to be seen as being a key attempt on his life. But King recalled the stabbing in one player in a historic moment. of his most famous speeches, his “Mountaintop” oration in which he prophesied his death which came only hours King’s visit later. King had come to Harlem to promote his first book, The story illustrates why physicians must exert extra Stride Toward Freedom: The Montgomery Story,1,2 his care when they care for very important people (VIPs). account of the year-long boycott that began with Rosa

The Pharos/Spring 2016 13 The Harlem assassination attempt on Martin Luther King, Jr.

Park’s arrest on December 1, 1955, and ended with the blade into his chest. Quickly a bystander knocked Curry’s Supreme Court decision that desegregated the Alabama hand away from the blade before she could pull it out city’s bus system on December 17, 1956. With youth, and stab King again. “I’ve been after him for six years!” charisma, and heroism, King, not yet thirty, had emerged shouted Curry. “I’m glad I done it!” Curry started to run. from the episode as the civil rights movement’s most A group of women who had been flanking King began visible figure. chasing her, brandishing umbrellas and shouting, “Catch King’s trip to New York City began with a television her! Don’t let her go!” Before they could reach her, the appearance on the Today show, followed by an outdoor store’s floor manager blocked their path. Walter Pettiford, rally in front of Hotel Theresa in Harlem. It was a state an advertising executive for the New York Amsterdam election year and politicians maneuvered to share the dais News, the city’s principal Negro-owned newspaper, with King, including rivals for the New York governorship grabbed Curry’s left arm and swung her around so that W. Averill Harriman and Nelson Rockefeller. Thousands he could grab her other arm. Then he proceeded to lead filled the street in front of the hotel.1 her toward the front of the store hoping to locate a store In the crowd was Izola Curry, a forty-two-year-old detective. As he held her, Curry kept repeating, “Dr. King loner, African American who favored rhinestone-rimmed has ruined my life! He is no good! The NAACP is no glasses, dangly earrings, and flashy garb. Neighbors knew good, it’s communistic. I’ve been after him for six years. her from her very public rants against street preachers. I finally was able to get him now!” Shortly afterward, I. B. The FBI received letters from her demanding to know Blumstein himself showed up with a security guard, who why communist agents were out to get her. Widespread handcuffed her.1pp66–67 suspicion that communists were behind the growing civil rights movement helped fuel the increasing political King remained alert throughout the episode, the backlash against King, obscuring the racism fueling the penknife in his chest. He tried to calm those around him. opposition. King, both a preacher and civil rights activist, “That’s all right!” he said. “That’s all right. Everything is was doubly suspect in Curry’s disjointed reasoning. She going to be all right!” Arthur Spingarn, national president wandered in the crowd, haranguing against communists, of the NAACP, held King’s hand and tried to comfort him Caucasians, and especially huckster preachers like King.1,3 as they awaited an ambulance. Bystanders debated whether Manhattan borough president Hulan Jack heard the to remove the knife. One, cooler and more knowledgeable, taunts and heckling from the platform. He expressed insisted that no one touch it. his apprehension to King as they stepped down. King At 3:38 PM, a phone at Mrs. Constance Jenning’s desk replied, “Oh God, don’t get a bodyguard!” And to William at Harlem Hospital rang. A man had been stabbed in Rowe, Jack’s assistant, “And don’t you try to act like one, the chest at Blumstein’s and needed an ambulance right either.” 1p63 away. Minutes later Ronald Adams, a driver, and Mrs. Russie Lee, a licensed practical nurse, sped down Seventh The stabbing Avenue toward the store. On their arrival, Lee saw King The next afternoon, Blumstein’s department store still seated and alert. She calmly repeated the instructions on West 125th Street held a book signing in its shoe not to touch the knife. King was lifted in the chair to department. King signed books and chatted with admirers. the back entrance of the store while Adams brought the At 3:30 PM Curry made her way through the crowd to face ambulance. Lee remained at his side during the return trip King. She clutched a curved eight-inch Japanese penknife to the hospital.1 with an ivory handle, and carried a .32 caliber automatic pistol in her purse. The hospital and surgeons Harlem Hospital was a 900-bed facility typical of a “Is this Martin Luther King?” she asked as she walked public hospital of the time. Patients unable to afford a straight up to King, hands concealed in her raincoat. “Yes, private physician filled the facility. Interns and residents, it is,” replied King, certain this was just one more of the nominally under the supervision of an attending physician, many fans he had been greeting for four days. Suddenly provided most of the care, but senior staff had private Curry brought her hand out of her raincoat in an arc. practices at separate offices and other hospitals. Trainees Instinctively, King yanked his left arm up to block the therefore routinely had free rein to manage patients on letter opener, cutting his left hand as Curry plunged the their own, and, as a result, gained an outstanding clinical

14 The Pharos/Spring 2016 education, with a large volume of patients with a wide procedures and surgical interventions. Harlem Hospital range of illnesses. The drawbacks of inadequate resources surgeons wrote authoritative articles on the management and lack of supervision, however, were undeniable. of trauma. Informed patients and their doctors stayed clear of public One such publication was on stab wounds to the hospitals like Harlem Hospital when they, or anyone they heart.4 Harlem Hospital surgeons documented fifty-seven knew, needed medical attention.1 percent survival among patients for whom they closed Among the public hospitals in New York there was also lacerations in the wall of the heart, a bold departure from a pecking order. Three medical schools sent their trainees pericardiocentesis, the then prevailing approach to such to Bellevue Hospital, the largest in New York. Harlem injuries. Harlem surgeons defended the procedure in Hospital, recently integrated, had no such affiliation. It spirited debates at professional meetings, and, in time, was one of only four training programs in the country at were vindicated when their approach became accepted which African-Americans could receive training beyond practice. Thus, despite public and surgical prejudice, their internship year. Harlem Hospital, with its biracial Harlem Hospital surgeons were among the best for the attending and resident staffs, was considered to be several injury that threatened King’s life. steps below Bellevue, so that taking King there led quickly The first to respond to King was first-year resident to gossip and second-guessing among the public, and in Charles Felton. He saw the knife and left it untouched. the medical community.1 He coolly examined his patient’s heart and lungs, and Trauma, however, was one field in which public conducted an electrocardiogram. Finding King stable he hospitals and their surgeons were superior. The locations reassured him that, for the moment, all was fine. Then a of public hospitals in inner cities guaranteed a steady wave of surgeons and nurses pushed him aside.1 stream of gunshot and stabbing victims. Resident trainees Among these were two superb thoracic surgeons. at public hospitals became accustomed to life-saving Emil Naclerio (1915–1985), son of Italian immigrants, had

Left, Dr. Emil A. Nacierio at the bedside of Reverent Martin Luther King, Jr. (© Bettmann/CORBIS) Right, Dr. John Cordice. (Photo Johnny Nunez. Bettmann/CORBIS)

The Pharos/Spring 2016 15 The Harlem assassination attempt on Martin Luther King, Jr.

trained at the Marquette Medical School in Milwaukee America’s opportunities. He attended City College, a and the Overholt Clinic in Boston.1 African-American springboard for generations of immigrants. The only surgeon John Cordice (1919–2013) (AΩA, New York African-American accepted in the entering class of 1926 at University, 1997, Alumnus) was junior to Naclerio but no Columbia University’s College of Physicians and Surgeons, less well trained. The son of a Durham, North Carolina, he withdrew when he discovered that Columbia’s teaching physician, he had attended the New York University hospital, Columbia-Presbyterian, would not allow black School of Medicine, completed his residency in surgery at students on its wards. He was fortunate to gain admission Harlem Hospital, and had advanced training in thoracic to New York University, where minority students were surgery in Manhattan, Brooklyn, and France.1 Naclerio more welcome.7 had written an extensive review on the management of After graduation, Maynard was one of the first four stab wounds of the heart,5 and co-authored another with black trainees at Harlem Hospital, the surgical residency Cordice on those involving the lung.6 integrated by Louis T. Wright, the first African-American The emergency department was a pandemonium of surgeon on its attending staff and its first to hold the photographers’ flashbulbs and crowds of doctors, nurses, position of director of surgery. Wright hired Maynard and the curious. Governor Harriman, campaigning in the after completion of his residency training to serve as the city, heard the news and went straight to the hospital. He hospital’s inaugural thoracic specialist. Maynard, however, resolved that King would not die on his watch. Surgeons had never, and would never, pursue additional thoracic from other New York hospitals arrived and milled outside training.1 the emergency suite, volunteering their opinions and A martinet, Maynard earned his sobriquet of “Little services. More than forty individuals offered to donate Napoleon.” Despite being chief of thoracic surgery, and blood. People packed the sidewalks and streets outside later director of surgery succeeding Wright, he was the hospital. considered a middling surgeon who seldom operated Both Naclerio and Cordice raced to the hospital as at Harlem Hospital. By the time of the King stabbing, soon as they heard the news, Naclerio from a wedding at Maynard had long since ceased to come in for off-hour the Waldorf-Astoria Hotel, Cordice from collecting mail emergencies. “The senior attendings never came in for with his daughter from his new office across the Hudson emergencies,” said John Parker, Harlem Hospital’s chief in Orange, New Jersey.1 King lay on a gurney and the trio resident in 1950. “I can’t recall Maynard ever coming in for waited for an operating room, which was ready. There an emergency.” 1p101 was only one holdup. Unofficial but ironclad protocol demanded that a patient of King’s stature required the The operation presence of Director of Surgery Aubré de Lambert It took more than an hour from King’s arrival to Maynard (AΩA, New York University, 1999, Alumnus).1 Maynard’s appearance, but King remained awake, his vi- But where was he? tal signs stable. Once Little Napoleon was on the scene, Cordice and Naclerio felt they could proceed. They The chief surgeon scrubbed as Chief Resident Leo Maitland placed a cutdown Maynard was at a midtown Saturday matinee, La intravenous cannula into King’s arm. King then received Parisienne, featuring Bridgette Bardot. After the movie he anesthesia as the surgeons entered his chest between the went to Manhattan General Hospital in lower Manhattan right third and fourth interspace, ligating the internal mam- to make rounds. The hospital administrator raced to mary artery in the process. They observed that Curry had Maynard as he entered the front door and turned him plunged the knife with such force that it had penetrated the around. The doctor was urgently needed uptown where thick manubrium. The knife’s tip stopped just short of the a very famous patient—he wasn’t told who—had been junction of the aorta and the innominate artery.1 stabbed in the chest. When Maynard arrived at Harlem While they worked, Maynard held court outside the Hospital the crowd blocked his entry. Police created a operating theater. “Gentlemen, this is a Harlem Hospital wedge formation, the surgeon at its center, and forced case,” he said, “and we are accustomed to trauma of this their way to King’s gurney. As he walked by Harriman, the sort.” 7p187 Then with confidence that would amaze surgeons politician hissed, “Where have you been?” 1p107 today, he invited some of his colleagues into the surgical Maynard was a Guyana native who had moved to suite to observe. New York at age fourteen and had made the most of Naclerio and Cordice, satisfied that King was in no

16 The Pharos/Spring 2016 danger, waited for Maynard to scrub in. The operation the blade out of King’s chest…Maynard removed the mostly completed, they offered Maynard the honor clamp again. Cordice placed a third Kocher clamp around of pulling the knife free. The bone, however, held the the blade…After placing this third clamp around the blade fast. blade, both Naclerio and Corice said, “Go on, take it out.” Maynard began tugging on the blade. Finally, with a fair By now Maynard had scrubbed and entered the surgical amount of effort it came out.1p109 field. Naclerio and Cordice demonstrated to him what they had before them. With his gloved hand, Maynard grabbed Maynard then scrubbed out and left the others to close King’s the protruding unsterile gauze-covered blade of the letter chest. The closure was simple, without a tube or drains.1 opener, attempting to extricate it from King’s chest. But In his memoirs, however, Maynard had a different the gauze slipped off and the blade knicked Maynard’s recollection of the operation: glove. It was torn. So Maynard had to leave the surgical field to change gloves…Maynard returned wearing new Analyzing the situation while scrubbing up, I gloves. At that point, Cordice took …a Kocher clamp…and realized why no one had proceeded with surgery, which placed it on the unsterile protruding section of the blade of ordinarily would have been done. Preliminary measures the letter opener, which had been covered once more with had contributed to the stabilization of the patient’s gauze. Then he handed it to Maynard, telling him, “Look, condition, so precipitate action had been withheld. In if you’re going to pull on it, pull on it with this.” the face of the unprecedented public reaction to the Maynard appeared a bit flustered. He took the Kocher assassination attempt, which brought to the hospital clamp off. Calmly, Cordice took a second clamp and government officials and dignitaries from every level, placed it around the blade and invited Maynard to pull as well as a concentration of the communication media,

New York Governor Averell Harriman stands at the hospital bed of Dr. Martin Luther King, Jr. © Bettmann/CORBIS

The Pharos/Spring 2016 17 The Harlem assassination attempt on Martin Luther King, Jr.

it was understandable that no one was eager to seize the responsibility, which could be better borne by the Surgical Director. There was also the strong deterrent of fear, fear that if anything went wrong or tragedy supervened in the course of surgery—and it could—they would be i dentified with the failure and, justly or unjustly, blamed. On the other hand, if everything went well with the Surgical Director at the table, those involved would at least have the credit of participating in a lifesaving effort of historic import on a famous man.7p187 U.S. civil rights leader Martin Luther King, Jr., waves to supporters from the steps of the In newspaper reports Lincoln Memorial August 28, 1963, on The Mall in Washington, DC, during the March on Washington where King delivered his famous “I Have a Dream” speech. AFP PHOTO/FILES and his memoirs, Maynard contended that he had entered the chest by removing the second rib; removal of the blade required that it be pushed define the “VIP syndrome” as a situation in which “a from below; that it had lacerated a number of blood patient’s special social or political status…induces changes vessels that had created “considerable difficulty,” 1p110 and in behaviors and clinical practice that can…lead to poor that removal of the blade required rongeuring part of his outcomes.” 10 They offer a set of guidelines to help ensure manubrium.7 None were true. With satisfaction, he noted that providers treat VIPs the same as their other patients. that his use of Penrose drains to handle possible infection In King’s case, two of the rules were broken: Don’t bend in the area had impressed the chief of thoracic surgery at the rules, and resist “chairperson’s syndrome.” 10 Naclerio Columbia.7 But no drains had been placed.1 and Cordice violated both when they decided to wait for Both Naclerio and Cordice kept silent in the decades Maynard’s arrival, delaying care when immediate surgery after the stabbing; Naclerio never spoke of it. When, in was required. King’s operation is another example of what 1996, Maynard gave another misleading interview in the every chief resident knows: The chair of surgery is too New York Times,8 Cordice tried to set the record straight in often the least capable surgeon in the hospital. One rule, a letter to the editor that was never published. His version however, was observed: Care should occur where it is most of the operation was finally published in Hugh Pearson’s appropriate.10 King was taken to Harlem Hospital, where book. Other eyewitnesses present in Harlem Hospital that he came under the care of two of the most experienced day confirmed that Naclerio and Cordice were the surgeons surgeons in the country for his injury. who performed King’s operation.1 The tendency to treat the famous, wealthy, and The speech influential with obsequiousness extends to medical care. King identified Maynard as his surgeon, and Neil Baum notes that there is an “ego boost” that comes many of his statements reflected Little Napoleon’s when such people need attention (Baum is Doctor Whiz for embellishments. Not exaggerated, however, was the Health & Fitness Magazine). He warns that the patient’s no- fraction of an inch from knife’s tip to disaster, a fact that toriety and the doctor’s submissiveness may interfere with impressed King to his last day.1p125 On April 3, 1968, the objective assessment and good medical decision-making.9 night before his assassination, he addressed a crowd in Jorge Guzman and colleagues at the Cleveland Clinic the Mason Temple in Memphis. As he neared the close

18 The Pharos/Spring 2016 of his speech, he recounted the Harlem stabbing. The Mine eyes have seen the glory of the coming of knife was so close to his aorta, he noted, “that if I had the Lord!11 merely sneezed, I would have died,” 11 an observation certainly heard from Maynard.7 King recalled a letter from Notes a ninth-grade white girl: “I’m simply writing to say that Hugh Pearson (–) is the major chronicler of the I’m so happy you didn’t sneeze,” she wrote.11 events in the review above, including a detailed background Then he used his brush with death and preacher’s ca- of the civil rights movement at the time in his book, When dence to build an emotional account of the movement’s Harlem Nearly Killed King. Cordice began to receive the milestones since the stabbing. recognition he deserved for his role in King’s surgery in the years before his death on December , . And I want to say tonight—I want to say tonight that I too am happy that I didn’t sneeze. Because if I had sneezed, References I wouldn’t have been around here in 1960, when students . Pearson H. When Harlem Nearly Killed King: The all over the South started sitting-in at lunch counters…  Stabbing of Dr. Martin Luther King, Jr. New York: If I had sneezed, I wouldn’t have been around here Seven Stories Press; . in 1961, when we decided to take a ride for freedom and . King ML Jr. Stride Toward Freedom: The Montgom- ended segregation in inter-state travel. ery Story. New York: Harper & Row; . If I had sneezed—If I had sneezed I wouldn’t have . Branch T. Parting the Waters: America in the King been here in 1963, when the black people of Birmingham, Years, –. New York: Simon and Schuster; . Alabama, aroused the conscience of this nation, and . Maynard AdeL, Cordice JW Jr., Naclerio EA. Pen- brought into being the Civil Rights Bill. etrating wounds of the heart; a report of  cases. Surg Gy- If I had sneezed, I wouldn’t have had a chance later that necol Obstet ;  (): –. year, in August, to try to tell America about a dream that . Naclerio EA. Penetrating wounds of the heart. Expe- I had had. rience with  patients. Dis Chest ;  (): –. . . .If I had sneezed, I wouldn’t have been in Memphis . Maynard Ade L, Naclerio EA, Cordice JW Jr. Trau- to see a community rally around those brothers and sisters matic injury to lung. Am J Surg ;  (): –. who are suffering. . Maynard Ade L. Surgeons to the Poor: The Harlem I’m so happy that I didn’t sneeze.11 Hospital Story. New York: Appleton-Century-Crofts; . . Neighborhood Report: Harlem; Reminiscing with Dr. His oratory soared. A tumult of voices and shouts began Aubrey Maynard: On saving Dr. King.  Jan . http:// to build in response. Men and women stood weeping, www.nytimes.com////nyregion/neighborhood- unable to control their emotions.12 It seemed that he some- report-harlem-reminiscing-with-dr-aubrey-maynard-on- how knew that he would not be so fortunate next time. saving-dr-king.html. Tears in his eyes, King gave his own farewell. The oration . Baum N. The care and feeding of your high-profile became known as his “Mountaintop” speech, second only patients. J Med Pract Manage ;  (): –. to the legendary “I Have a Dream” speech of 1963. . Guzman JA, Sasidhar M, Stoller JK. Caring for VIPs: nine principles. Cleve Clin J Med ;  (): –. We’ve got some difficult days ahead. But it really doesn’t . Martin Luther King, Jr. I’ve Been to the Mountaintop. matter with me now, because I’ve been to the mountaintop. American Rhetoric Top  Speeches. http://www.american- And I don’t mind. rhetoric.com/speeches/mlkivebeentothemountaintop.htm. Like anybody, I would like to live a long life. Longevity . National Public Radio. Echoes of . Remembering has its place. But I’m not concerned about that now. I just MLK’s prophetic “mountaintop” speech.  Apr . http:// want to do God’s will. And He’s allowed me to go up to the www.npr.org/templates/story/story.php?storyId=. mountain. And I’ve looked over. And I’ve seen the Promised Land. I may not get there with you. But I want you to know The author’s address is: tonight, that we, as a people, will get to the Promised Land! Sacred Heart Medical Group And so I’m happy, tonight. 5153 North Ninth Avenue I’m not worried about anything. Pensacola, Florida 32504 I’m not fearing any man! E-mail: [email protected]

The Pharos/Spring 2016 19 The uses of medical oaths in the twenty-first century

Canada. He conducted his survey every decade. His last published report was based on survey data collected in 1999, and was published in The Pharos in 2003.2 Crawshaw’s surveys served three primary purposes: 1. To document the use of oaths and their administration in undergraduate medical education. 2. To evaluate how nascent medical practitioners were being introduced to the ethics of the medical culture. 3. To use the practice of oath-taking as a platform for engaging in conversation about what the barometer is, and Illustration by Risa Aqua. should be, for ethical discussion in medicine. There has been much academic debate and critique on the structure and function of oaths and oath-taking in the Ralph S. Crawshaw, MD; Byron A. Foster, MD, MPH; current cultural and ethical milieu of twenty-first century Matthew Iles-Shih, MD, MPH; medicine.3 The discussion has centered on the extent to and John Stull, MD, MPH which traditional medical oaths adequately address: Ralph S. Crawshaw, MD, 1921–2014, (AΩA, New York • The diverse ethical challenges that modern physicians face. University, 1973, alumnus); Byron A. Foster, MD, MPH, is • The inherent competing interests that physicians may Assistant Professor, Department of Pediatrics, University perceive, deriving from their own religious beliefs and the of Texas Health Science Center; Matthew Iles-Shih, MD, ethical codes of various professional associations. MPH, is a Resident Physician, Department of Psychiatry • The evolving nature of the patient-physician & Behavioral Sciences, University of Washington; and relationship. John Stull, MD, MPH, is Assistant Professor, Department • The tension between the public health principles of of Public Health and Preventive Medicine, Oregon Health equity and justice (common good), and the focus of tra- & Science University (OHSU), Program Director, OHSU ditional medical oaths on an allegiance to the good of the General Preventive Medicine Residency and Director, individual patient. OHSU MD/MPH Program. One of the goals of the current study was to elucidate what leaders in medical education are thinking in continu- ollowing up on a 1959 survey by Donald Irish and ing to administer medical oaths in the twenty-first century. Daniel McMurry,1 in 1969, Dr. Ralph Crawshaw Another goal was to continue the dialogue on the roles began to survey medical school deans on their use of medical oaths, how they influence both individual and ofF oaths among medical students in the United States and collective commitments to core ethical principles, and how

20 The Pharos/Spring 2016 Illustration by Erica Aitken.

that influences professional development and behavior. medical school administers an oath; what form of oath A newer trend, statements of principles, may be emerg- is used; when is the oath administered; recent changes to ing as a replacement ethical code in medical schools where the oath’s form or use; and an open-ended question on the students find the traditional oaths insufficient to inform rationale for use or non-use of an oath. their own practice or frame discussion on the ethics of Two additional questions were added to the 2009 sur- medicine with the public or their colleagues. The 2009 vey on the use of statements of principles: whether the Crawshaw survey therefore was modified from prior ver- school is using a statement of principles; and who took the sions to include a question on the use of statements of lead in developing the statement. principles. The survey was sent by mail in January/February 2009 to the deans of 147 medical schools in the United States Methods and Canada. A letter outlining the history of the project The 2009 survey was based on prior surveys conducted and a copy of the results from the 1999 survey were in- by Dr. Crawshaw over the past fifty years.2 Original ques- cluded as background. Non-respondents were sent one tions included in the 2009 survey were: whether the follow-up reminder and survey packet. The survey was

The Pharos/Spring 2016 21 The uses of medical oaths in the twenty-first century

considered closed in August 2009, and all responses tabu- The occasion on which an oath is administered was lated at that time. Descriptive statistics were completed reported in 129 of the 135 responses, and varied widely. on the resulting data in R (a statistical computing software Forty-eight (37) of schools reported administering an program) and Microsoft Excel. oath only at graduation. The most common occasion other than graduation was during a white coat ceremony. Results The form of the oaths used was reported by 98 schools. Of the 147 surveys sent out, 135 (92) schools returned The modified version of the Hippocratic Oath continues to complete surveys. Although this is a very good response be the most used at 33.3; 15.6 use the Oath of Geneva; rate, the response proportions have gradually decreased and 11.1 use an unmodified translation of the traditional over the past fifty years (Table 1). Hippocratic Oath (Table 2). All of the 135 responding schools reported using an oath in 2009. The practice of oath-taking has steadily increased over Table 2. Types of Oaths Administered at the past fifty years, from 72 in 1969, to 100 in both 1999 U.S. and Canadian Medical Schools since 1959 and 2009 (Table 1). (percent) 1959 1969 1979 1989 1994 1999 2009 Hippocratic 11.6 30.9 68.4 3.1 4.8 11.3 11.1 Modified 21.7 32.1 38.5 52.3 55.2 36.1 33.3 Table 1. Reported Use of Oaths Geneva 18.8 26.2 32.5 29.2 24.0 33.8 15.6 over Fifty Years in U.S. and Canadian Medical Schools Covenant – 0 0 0.8 0 2.2 0 1959 1969 1979 1989 1994 1999 2009 Maimonides – 0 5.1 3.1 3.2 3.0 1.5 Responding 97 98 130 142 141 140 147 U.S. and Other 46.4 9.5 8.5 13.1 12.8 11.3 11.1 Canadian Unknown 1.4 1.2 2.6 0 0 3.0 27.4 schools Note: The denominator for the proportions tabulated in the 2009 No response 1% 2% 3% 4% 7% 5% 8% column is the total of the 135 responses (including the 27% non- % (n) (1) (2) (4) (6) (10) (7) (12) responses on type of oath (classified as “unknown”). It is unclear how “unknown” was decided in prior surveys. The traditional Responding 72% 88% 93% 96% 95% 100% 100% Hippocratic Oath in its unmodified version is labeled “Hippocratic;” schools that (69) (84) (117) (130) (125) (133) (135) the modernized version of the Hippocratic Oath as written by Louis use an oath Lasagna is labeled “Modified;” the Declaration of Geneva is labeled % (n) “Geneva;” a covenant of any form is labeled “Covenant;” and the Prayer of Maimonides is labeled “Maimonides.” The 1994 data was not the focus of a stand-alone article, but was collected by Dr. Crawshaw and cited in a 1996 article.4

Table 3: Reported Use and Origins of Statements of Purpose in U.S. and Canadian Medical Schools Uses of Statement Yes No No of Purpose Response %n 86% (116) 13% (17) 1% (2) Authors of Students Faculty Other* No Statement of Response Purpose % of “yes” (n) 23% (27) 24% (28) 41% (47) 12% (14) * Responses included combinations of student and faculty, administrators, administrators and students, and administrators and faculty

22 The Pharos/Spring 2016 Of the 135 responding surveys, 15.6 (21) reported to use the results as a stimulus for future discussion on that they had considered changing the form of oath used. the role oath-taking and related behaviors have in medical Changes considered focused on the wording of the oath to education and practice. remove references to a deity, modernizing the oath, and The near-universal practice of oath-taking has been including more student involvement in the type of oath maintained over the forty years leading up to, and includ- to be used. ing, the 2009 survey. That fact, and the consistent admin- Most schools—87.2—reported having some version of istration of oaths in transition ceremonies at the start of a statement of principles in place. The statement of prin- medical school and at graduation, suggests the importance ciples was codeveloped by students and faculty in 46.1 of of oath-taking as a ritual of initiation into the medical responding schools, by students alone in 26.5, and faculty profession. This is reinforced by the qualitative reports alone in 27.5 (Table 3). from medical school deans that tradition, professional- Twenty-seven percent of schools responded to the ism, commitment to principles, and patient care are major question asking for an explanation of the reasoning behind motivational considerations for including oaths in medical their school’s use of a medical oath. These responses re- school ceremonies. vealed several common themes: tradition; professionalism; In addition to serving as a mechanism for induction and commitment or re-commitment to patients (Table 4). into a professional community and a mark of membership, additional plausible functions of oath-taking in medical Table 4: Illustrative Quotes from Qualitative Analysis education include: • A symbol and public declaration of a social contract Tradition Professionalism Commitment between the profession and its individual members, and It is a tradition here Reinforcements Commitment society as a whole. that the student of the tenets of to common • Cultural markers delineating the boundaries between graduating class professionalism principles and medicine and its collegial trades and professions. can write the oath and humanism. values is essential. • A symbol of the profession’s struggle to maintain its each year. autonomy. The oath is an It contains a It reminds us why • A way to highlight the profession’s values. important part reminder that we do the things • A means to increase collective and individual of our ongoing medicine is we do, and it is a accountability. tradition. a profession reaffirmation of dedicated to the the ‘rules’ we live • A foundation for ethical practice within the well-being of by. profession. people. Oaths and the practices through which they are pro- Tradition. Professionalism in Symbolic of duced, debated, and performed are important cultural ar- Impact of public medical ethics. commitment to tifacts that evolve in response to changes within medicine’s declaration of profession and deeper systems of meaning and practice. principles. patients. The observation that the modified Hippocratic Oath To follow tradition. We use an oath Oath ceremony (33.3), and the unmodified Hippocratic Oath (11.1) as an important is a time of continue to be used in a large proportion of schools fur- symbol of celebration as well ther supports the function of oath-taking as an expression professional as commitment. of tradition. This is particularly interesting given that the attributes and to remind students Hippocratic Oath contains language with which modern of the profession medical students may feel uncomfortable. and society’s The free-text comments expressing the schools’ rea- expectations of sons for administering an oath did not include specific physicians. discussions of ethical principles or the role of a physician in society. This is consistent with a 2009 survey of U.S. physicians that found that while 97 of respondents had Discussion taken an oath during medical school, only 26 indicated This survey provides the opportunity to observe the that the oath influenced their practice “a lot;” and another patterns of current and past oath-taking behaviors, and 37 responded “somewhat.” 4 These findings suggest that

The Pharos/Spring 2016 23 The uses of medical oaths in the twenty-first century

for a new generation of medical practitioners who are described as “conventional,” “rule-conscious,” exhibiting greater “openness to change,” and having a tendency to resist appeals to tradition when this comes into conflict with their other values.5–7 This desire for coherence, compre- hensiveness, and universality highlights an interesting paradox. The limited scope and lack of overarching philosophical coherence of traditional oaths may grant an ability to reach across different historical moments and ide- ologies, while at the same time, this con- servative minimalism is also the source of an inability to speak in as meaningful Ralph Crawshaw at a Lifeworks Northwest event in 2010. a way to many students’ and physicians’ Courtesy of Lifeworks Northwest. most central concerns and passions. Students have also criticized traditional oaths and oath taking for their insufficiency in substantively promoting oaths and oath-taking are less important than might be the formation and consolidation of a coherent profes- assumed. sional identity, both on collective and individual levels. However, of the 11.1 of schools reporting that they used Introductions to the history and content of oaths in the a non-traditional oath (reported as “Other”), almost half used medical humanities curriculum often emphasize oaths’ an- an oath developed either by the institution or by students. tiquity and specificity, and can exacerbate students’ lack of The majority of schools with a Statement of Principles in emotional connection to them, further highlighting, rather place reported that these statements were developed by stu- than addressing, their concerns about content and con- dents and/or faculty, indicating a high level of engagement by temporary relevance. For students, processes of collective, these new professionals in articulating the ethical ideals and team-based exploration, engagement, and individualized standards to which they should be held. expression are valued and ingrained in practice.6,8 This is It is important to consider the patterns of oath-taking supported by the fact that students had a role in develop- over the past five decades and what they indicate about the ing nearly three-quarters of the statements of principles, evolving concerns of contemporary physicians in training, as reported in the survey. as well as their teachers. The free text comments collected A careful consideration of oaths and statements of in the survey suggest that students place considerable im- principles prompts reflection on a possible gap between portance on professional ethics. However, the comments the codifications of professional ideals and the rituals also suggest a growing sense that traditional medical oaths assigned to them, and their application in practice. This and associated oath-taking rituals are insufficient guide- gap is potentially dangerous—both for students and the posts to navigate the complexities of medical education profession—because it risks leaving us rudderless in our and practice. attempts to think through and address medicine’s larger Robert Veatch has argued that the plurality of oaths, ethical problems. This, in turn, leaves the more conscien- inter-oath incongruities, and lack of epistemological pri- tious among us to seek out and develop primary iden- macy undermine the status of any oath as a code of eth- tification with ethical, moral, and social traditions and ics.3 To this we would add that poor coherence as ethical frameworks external to medicine. While this result is not frameworks—both across oaths and between oaths and a in itself problematic, it risks a gradual loss of identifica- variety of professional ethical codes—plays an important tion with the profession of medicine, as well as a potential role in undermining the authority of oaths and oath-taking abdication of our collective responsibility to address many

24 The Pharos/Spring 2016 of the most pressing ethical challenges of our time. contributions to earlier versions of this manuscript: The fundamental problem is not that medicine lacks a A metaphor for oaths: a compass to sail by which has lost singular, explicit, coherent moral philosophy. Rather, it is its magnetism. the perception that as a profession we have failed to create, and diligently maintain, a culture that allows for, and The professed high moral position of the medical oath in encourages, the critical thinking, debate, and continuous ongoing medical practice fails to address the physician’s sharing of ideas for engagement that result in an ethical need to engage with enduring cultural, economic and practice—a genuine sense of participation in a moral com- moral issues present in every clinical practice of medicine. munity, and individual fulfillment. A structured space in which wide-ranging and sus- Succinctly, to live the full life granted to a physician, each tained discussion can take place is needed. We must graduate should construct her/his own oath as a supplement develop and ensure a place in which students, faculty, to the Hippocratic Oath. Thus, each graduate shall have her/ and established practitioners can explore and adapt the his proper guide to a fulsome life of service and honor. conceptual frameworks and ethical perspectives that will enable the effective assessment and engagement in the practice of medicine. References . Irish DP, Mcmurry DW. Professional oaths and Ameri- Conclusion can medical colleges. J Chronic Dis ; : –. So what role might oaths have in addressing this need? . Crawshaw R. Swearing medical oaths, . The As suggested above, attempting to comprehensively Pharos  Winter: –. broaden the scope of medical oaths, or to transform them . Veatch RM. The sources of professional ethics: why into more systematic ethical frameworks would render professions fail. Lancet ;  (): –. them more contentious, limit their universality, and make . Crawshaw R, Link C. Evolution of form and circum- them unwieldy as a public document and ritual object. stance in medical oaths. West J Med ; : –. A more practical and useful objective would be to look . Antiel RM, Curlin FA, Hook CC, Tilburt JC. The im- for ways to leverage the cultural significance of oath-taking pact of medical school oaths and other professional codes as the first step toward establishing forms of practice and of ethics: results of a national physician survey. Arch Intern cultural dispositions that promote curiosity about, and Med ;  (): –. continued collective engagement with, what it means to . Howe N, Stauss W. Millennials Go to College: Strate- be a physician. Linking the oath and its content to the gies for a New Generation on Campus, Second edition. Great continued development of the student-driven statements Falls (VA): LifeCourse Associates; . of principles may be a starting point. Across the medical . Borges NJ, Manuel RS, Elam CL, Jones BJ. Comparing experience, this kind of linkage could serve as a way for millennial and Generation X medical students at one medical students, individually and collectively, to revisit the oath, school. Acad Med ;  (): –. and its substantive application to their evolving profes- . Twenge JM. Generational changes and their impact in sional identification. the classroom: teaching Generation Me. Med Educ ;  Dr. Ralph Crawshaw’s interest in oaths over the past (): –. fifty years came from a deep desire to understand the role . Laughlin C, Barling J. Young workers’ work values, at- of medical training in creating a culture in medicine of the titudes, and behaviours. J Occup and Org Psych ; : highest ethical standards while also maintaining a critical –. eye on how those ethics—and the oaths that embodied them—inform practice. He thought of his once-per-decade Acknowledgment survey of medical oath-taking behaviors akin to tracking The article was written with Dr. Crawshaw’s input and data, one of medicine’s “cultural vital signs.” but was published posthumously. The modification of the current survey to include statements of principles reflects his continued curiosity and The authors can be contacted at: drive to find new ways of checking the ethical pulse of the Byron A. Foster, MD: [email protected] medical community. Matthew Iles-Sheh, MD: [email protected] In memoriam, we close this paper with some of his John Stull, MD, MPH: [email protected]

The Pharos/Spring 2016 25 Shakespeare, William (1564-1616). Engraving by William Holl. January 02, 1754. Credit: PHAS

26 The Pharos/Spring 2016 Shakespeare’s Macbeth An insight into politics, religion, and the King’s Touch

‘Tis called the Evil. A most miraculous work in this good king; Which often, since my here remain in England, I have seen him do. How he solicits heaven, Himself best knows. But strangely visited people, All swoln and ulcerous, pitiful to the eye, The mere despair of surgery, he cures, Hanging a golden stamp about their necks, Put on with holy prayers. And ‘tis spoken To the succeeding royalty he leaves The healing benediction. With this strange virtue He hath a heavenly gift of prophecy, And sundry blessings hang about his throne That speak him full of grace. —Macbeth, Act IV, Scene III1pp134–35

Fleta Netter Bray The author (AΩA, University of Miami, 2016) is a mem- God’s agent on Earth, thus affirming his or her Divine Right ber of the Class of 2016 at University of Miami Miller to rule.5p582 The concept of Divine Right would continue to School of Medicine. This essay won first place in the be significant throughout the reign of James I.6p306 2015 Helen H. Glaser Student Essay Competition. In 1533, King Henry VIII (1491–1547) broke with the papacy in Rome and founded the Church of England so he year is 1606, and William Shakespeare has writ- that he could marry his pregnant mistress, Anne Boleyn, ten Macbeth, which warns against excessive ambi- in hopes of securing a male heir.2pp17–18 Over the ensu- Ttions to power. Through Macbeth, Shakespeare ing years, a zealous and often bloody tug-of-war between shows that he is a savvy interpreter of the political, reli- Protestant and Catholic denominations and their royal gious, and even medical sentiments of the time. representatives plagued England. Between Henry VIII and This passage from Macbeth alludes to the concept of James I, three of Henry’s children held the throne, includ- a divine political order and describes the centuries-old ing Edward VI (1537–1553), the Catholic Queen “Bloody” English practice of the “King’s Touch,” a ceremonial lay- Mary I (1516–1558), and the Protestant Queen Elizabeth I ing on of hands through which English monarchs offered (1533–1603).3pXXI benediction and healing of the “evil” disease scrofula. The Before Elizabeth I died in 1603, she refused to name an King’s Touch provided evidence that the monarch served as heir. The Scottish King James VI was the heir by the usual

The Pharos/Spring 2016 27 Reviews and reflections

of tuberculosis and may be complicated by ulceration, draining sinuses, or abscess formation.8pp911–12 The disease is curable and typically responds to treatment with a multi- drug regimen of rifampicin, isoniazid, ethambutol, and pyrazinamide.7p559 Prior to the twentieth century, scrofula followed its natural course, which involved a painstakingly slow but eventual recovery, or, rarely, worsening disease and death. This condition lent itself to the miraculous, as spontaneous remission could easily give the illusion of the individual having been cured.9p20 Through the King’s Touch, the royal personage laid claim to a hereditary and exclusive ability to cure the disease, professing divine power and authority over the common people.5p582 The origins of Divine Right can be traced back to the time of Charlemagne (circa 742–814). Charlemagne, referred to by some as the father of Europe,10p8 equally used warfare10p103 and religious conversion10p309 to achieve his vision of a unified Christian kingdom spanning most of present-day Western Europe.10p1 When Charlemagne was a boy, Pope Stephen II (died 757) anointed his father, Pippin III (714–768), King of the Franks, and Charlemagne was 10p292 London Queen Mary I touching the neck of a boy for anointed heir to the new dynasty. From that time, the the King's evil (scrofula). Watercolor by M.S. Lapthorn, Christian God was the explicit source of royal authority 1911, after a watercolour, 16th century. Wellcome Library in Europe.10p295 On December 25, 800, Pope Leo III (died Catalogue. 816) crowned Charlemagne emperor of the Romans, creating an alliance that would strengthen the position of both Charlemagne and the Christian church.10p115 By the late rules of primogeniture, and though foreign-born, he had 800s, Charlemagne’s empire had dissolved, but he had support across the religious spectrum with his Protestant succeeded in establishing Christianity in Western Europe. upbringing and Catholic mother.3pp5–6 James thus became From the ninth century onward, kings of England and King James I of all Great Britain (1566–1625).3pp113,242 France were anointed with holy oil, then crowned.9p38 James I ascended the throne in a time of political and As Christianity became accepted within the regions of religious tensions. A year after his coronation, a group of present-day England and France, the historical precedent Catholic revolutionaries attempted to blow up the English that governments ruled through the will of God became House of Lords in the Gunpowder Plot of 1605.4pp54–56,88 well established. In the Bible, Jesus, in addition to healing Guy Fawkes attempted to assassinate James, his family, and sin, also performed miraculous acts of physical healing. On all of Parliament. seven of these occasions, he healed by touch.11p107 In Mark William Shakespeare (1564–1616) quite surely, and 2:17, Jesus stated, “It is not the healthy who need a doc- rather shrewdly, wrote Macbeth with James I in mind. The tor, but the sick. I have not come to call the righteous, but tragic play serves as an allegory to illustrate that greedy at- sinners.”12p1543 The Bible states that after Jesus’ death and tempts to imbalance the natural order of power would be resurrection, he returned to the eleven apostles and told met with a gruesome fate. them, “Whoever believes and is baptized will be saved . . . . Today, scrofula is better known as tuberculous cervi- And these signs will accompany those who believe. . . they cal lymphadenitis, which presents as a slowly progressive will place their hands on sick people, and they will get well” swelling of a single group of cervical lymph nodes. It is (Mark 16:16–18).12p1573 caused by infection with Mycobacterium tuberculosis or Which European monarch first instituted the King’s other nontuberculous mycobacteria.7pp556–57 Lymphadenitis Touch is unclear. Some scholars contend that Robert the is one of the most frequent extrapulmonary manifestations Pious (circa 970–1031), King of France, was the first to

28 The Pharos/Spring 2016 scraping away and clamping the flesh overlying it, and removing any attached nodes. The procedure could take days if bleeding was heavy.14p98 Those with scrofula often fared better with the King’s Touch of the English and French monarchs than the practices of medieval physicians. Early recipients of the royal benediction fared well, with care taken to provide food, shelter, and rest until cured.5p581 Despite these early successes, the practice was retired until Henry II of England (1133–1189) reinstituted the benedictions with great fervor.5pp581–82 He claimed that his healing acumen was given to him from Edward the Confessor on his mother’s side. Further, he was married to Eleanor of Aquitaine (1122–1204), the former wife of the French King Louis VII (1120–1180), who had practiced the King’s Touch. Over the next several centuries, the English and French monarchies continued to evolve the practice of the King’s Touch. Henry II instituted the gift of a holy medallion to those with scrofula, and Henry VII (1457–1509) innovated the pomp of a ceremony and the gift of an angel, called a “touch-piece.” 5p582 Even with the religious schism of the Reformation, the healing rite continued in England; however, the practice was never instituted in Scotland. Edward VI performed the act despite his inclinations to rid the state of Catholic Charles II touching a patient for the king's evil (scrofula) customs,9p166 and both Mary I and Elizabeth I instituted surrounded by courtiers, clergy and general public. Engraving by R. White. the Queen’s Touch. Wellcome Library Catalogue Upon his ascension to the English throne, James I faced a difficult decision mired in centuries of tradition, religion, and politics: continue a practice he de- cure scrofulous patients with his touch,5p581 but others spised, a tradition steeped in Catholic sacrilege, idolatry, suggest the practice originated in England with Edward the and superstition; or break an ancient custom that the Confessor (circa 1003–1066).13p73 Regardless of the origi- c ommon people embraced as lending divine authority to nator, it is clear that medieval medicine was often more his throne.5p583,9p191 James I was devoutly religious, and in deadly than the disease itself. Treatments ranged from the year 1611 would authorize the English translation of the continued practice of the Greek four humours, in which Bible, known as the King James Version. He believed that imbalances of black bile, yellow bile, phlegm, and blood God sanctioned his rule.9p199 were corrected through practices such as induced bleeding It is impossible to discern whether Shakespeare believed or vomiting,14p17 to injurious behavior, such as the use of a in the healing powers of the King’s Touch, but several pas- hot iron to cure a headache.14p127 sages in Macbeth may be subtle jabs from a skeptic. Also, Many physicians at the time believed that scrofula re- the scene of the drunken porter, in Act II, Scene III, may be sulted from gluttony and a careless diet. Therefore, the first a reproach to James I for his excessive drinking habits,15p153 step toward curing it was a restrictive diet and avoidance and the general aristocratic excess of Macbeth might reflect of “all things that fill the head with fumes,” such as garlic upon James’ exorbitant spending habits.3p138 and onions, strong wine, shouting, worry, and anger.14pp96–97 James I continued to practice the King’s Touch, despite Medicinal treatment consisted of a plaster of lily root, un- expressing great distaste for it. The ritual sprang from deep ripe figs, bean flour, and nettle seed. Attempts were made Catholic traditions, but the King did not believe that he, or to rupture the lesions with the help of blister beetles.14p97 any other king, had the power to cure scrofula—only God Surgery consisted of an incision of the scrofulous node, could perform such miracles.16p166 Despite his concerns

The Pharos/Spring 2016 29 interpretation exists is a true testament to Shakespeare’s genius—not only as a literary master, but as a critical ana- lyst of his time.

References . Shakespeare W. Macbeth. New Haven (CT): Yale University Press; . . Rex R. Henry VIII and the English Reformation. New York: St. Martin’s Press; . . de Lisle L. After Elizabeth: The Rise of James of Scotland and the Struggle for the Throne of England. New York: Ballan- tine Books; . . Haynes A. The Gunpowder Plot: Faith in Rebellion. Great Britain: Sutton Publishing; . About Fleta Netter Bray . Currelly CT. The King’s Evil and the Royal Touch. Can Med Assoc J  May;  (): –. Originally from Melbourne Beach, Florida, I . Lamont W. Godly Rule: Politics and Religion, -. graduated from the University of Florida in 2011 London: Macmillan St. Martin’s Press; . with a degree in microbiology. I am now in my . Fontanilla JM, Barnes A, von Reyn CF. Current fourth year of medical school at the University of Diagnosis and Management of Peripheral Tuberculous Miami Miller School of Medicine. I live in Miami Lymphadenitis. Clin Infect Dis ;  (): –. with my husband, Eric, and our beautiful son, . Dandapat MC, Mishra BM, Dash SP, Kar PK. Peripheral Nathan. lymph node tuberculosis: a review of  cases. Br J Surg  Aug;  (): –. . Bloch M. The Royal Touch. New York: Dorset Press; . over the idolatry of gold medallions and touch-pieces, he . McKitterick R. Charlemagne: The Formation of a recognized their importance for the promotion of alle- European Identity. United Kingdom: Cambridge University giance to the English monarchy. He altered the ritual to ex- Press; . clude as many papist elements as possible, and changed the . Wilkinson J. The Bible and Healing: A Medical medallion’s motto to “A DOMINO FACTUM EST ISTVD” and Theological Commentary. Edinburgh: The Handsel (This was the Lord’s doing).16p167 Press; . The practice continued and reached its peak in England . The Holy Bible, New International Version. Grand with Charles II (1630–1685), who had touched one hundred Rapids (MI): Zondervan; . thousand individuals by the end of his twenty-five-year . Mortimer R. Edward the Confessor: The Man and the reign.9p212 Charles’ healing was so popular that he sched- Legend. Woodbridge (UK): The Boydell Press; . uled healing sessions by proclamation, and required that . Demaitre L. Medieval Medicine: The Art of Healing, those seeking a cure procure a certificate testifying that the from Head to Toe. Santa Barbara (CA): Praeger; . individual had not sought the King’s Touch previously.17 . Fawkner HW. Deconstructing Macbeth: The The last English monarch to carry out the practice was Hyperontological View. Cranbury (NJ): Associated University Queen Anne (1665–1714).9p220 The King’s Touch ended en- Presses; . tirely with Charles X of France (1757–1836), who issued the . Deng S. Healing angels and “golden blood:” Money last touch in 1825.9p228 and Mystical kingship in Macbeth. In: Moschovakis N., edi- Monarchs who practiced the King’s Touch enjoyed tor Macbeth New Critical Essays. New York: Routledge; : enormous strengthening of their positions that came with –. divine sanction of their power. While James I ultimately . Charles II. At the Court at Whitehall the Ninth of continued the practice, we may never know if Shakespeare January . Early English Books Online. London: Assigns of espoused support of the monarch as divine ruler, or subtly John Bill Deceased: and by Henry Hills, and Thomas Printers mocked the concept of Divine Right. That such a wide to the Kings most Excellent Majesty. Newcomb; .

30 The Pharos/Spring 2016 chronic illness The effects of systemic sclerosis as seen through the works of Paul Klee

Paul Klee’s Little Jester. 1929. © VG Bild-Kunst, Bonn 2014. Art in a time of

Grace Prince, MD The author (AΩA, University of Virginia, 2015) is an Internal subsequent years, he was plagued by the tissue thickening, Medicine resident at the University of North Carolina at fibrosis, and multi-organ dysfunction that characterize the Chapel Hill. This essay won second place in the 2015 illness.2 The life changes Klee underwent following this Helen H. Glaser Student Essay Competition. diagnosis led to rather abrupt changes in his expression of self as seen in his art. The art of mastering life is the prerequisite for all further While he is best known for his earlier works depicting forms of expression, whether they are paintings, sculp- landscapes and geometric architecture using rhythmic tures, tragedies, or musical compositions. bursts of color, it was Klee’s portrayal of the human body —Paul Klee1 that evolved most through his lifetime, and best demonstrates how his deteriorating health registered in his odern artist Paul Klee (1879–1940) penned the art. The fanciful, light-hearted figures that appeared in above words as a young man in his twenties, not his earlier work would transform into darker, deformed, Mknowing that his ability to master his own life macabre beings. and his art would eventually slip from his grasp. By recognizing both the thematic and technical changes When Klee was fifty-six years old, a series of medi- in his art one can begin to glimpse the struggle that was cal complaints led to a diagnosis of systemic sclerosis. In his illness.

The Pharos/Spring 2016 31 Paul Klee

About Grace Prince

Originally from Martinsville, middle class and upper class welcomed its lightheartedness Virginia, I attended Wake Forest as a means of escape from the difficulties of the prewar and University and graduated in 2011 with interwar periods. Klee specialist Jürgen Glaesemer stated, a major in biology and a double minor “To withdraw as far as possible from the bitter realities in- in chemistry and art history. It was stead of facing up to them is not an uncommon tendency of at Wake Forest that I discovered my a socially privileged class in times of great crisis.” 5 passions for medicine and art, finding Klee’s compositions of joyous color, childlike geometric that both require a delicate under- forms, fantastical figures, and an inherent sense of whimsi- standing of the narratives of people’s cal movement found popularity with those in search of a lives. I continued on to the University of Virginia simpler world of the imagination. (UVA) School of Medicine where I was encouraged A figure from the imagination comes to life in Little to appreciate “the art of medicine” and explore the Jester in a Trance (1929). Using watercolors and oils on hes- many facets through which the humanities can teach sian fabric, Klee conjures a sense of vitality and goodness us about patient care. I graduated from UVA in 2015 by painting a background of gold from which the figure and have begun an Internal Medicine residency at emerges. Darker shadows exist only to contour the figure’s the University of North Carolina at Chapel Hill. curves as it assumes a dynamic pose, as if walking through Art is a medium through which we relive history, the world around it. Somewhat unusual for an early Klee feel emotion, appreciate mastery, and uncover inspi- work, the remaining use of colors is restrained—scant ration. With this essay, I learned the narrative of an shades of coppery red and lines of deep gray provide the artist through his artwork, writing, and illness, and only variation from hues of yellow and gold. By choosing was, once again, inspired. a monotone palette balanced by just a few splashes of op- posing colors, Klee showers the image with light, and Little Jester radiates a glow that warms and energizes the viewer. The Little Jester figure itself has animalistic features such Klee’s beginnings and his early style as a feathery tail and cone-like skull. The intersecting lines Klee was born December 18, 1879, in Münchenbuchsee, and use of color over the figure’s torso give the illusion of Switzerland, where he grew up under the tutelage of his fish scales. The thumb and fingers resemble the pincers of musician father. Despite being a gifted violinist and a self- a crustacean. To complement the light-colored palette, the identified poet, Klee chose to pursue studio art.3 He spent figure flashes a friendly grin. The title word “jester” adds to three preliminary years of study at Knirr’s Preparatory the piece’s playfulness. It is as if Klee himself were poking School in Munich. After a few years of European travel, fun at the world around him and searching for good humor Klee settled in Munich at the request of his wife, Lily. They among the common, the mundane, and even the serious.1 remained there for the next fourteen years, leaving only to Over time, all naturalistic tendencies vanished from fulfill his military obligation during World War I.1 Klee’s work in favor of depictions of memories and fantas- Many of Klee’s early pieces were watercolors, etchings, tical ideas. After 1915, he refrained from using any models and drawings, the latter of which he often chose to leave or photographs, finding that reliance on them hampered in black and white.4 His style changed following a brief his own creative process.3 The majority of his portraits trip to Tunisia in 1914. Entranced by the vibrant Tunisian are done on paper with brisk, short pencil and ink strokes surroundings, he preserved them in his art by infusing his that—most appropriately, given Klee’s musical upbring- pieces with rhythmic splashes of primary colors.2 Klee’s ing—give the works staccato-like movement, and an air of work was noted for his use of color that gave so much of it lightness and agility. Klee’s portraits satirize humanity in a childish purity and gleefulness, while also creating a bold a playful way, creating a “gallery of caricatures” 3 far more sense of contrast and opposition. amusing than their more realistic likenesses. Klee mastered the ability to create “a world of fancy, Klee’s style of German Romanticism full of irony, whimsy, and impish humor,” 3 writes Sabine From 1900–1920, Klee’s work demonstrates the influ- Rewald, curator of modern art at the Metropolitan Museum ence of German Romanticism, which, in contrast to the of Art in New York. It was much later that Klee’s gleeful seriousness of English Romanticism, valued wit, humor world would turn into a morose domain of despair. and beauty. As this movement swept over Germany, the

32 The Pharos/Spring 2016 Playing with perspective In the 1930s, Klee began to depart from his earlier lighthearted style, as the figures he depicted grew more realistic and human in their features. However, these portrayals are a far cry from the distorted human images he produced in the later years of the decade, closer to the end of his life. Error on Green (1930), is representative of Klee’s transitional period. In it, Klee begins to play with perspective and planarity in his art. His choice of background color in Error on Green is an earthy green with undertones of yellow, creating a blended color that appears impure and murky. This muddled background adds to the feeling of uneasiness that, coupled with the title, has the viewer searching for a mistake in the painting. The face in the center appears more realistic and human than the mythical being depicted just one year prior in Little Jester. Millionaire art collector G. David Thompson pointing at a painting by Paul Klee A geometric circle serves as the figure’s entitled “Error on Green.” Photo by Yale Joel/The LIFE Picture Collection/Getty Images. head, which sits disproportionately atop a tiny body that teeters beneath the head’s weight. Klee takes a simple approach in drawing the torso In his personal reflections, Klee claimed that his satirical and lower limbs, using lines that are both thin and suc- style helped him serve the ideal of beauty—by depicting its cinct. He dedicates his attention, instead, to the features of opposite, he believed one could gain appreciation of the the figure’s face. The eyes are asymmetric, with pupils set aesthetically pleasing and perfect.1 This could have been in opposite directions for a disconnected gaze. However, his intention in creating the asymmetric human figure in the asymmetry actually results from the simultaneous de- Error on Green. Perhaps the “error” mentioned in the title piction of different vantage points on a single plane. The is neither artistic nor technical, but rather the reality of the viewer observes the right eye from an en face perspective, flawed human body. What distinguishes the depiction of while the artist captures the left eye at an oblique angle. the body’s imperfections here from Klee’s later works is the One can also see Klee’s play on perspective by examining lack of physical distortion and emotional suffering. Like the rectangular structures just below the left eye. He shows many of Klee’s early works, there is little or no overt emo- them from an oblique angle, bringing multiple dimensions tion in Error on Green, and its tone remains playful with the to a single planar image. artist’s tricky manipulations of perspective. The nose is perhaps the most bizarre feature defining the face. Its two elongated sides consist of dark lines that Symptoms of a new disease extend up the face, arch above the eyes like eyebrows, and In 1935, Klee was diagnosed with pulmonary and car- drift off the front of the image. The figure’s thin red lips diac complications of the measles virus.6 His son, Felix, are tilted, as if uncertain, and are incongruously placid recalls his father having a rash and recurrent fevers that considering the lone black tear that runs down the figure’s can be characteristic of measles. In December 1936, Klee’s face along with the smudgy lattice of lines on the cheek that physicians diagnosed him with systemic sclerosis.1 Dr. suggest a bruise or other blemish. It is possible that the tear John Varga, professor in Medicine-Rheumatology and and blemish are meant to represent imperfection rather Dermatology at Northwestern University, notes that than physical or emotional pain. the rash and fever described by Felix could have been

The Pharos/Spring 2016 33 Paul Klee

resulted from hand con- tractures.2 He also stopped smoking at the time of his diagnosis, suggesting that his disease may have affected his lungs.3 In 1916, while serving in the German armed forces, Klee experienced low-grade fevers that resulted in his taking sick leave. Though he did not document the etiol- ogy of these fevers,3 it is possible that they were related Left, Paul Klee photographed in 1922. Above, this photo of Paul Klee taken in 1939, to swelling in his mouth shows changes in his facial appearance preceding the fevers. It is caused by skin tightening, suggestive of also conceivable that these scleroderma. ullstein bild/Contributor. febrile episodes represented a systemic manifestation of his autoimmune illness rather than manifestations of systemic sclerosis rather than mea- an infection. They also could have been the result of poor sles.2 Dr. Gunter Wolf, a physician with the Division of oral hygiene and the gingival disease that can occur with Nephrology and Osteology at the University of Hamburg, systemic sclerosis as sufferers develop perioral muscular proposes that an episode of the measles could have trig- fibrosis and microstomia, limiting their capacity to open gered an autoimmune condition, like systemic sclerosis, as their mouths, both for eating and cleaning.8 a sequela of the viral infection.7 Other symptoms described by Klee in his diary entries Systemic sclerosis is a connective tissue disorder involv- of 1916 include recurrent headaches, general pallor, and fa- ing the skin and multiple internal organs. It is characterized tigue, possibly due to anemia that is a common component by tissue thickening, fibrosis, and subsequent dysfunction of autoimmune illnesses, or secondary to pulmonary and of involved areas. The lungs, esophagus, and other sites cardiac dysfunction. During this period, he also described within the gastrointestinal tract, heart, and kidneys are the ongoing weight loss.1 sites most prone to involvement.8 As early as the mid-1910s, An accidental fire destroyed Klee’s medical records Klee described what could have been early symptoms shortly before his death.7 The symptoms he described in of systemic sclerosis in his diaries, as he was plagued by his diaries now serve as the best guide for deciphering the arthritis, digestive trouble, respiratory complaints, fevers, specifics of his illness. Based on his diary entries, and the and fatigue. accounts of his son, Klee likely suffered from diffuse cuta- From 1916–1918, Klee described frequent gastrointesti- neous systemic sclerosis rather than the limited cutaneous nal distress, suffering from “intestinal pains, on the verge variant.8 This conclusion is based on the distribution of of taking digestive pills.”1 Felix remembers a more classic Klee’s symptoms. Skin involvement was not limited to the manifestation of systemic sclerosis that his father dealt with hands as would be expected in limited cutaneous systemic several years later when he had great difficulty swallowing sclerosis. Though Klee described cramping of the hands, his food, likely due to esophageal dysmotility secondary to his son noted well-preserved functionality, “Some victims tissue fibrosis. As a result, Klee refused to eat around other suffer from paralyzed hands, but luckily for my father, this people, even his family, out of fear of embarrassment.3 did not happen.” 3 Another symptom of systemic sclerosis that affected Felix also describes changes in his father’s facial ap- Klee’s body and his way of life was arthritis. Klee, who had pearance caused by skin tightening, which is more sugges- played the violin for an hour every morning since he was a tive of a diffuse process where scleroderma of the skin is child, ceased his musical efforts in the 1930s, perhaps due more prominent than sclerodactyly. Felix did not describe to arthritic pain or the limited dexterity that would have Raynaud’s phenomenon, a vascular complication involving

34 The Pharos/Spring 2016 1930, the image from 1939 shows Klee’s face as thin, and as Varga notes, hollowed, un- doubtedly the result of temporal and neck wasting from weight loss. His skin appears shiny with scattered telangiectasias visible on the right cheek and overlying the bridge of the nose. The photographs also depict the characteristic Mauskopf appearance of systemic sclerosis, “taut and shiny skin, loss of wrinkles, and occasionally an expressionless facies due to reduced mobility of the eyelids, cheeks, and mouth . . . the nose assumes a pinched, beak-like appearance.” 8 In comparison to Klee’s relaxed smile and soft gaze in 1930, he stares blankly at the camera in 1939 with a widened gaze. Though his face appears frozen in an expressionless Klee’s The Golden Fish (circa 1925) was one of his seventeen pieces of art mask of sorts, his lips are drawn downward on display in the 1937 Entartete Kunst (Degenerate Art) exhibit. Hamburger to create a frown. The beak-like changes in Kunsthalle, Hamburg, Germany his nose, a notable aspect of the Mauskopf appearance, add to the severity and harsh- ness of Klee’s facial changes. With such dramatic changes in his gen- the fingertips that is more common in the limited form of eral functioning as well as his appearance, it is not surpris- the disease. The degree of Raynaud’s phenomenon in such ing that Klee’s artwork evolved in parallel. Functionally, patients is often severe, leading to digital ischemia with Klee’s worst year was 1936, when he produced a mere ulcer formation and resorption of the terminal phalanges. twenty-five works, considerably fewer than in each of his Though such changes may have occurred in Klee’s hands, earlier years. This would prove to be his nadir; he created their absence in his diary, particularly since they would thousands of pieces between 1937 and 1940, the last four have had a profound impact on his dexterity and artistic years of his life, with 1,253 works of art created in 1939.3 ability, suggests otherwise.8 What is curious about this late surge of creativity is that Joint arthralgias affects patients with both types of Klee’s physical appearance as well as his functional capac- systemic sclerosis. The same is true of pulmonary fibrosis, ity changed the most during his final years when there was though the resulting shortness of breath is often more a definite shift in his artistic style and technique. “Lines severe and more frequent in the limited form. This only turned into bars . . . unknown elements of his art until weakly refutes Klee’s diagnosis with diffuse cutaneous then,” recounts Felix.3 His later pieces are more commonly systemic sclerosis, as his long-standing tobacco use surely compositions of errant brush strokes, and thick, bar-like contributed to his pulmonary complaints. lines that differ markedly from the fine outlines character- In part due to weight loss, but also due to general scle- istic of his earlier works. Klee himself described his diffi- rosis of the skin, Klee’s most dramatic and outwardly vis- culty with creating lines, “The line! My lines of 1906/7 were ible changes manifested in his face. Felix recalls, “He lost my most personal possession. And yet I had to interrupt weight, his skin tightened, and his appearance changed. them, they are threatened by some kind of cramp . . . I just You can see these changes in the photographs of him made couldn’t make them come out.” 1 In this entry from the late in 1939 and 1940.” 3 When comparing these photographs, 1930s, Klee reveals that he has lost control of his creations one can appreciate the change in appearance that Felix on the most basic level; he is unable to physically transfer described. Varga decodes the effects of disease on Klee’s the lines from his mind to an artistic medium. As an art- facial features best when he states, “The [later] pictures ist who found inspiration for his pieces in his imagination, show . . . hollow cheeks, and taut facies with drawn lips Klee found it increasingly difficult to let his thoughts flow and prominent nose.” 2 Compared to the photograph from freely through his cramped and contractured hands.

The Pharos/Spring 2016 35 Paul Klee

Paul Klee’s Vivilant Angel (1939). Paul Klee’s Outbreak of Fear (1939). Zentrum Paul Klee, Bern, Zentrum Paul Klee, Bern, Bildarchiv. Bildarchiv.

Klee’s frustrations were not limited to his health alone. The disappearance of color from his art could allude to his In 1933, having struggled to create against the menac- illness, serving as a symbol of the fatigue or lack of vigor ing backdrop of the rising National Socialist govern- from the progression of the chronic disease. ment, he fled Germany for Bern, Switzerland. Four years Klee created the Vigilant Angel using a white outline later, seventeen Klee works were on view in the Entartete against a backdrop of black. The outline of the angel ap- Kunst (Degenerate Art) exhibit, a Nazi-supported show in pears shaky and uneven. For the first time, traces of imper- Munich that denounced countless modern artists.9 fect lines are visible in Klee’s pen strokes. Considering how Klee found sanctuary in Bern, and for years desperately much Klee has prized his lines, this departure represents sought reinstatement of his native Swiss citizenship, but the artist’s faltering fine motor skills, rather than a deliber- his application was denied. For his remaining years, he was ate shift in his style. a man without a country—a guest in his homeland, and a The tone of the work is haunting, as the angel itself ap- spectator of his adopted Germany, as it succumbed to the pears ghostly, its white outline stark against a black abyss. dark forces of Nazism.3 The angel’s ghoulish eyes stare widely at the viewer in an inescapable, all-seeing gaze. It is easy to envision this angel A compositional change: The elimination of color as an angel of death, a phantom-like presence waiting for In the late 1930s, Klee began using palettes of bland col- the viewer, or even for Klee himself. While Klee had re- ors and black and white instead of the infusion of color of marked boldly in his youth that, “I am God. So much of the his previous images. Vigilant Angel (1939) is a work of pen divine is heaped in me that I cannot die,”1 this angel is an and tempera on black newspaper. Though it depicts one eerie reminder of the inevitable mortality that clashes with of a host of angels that Klee created throughout his career, the ideals of permanence and invincibility. it is notable in that it is an image done in black and white.

36 The Pharos/Spring 2016 Paul Klee’s Death and Fire (1940). Zentrum Paul Klee, Bern, Bildarchiv.

A thematic change: The insertion of emotion right corner of the image, crying out in agony over its fate. In his final years, Klee turned away from the lighthearted Alongside the face’s skewed eyes and open mouth, the nose work he was known for, and embraced deeper, more com- appears upside down, further adding to the sense of painful plex emotion. Outbreak of Fear (1939) bursts with emotion contortion. This is the most expressive and emotional of and connotations of despair, agony, and pain. In this image, Klee’s faces to date. As Temkin suggests, “The image reads Klee dismembers the human body into multiple pieces. as one of Klee’s puppets come apart.” 4 Klee uses a melancholy deep blue to fill the background Varga proposes that it is in these later images of dis- space. The fragmented limbs float motionless atop the figured faces with outbursts of emotion we “see the artist pool of blue. With this carefully laid-out display of body trapped in the prison of scleroderma, the steel cage of parts, Klee gives the viewer an image of demise and decay. his own physical immobility.” 2 Like so many other art- The title word “Outbreak” suggests a plague or some other ists, Klee likely used his art for emotional reflection and disease process that can devastate and deconstruct the hu- study of his own flesh. Rather than caricaturing the world man body. Perhaps Klee himself felt this generalized sense around him, his late works represent his retreat into the of bodily disarticulation as a result of his own illness, or realities of his own body. recognized his own body as fragmented parts having been undone, one from the other, by a fibrosing disease.7 A new art form and a tribute to death Ann Temkin, a curator at the Museum of Modern In Death and Fire (1940), one of Klee’s final works, he Art, suggests a theme of containment, even entrapment, summarizes his conclusions about life, death, and afterlife. within the arrangement of the various pieces of human A composition of oil on the coarse, fibrous medium of anatomy as they take on a block-like, enclosed conforma- jute, the work appears gritty and grainy. The background is tion.4 The head, removed from its corpus, sits in the upper filled with tones of red, amber, and yellow. Overlaying the

The Pharos/Spring 2016 37 Paul Klee

glowing color are the crude, dark, “crayon-like” 7 lines that Klee may have held his mirror to others in his early por- Klee has now embraced. Presumably, his arthritic grasp traits, but his final works gave him opportunities to hold could now only work with wider, larger tools. that same mirror up to himself and show how he saw his The image itself seems to be a timeline to be read from physical being as well as his soul: transformed by illness— right to left. To the far right is a fit, active human form, stylistically, compositionally, and emotionally. representing Klee’s youthful vigor of the past. A face with a What is captivating about Klee’s unrestrained expres- striking skull-like appearance occupies the center. The eyes sion in his final works is the sense of acceptance and and mouth are letters. The mouth is a sideways “t,” the eyes hope in images like Death and Fire. Dr. Richard M. Silver, are an “o” and an upside down “d.” Taken together, these let- Distinguished University Professor, and Director of the ters form the word Tod, the German word for death.2 This Division of Rheumatology and Immunology at the Medical crude, skeleton face is literally marked with death. University of South Carolina, notes that Klee found not The central face casts its gaze leftward, toward what may only solace, but also happiness “in a life’s work that brought represent a time to come or a life beyond death. The circu- him nearer to an understanding of creation.” 6 lar form at the top left is suggestive of a moon, sun, or other By documenting the changes in his own mirror im- cosmic entity. Most likely, this cosmic element is the moon, age, Klee arrived at a place of understanding after years of as similar forms appear in other Klee works. In mythology, tumult and torment. It was his art that immortalized his the moon connotes the land of the dead, a receiving ground journey, and its evolution that chronicles his personal battle for souls, and often alludes to life beyond death. Here, the with his health, as well as the means by which the rest of image of the moon is the only area where color breaks the world can understand the gravity of his illness and the through its black borders. Klee’s inclusion of the moon as impact it had on his life. a cyclical element of nature with its ever-renewing phases confers a sense of eternal life, a luminous state of transmu- References tation beyond the agony of dying with which the central . Klee, F. The Diaries of Paul Klee: –. Berkeley: figure must reckon.10 University of California Press, . Death and Fire treats death somewhat optimistically as . Varga, J. Illness and art: the legacy of Paul Klee. Curr it depicts an eternal afterlife of tranquility, peace, and com- Opin Rheumatol ,  (): –. pleteness. As Varga concludes, the figure on the far right . Rewald, S. Paul Klee: The Berggruen Klee Collection in “walks forward without hesitation, even though his next the Metropolitan Museum of Art. New York: The Metropoli- step is into his own grave. Klee now knew that the end was tan Museum of Art, . approaching. He was now unafraid of death.” 2 . Temkin, A. Klee and the Avant-Garde –, in One can view the central figure in the same light—await- Paul Klee: His Life and Work, editor C. Lanchner. New York: ing the afterlife. Klee had written about death many years Museum of Modern Art, . before his illness, saying, “I philosophize about death that . Glaesemer, J. Klee and German Romanticism, in Paul perfects what could not be completed in life. The longing Klee: His Life and Work, editor C. Lanchner. New York: Mu- for death, not as destruction, but as striving toward perfec- seum of Modern Art, . tion.” 1 With his natural aging and hastened deterioration, . Silver, R. Captive of art, not disease: Paul Klee and his death represented more than perfection for Klee, it repre- illness, scleroderma. The Pharos Winter , –. sented a place of peace, freedom from suffering and pain, . Wolf, G. Endure!: how Paul Klee’s illness influenced his and his only escape from his progressing illness.7 art. Lancet ,  (): –. . Varga, J. Systemic Sclerosis (Scleroderma) and Related Klee’s death and legacy Disorders, in Harrison’s Principles of Internal Medicine, Klee died June 29, 1940, in Locarno-Muralto, th edition, editors D.L. Longo, A.S. Fauci, D.L Kasper, S.L. Switzerland, during a hospitalization for dyspnea.6 The Hauser, J. Jameson, J. Loscalzo. New York: McGraw-Hill, . works from his final years represent his thoughts and emo- . Werckmeister, O.K. From Revolution to Exile, in Paul tions on a most intimate level. Klee said, “Some will not Klee: His Life and Work, editor C. Lanchner. New York: Mu- recognize the truthfulness of my mirror. Let them remem- seum of Modern Art, . ber that I am not here to reflect the surface (this can be . Luprecht, M. Of Angels, Things, and Death: Paul Klee’s done by the photographic plate), but must penetrate inside. Last Painting in Context. New York: Peter Lang Publishing My mirror probes down to the heart.” 1 Inc., .

38 The Pharos/Spring 2016 In an instant

Maya Armstrong The author is a member of the Class of 2018 at The But the part that really got me (the part that almost Ohio State University College of Medicine. This essay made me cry) came a little later. She was talking about her won third place in the 2015 Helen H. Glaser Student younger, wilder years. You smiled at that. Maybe you knew Essay Competition. her then. Maybe you didn’t, but I could tell that you could picture it—and you approved. But that wasn’t it either. ou were with her today at the oncologist’s office. She might be getting a double mastectomy. She won’t She already had a lump removed and found out find out for another month or so when she goes to see Ythat she’s positive for BRCA2. In an instant, her life the surgeon. Another surgery. Another defining part of was changed, and soon she had a full hysterectomy. Her her female anatomy potentially being sliced away. And uterus is gone. Her ovaries are gone. The surgery was done she was talking about the reconstruction as if it were al- using a robot. The incisions were minor. Those wounds ready a done deal—and that she wanted to show her scars will heal. Harder to say about the rest of her, which is why proudly—maybe not as proudly as she had once flashed her I’m glad that you were there. bodacious ta-tas, but she could still be sexy after all…Right? For most of the visit, you didn’t seem engaged. I couldn’t That was when you did it. The look was so spontaneous, tell whether you were bored or stunned or just had your so tender and sincere. In an instant, it gave you away— mind on other things. You probably wished that you were told the secret of your love for her feisty spirit and of anywhere else in the world but there. I can’t say that I your fear that that very feistiness might be extinguished blame you. But then there was the moment when you before your eyes. joked (sort of) about her mood swings. She had brought I don’t know if she saw the look, but I hope she did. them up—playfully enough to partially mask her anxi- And I hope that you are able to tell her…even when she’s ety—and you gave her a look that said, being emotional or bossy or stressed out beyond belief… “Don’t blame your mood swings on that you love her fire—and that you’ll tend it for her… the cancer.” But somehow in that keep the embers glowing even on days when she can’t look, there was also a tender- remember what it was like to be so carefree and full of ness…an understanding that life. I hope it doesn’t come to that. I hope that the two of nobody’s perfect, and you spend the rest of your days laughing in cancer’s face we’re all just do- and celebrating your victory. But most likely there will be ing the best days (there usually are) when fear and uncertainty will get that we can. the best of her —and it may come out in some pretty ugly ways. When that happens, just take her in your arms and look into her eyes and tell her that she’s got really gor- geous tits…but that they do not compare to the beauty that she has added to your life.

About Maya Armstrong My circuitous route to medical school took me through graduate studies in the tropics; a cancer research laboratory in Boston; teaching in im- poverished colonias in Mexico; and experiments in creativity in the Nevada desert. I’ve been a volunteer coordinator, a writer/editor, and even a mas- sage therapist—all of which have, in their many strange and wonderful ways, led me to medical school at The Ohio State University, where I am in my second year.

The Pharos/Spring 2016 39 From medical student to midwife The day I delivered my daughter on our bedroom floor

Kevin Lowder The author is a member of the Class of 2016 at Texas (The adrenaline coursing through my body was assuring Tech University Health Sciences Center Paul L. Foster me that shaving fifteen minutes off my twenty-five-minute School of Medicine. This essay won honorable mention commute to the hospital was not only plausible, it was in the 2015 Helen H. Glaser Student Essay Competition. actually a stroke of brilliance.) “No, I can’t move.” She looked up at me, her eyes the don’t think I can make it down to the car.” size of saucers. There it was: the phrase every expectant father “Oh, man. . . .” dreads hearing from his wife as they prepare to leave Before I proceed, I should pause to expain the context Ifor the hospital. In the blink of an eye the staircase from of our predicament. My wife Rachel and I were expecting our second story apartment became as daunting as the our second child—another little girl—and the due date Himalayas. was right in the middle of my combined OB/GYN and “Honey, are you sure??” I pleaded, “I can carry you Pediatrics clerkship. My clerkship directors gave special down the stairs if we need to!” The panic in my brain permission for Rachel to serve as my “continuity patient,” was spilling uncontrollably out of my mouth. “And then,” rather than randomly selecting a patient from the clinic for I continued, “I’ll run every red light and break every me. This was fantastic news, since it meant that not only speeding law and get us to the hospital in ten minutes!” would I be able to attend her pre-natal appointments, but

40 The Pharos/Autumn 2010 I would actually be required to. (Not a great substitute for decided that she would just track the contractions by date night, but beggars can’t be choosers.) herself and wake me up when she thought it was about Before the birth of our first daughter, Rachel had time for us to leave for the hospital. After all, she had done informed me that she was not keen on the idea of having this before, our bags were packed, and everything was in a needle stuck into her spine and expressed a desire to “go place. What could possibly go wrong? natural.” So I agreed to attend a weekly birthing class with The first hour, contractions were seven minutes apart. her that would help prepare her physically and mentally Close enough to justify going to the hospital, but she for a natural birth. As it turned out, she had a very smooth decided that she’d much rather labor in the comfort of our first delivery and decided to pursue another natural home than at the hospital. The next hour they were six birth this time around. She was referred by a friend to a minutes apart. The third hour, the contractions were still highly-regarded local midwife—a match made in heaven. six minutes apart, but with a few intervals of only two to Unfortunately, just two weeks before the due date, our three minutes apart. Then her body started to shake. She midwife informed us that she was retiring and would not woke me up, and after explaining the intervals and the be there for the birth. Ouch. shaking to me we decided that the time had come for us As luck would have it, I was currently stationed on to grab our bags and go. My wife’s parents live about three the Labor and Delivery (L&D) floor at the same hospital miles down the road from us, so we called them to come where we planned to have our baby. I quickly recruited a watch our two year old while we went to the hospital. team of nurses, residents, and attending physicians who “We’ll be there soon!” they told us excitedly. assured me that they would help my wife have the labor In the meantime, Rachel went to use the restroom before she desired if they were on duty when we came in. Even leaving the house. Almost immediately, any semblance of so, the thought of transferring care at this point in the still being in early labor disappeared. Still seated, her whole pregnancy was a source of great anxiety for her. body began to shake much more strongly than before. I After about a week’s worth of conversations between us had just changed into my hospital scrubs when she called and after feeling reassured through much prayer, Rachel out to me to come hold her, a sound of worried urgency in informed me that she finally felt completely at peace her voice. I bounded over to her and she leaned her weight that everything would turn out just fine. And so the days into me as I held her until the violent contraction subsided. passed, and the due date came and went. My last day Sensing that we were on a deadline, I frantically returned on OB/GYN was on a Friday and—with no signs of our to grabbing a few last-minute items to throw in the bags. I baby—I asked my little team to be on the lookout for us. hadn’t gone far when she called me back to her—she hadn’t That Sunday morning Rachel woke up at 2:00 AM moved and was already having another contraction. And with painful contractions. I was in my standard sleep that’s when the blood came. deprivation-induced coma, so she (who, as I had previously “I don’t think I can make it down to the car.” established, has a much higher pain tolerance than I do) “Honey, are you sure? I can carry you down the stairs

The Pharos/Spring 2016 41 From medical student to midwife

if we need to! I’ll run every red light and break every would provoke her to cry and open up her lungs. A huge speeding law and get us to the hospital in ten minutes!” wave of relief washed over me when that strong little cry “No, I can’t move.” rang out in our apartment, a new life greeting the world on “Oh, man. . . .” a Sunday morning just before dawn. Almost immediately My heart fell into my stomach. Though I had already my adrenaline evaporated. A sensation of warm pressure delivered what felt like a million placentas, I had only erupted over my entire body and was replaced by a fine caught two babies in my time on L&D, and both times my layer of cool sweat. Finally, after nine months of waiting— instructor’s hands were around mine, walking me through and one intense roller coaster of a morning—we had done the maneuvers to help guide a baby out. My mind began to it! (And the fans went wild!!) race. What are we going to do?! Who is going to help us?? At The following minutes and hours went by in a blur. that moment I realized that there would be no one there to Just minutes after the birth, my in-laws arrived to find my help us. It was just Rachel and me. beautiful wife reclined against the cupboards of our exter- There is a common phrase that in these types of nal bathroom vanity with a baby already on her chest. In situations your life will flash before your eyes. While it the fifteen minutes since we had called them, we had al- wasn’t my entire life that flashed before me, time did ready had our baby. Next to arrive was the EMT crew who stand still momentarily and I was taken back to the we had called right after the delivery to ask how we should conversation with Rachel in which she described the proceed. At the recommendation of the 911 dispatcher, peaceful reassurance she had felt in her prayers that I had used a shoelace to tie off the umbilical cord. The everything would turn out all right for us. A feeling paramedics cut the umbilical cord and then carried Rachel of calm, determined confidence flooded through me. I down the stairs to the ambulane in a bed sheet that trusted then that God would take care of our little family. served as a makeshift hammock. I rode in the back of the Eyes set and shoulders back, I transformed into the ambulance with Rachel, and we smiled at each other the chief of trauma surgery. Two pumps of lavender-scented whole way as we gazed at the beautiful little angel that had bathroom hand soap and I was scrubbing in. Clean hands? just joined our family. Check. Clean towels? Check. It was game time, and my What’s amazing to me is how much we’re capable of adrenaline flowed as an imaginary stadium of fans inside when necessity requires it. If someone had asked me if I my mind cheered me on. When I turned to help Rachel could deliver a baby at home, I would have emphatically stand up from the toilet where she had been sitting f rozen assured them that I most certainly could not. In retrospect, and trembling, I found that she was already standing. I shouldn’t have been so quick to doubt myself. This is Exerting all of her strength, she made it to the towels I had now my third year of medical school. I’ve studied longer laid down. Then the next curve ball came. She instinctively hours, worked longer shifts, and gotten more done on fell down onto the towels in the only comfortable position: less sleep than I ever thought I could. I was certain that I kneeling on all fours. couldn’t deliver a baby at home, and yet I did. It’s exciting My jaw dropped (a collective gasp sounding from my to be wrong about my self-imposed limitations. I look at little mind-stadium of fans) and my confidence wavered. my new daughter with new hope in my heart. What else Speaking as the baby’s father, rather than the baby’s have I been wrong about? doctor, I explained to her that I had never even seen a baby delivered from all fours, and I pleaded with her to try to About Kevin Lowder turn over onto her back. Born and raised in Northern California, I attended “I can’t move!” she managed to gasp out between Brigham Young University in Provo, Utah. After a two-year contractions. That settled the matter. Hands and knees it was. deferral of my enrollment in college to serve a mission for After only a few minutes of her heroic pushing and the Church of Jesus Christ of Latter-Day Saints in Brazil, my careful maneuvering, our baby girl fell gently into the I returned to BYU, and one year later married my wife, towel in my arms. The interesting thing about a baby being Rachel. We had our first child seventeen months later pushed out from all fours is that her face was looking up as I was completing my bachelor’s degree in Nutritional at me the whole time, and it was a very surreal moment to Science. I am now attending medical school at the Texas stop and realize that mine was the face to welcome her into Tech University Health Sciences Center El Paso Paul L. this world. As I had learned to do during my clerkship, I Foster School of Medicine, and love coming home each began the vigorous drying of her little body, hoping that it evening to the laughter and smiling faces of all my girls.

42 The Pharos/Spring 2016 Breaking the oath: Why physicians torture

Taylor R. Brooks The author is a second year medical student at the University of Cincinnati College of Medicine. This essay won honorable mention in the 2015 Helen H. Glaser Student Essay Competition.

hroughout history there have been examples of in- Tdividuals being tortured and maimed in order to obtain proprietary information. It’s hard to believe, but even in today’s world, torture is common and an almost daily news topic. Here is a fictional portrayal illustrating known tactics employed to obtain information from detainees:

A man is taken into custody by the United States Central Intelligence Agency (CIA) on suspicion of con- is alert, aware of his surroundings, and without spiring to conduct acts of terrorism. While detained, the any obvious mental illness. The detainee suffers man is subjected to enhanced interrogation techniques in from chronic asthma, but the physician does not report order to extract information. After a few days of interro- this because he fears that it could preclude additional in- gation, the man confesses, in great detail. He also reveals terrogation sessions. his plans to attack buildings in major metropolitan cities The physician knows the interrogation techniques used in an attempt to maximize the loss of life. Despite the lack on the man were inhumane and in contradiction of his of sound evidence against the man, like incriminating sworn professional oath. He must approve the detainee for e-mails or suspicious travel history, the case against him additional interrogation or face charges of abandonment, is thought to be particularly strong. During the interroga- and permanent blacklisting by his employer. He recom- tion, the man provides detailed and specific information mends that more extreme techniques like waterboarding about terrorist groups and other topics that the inter- be discontinued in favor of milder ones, for he fears that rogators believe only an insurgent could know. The next respiratory stress induced by waterboarding could exac- day, the man confesses again to the charges, provides the erbate the man’s asthma, and potentially result in his pre- interrogators with additional information regarding other mature death. The physician recommends stress positions operatives and targets, and undergoes examination by a and prolonged standing as alternatives. CIA-contracted physician to determine his physical and It is later discovered that the man is innocent of the mental health. crimes with which he was charged. He has no connections During the physical exam, the man confides in the to terrorist groups, he has never trained to conduct acts physician that he is innocent of the crimes for which he of terrorism, and he has no intention of hurting anyone. is being charged. He claims that his confession was due to The man was falsely detained on insufficient evidence, the intense interrogation techniques, and he would have suffered inhumane interrogation techniques, and provided said anything to make it stop. During the physical exam he false information.1

The Pharos/Spring 2016 43 Breaking the oath

On December 9, 2014, the Congressional Senate Select the court system superseded confessions as the preferred Committee on Intelligence released a report summarizing modality by which investigations proceeded. Other, more the CIA’s detention and interrogation program. The report sophisticated forms of criminology replaced torture as documented interrogation events involving detainees in information-gathering tools. the years after the September 11, 2001, terrorist attacks.2 Torture was resuscitated in the twentieth century by the Following the report’s release, many expressed their dis- regimes of Benito Mussolini, Joseph Stalin, and Adolph gust with the CIA and the people who assisted them, in- Hitler, who institutionalized torture. They authorized cluding physicians involved in the design and facilitation the practices, protected the practitioners, and combined of what many have called torture. torture with fear and propaganda in order to exert the Torture, as defined by the American Medical dominance of the state over her enemies. Association (AMA), is “deliberate, systematic, or wan- The heinous acts of Nazi physicians during World ton administration of cruel, inhumane, and degrading War II are perhaps the most recognized examples of treatments or punishments during imprisonment or de- torture in modern history. Their actions were placed tainment.”3 This definition encompasses some of the “en- under scrutiny in trials following the war. The repercus- hanced interrogation techniques” employed by the CIA, sions of the trials eventually led to the adoption of the e.g., sleep deprivation, cramped confinement, prolonged first international human rights agreements, the United stress positions, waterboarding, and humiliation. Nations Universal Declaration of Human Rights, and The Senate report describes the enhanced interrogation the Fourth Geneva Convention.5 Since the ratification of techniques, and implicates physicians in at least three ways: these articles nearly seventy years ago, other protocols, physicians designed methods that would not leave physical declarations, and conventions have been drafted with evidence; physicians monitored the health of detainees in the intent of aiding medical personnel in defining and order to prolong interrogation sessions; and physicians fal- preventing torture. sified medical records and death certificates to conceal the Despite torture’s long history and the wealth of proc- sometimes fatal results of interrogational torture. lamations against it, there is a dearth of empirical studies The AMA formally rebuked the actions of physicians on its efficacy in producing true, reliable information. who participated in the CIA interrogations affirming that According to research obtained from law enforcement, the complicity with, or participation in, torture violates core social sciences, and governmental agencies, the use of co- tenets of medical ethics, and compromises the role of ercion appears to harm intelligence collection and analysis. physicians as healers. Not only does partaking in torture When detainees are subjected to coercive interrogation transgress the principle of non-malfeasance—first, do no tactics, resistance to cooperation and the probability of ad- harm—but it also contravenes the Hippocratic Oath, and mitting false confessions both increase. Coercion creates devalues the societal role of physicians to intelligence a competitive dynamic between the interrogator and the gathering. subject. Detainees subjected to coercion are more likely Lessons from the literature to reject the interrogators position and not comply. In contrast, detainees subjected to tactics involving persua- Torture has been used for thousands of years to ex- sion with the potential for mutual gain are more likely to tract information from detainees. The ancient Athenians engage in productive conflict resolution.6 used torture to extract information from slaves, while the When detainees are threatened, they are likely to be- Romans used it to garner information as well as to pun- come more resistant to further interrogation. The strength ish. In the Middle Ages, the first “how-to” interrogation of resistance is largely determined by the nature of the manual was drafted by monks and used to obtain confes- threat and how the interrogator delivers it. The most ef- sions from parishioners. Processus inquisitionis, as it was fective threats are subtle, and are perceived by the target called, instructed clergymen to lead the penitent through as legitimate, whereas extreme or transparent threats—the the examination of their conscience. It gave tips on how threat of death—tend to make subjects significantly less to excavate the motives and circumstances surrounding compliant. Subjects are more likely to cooperate when the an event, and how to help contrite parishioners overcome appeal to fear is high, the legitimacy of the threat is estab- obstacles to truthful confessions.4 This manual was the lished, and the reward for compliance is significantly more modus operandi for the next few centuries until The favorable than consequences of the threat.7 Enlightenment, when judicial evaluation of evidence and Research in the social sciences and law enforcement

44 The Pharos/Spring 2016 supports the use of non-threat- ening interrogation methods. It encourages the use of alternative techniques that increase rapport between parties. Proponents argue it may be more effective to identify and manage the roots of noncom- pliance before resorting to coercive measures. In these scenarios, interrogators depersonalize the interaction, and speak of hypothetical situations. Interrogators attempt to bolster the subject’s self-esteem and sense of competence by reframing their role as an expert rather than a target.8 Techniques that avoid coercion yield more accurate information than those that incorporate coercive measures which are more likely to yield false confessions.9 When using coercive measures detainees feel forced into making false confessions as a means to escape a stressful or unbearable situation. The intelligence they provide seems plausible, so it provides temporary relief while the interrogators investigate the leads. The detainees fully appreciate the potential ad- Illustration Jim M’Guinness verse consequences of their false confession being exposed—like punishment and prolonged, harsher interrogation—but they a monumental effort devoted to conventional research into place more value on relief from the current situation human psychology and interrogation techniques. Between than on the aversion from future punishment for a false 1956 and 1963, the CIA and the American government confession. spent billions of dollars on this research, and named the Lessons from governmental organizations collective effort “project MKUltra.” During this time, ap- proximately one hundred patients admitted to the Allan In the 1950s, the United States government began Memorial Institute in Montreal, Canada, became unwit- exploring the limits of human consciousness in order to ting test subjects for the CIA’s psychological research develop weapons against the Soviet Union. Chilling, yet project. These individuals were subjected to prolonged unsubstantiated, stories circulated among CIA agents isolation and sensory deprivation designed to increase about how the Soviets used techniques like brainwashing their willingness to divulge different types of information. and truth serum to gather information about the Allies. By 1963, CIA researchers determined that these types The CIA was convinced that “the style, context and man- of techniques far exceeded more injurious and coercive ner of delivery of the ‘confessions’ were such as to be techniques in their efficacy. Individuals subjected to isola- inexplicable unless there had been a reorganization and tion and sensory deprivation for even a few days became reorientation of the minds of the confessees.” 10 significantly more compliant with the interrogation.10 In an effort to uncover the secrets of the allegedly suc- The findings of the CIA’s research between 1950 and cessful Soviet interrogation techniques, the CIA undertook 1963 were compiled as the foundation for the KUBARK

The Pharos/Spring 2016 45 Breaking the oath

(the code name the CIA used for itself) interrogation of the Inspector General that evaluated the CIA’s claims manual. This manual served as the CIA’s foremost inter- of the effectiveness of enhanced interrogation techniques. rogation reference for the next forty years, and spawned In regard to potential terror plots, it concluded, “it is not others, including the CIA’s Human Resource Exploitation clear whether these plots have been thwarted or if they Manual of 1983, and the Army Interrogation Field Manual remain viable or even if they were fabricated in the first FM 34-52 of 1987. These manuals tailored the KUBARK place. This Review did not uncover any evidence that these interrogation techniques to diverse populations and sce- plots were imminent.” 2 In addition, members of the CIA narios. The KUBARK manual also laid the foundation directly involved in the interrogation of Mohammed noted for the CIA’s modern-day interrogation strategies, which that he “responded more to ‘creature comforts and a sense eventually made their way into the protocols of United of importance’ and not to ‘confrontational’ approaches.” 2 States interrogation efforts following 9/11. In addition to Mohammed, multiple other detainees pro- The efficacy of different interrogation techniques was vided “significant accurate intelligence prior to, or without meticulously documented and evaluated from the begin- having been subjected to these techniques.” 2 ning of project MKUltra. In criticism of the KUBARK The primary conclusion of the Senate report was that interrogation strategies, it was noted that death threats “use of enhanced interrogation techniques was not an ef- are often “worse than useless. . . .” The evaluations of fective means of acquiring intelligence or gaining coopera- the Human Resource Exploitation Manual reached tion from detainees.” 2 similar conclusions, stating that “use of force is a poor How could they? technique. . . .” 5 Other countries investigating torture as an interrogation tool found it to be unreliable as well. The CIA’s efforts paralleled the findings in the litera- Reports from Nazi Germany, China, North Vietnam, ture and confirmed torture’s futility to acquire factual and Great Britain, and Israel all found torture to be unreli- advantageous intelligence. Given these observations, and able during questioning. As predicted by situations in the fact that torture violates codes of medical ethics, the law enforcement, prisoners subjected to torture gave salient question remains: why are some physicians still inaccurate, misleading, or blatantly false information complicit in torture? under duress.5 One study showed that American prison- Physicians may comply with torture for a number of ers of war were more resistant to interrogation when reasons, but perhaps the most important is that the physi- physically tortured; they were more likely to make anti- cians who work for military or governmental organizations American statements only when interrogated by other, have to emphasize nationalistic or institutional loyalties non-coercive means.11 over the duties they have to their patients. According to The findings in the Senate’s 2014 report were consistent their professional oath, physicians are responsible for with research in the social sciences and law enforcement, increasing good, and decreasing suffering for their pa- as well as the reviews of MKUltra and its progeny. The tients. According to their nationalistic or organizational Senate report concluded that enhanced interrogation loyalties, physicians must help the CIA obtain the amount techniques used on detainees after 9/11 were an ineffec- of true, reliable information that will save the greatest tive means of obtaining accurate information and gain- number of lives, by any means necessary. When these two ing detainee cooperation. Of the detainees subjected to systems contradict each other, the physician is faced with enhanced interrogation techniques, 18 produced no a dilemma: does the physician act in the best interests of intelligence whatsoever.2 The Senate also discovered that the patient, or the country? Physicians are often forced to multiple detainees fabricated information on top-priority choose the good of many over the good of a few because of issues. One of the United States government’s high- the institutional dogma within which they operate. est priority targets in the War on Terror, Khalid Sheikh After 9/11, CIA-contracted physicians adopted a com- Mohammed, often provided fictitious or inaccurate infor- monly employed anti-terrorism philosophy, the “ticking mation as a means to escape the enhanced interrogation time bomb” scenario,5 wherein the detainees are the techniques he was undergoing. Repeatedly, he admitted to enemy in the eyes of the CIA, and each of them has valu- plots that were abandoned or already disrupted, and con- able information that may save innocent lives. Moreover, fessed false information in order to tell CIA interrogators there is a finite time until a future enemy attack such that “what he thought they wanted to hear. . . .” 2 the interrogators are “racing against the clock.” Therefore, The report disclosed a review conducted by the Office the CIA and the physicians it employs must extract this

46 The Pharos/Spring 2016 critical information by whatever means necessary. Conclusions The benefits of extracting information are putatively Physicians contracted by government agencies could great as they may prevent another attack similar to 9/11. be considered sentinels for human rights violations. They Hence, physicians are justified in abetting or engaging in receive the patients Amnesty International and the Red torture in order to save the lives of many. Cross may never see. Hollywood also makes a seductive case for torture’s When presented with potential cases of torture, physi- usefulness and its place in the interrogation process. cians must remain steadfast to the codes and ethical tenets The television series 24, and numerous others including of their profession regardless of the scenario and irrespec- Homeland, The Blacklist and Chicago P.D., portray tor- tive of their employer. ture and coercive interrogations as a “secret weapon” that It is clear that the use of torture during interrogations agencies employ against the enemy with 100 efficacy.5,13 is ineffective at producing factual, reliable information. These shows, and others like them, have been criticized The variety of false information obtained through torture for potentially breeding American acceptance of torture. may confound intelligence efforts, and result in significant CIA representatives appeared numerous times before setbacks. Torture also fails to advance national interests the United States Department of Justice and presented as it alienates potential informants due to fear of suffering inaccurate information about the importance, and success, a similar fate, and it infuriates the populations at whom of the interrogation program. The CIA framed their ac- the torture is directed. Torture creates new enemies and tions within the ticking time bomb ideology, and claimed distances old allies, and it stoops to the brutal level of ter- that enhanced interrogation techniques produced specific, rorism by fighting one iniquity with another.5 actionable intelligence that saved lives.2 The philosophical assumption upon which torture rests The CIA may have reiterated these claims in combina- is mistaken. The ticking time bomb scenario has its roots tion with Hollywood dramatizations in order to convince in utilitarianism—by torturing a few, the lives of many can physicians of torture’s efficacy and motivate them to com- be saved, so the ends justify the means. This approach as- mit human rights atrocities. Thus, physician adoption of sumes that the detainees know when the next attack will institutional ideology, in combination with high contextual take place, and the information they provide as a result of tension, is possibly a motivator for physicians to commit torture will be true.16 human rights violations. In order to prevent physician compliance with torture, Perhaps another reason for physician participation in punitive measures, awareness, and education need to be torture is that the physicians who abet torture believe it emphasized. It is nearly universally accepted that torture may help them promote their careers. They comply with is unethical and in violation of human rights. Countries their institution’s policies and attitudes on torture, despite should actively support extant human rights proclama- any ethical qualms they may personally hold. Their goal tions by prioritizing the identification and persecution of is to ascend rank, and gain the accompanying prestige. physicians who torture. Argentina and Chile, whose gov- German physicians joined the Nazi party and adopted its ernment bodies aggressively pursue physicians involved views, including the pseudoscience of eugenics. During the in torture, serve as models.17 These countries provide a war, these physicians were portrayed as noble instruments reporting mechanism whereby claims of human rights vio- of “public health” as they conducted genocide.14 Infamous lations may be made to the appropriate state departments Nazi physician Josef Mengele espoused this career path, in order to prompt an investigation. Licensing medical and he became a high-ranking SS officer for his (ultimately organizations, in collaboration with the government, then misguided) efforts. sanction physicians found guilty of the charges brought Similarly, physicians are rewarded with status and pres- against them. tige for using their advanced medical knowledge to further In addition to vigorous pursuit of offenders, coun- the cause of the institution. Psychologists Jim Mitchell and tries should widely publicize these investigations. The Bruce Jessen made eighty-one million dollars for designing spectacle of public shaming, in combination with steep the CIA’s interrogation program.2 sanctions, may deter physicians from complying with Lucrative opportunities, in combination with the pres- torture. Fervent news coverage of these investigations tige of a high-ranking position and power over another draw the topic into the public eye. Widespread support human being, may explain why some physicians have been of anti-torture sentiments may impel physicians to take torn from the more noble duties of their profession. up the cause and identify those who comply with torture.

The Pharos/Spring 2016 47 Breaking the oath

These physicians, together with motivated individuals and the War on Terror. New York: Random House; . outside of medicine, can form interdisciplinary teams . Borum R. Approaching Truth: Behavioral Science Les- dedicated to the identification of any individual who sons on Educing Information from Human Sources; in Fein participates in torture. Dr. Steven H. Miles, a professor R, editor. Educing Information Interrogation: Science and of medicine and bioethics at the University of Minnesota, Art Foundations for the future: Intelligence Science Board is a leader in the movement to end torture. He maintains Phase  Report. Washington(DC): National Defense Intel- a website, www.doctorswhotorture.com, that provides ligence College Press; . resources and documents countries that have successfully . Witte K, Allen M. A Meta-Analysis of Fear Appeals: held physicians accountable for participating in torture. Implications for Effective Public Health Campaigns. Health Websites like Miles’ aid in the dissemination of relevant Educ Behav  Oct; : -. information against torture, and serve as a rallying point . Knowles E, Linn JA, editors. Resistance and Persua- whereby individuals of varied backgrounds can converge, sion. Mahwah(NJ): Lawrence Erlbaum Associates; . exchange ideas and information, and work together to . Gudjonsson G. ‘I’ll help you boys as much as I can’: end torture. How eagerness to please can result in a false confession. J Fo- Education about torture and how to stop it should be rensic Psy  Sept ; : -. incorporated at all levels of medical training. Instruction . McCoy AW. Cruel Science: CIA Torture and U.S. in medical ethics with a focus on medical complicity in Foreign Policy. N Engl J Public Policy ;  (). torture has been proposed as a supplement to medical . Segal J. Correlates of Collaboration and Resistance school curriculum.18 Lessons in medical ethics, comple- Behavior Among U. S. Army POWs in Korea. J So Issues mented by the evidence against the efficacy of torture, ;  (): -. can teach medical students how to identify and advocate . Destro R. Forward in: Educing Information Inter- against medical complicity in torture. Additionally, con- rogation: Science and Art Foundations for the future: Intel- tinuing medical education credits could be provided to ligence Science Board Phase  Report. Washington(DC): physicians who enroll in ethics classes that focus on ad- National Defense Intelligence College Press; . vocating against torture. These curricular expansions will . Rampell C. Television convinces Americans that tor- inform medical professionals of the evidence against torture is okay. The Washington Post  Dec . ture, and educate them on the most appropriate course . Proctor RN. Racial Hygiene: Medicine Under the of action when torture is suspected or recognized. Those Nazis. Cambridge: Harvard University Press; . dedicated to the medical profession should do everything . Beck J. ‘Do No Harm’: When Doctors Torture. The in their power to unite against physician complicity with Atlantic;  Dec . Available at http://www.theatlantic. torture and stop it. com/health/archive///do-no-harm-when-doctors- torture//. References . Siddiqui NA, Civaner M, Elci OC. Physician Involve- . Gudjonsson G. The Psychology of Interrogations and ment in Torture: An Ethical Perspective. J Med Humanit Confessions: A Handbook Vol . West Sussex (England):  Mar;  (): -. John Wiley & Sons, Ltd; . . Miles SH, Alencar T, Crock BN. Punishing physi- . Senate Select Committee on Intelligence. Commit- cians who torture: A work in progress. Torture ;  (): tee Study of the Central Intelligence Agency’s Detention -. and Interrogation Program;  Dec . Available at http:// . Hoffman SJ. Ending medical complicity in state- www.intelligence.senate.gov/publications/committee-study- sponsored torture. Lancet  Oct ;  (): -. central-intelligence-agencys-detention-and-interrogation- program.gov/study/sscistudy.pdf. About Taylor Brooks . AMA. Opinion .-Torture;  Dec. Available at http://www.ama-assn.org/ama/pub/physician-resources/ I am a second year medical student at the University of medical-ethics/code-medical-ethics/opinion.page? Cincinnati College of Medicine. I enjoy writing schol- . Given JB. Inquisition and Medieval Society: Power, arly essays, philosophical essays, and poetry in my free Discipline, & Resistance in Languedoc. Ithaca (NY): Cornell time. I aspire to a career in internal medicine, and I University Press; . hope to maintain writing as an integral part in both my . Miles SH. Oath Betrayed: Torture, Medical Complicity, personal and professional lives.

48 The Pharos/Spring 2016 Medicine in the movies It’s still alive: Victor Frankenstein

Victor Frankenstein, starring Daniel Radcliffe and James McAvoy. Twentieth Century Fox Film Corporation/Photofest.

Lester D. Friedman Lester Friedman is a professor in the Media and Society ary Shelley’s Frankenstein (1818) remains as popular Program at Hobart and William Smith Colleges, Geneva, today as it was during the author’s era—perhaps New York, and a member of The Pharos Editorial Board. evenM more so. Her novel has become the fountainhead for seemingly endless rivers of remakes, sequels, plays, video games, and various other types of productions that Victor Frankenstein continue to inundate our TV, Internet, and movie screens. Starring Daniel Radcliffe, James McAvoy, Jessica Brown None of the friends—Lord Byron, Percy Shelley, John Findlay. Polidori, MD—telling ghost stories in the elegant Villa Directed by Paul McGuigan. Rated PG-13. Running time 110 Diodati near Lake Geneva (Switzerland) during the wet minutes. summer of 1816 could possibly have imagined the astound- ing success of young Mary’s story. Neither could they have envisioned that her book’s title would become a perennial Something was waiting for him in the darkness, a part of catchword encapsulating society’s fears of misguided sci- himself he could not deny. entific experimentation and unruly technologies. Far more —Alice Hoffman than simply a work of fiction, Frankenstein has morphed The Museum of Extraordinary Things1 into a cultural myth that continues to exert a profound

The Pharos/Spring 2016 49 Shown from left: Basil Rathbone (as Baron Wolf von Frankenstein), Boris Karloff in Son of Frankenstein, 1939. Universal Pictures/Photofest. influence on the dreams and nightmares of Western America during the years of the Great Depression and the civilization. carnage of World War II found apt representations on the Had it not been for the movies, as Stephen King ob- screen in Frankenstein and Universal’s other monster mov- serves in Danse Macabre (1980), 2 Mary Shelley’s “modest ies featuring mutilated creatures. gothic tale” might well have remained the province of The second celebrated series, produced by England’s earnest English majors, instead of transforming into an Hammer Films (1957–1974), includes: Curse of Frankenstein immensely popular cultural archetype. (1957), Revenge of Frankenstein (1958), Evil of Frankenstein At last count, some 200 movie titles with the word (1964), Frankenstein Created Woman (1967), Frankenstein “Frankenstein” embedded within them currently exist. Must Be Destroyed (1969), and Frankenstein and the This list includes titles with the words “Frankenstein” Monster from Hell (1974). The Hammer productions re- and “Monster,” titles with the words “Frankenstein” and vived the Gothic horror film, replacing the giant, often “Doctor,” and titles with a reference to “Frankenstein” mutant monsters of the 1950s with atmospheric environ- noted. These productions about the man and his creation ments dominated by a sense of foreboding, and inhabited have an extensive history, stretching from silent films such by human predators. as Edison’s Frankenstein (1910), to Victor Frankenstein Both the Universal and the Hammer films circle around (2015), and forward into forthcoming productions such the same general ideas gleaned from Mary Shelley, includ- as This Dark Endeavor: The Apprenticeship of Victor ing scientific hubris, the morality of medical research and Frankenstein, The Casebook of Victor Frankenstein, experimentation, and the enduring battle between doing Frankenstein Created Bikers, and director Guillermo del good for society and being seduced by hubris to do evil, Toro’s planned adaptation. That’s not even consider- but with a different emphasis. While the Universal di- ing ongoing TV programs (Penny Dreadful), and video rectors shot in black-and-white, their later counterparts games for children (Island of Dr. Frankenstein) and adults saturated Hammer’s productions in vibrant color—mostly (Frankenstein: Through the Eyes of the Monster). a lurid red, of course. The first great series of Frankenstein films, the Universal Universal’s directors filled their worlds with the cavern- Pictures cycle (1931–1948), includes Frankenstein (1931), ous residences of aristocrats, while Hammer’s characters Bride of Frankenstein (1935), Son of Frankenstein (1939), The usually work within more middle-class environments. Ghost of Frankenstein (1942), Frankenstein Meets the Wolf The Universal films exist in an uncertain time frame and Man (1943), House of Frankenstein (1944), House of Dracula fictional countries, whereas most Hammer versions take (1945), and finally, Abbott and Costello Meet Frankenstein place during the Victorian era. In the earlier Frankenstein (1948). The fearful period of national anxiety that gripped movies, violence is usually depicted off screen, in the

50 The Pharos/Spring 2016 brilliance, and employs him as an assistant in his laboratory experiments to create life from dead matter using electricity. Together, they build a large human being, called Prometheus (Spencer Wilding), that contains two hearts and two sets of lungs, and shock him into life using a variety of devices and lightning. From there, of course, things go badly and people are murdered. Eventually, the creature is killed, while Frankenstein escapes to the Scottish countryside, perhaps to continue his experimental quest. Although Director Paul McGuigan mounts a stylish production, Victor Frankenstein’s almost two-hour running time moves in fits and starts. The plot never manages to capture the viewer’s attention, and the characters are basically one- dimensional. It also engages only superficially with the profound questions raised in Shelley’s novel and the best of its adaptations, choosing instead to focus on a trite ro- Young Frankenstein, 1974. Shown from left: Gene Wilder (as Dr. mantic story, and appending characters who add little to Frederick Frankenstein), Peter Boyle. Universal Pictures/Photofest. the overall complexity of the story. Take my advice and save some money. Instead, down- shadows or in quick sequences, while the later movies load the 1931 Boris Karloff version or, perhaps even better, show their characters’ nasty deeds and macabre murders watch Bride of Frankenstein (1935). in more graphic detail. Finally, in the Hammer movies Frankenstein is inescapable. As Allison Kavey notes Frankenstein’s creation usually appears opaque, one- in Monstrous Progeny: A History of the Frankenstein dimensional, and animalistic, unlike his more sympathetic Narratives, this morning you could have eaten a marsh- portrayal in previous films produced by Universal. mallow Frankenstein creature for breakfast, and while Most crucially, however, the Hammer cycle shifts the reading your newspaper, encountered an analogy between focus of the Frankenstein films from reanimating dead Monsanto’s genetic manipulation of crops and Victor tissue to transplanting organs and body parts. When Frankenstein’s creation. On the way to work, you might Universal’s creature awakes, he has no idea whose body have seen a billboard advertising the latest Frankenstein parts and organs compose him, no memory of a past film while your local radio station compared the genera- history, and he never inquires about the identities of his tion of organs from stem cells to Victor’s transformation donors. Is he, therefore, human, animal, or something in of dead flesh into a living monster. At Dairy Queen, you between? Conversely, the Hammer films never question could purchase an ice cream bar—in an attractive shade of whether the creature is human or something entirely dif- green—made to look like the creature, while watching his ferent. Such fundamental identity questions strike a decid- cartoonish offshoot on The Munsters. edly modern note. Frankenstein and his creature appear as icons of scien- The newest branch of the Frankenstein family tree, tific hubris, consumable tasty treats, and artistic represen- Victor Frankenstein, offers an intriguing perspective from tations of the monstrous—sometimes comic, sometimes which to consider the basic flow of the Frankenstein narra- tragic, but always the same story with the same characters tives that examine the outcomes, costs, and responsibilities struggling through serial murders, madness, despair, and of creating artificial beings or reanimating dead bodies. pitchfork-wielding mobs. Here, Frankenstein’s (James McAvoy) assistant Igor Kavey rightly contends that we turn back to Mary (Daniel Radcliffe) becomes the central figure. (Although Shelley’s fictional character and his grotesque creation to Shelley never included such a figure in her novel, he tell us more about how to be human, and we are frustrated first appeared in nineteenth-century stage adaptations when we find more questions than answers. The novel and later became a staple in the Universal movies.) emphasizes the importance of limiting scientific inquiry Frankenstein frees Igor from his life as an abused circus to approved topics and methodologies, but it goes silent clown, eliminates his physical deformity, recognizes his on some very important points, not the least of which is

The Pharos/Spring 2016 51 Medicine in the movies

what constitutes humanity, and can it be manufactured? The flip side of that question is also important: Are all people inherently capable of humane behavior, or must the human characteristics of ambition and desire derail the angels of our better natures and thus endanger our ability to be human? These are not simple questions, and they keep us coming back. Our constant need for Frankenstein tells us not how far we have come in the last two hundred years, but how little distance we have covered in reconciling ourselves to the complicated competing demands of defining “good” scientific work in balance with ethical treatment of subjects. Like the creature himself, these questions remain omnipresent despite our best efforts to banish them.

Interesting medical connection The pacemaker came from the Frankenstein movie. —Jean Rosenbaum, MD from the short film, Frankenstein and the Heart Machine (The Pacemaker)

Jean Rosenbaum, MD, the inventor of the pacemaker, freely admits that his inspiration for this widely used invention “comes from the Frankenstein movie.” In 1951, as a freshman medical student, he witnessed the untimely death of a young woman whose heart stopped beating, a disturbing event that almost caused him to drop out. That night, Rosenbaum had a vivid dream about Frankenstein’s creature (he had seen the 1931 film as a young child) being hoisted into the lightning storm and the electricity that brings him to life. Inspired by this, Rosenbaum wondered if a small jolt of electric current could be mechanically produced to stimulate a damaged heart to cause it to beat Thank you, Dr. Dans regularly, thus reviving a patient. He put together a por- table machine to perform this function but, after testing the fter twenty-six years of writing “The physician results successfully on animals and freshly arrived DOAs, at the movies,” Dr. Peter Dans (AΩA, Columbia his superiors still deemed the process too dangerous for University,A 1960) is retiring to sit back and enjoy movies use on a living human being. Frustrated during this two- as entertainment. year waiting period, Rosenbaum (nicknamed the “Black I know I speak for all of us at The Pharos, and for all our Vulture” by his colleagues) felt like he was Dr. Frankenstein, readers in saying, “Thank you, Dr. Dans.” and the timorous medical community the frightened town Dr. Dans is a graduate of Columbia University College mob. Finally, he was given a chance to demonstrate how the of Physicians and Surgeons, and did his residency on machine would work on a patient whose heart had stopped the Osler Medical Service at Johns Hopkins Hospital. for three minutes. The rest is medical history. He was one of the first assistant residents to be sent to Calcutta for three months to care for cholera patients, References following which he finished his residency at Presbyterian . Hoffman A. The Museum of Extraordinary Things: A Hospital in New York. He subsequently was a United Novel. New York: Scribner; . States Public Health Service research associate in viral . King, S. Danse Macabre. New York: Everest House; diseases at the National Institutes of Health, and did an . infectious diseases fellowship at Boston City Hospital.

52 The Pharos/Spring 2016 Dr. Dans joined the faculty at the University of Colorado was portrayed in film. Health Sciences Center (UCHSC) in 1969, where he was In 2002, Dr. Dans published the book, Doctors in the director of student/employee health services. While at Movies: Boil The Water And Just Say Aah. UCHSC, he also started an adult walk-in clinic, sexually Over the years, Dr. Dans has written more than 280 movie transmitted diseases clinic, and a migrant health clinic. reviews. In addition, he has published four articles in The During this time, he was recognized as an outstanding Pharos—“The great zebra hunt: A view of internal medicine teacher, practitioner, and scholar. from the walk-in clinic” (1978); “Passengers and patients: In 1978, he was named a Robert Wood Johnson Some ruminations about quality of care” (1988); “Is Alpha Health Policy Fellow at the Institute of Medicine at the Omega Alpha still relevant?” (1994); and “David Seegal: Ic ne National Academies of Sciences. He then returned to wat and other maxims of a master teacher” (2014). Johns Hopkins Hospital where he established an Office of Dr. Dans has served our profession, AΩA, and The Medical Practice Evaluation. At this time, he also directed Pharos with dignity and perspicacity. He is an outstanding the medical school course, “Ethics and Medical Core,” and clinician, teacher, scholar, leader, and writer. served as deputy editor of the Annals of Internal Medicine. Thank you, Dr. Dans, for all you have contributed to Dr. Dans has had a long-standing interest in, and advance and influence the medical profession. And thank passion for, the movies. He ran a movie program at the you for your invaluable movie reviews, they have been University of Colorado for faculty to watch a movie and entertaining, insightful and truly enjoyable. We wish you then have and in-depth discussion following the viewing. the best! At Johns Hopkins, he was the AΩA Chapter Councilor, and he and Ralph Crawshaw (The Pharos original movie Richard L. Byyny, MD, FACP reviewer) did a presentation exploring how medicine Editor

Dr. Dans was taught and mentored by outstanding teachers and clinicians, Dr. Dans, including: Reading your article “David Seegal: Ic ne Warde Allan, MD wat and other maxims of a master teacher” Dana Atchley, MD (AΩA, Johns Hopkins University, 1915) in the Autumn 2014 issue of The Pharos (pp. Paul Beeson, MD (AΩA, McGill University Faculty of Medicine, 1946) 4–7) was refreshing to me. I wanted to thank Katherine Borkovich, MD (AΩA, Johns Hopkins University, 1939) you for it. Recognizing our own pitfalls and Richard Chase, MD acting on them to improve and provide the Leighton Cluff, MD (AΩA, George Washington University, 1962) best patient care is pivotal, and important to Loretta Ford, MD be taught to physicians in training. Robert J. Glaser, MD (AΩA, Harvard Medical School, 1953) I will be using your article as a reference Mac Harvey, MD for the students and residents that rotate Bob Heyssel, MD with me. I also gave a copy to my son, who Edgar Leifer, MD (AΩA, Columbia University, 1945) is fifteen years old, and desires to one day Victor McKusick, MD (AΩA, Johns Hopkins University, 1946) become a physician. Gordon Meiklejohn, MD (AΩA, McGill University Faculty of Medicine, 1936) Once again, thanks! James Morgan, MD Monica M. Manga, MD Richard Ross, MD (AΩA, Harvard Medical School, 1947) (AΩA, University of Texas Medical School David Seegal, MD (AΩA, Harvard Medical School, 1927) at Houston, 2005) Henry Silver, MD (AΩA, University of Colorado, 1969) Visalia Medical Clinic Charles Smith, MD E-mail: [email protected] Arthur Wertheim, MD (AΩA, Sidney Kimmel Medical College, 1938)

The Pharos/Spring 2016 53 Letters to the editor

“Resilience and leadership for the challenges measure reflected a headlong race to the bottom in the ahead” industry until the Affordable Care Act (ACA) limited these excesses.* In short, market-driven insurance all but assures In the Autumn issue of The Pharos (pp. 2–4), Darrell uncertainty and dysfunction in the delivery of care. Health G. Kirch, MD, writes movingly about physician burnout, care should be financed as are other public goods like fire depression, and suicide. In the same issue (pp. 66–7), Paul and police protection, not in a manner more appropriate D. Miller, MD, laments the rise in authority of insurance to discretionary consumer spending. companies and hospital administrators whom he sees as Sadly, the wasteful excesses of free-market medicine muscling doctors and patients aside in making medical are not limited to the private sector. In order to survive decisions. While most would agree that what is ailing in this byzantine system, nonprofits have had to bulk up, American medicine is overdetermined, it seems to me hiring armies of billing specialists, middle managers, and that there is an important nexus between the thoughtful executives (the latter command salaries that are often observations of Drs. Kirch and Miller: In recent decades, commensurate with the excesses of the private sector).1 while doctors were busy taking care of patients, corporate While adding lots of cost to the nonprofit’s balance sheet, actors seized the opportunity to assume a dominant role these workers typically deliver no patient care. in the culture of medicine, resulting in many of today’s What has not changed in contemporary medicine is dystopian realities. that doctors, nurses, and other clinicians who work with What is wrong with the rise of corporate medicine is patients continue to deliver the goods. What has changed that free market values, which may be perfectly fine in the is that the efforts of these clinicians (the billable life blood making of automobiles (things like the allocation of capital of the system) must now support the burgeoning army to pay shareholders, advertisers, and executives) have little of non-clinical personnel needed to run the hospital or legitimate place in medicine. The private health insurance the practice—is it any wonder that solo practitioners are industry offers an excellent example: For insurance compa- vanishing? The math simply won’t work. Doctors then nies, any thoughtful, market-driven business plan calls for inevitably fall under the lash of “productivity metrics,” feel delay, if not outright denial, of benefit payment. The virtu- subjugated by their corporate overseers, and are prone to ally universal experience of doctors, patients, and hospitals becoming demoralized. This existential state, of course, bears testimony to this. Yet more problematic is the indus- looks phenotypically very much like depression. try’s shameless use of a metric called “medical loss ratio.” Kirch looks hopefully to medical leadership. Defined as that portion of the premium dollar that actu- Unfortunately, much of the training of tomorrow’s physi- ally goes to provide care (as opposed to being siphoned cian leaders seems to emerge from and to replicate the off to executives, shareholders, and other overhead), this very corporate models that are weighing us down. More unfortunately, the seduction of the board room and of inflated compensation (the golden handcuffs that often * The ACA penalizes private insurers who deliver less than seem to bind physician leaders to the corporation) ap- %–% of premium dollars to actual health care and qual- pear at times to distract these leaders from the primacy of ity improvement activities. In striking contrast, Medicare, patient care and from loyalty to colleagues. If leadership which is what a publicly funded alternative to private insurance might look like, boasts an administrative overhead of is the answer, it lies more in the model of Moses than of %.2 In the gulf between % and the %–% overhead of Donald Trump. “for profit” systems lies prodigious waste that drives a large Despite this carping, I share Kirch’s hope for American part of our country’s inordinate spending on health care. Our medicine. (I would do it all over again.) The science that failure to enact a Medicare-for-all system comes, in other informs our work is breathtakingly exciting, and is just words, at the expense of maintaining a system of corporate getting better. The scope of our ability to help patients welfare for the insurance industry. is growing apace (consider the example of childhood

54 The Pharos/Spring 2016 leukemias). And we continue to attract medical students . A Primer on Medicare Financing. Henry J. Kaiser Fam- and residents who, if anything, are better than we were. I ily Foundation  Jan . http://kff.org/health-reform/ just hope that the excesses and inequities of free-market issue-brief/a-primer-on-medicare-financing. medicine don’t steal their idealism. And I hope, perhaps against reason, that there may be among them a Moses or George McNeil, MD two who can lead us out of our bondage to the corporation. (AΩA, Columbia University, 1971) Associate Professor of Psychiatry References Tufts University School of Medicine . Hartocollis A. At New York-Presbyterian Hospital, its E-mail: [email protected] ex-CEO finds lucrative work. New York Times  July .

“The tragedy of the electronic health record”

I couldn’t resist placing captions on the cover of the Summer 2015 issue of Alpha Omega Alpha Honor Medical Society Summer 2015

The Pharos. I feel it truly represents a capsulized interpretation of the major problems with the use of electronic health records.

Mario J. Sebastianelli, MD (AΩA, Sidney Kimmel Medical College, 1961) Dunmore, Pennsylvania

C1.indd 1 7/1/15 10:56 AM

The Pharos/Spring 2016 55 Reviews and reflections

David A. Bennahum, MD, and Jack Coulehan, MD, Book Review Editors

The Fifteen Minute Hour: Therapeutic Talk in The authors report that primary care profession- Primary Care, Fifth Edition als fail to recognize two-thirds of emotional disorders. Marion R. Stuart, PhD, and Joseph A. Lieberman III, Productivity demands, time constraints, lack of curiosity, and insufficient skills hinder their efforts. Stuart and MD, MPH (AΩA, Sidney Kimmel Medical College, 1990, Alumnus) Lieberman urge practitioners to use a technique called Radcliffe Publishing, London, 2015 “BATHE,” an easy acronym to help remember to explore the psycho-social problems of a patient: Reviewed by Dean Gianakos, MD B is for background—“What has been going on in your life since your last visit?” or Christmas, my wife or- A is for affect—“How do you feel about it?” dered an elaborate train set T—“What troubles you the most about it?” Ffor our two-year-old grandson. H—“How are you handling it?” The gift arrived in the mail two E is for empathy—“That must be difficult for you.” days before the holiday. My job The authors explain how the same BATHE acronym was to assemble it. How hard can be used to explore not only the patient’s psycho- could it be? After dinner, I went social problems, but also the positive experiences in the to the basement and opened the patient’s life: large, brown box. There were B—“What’s the best thing that’s happened to you since hundreds of pieces, includ- your last visit?” ing more than fifty screws and A—“How did that make you feel?” bolts, and fifteen pages of instructions! Several hours into T—“What are you most thankful for?” the construction, I felt frustrated and inept. I have never H—“How can you make that positive experience hap- considered myself mechanically inclined. That’s the story pen again?” I’ve been telling myself for years. However, what would E is for empowerment—“That’s fantastic!” happen if I told myself a different story? I could say to In this new edition, they expand on ways to make the myself: I may not be an engineer, but with time, patience, patient feel responsible, confident, and accepted for the and persistence I can put this thing together. person they are. Therapeutic progress does not occur In their superb, fifth edition of The Fifteen Minute unless the patient feels heard, appreciated, and highly re- Hour: Therapeutic Talk in Primary Care, Marion Stuart, garded by the professional: PhD, Professor Emeritus of Family Medicine, Robert Wood Johnson Medical School, and Joseph Lieberman, Before we can make a therapeutic intervention, we MD, MPH, Professor of Family and Community Medicine, must listen and hear the patient’s experience of pain, Thomas Jefferson University, define psychotherapy as frustration, anxieties, or perceived limits. Patients must “helping patients to edit their stories. It is clear that the be allowed to tell their stories. It is crucial to encourage stories we tell ourselves about who we are and of what we patients to give us a brief synopsis rather than a multi- are capable determine how we will function in the world volume saga. A useful technique is to lead with an open and to what extent we will achieve our potential.”p86 question, such as “Tell me briefly” . . . let the patient talk Patients usually don’t complain about their inability for about two minutes and then summarize what we have to build toy trains, but they do stress over how to quit heard. . . . When you actively listen and then reflect the smoking, modify their diets, curb alcohol use, or live a patients’ concerns back, patients know that they have been meaningful life. Stuart and Lieberman provide pragmatic heard and understood. We cannot provide reassurance ways for primary care physicians to coach patients through or remove impediments to adherence until we accurately these challenges. One of my favorite tips is: recognize the define the patient’s concerns. When this is followed by amazing power of the word “yet.” Remind the patient, you empathic responses, it makes patients feel competent as haven’t quit smoking yet. This statement communicates well as connected to the practitioner. This creates a highly the physician’s confidence in the patient’s ability to quit— therapeutic condition.p86 maybe not today, but sometime in the future. Over time, the patient begins to tell himself a different story—I can None of this is easy to do, especially in an era in which do this! physicians are rewarded more for productivity, efficiency,

56 The Pharos/Spring 2016 and documentation than their ability to form trusting re- completed innumerable inter- lationships with their patients. views, Hamilton compiles and For those of us who want to improve our communica- organizes this vast amount of tion and relational skills, there are few books better than information into an exceptional this one. I’ve read it multiple times, and return to it fre- and easily readable account. quently. The fifth edition provides updated chapters and Some of the book is written for excellent references on mind-body relationships, cogni- an audience limited to special- tive behavioral therapies, and the particular challenges ists in the field, but Hamilton’s of difficult patients. Furthermore, I’ve found the BATHE descriptions of the beginnings techniques helpful in my relationships with friends and of American public health, and family. For example, when I ask my daughter, what’s the the outline that he offers of vari- best thing that happened in school today, it implies some- ous infectious agents, will be of thing positive really happened in school today (she simply interest to the general reader as has to search her mind for it). well as the specialist. The authors can be a little repetitious (they spend a lot To be honest, I was not certain this read would be ter- of time on BATHE), and they include more psychology ribly fun. I wondered how a single division of one depart- than most internists and family physicians probably care ment could form the basis for an entire book. I was most to read about. However, I believe the payoffs are consider- happily surprised. able. Developing curiosity, deep knowledge, and concern The book is more than just a history of academic life, for the patient’s psychological health is a great way to as Hamilton completes a thorough review of the Duke connect with our patients, and to get the results we want University Medical Center Archives. He examines the for our patients. Building trusting relationships is one of importance of many relevant infections, and gives his own the fundamental joys of practicing primary care medicine. account of some of the more important infectious diseases Speaking of building, I finally finished my grandson’s in the history of the American South. train set. The train tracks, tunnels, and bridges fit together, The reader will better understand how tuberculosis, and the train runs smoothly. I doubt my grandson will HIV, and a number of other diseases shaped communities, notice that there were several screws and bolts left over. medical education, and public health. Most interesting to me as a cardiologist and a Duke University Medical School Dr. Gianakos is Director of Medical Student Education, graduate, is how Hamilton reviews the development of Centra Health. He is a member of the Editorial Board of The the Duke criteria for endocarditis developed by Dr. David Pharos. His address is: Durack and his colleagues. 2323 Memorial Avenue, #10 As detailed in the book, many major contributors to Lynchburg, Virginia 24501 academic medicine passed through the halls of Duke E-mail: [email protected] University, and shaped both the home institution and numerous other medical centers over the years. The author also acts as a skilled historian in recount- ing the history of North Carolina, the city of Durham, the The History of Infectious Diseases at Duke South, and the place of each in the United States as a whole. University In the Twentieth Century Hamilton provides insights into the racial issues dur- John D. Hamilton, MD ing the boom of the tobacco industry that so profoundly Lulu Publishing Services, Raleigh, North Carolina, 2015 shaped the area. It is important to remember that racial segregation required separate medical schools and medical Reviewed by Daniel Friedman, MD societies for Caucasian and African-American physicians. Conditions were poor, and mortality was much higher for r. John Hamilton, now retired, was a long-stand- African-Americans than for whites. ing member of the Infectious Disease Staff at Duke The author also details the 40 million gift James B. University.D He details the history of that department from “Buck” Duke gave in December 1924 to create what is his own extensive experience as well as the memories now known as Duke University. He describes the ma- of many other faculty members and personnel. Having jor players in the development of this most important

The Pharos/Spring 2016 57 Reviews and reflections

medical center and university, how challenging the start neurosurgeon. The descriptions of the surgery hold one’s of the medical school was, and how persistence and Mr. attention with fierce focus. Duke’s support paid off. The following chapters focus on Marsh’s mistakes and The references are extensive and will allow those failures, both in surgery and diagnosis. He is brutally hon- interested in specific areas to delve much deeper. One est, and owns his responsibility and accountability in a way cannot imagine the countless hours Hamilton invested in most accomplished neurosurgeons would have difficulty writing this book. The charts outlining the history of the incorporating. Marsh even makes reference to instances in Department of Medicine and the Division of Infectious which he has advised next of kin to sue. Disease are very helpful. The average reader may not Marsh, who is now sixty-five years old, began his medi- probe into every word, but the author’s historical insights cal career as an orderly, matriculated through medical are worthwhile and will be valuable to many readers. school, and was a senior house officer for eighteen months on an ICU. He was becoming bored and disillusioned by a Dr. Friedman is Medical Director for the Heart Center at career in medicine, when by happenstance he was invited Presbyterian in Albuquerque, New Mexico. His address is: to observe an operation to remove a brain aneurysm. This Presbyterian Heart Group was his first time in the neurosurgical operating theatre, 201 Cedar SE, Suite 7600 “it was considered too specialized and arcane for mere Albuquerque, New Mexico 87107 students,”p12 he said. It was an operation to clamp off an E-mail: [email protected] aneurysm, and for Marsh, “it was love at first sight.”p14 His passion for and dedication to his “love” is evident through out the book. Marsh’s choice to become a brain surgeon, specializing Do No Harm: Stories of Life, Death, and Brain in tumors, turned out to have an ironic twist. At the age of Surgery three months his son was diagnosed with a tumor, located Henry Marsh, MD deep in his brain. Fortunately, following surgical removal, St. Martin’s Press, New York, 2015 the tumor turned out to be benign. This experience helped Marsh gain insight about holistic care of his patients. Reviewed by Herbert J. Hoffman, PhD “Anxious and angry relatives are a burden all doctors must bear, but having been one myself was an important part of r. Henry Marsh’s treatise my medical education.”p110 is more than just about He gained further insight into his profession when he life,D death, and brain surgery. became a patient as a result of a severe threat to his eye- The strong philosophical ob- sight, critical for a surgeon. In retrospect, he dismissed servations, which are liberally symptoms that he would have recognized in a patient. sprinkled through the various His treatment was spaced over a couple of months, inter- chapters, enhance the author’s spersed by a broken leg, a vitreous hemorrhage and a reti- contribution to understanding nal tear. After a series of successful outcomes, he reflected, the professional and personal “I had been lucky compared to my patients, and I was full of life of a leading neurosurgeon. profound and slightly irrational gratitude for my colleagues The volume is composed of that all patients have when things go well.”p230 twenty-five chapters with titles Every surgeon deals with life and death decisions on a such as “Haemangioblastoma,” daily basis, working through outcomes that may or may “Leucotomy,” “Medulloblastoma,” and “Oligodendroglioma.” not be positive for the patient. Marsh makes a number of However, while these medical terms will be familiar to phy- pointed, relevant observations. He notes that surgeons, sicians, they should not deter the lay reader from opening other than neurosurgeons, have patients who either die or Do No Harm. recover. Not so for the neurosurgeon, their “failures” may Each chapter is like a short novella. The first ten linger on the wards for months, a constant reminder for a chapters focus on the surgical successes (extraordinarily caring surgeon like Marsh. The favorite surgeon defense difficult cases primarily to remove or reduce brain mechanisms of compartmentalization and denial are not tumors), and individual cases of Dr. Marsh, a British prominent in Marsh’s repertoire. He describes cases in

58 The Pharos/Spring 2016 which he develops an emotional investment in the patient education, patient care, and his efforts to cope, which underscores his basic hu- research, and community ser- manity and commitment to his patients. vice in university based aca- The neurosurgeon deals directly with issues of life and demic medical centers has death on a daily basis—in addition to the in-between space proven superior to the often of permanent disability. Brain surgery rarely comes about more dispersed arrangements without significant risk to the patient’s quality of life—or elsewhere. But even cherished life, itself. Marsh observes that as he has become older and beliefs deserve reevaluation. more experienced, he has become more “realistic about the This is an excellent time to do limitations of surgery,”p124 and more concerned about the so as it is about one hundred patient’s quality of life post surgery. “It is easy enough to let years since the issuance of the someone die if one knows beyond doubt that they cannot Flexner report—which started be saved.”p235 The struggle comes for Marsh, “when I do not it all—and because the basic know for certain whether I can help or not, or should help foundations upon which academic medical centers are or not, that things become so difficult.”p235 Marsh shares built may be beginning to crumble. his process of judgment on numerous occasions, including The Flexner report had two major goals—one was to both his spectacular successes and dismal failures; his shar- eliminate the many rather marginal proprietary medical ing with patients that there is no hope, that it is time to die; schools, and the other was to establish the university- and his fear of being wrong. based, science-oriented teaching hospital that originated Throughout the book, Marsh rails against the National in Germany and had been recently introduced into the Health Service and what he perceives as over regulation, United States at Johns Hopkins, as a model for medical irrational regulations, and how things used to be better. education. Both goals were achieved, the elimination of These comments in no way take away from the greater sig- the small proprietary schools quite rapidly, the dominance nificance of his volume, but do provide additional insight of the university-based academic medical centers more into his feelings of loss of authority and his lamenting of slowly, but eventually quite profoundly. This dominance how things used to be. was greatly facilitated in the post World War II years Marsh’s command of the written word, his ability to by the extensive expansion of the National Institutes of share his observations, and the many metaphors liberally Health (NIH) extramural program, the huge influx of clini- sprinkled throughout, make for an easy and compelling cal dollars generated by the proliferation of both public read. The reader will also gain more than a modicum of and private health care insurance, and several decades of medical education. I enjoyed the book and I enjoyed meet- strong support for public universities. ing Dr. Marsh. I hope you have a similar experience for this As pointed out by many of the contributors in this book will do you “no harm,” and perhaps a lot of good. timely and informative collection of twenty-five essays sponsored by the American Association of Academic Dr. Hoffman is a retired clinical psychologist. His e-mail ad- Health Centers (AAHC), the keystone upon which the dress is: [email protected]. structure of these centers has depended is the ability to cross-subsidize within and between their several missions. The most important of these has been the ability to use The Transformation of Academic Health funds generated by the practice of medicine—both by hos- Centers pitals and individuals—to subsidize education, research, and public service. It is the large decline in the availability Steven A. Wartman, MD, PhD (AΩA, Johns Hopkins University, 1970), editor of this subsidy, as a result of reductions in reimbursements Academic Press, Elsevier, Cambridge (MA), 2015 by both public and private payers, that now provides the strongest challenge to academic medical centers. But there Reviewed by Norman H. Edelman (AΩA, New York are others as well. NIH funding has plateaued, and public University, 1961) support for state universities has been reduced over the past two decades, in some cases severely. ne of the most cherished beliefs in American aca- There seems little choice to the contributors of this Odemic medicine is that our system of integrating volume but to learn to adapt to the new environment. To

The Pharos/Spring 2016 59 Reviews and reflections

this end, Dr. Wartman has gathered an impressive array of is hard enough to teach students to be good practitioners, academic medical center leaders to lay out the problem, and adding a bit of material on population health to the describe the steps they have already taken to adapt, and curriculum won’t make them competent in public health. opine on future directions. In this era of the team approach, we need to add profes- The book is roughly organized into three sections: sionals adequately trained in public health to the skill mix financial considerations, research challenges, and educa- of modern health care delivery teams and systems, rather tional changes. The first section was the most informa- than expect undifferentiated physicians to do it all. tive, perhaps because it is the most compelling. The brief The AAHC differentiates itself from the Association foreword is a candid description of the current state of of American Medical Colleges by requiring that members affairs; no white wash, no platitudes, ending with the train health professionals in addition to physicians. Thus, conclusion that “we have a dire need to re-engineer our one omission, although understandable given the magni- organizations.” tude of the task, is a discussion of the other health profes- The descriptions of the reorganization approaches at sions as distinct entities. Northwestern University and Vanderbilt University, each What’s the bottom line? Where are academic medical of which have adopted somewhat differing models of the centers headed? Those already strong and those that are corporate approach to achieving efficiency, were most nimble will survive and may even become stronger by informative. adopting efficient corporate management practices and The chapter on market consolidation is especially well increasing consolidation, perhaps at a price of further es- done, pointing out to skeptics like me that we are mostly trangement from their parent universities. Many, however, past the time when virtually the only rationale for con- may fall on hard times and have to downsize one or more solidation was the enhanced negotiating power provided of their tripartite missions. At this point, research requir- by enlargement of market share. There are now many im- ing subsidies (that is, all but private sector-supported peratives to consolidate, and continued movement in that research) seems to be at greatest risk. In addition, some direction seems inevitable. centers at state universities may be especially vulnerable The chapters on research mostly advise our institu- as policies regarding public employee prerogatives are tions to tool up in order to follow the new trends in fund- often at odds with the imperatives of corporate style re- ing exemplified by the large population-based initiatives engineering. Thus, it is critical that state policymakers sponsored by the Patient Centered Outcomes Research understand the support their medical institutions need to Institute. One contributor did advise expansion of compete effectively in the marketplace. university/private sector partnerships as a source of sub- Perhaps worth mentioning here is an additional dy- stantial new research funding. However, the potential namic that is challenging the academic medical center challenge of such partnerships to the historical role of model of medical education. This relates to the multitude the university as the site of unrestrained scholarship un- of new osteopathic and allopathic medical schools that encumbered by commercial ties is not discussed here. have been, and are being, established. They are a result of Nonetheless, there is a separate chapter which does dis- the pent-up demand, at least with regard to M.D. degrees, cuss the impact of the current evolution of the academic released when the M.D. degree granting establishment medical center on its relationship with the mother uni- lifted its de facto twenty-five-year freeze on nationwide versity. Suffice it to say, the ongoing forces are strongly enrollment. One might include the foreign schools train- centrifugal. ing United States nationals in this mix as well. With few The chapters on education tend to manifest the basic exceptions these students do their clinical training in conceit of most medical educators—the belief that the medium-sized community hospitals mainly outside of the educational process can change the delivery system. For academic health center umbrella. Furthermore, partially example, there is considerable attention given to the vir- as a result of an arcane Medicare policy on funding of new tues of inter-professional education among the various residencies, many of these hospitals lack any previous ex- health care professions, but few examples of institutional- perience in medical education. ized success. Taken together, the trends discussed herein would In a somewhat similar vein, there is discussion of the seem to predict that a considerable number of students need to teach medical students and residents the principles who study medicine in the United States will soon do so of population health. This is well meaning but off base. It outside of an environment of scholarship and inquiry.

60 The Pharos/Spring 2016 What would Abraham Flexner say? fact, Andrea Wulf, the author of The Invention of Nature: Overall, I think that this is a very worthwhile volume Alexander von Humboldt’s New World, makes the extraor- and congratulate the AAHC for taking a timely, insight- dinary claim, “more places are named after Humboldt than ful, and hard look at the present state of academic medi- anyone else.” p7 cal centers. The book should be of interest to all people Why doesn’t von Humboldt appear among the handful in academic medicine—even if they are not involved in of popularly celebrated nineteenth-century scientists? The administration—if only to understand the changes in chief reason, Wulf suggests, resides in the man’s variety. their own institutions in the context of fast moving na- His contributions range from innovations in the mining tional trends. One can only hope it will also be read by a industry (e.g., miners’ masks and lamps) to discoveries in broader audience so that they may understand the pro- volcanism, geomagnetism, botany, ecology, and climatol- found changes taking place in these essentially unique ogy. However, unlike Charles Darwin and James Clerk American and Canadian institutions the public has long Maxwell, whose theories changed the world, the signifi- held in high esteem. cance of von Humboldt’s “big idea” was not fully appreciated until recently. Although most people now appreciate Dr. Edelman is Professor of Preventive Medicine, Internal the importance of his theory, they do not associate it with Medicine, and Physiology and Biophysics at the State Univer- his name. Wulf intends to remedy this situation by show- sity of New York at Stony Brook. His e-mail address is: ing that Alexander von Humboldt invented our modern [email protected]. concept of nature. He was born in 1769 to an army officer father—who died when von Humboldt was a young boy—and a wealthy The Invention of Nature: Alexander von domineering mother. Always adventurous and nature lov- Humboldt’s New World ing, von Humboldt longed to travel and study natural sci- Andrea Wulf ence, but his mother insisted on a practical education and Alfred A. Knopf, New York, 2015 a “useful” career. After studying finance at university, the young man became an inspector in the Prussian Ministry Reviewed by Jack Coulehan, MD (AΩA, University of of Mines. He was responsible for visiting mines through- Pittsburgh, 1969) out Prussia, but carved out time to study geology and search historical documents for evidence of possible ore he Humboldt current, a deposits. When his mother died in 1796, von Humboldt’s vast stream of cold water inheritance freed him to pursue his chief ambition, a pro- thatT flows northward along the longed journey of scientific exploration. After obtaining west coast of South America the best scientific instruments available, in 1799 he and his from southern Chile to north- companion, Aimé Bonpland, set out on a five-year odyssey ern Peru, supports an exuberant through the Spanish colonies in South America, Mexico, variety of marine life, and is, by and Cuba. far, the most productive ecosys- Their exploits included climbing Chimborazo, a vol- tem in the world. In his time, the cano then thought to be the highest mountain on Earth, Prussian naturalist Alexander where a chasm forced them to turn back at 19,400 feet. No von Humboldt (1769–1859), who one had ever climbed that high before. discovered this current, was They explored the Orinoco River system, proving that considered the greatest scientist it communicated with the Amazon. South of Quito they in the world, though today his name is far from a house- discovered the Earth’s magnetic equator. And, of course, hold word. they collected thousands of specimens. A true polymath—botanist, geologist, geographer, On the trip home to Europe in 1804, von Humboldt explorer, and visionary—von Humboldt shares his name visited the United States, where he struck up an enduring with glaciers, rivers, waterfalls, mountain ranges, parks, friendship with President Thomas Jefferson, who had just and towns scattered throughout the world from Greenland dispatched Lewis and Clark on their epic journey to the to Tasmania—though his accomplishments remain rela- Northwest. tively unknown, at least in the English-speaking world. In Lionized throughout Europe, von Humboldt settled in

The Pharos/Spring 2016 61 Reviews and reflections

Paris to begin the process of analyzing his data and writing He was the first naturalist to target a general audience in about his discoveries. Among his first books were Essay on his books, rather than solely writing for fellow scientists. the Geography of Plants, in which he invented the concept His works strongly influenced a wide range of major of vegetation zones, and Personal Narrative, a description figures, for example, Simon Bolivar embraced the unitary of his travels that later served as a model for Darwin’s conception of land and nature when developing a revolu- Voyage of the Beagle. For more than two decades, von tionary ethos for South American independence. Darwin Humboldt remained primarily in Paris and Berlin, refining studied and annotated von Humboldt’s Personal Narrative his theories about what are now called ecology, climatol- throughout his journey on HMS Beagle. Henry David ogy, and environmental science. Thoreau incorporated ideas he found in Cosmos and Views His only other journey of discovery occurred in 1829, of Nature into his own philosophy. John Muir brought von when he led a six-month expedition through Siberia. Humboldt’s environmental ideas to fruition. He died in April 1859 at the age of eighty-nine, several Two final points about Wulf’s excellent biography. First, months before one of his greatest admirers published a von Humboldt’s sexuality. He never married, and his life book called The Origin of Species. was characterized by a series of intense male relationships, Before von Humboldt’s time, Europeans viewed the nat- beginning with his colleague, Aimé Bonpland. His letters ural world from an instrumental perspective. God created to these men certainly suggest sexual intimacy. However, plants and animals for man’s use. Wilderness served no in the long run, curiosity about a historical figure’s sexual useful purpose and was, therefore, to be exploited. Human practices seems pointless. The much more important is- beings gave meaning to the land by controlling, improving, sue is von Humboldt’s strong and consistent opposition to and cultivating it. However, von Humboldt introduced the slavery. In his books on the Americas, he dedicated sec- idea that nature is “a living whole, not a dead aggregate.”p88 tions to describing the conditions of slaves and indigenous He appreciated the complex interaction of flora and fauna people. He often expressed disgust for the inhumane as a natural system that existed for its own sake, without conditions in which indigenous people and others were reference to humanity. As Wulf explains: treated. In fact, abolition of slavery was the one issue upon which von Humboldt and Jefferson disagreed. Humboldt revolutionized the way we see the natural Reading The Invention of Nature left me with a sense of world. He found connections everywhere. “In this great satisfaction. It’s not often that a book introduces you to a chain of causes and effects,” Humboldt said, “no single fascinating character so little understood, yet so influential fact can be considered in isolation.” With this insight, he in creating today’s view of the world. invented the web of life, the concept of nature as we know it today. p5 Dr. Coulehan is Emeritus Professor of Preventive Medicine, and Senior Fellow of the Center for Medical Humanities, His systematic observations led him to develop the Compassionate Care, and Bioethics at the State University of modern concepts of isotherms, plant geography, ecological New York Stony Brook. He is a member of The Pharos Edito- systems, vegetation zones, and climate change, the latter of rial Board, and is The Pharos’ Book Review Co-Editor. His which is of particular importance today. He was the first to address is: demonstrate the destructive effects of human activity on 51 Pineview Lane climate. He studied deforestation in Venezuela, showing Coram, New York 11727 that it led to soil erosion and crop reduction. He argued E-mail: [email protected] that forests enrich the atmosphere with moisture and freshen the air (without, of course, understanding the roles Jonas Salk: A Life of oxygen and carbon dioxide). He predicted that man’s Charlotte DeCroes Jacobs manipulation of the environment might someday lead to Oxford University Press, 2015 deleterious global climate change. These ideas were originally expressed in Views of Reviewed by Elaine Thomas, MD Nature, “a scientific book unembarrassed by lyricism.”p132 In later life, von Humboldt published Cosmos, an immense he paralyzing disease poliomyelitis terrified five-volume work that presented a comprehensive survey Americans in the 1950s, and Dr. Jonas Salk was cast of natural history, starting with the origin of the universe. asT their savior when he created a successful vaccine.

62 The Pharos/Spring 2016 This son of Jewish immigrants Salk Institute, now a respected research center, never sup- was a junior scientist when he ported his goal of metabiologic research, and eventually pushed his way into the com- pushed him out as director. pany of polio researchers. His Author Charlotte Jacobs, a professor of medicine at inactivated-virus vaccine was Stanford University, meticulously researched this biogra- based on relentless laboratory phy, with interviews of people who knew Salk and other work rather than an innovative key figures. idea. He collaborated with the She explores Salk’s personality through his correspon- private National Foundation dence, insomniac journal musings, and somewhat sad love for Infantile Paralysis as well life. Her style is engaging for medical and lay readers alike. as pharmaceutical companies, Jacobs does not cover some parts of the Salk story, such earning the disdain of tradi- as the reasons his late-life attempt at a therapeutic HIV tional academics. vaccine failed; or the 1950s FBI investigation of Salk, which A working committee of scientists and funders argued could have shut down his work if they had found incrimi- about his study design in ways echoed in recent projects nating communist activities. And little is said of the ironic such as HIV vaccine trials. The group limited Salk’s con- endgame: years after Sabin’s live vaccine displaced Salk’s, tribution to the design of the 1954 randomized trial of and after Salk’s death, the United States has returned to his vaccine, but the popular press regarded him as the inactivated vaccine for safety (although live vaccine is still trial’s leader. In one of the largest interventional stud- preferred in the developing world because it contributes ies ever conducted, mountains of data were collected on to herd immunity). punch cards and fed into primitive computers. The public Thanks to these competing researchers and thousands clamored to participate, in contrast to today’s suspicion of of others, a deadly disease is now close to extinction. research and vaccines. For the story of polio vaccine in its cultural context, When the trial was successful, Salk became an over- a shorter and very readable book is Polio: An American night media star, giving television interviews and writing Story, by David Oshinsky. However, Jonas Salk: A Life is articles for popular magazines. This brought scorn from worth reading for those considering a career in science or his fellow scientists, while his office was swamped with medicine for the questions it raises: How does personality letters and gifts from the grateful public. affect our successes? Why did Salk, rather than others, Salk’s rivalry with Dr. Albert Sabin, the physician who become a popular hero, and why wasn’t he respected in championed a live-virus vaccine, was professional, per- the research establishment? How do social context and sonal, and hyped by the media. During scale-up of Salk’s pure chance shape careers? How does an early success inactivated vaccine production, the Cutter Company pro- shape—or derail—a career, and how can a successful duced batches that inadvertently contained live virus and scientist avoid being trapped by the notoriety of earlier infected a number of children. Historians refer to this as achievements? “the Cutter incident.” Sabin called it “the Salk incident.” Many of Salk’s actions—bending university rules, push- Only forty years old at the time of the trial, Salk ing for early uncontrolled clinical trials, allowing pri- struggled for the rest of his life to maintain relevance and vate funders to influence research designs—would have self-esteem in the research world. He remained a public made him a pariah if the vaccine trial hadn’t succeeded. hero without gaining the scientific accolades he craved. However, such gambles are common in the scientific Evidence conflicts as to whether Salk was a self-promoting world. How does an aspiring researcher (or clinician or publicity hound or a modest, dedicated humanitarian—or entrepreneur) decide when to play by the rules and when a bit of both. for fight for a new idea? In the 1960s and 1970s, Salk indulged his lifelong interest in metabiology, a vague exploration of science as a Dr. Thomas is a Professor in the Department of Medicine, path to higher consciousness, human unity, and care for Division of Infectious Diseases at the University of New the planet, asking, “Are we being good ancestors?” Also Mexico Health Sciences Center. Her address is: during this time, to free scientists from the constraints 2211 Lomas NE, MSC 10-5550 of universities and funders, he created the Salk Institute, Albuquerque, New Mexico 87112 although his poor administrative skills almost sank it. The E-mail: [email protected]

The Pharos/Spring 2016 63 2015 Honor roll of donors

Joseph I. Bernstein (1952 Albany Medical College) lpha Omega Alpha would like to take this opportunity C. Roger Bird (1977 Loma Linda University) to thank its members and donors for their generous Robert L. Black (1973 University of Alabama at Birmingham School of A Medicine) contributions. Your donations, in addition to member Denise L. Blocker (1990 University of Toledo College of Medicine) annual dues, support and expand our twelve national James K. Bouzoukis (1956 University of Maryland) programs for medical students, residents, faculty and Reagan Howard Bradford (1961 University of Oklahoma College of Medicine) physicians. Malcolm A. Brahms (1950 Case Western Reserve University) (The member’s induction year and the school at which Laurence S. Brody (1960 University of Southern California) he/she was inducted are in parentheses.) Lawrence O. Broussard (1955 Louisiana State University School of Medicine in New Orleans) James S. Brown (1968 Indiana University) Joseph K. Bush (1961 University of Tennessee Health Science Center) Thank you! Robert L. Caldwell (1984 University of Rochester School of Medicine and Dentistry) Charles V. Capen (1973 University of Tennessee Health Science Center) David A. Caplin (1975 University of Cincinnati) Phyllis L. Carr (2003 Boston University School of Medicine) Elizabeth Carter (1981 University of Texas Medical Branch) $1–$25 donation Nelson D. Castellano (1970 University of Miami) Terence Tat-Yin Chan (1979 Loma Linda University) Ross Abrams (2001 Johns Hopkins University) Robert L. Chesanow (1975 Washington University in St. Louis School of Charles V. Adair (1947 Case Western Reserve University) Medicine) Billy B. Alexander (1955 University of Texas Medical Branch) Richard C. Childs (1980 University of South Alabama College of William Edward Allard (1957 University of Vermont) Medicine) Herbert M. Allen (1970 University of Virginia) Lewis R. Cimino (1971 Creighton University) Joseph S. Alpert (1969 Harvard Medical School) Melba Colon (2012 Universidad Central del Caribe) Don P. Amren (1957 Yale University School of Medicine) Roy J. Correa (0956 University of Michigan) Steven M. Amster (1999 George Washington University) Richard H. Cowan (1971 University of Tennessee Health Science Center) Joseph Thomas Anderson (1989 University of South Carolina) Trevor J. Craig (1958 McGill University Faculty of Medicine) Barry M. Arkin (1973 University of Rochester School of Medicine and Lucy S. Crain (1991 University of Kentucky) Dentistry) Gregory H. Croll (1983 University of Missouri) Herbert J. Ashe (1979 Louisiana State University School of Medicine in Sharon Sabati Dailey (1981 Medical University of South Carolina) New Orleans) Frederic G. Dalldorf (1977 University of North Carolina) Robert F. Ashman (1966 Columbia University) Francisco Aviles-Roig (1967 University of Puerto Rico) Samir K. Ballas (1967 American University of Beirut) William M. Barr (1954 Medical University of South Carolina) George R. Barry (1942 University of Chicago) AΩA Programs and Awards Charles P. Barsano (1997 Rosalind Franklin University of Medicine and Science) John B. Bassel (1969 Vanderbilt University) Administrative Recognition Award Martin L. Bassett (1974 Oregon Health & Science University School of Carolyn L. Kuckein Student Research Fellowship Medicine) Edward D. Harris Professionalism Award Susan E. Bates (1978 University of Arkansas) Robert J. Beach (1974 University of Maryland) Fellow in Leadership Award David B. Bell (1968 University of Colorado) Helen H. Glaser Student Essay Award Timothy C. Bell (1981 Tufts University School of Medicine) Medical Student Service Leadership Project Award Neil C. Bender (1963 University of North Carolina) Nathan A. Benson (1973 University of Arizona) The Pharos Student Poetry Contest Gretchen Glode Berggren (2010 University of Nebraska) Postgraduate Award James L. Bernat (1973 Geisel School of Medicine at Dartmouth) Robert J. Glaser Distinguished Teacher Award Robert H. Moser Award Visiting Professorships Volunteer Clinical Faculty Award Nicholas A. Danna (1974 Louisiana State University School of Medicine Caleb Michael Graham (2013 University of Mississippi) in New Orleans) Ian Anthony Grasso (2014 Uniformed Services University) Philip R. Daoust (1968 Tufts University School of Medicine) Leonard Joseph Graziani (1975 Sidney Kimmel Medical College) Ronald Lee Davis (1981 Louisiana State University School of Medicine in Gary I. Greenwald (1980 Yale University School of Medicine) New Orleans) Paul D. Griesmer (1953 Sidney Kimmel Medical College) George A. Dean (1955 Wayne State University) Robert Allen Gustafson (1986 West Virginia University) Jesse C. Delee (1970 University of Texas Medical Branch) George N. Guzzardo (1976 Louisiana State University School of Anthony Demaria (1981 Rutgers New Jersey Medical School) Medicine in New Orleans) Marielaina Derose (1994 Sidney Kimmel Medical College) Leonard T. Haas (1970 St. Louis University) Carl M. Devore (1979 Albany Medical College) Maryann Haflin (1971 Drexel University College of Medicine) Keith A. Dimond (1965 University of Cincinnati) Rachel F. Haft (1986 Washington University in St. Louis School of J. Lee Dockery (1980 University of Florida) Medicine) Jack W. Doucette (1954 University of Michigan) Lanny B. Hale (1976 Medical College of Wisconsin) Steven D. Douglas (1962 Weill Cornell Medical College) Richard H. Hallock (1978 University of Maryland) Joel B. Dragelin (1987 Sidney Kimmel Medical College) Peter R. Handley (1993 Wayne State University) Miles Aaron Dunbar (2013 University of Mississippi) Kenneth H. Hanger (1977 University of Maryland) Ramon S. Dunkin (1956 Indiana University) Daniel J. Hanson (1953 University of Minnesota) Thomas D. Easley (1967 University of Texas Southwestern Medical Alexander Hantel (1981 University of Illinois) Center at Dallas) Cary S. Hart (1976 University of California, Davis) Bennett B. Edelman (1975 Johns Hopkins University) Thomas Ewald Heer (1988 David Geffen School of Medicine at Richard M. Egan (1968 Creighton University) University of California, Los Angeles) Sam F. Elder (1961 University of Miami) Csaba Hegyvary (1976 Rush Medical College) Susan K. Elgee (1981 University of Washington) Emery C. Herman (1953 Johns Hopkins University) Dale J. Ellenberg (1979 Northwestern University) Randall T. Hermann (1969 David Geffen School of Medicine at Andrew B. Epstein (1981 University of Arizona) University of California, Los Angeles) Christopher Thomas Erb (2008 University of Illinois) Keith A. Heslinger (1989 Wayne State University) John E. Erickson (1980 George Washington University) Harry J. Hirsch (1971 Allegheny University of the Health Sciences) Philip J. Feitelson (1965 University of Louisville) Margaret C. Hochreiter (1978 Washington University in St. Louis School Lenora I. Felderman (1981 New York Medical College) of Medicine) Charles R. Felton (1977 University of Texas Health Science Center at San Irwin Hoffman (1993 University of New Mexico) Antonio) Gary N. Holland (1979 David Geffen School of Medicine at University of Michael R. Fischetti (1969 Albany Medical College) California, Los Angeles) Edward G. Fisher (1961 Howard University) William C. Holliday (1973 Ohio State University) Gerald F. Fletcher (1961 Emory University) Alan Berch Hollingsworth (1974 University of Oklahoma College of Robert E. Florin (1952 University of Southern California) Medicine) Gary N. Foulks (1969 Columbia University) Leland E. Holly (1953 Northwestern University) John L. Fowlkes (1984 University of Texas Health Science Center at San Melvin Horwith (1950 Albany Medical College) Antonio) Harold R. Howe (1980 Wake Forest School of Medicine) Martin J. Fox (1978 Medical College of Wisconsin) John T. Howell (1980 Columbia University) Melvin J. Fratkin (1963 Virginia Commonwealth University) Judith A. Hsia (1978 University of Illinois) Cesar Freytes (1979 University of Puerto Rico) Robert E. Hurley (1960 University of Virginia) William F. Fritz (1949 Johns Hopkins University) Robert P. Irons (1981 University of Virginia) Wayne S. Fuchs (1979 Icahn School of Medicine at Mount Sinai) Carlos M. Isales-Forsythe (1981 University of Puerto Rico) Donald S. Gair (1950 Harvard Medical School) Joelle L. Jakobsen (1996 Loma Linda University) Michael John Gandour (1979 University of Miami) Christopher F. James (1977 University of Maryland) Elizabeth A. Garrett (1979 University of Missouri) Thomas M. James (1976 University of Oklahoma College of Medicine) Michael K. Georgieff (1979 Washington University in St. Louis School of Daniel J. Johnson (1979 Ohio State University) Medicine) Susan J. Jones (1979 University of Arizona) Susan W. Gilbert (Case Western Reserve University) Ichabod Jung (1995 Medical College of Wisconsin) Martin C. Glover (1976 University of Alabama at Birmingham School of Barry F. Kanzer (1979 State University of New York, Upstate Medical Medicine) University) Harold J. Goald (1954 Temple University) Murray M. Kappelman (1953 University of Maryland) John C. Gocio (1979 University of Arkansas) Ronald Kapusta (1960 McGill University Faculty of Medicine) Jerry L. Goddard (1970 Tulane University) Richard G. Katz (1968 Johns Hopkins University) Stuart H. Gold (1981 Vanderbilt University) James P. Kauth (1961 Medical College of Wisconsin) William S. Goldstein (1990 Wayne State University) Chester J. Kay (1960 State University of New York, Downstate Medical David J. Goode (1966 Wake Forest School of Medicine) Center) Leslie Lash Goodwin (1977 University of Utah) William P. Keefe (1954 University of Maryland) Bobby L. Graham (1982 University of Mississippi) Daniel E. Keim (1967 Yale University School of Medicine)

The Pharos/Spring 2016 65 2015 Honor roll of donors

Keith Kenter (1990 University of Missouri) Harry J. Mobley (1970 Louisiana State University School of Medicine in David K. Kentsmith (1980 University of Nebraska) New Orleans) Loren H. Ketai (1978 University of Michigan) Bernadine A. Moglia (1987 Pennsylvania State University College of Nadim Youssef Khoury (1961 American University of Beirut) Medicine) Thomas W. Kiernan (1988 Rutgers New Jersey Medical School) George Carl Mohr (1957 Harvard Medical School) Paul E. Kim (1999 Baylor College of Medicine) Dennis M. Moritz (1981 University of Illinois) John W. Kirk (1970 Weill Cornell Medical College) Thomas W. Muhlfelder (1965 Sidney Kimmel Medical College) Kenneth W. Kizer (1976 David Geffen School of Medicine at University John B. Muldowney (1975 Northwestern University) of California, Los Angeles) Sonya Naryshkin (1981 University of Louisville) Edward C. Klatt (1976 Loma Linda University) James J. Navin (1960 Creighton University) Quentin F. Knauer (1957 Case Western Reserve University) Karl F. Niehaus (1953 University of Nebraska) H. S. Kott (1960 University of Virginia) Bruce C. Nisula (1969 Harvard Medical School) Michael J. Kornstein (1980 State University of New York Upstate William N. O’Conner (1994 University of Kentucky) Medical University College of Medicine) Alice Amy Onady (1987 Wright State University Boonshoft School of e) Jennifer Lynn Kraschnewski (2004 University of Wisconsin School of Michael S. Oneill (1990 Texas Tech University) Medicine and Public Health) Kwame Osei (1988 Ohio State University) John R. Krause (1965 University of Pittsburgh) Martin W. Oster (1970 Columbia University) Michael J. Kraut (1977 Wayne State University) David M. Parham (1976 University of Tennessee Health Science Center) Paul A. Krogstad (2010 Tulane University) Clifton L. Parker (1964 Virginia Commonwealth University) Marshall K. Kubota (1979 Saint Louis University) Jeffrey A. Passer (1971 University of Nebraska) Samuel Thomas Kunkel (2014 University of Cincinnati) Celeste H. Patrick (1982 Medical University of South Carolina) Alan T. Lau (1981 University of Hawaii) Robert B. Pauszek (1964 Indiana University) Bryan K. Lee (1977 University of Minnesota) Steven Z. Pavletic (1995 University of Nebraska) Dolores A. Leon (1974 Oregon Health & Science University School of David R. Paz (1977 Allegheny University of the Health Sciences) Medicine) Paul E. Pepe (1975 University of California, San Francisco) Joseph B. Leroy (1971 Medical College of Georgia at Georgia Regents Gilbert J. Perry (1980 Rutgers New Jersey Medical School) University) Sophia Brothers Peterman (1980 University of Michigan) Murray Levin (1960 Tufts University School of Medicine) Robert G. Peterson (1977 Wake Forest School of Medicine) Mitchell I. Levine (1979 University of Michigan) Charles Phelps (1976 University of Texas Medical Branch) James M. Lipstate (1979 Tulane University) Val M. Phillips (1978 Rutgers New Jersey Medical School) Henry S. Loeb (1959 Northwestern University) Gregory Podsakoff (1976 Loma Linda University) Alfred E. Lounsbury (1979 University of Minnesota) Marianne Pohle (1958 Tulane University) Susan L. Lucak (1981 Albert Einstein College of Medicine of Yeshiva George L. Popky (1974 Drexel University College of Medicine) University) John T. Powell (2002 Sidney Kimmel Medical College) Lorenz Lutherer (2008 Texas Tech University) Sally W. Pullman (1980 University of Cincinnati) Rob Roy MacGregor (1964 Harvard Medical School) Donald O. Quest (1969 Columbia University) Eric S. Marks (1973 Wake Forest School of Medicine) Scott Radow (1976 West Virginia University) J. T. Marotta (1970 University of Toronto Faculty of Medicine) Jerald H. Ratner (1970 Allegheny University of the Health Sciences) Nancy Sharon Martin (1982 University of Mississippi) John H. Redpath (1968 McGill University Faculty of Medicine) Richard L. McDougal (1977 University of Arkansas) Ryan M. Rehl (2001 Ohio State University) David Wayne McFadden (1980 University of Virginia) F. M. Ricker (1964 University of Washington) William (Mike) M. McGaw (1963 University of Miami) Michael E. Rinow (1974 University at Buffalo, School of Medicine and Terrence G. McGaw (1996 University of Nevada School of Medicine) Biomedical Sciences) Brian Jay McGrath (1981 Albany Medical College) Wallace P. Ritchie (1977 University of Virginia) Floyd L. McIntyre (1979 University of Oklahoma College of Medicine) Joan Bowes Ritter (1990 Georgetown University) Jesse N. McNiel (1960 University of Arkansas) Lin E. Roberts (1981 Rush Medical College) Jeannie Marie McWhorter (1999 University of South Florida) Robert P. Roca (1978 David Geffen School of Medicine at University of David B. Melchinger (1965 Yale University School of Medicine) California, Los Angeles) Darlyne Menscer (1979 University of North Carolina) Aylin R. Rodan (2004 University of California, San Francisco) Howard T. Meny (1981 New York Medical College) David L. Rollins (1976 Rosalind Franklin University of Medicine and Gregory G. Messenger (1980 Wayne State University) Science) Jeffrey J. Miller (1992 Sidney Kimmel Medical College) James A. Rommer (1978 Weill Cornell Medical College) Scott B. Miller (1979 University of Toledo College of Medicine) David Mayer Roseman (1951 Johns Hopkins University) Lynn D. Mitchell (1962 University of Missouri) Louis Rosenblum (1947 University of Illinois) Mark R. Mitchell (1981 Meharry Medical College) Louis M. Rosner (1977 Rosalind Franklin University of Medicine and Sally E. Mitchell (1976 Ohio State University) Science) Frederick S. Mittleman (1969 Creighton University) Peter R. Rothe (1980 University of Wisconsin School of Medicine and George S. Miz (1979 Loyola University, Stritch School of Medicine) Public Health) Alan R. Mizutani (1950 University of Vermont) Kelly P. Roveda (1989 University of South Alabama College of Medicine)

66 The Pharos/Spring 2016 David R. Rovner (1954 Temple University) Susan W. Waters (1981 Baylor College of Medicine) Jonelle C. Rowe (1969 University of Vermont) Mary H. Weightman (1961 Temple University) Bernard Rubin (1953 University of Chicago) Diana P. Weinberg (1972 New York University) Deborah C. Rubin (1981 Albert Einstein College of Medicine of Yeshiva Peter F. Weinberg (1977 New York University) University) Arnold H. Weinstein (1959 Sidney Kimmel Medical College) Robert L. Rudesill (1947 Indiana University) Carolyn H. Welsh (1979 Boston University School of Medicine) Matthew Rudorfer (1977 State University of New York, Downstate Kurt L. Wiese (1981 Weill Cornell Medical College) Medical Center) Donald F. Williams (1959 University of Kansas) William Rutledge (1979 Meharry Medical College) Susan V. Williams (1981 Louisiana State University Health Sciences Jack Ryan (1979 Wayne State University) Center Shreveport) Timothy Patrick Ryan (2011 Eastern Virginia Medical School) Charles A. Winterling (1958 University of Rochester School of Medicine Richard Bradley Sack (1958 Oregon Health & Science University School and Dentistry) of Medicine) William W. Winternitz (1945 Johns Hopkins University) William P. Sadler (1956 Johns Hopkins University) Robert H. Wise (1980 Vanderbilt University) Arthur L. Sagone (1962 University of Pittsburgh) Murray Wittner (1960 Yale University School of Medicine) Kathy J. Schilling (1980 University of Miami) Thomas E. Witzig (1979 University of Illinois) Richard A. Schmaltz (1978 University of South Dakota) Judith A. Wynnemer (1966 University of Wisconsin School of Medicine Theodore L. Schreiber (1977 Weill Cornell Medical College) and Public Health) Richard D. Schroeder (1981 Northwestern University) John F. Yerger (1960 Temple University) Evelyne Albrecht Schwaber (1959 Albert Einstein College of Medicine of Roy T. Young (1965 State University of New York Upstate Medical Yeshiva University) University College of Medicine) Alfred G. Scottolini (1953 Sidney Kimmel Medical College) Mary M. Zutter (1981 Tulane University) Cynthia L. Sears (1976 Sidney Kimmel Medical College) Steven C. Zweig (1979 University of Missouri) Joel A. Sender (1974 Albany Medical College) George F. Sengstack (1956 George Washington University) Stanley R. Shane (1958 University of Kansas) Anthony Shaw (1980 University of Virginia) $26–$50 donation Keith N. Shenberger (1977 Geisel School of Medicine at Dartmouth) Cynthia K. Aaron (1984 Drexel University College of Medicine) Harry C. Sherman (1957 Medical College of Georgia at Georgia Regents Hussein D. Abdullatif (2014 University of Alabama at Birmingham University) School of Medicine) Steven L. Shore (1966 Johns Hopkins University) Dana C. Abraham (1988 University of Arkansas) Kevin Shumrick (1979 University of Cincinnati) Irving Paul Ackerman (1949 Columbia University) Neil H. Shusterman (1977 Sidney Kimmel Medical College) J. Michael Adams (1993 University of Nebraska) John W. Singleton (1956 Harvard Medical School) Robert T. Adlam (1979 Medical College of Wisconsin) Peter C. Smith (1981 Wayne State University) Lawrence W. Allen (1962 Case Western Reserve University) Samuel N. Smith (1968 Wake Forest School of Medicine) Rhea J. Allen (1989 University of Iowa) James V. Soldin (1978 University of Minnesota) Shirley C. Anderson (1983 University of Washington) Stanley M. Spinola (1977 Georgetown University) Tom Anderson (1982 Medical College of Wisconsin) Bonita F. Stanton (1976 Yale University School of Medicine) Jared L. Antevil (1998 University of Virginia) Dennis J. Stapleton (1979 Wayne State University) Diana Antoniskis (1982 University of Nebraska) Marc Peter Steinberg (1977 University of South Florida) George Foster Armstrong (1952 Duke University School of Medicine) Mark J. Stephan (1971 University of Colorado) John H. Armstrong (1988 University of Virginia) John E. Stephenson (1976 Tulane University) Michael J. Armstrong (1994 Medical College of Wisconsin) John F. Stremple (1963 Medical College of Wisconsin) Thomas Francis Arnold (2013 University of North Dakota School of Steven C. Stricker (1977 University of California, Irvine) Medicine and Health Sciences) Walter H. Sturm (1979 State University of New York, Downstate Medical Dominic D. Aro (1993 New York Medical College) Center) Robert G. Atnip* (1976 University of Alabama at Birmingham School of Cary E. Sullivan (1945 Emory University) Medicine) Armando Susmano (1975 Rush Medical College) David E. Attarian (1980 Duke University School of Medicine) Robert J. Temple (1965 New York University) Rodrigo Azuero (2002 Albany Medical College) Catherine Thomasson (1983 Wayne State University) David Brian Badesch (1982 University of Virginia) Charles A. Thornton (1980 University of Iowa) Byron J. Bailey (1994 University of Texas Medical Branch) Barbara H. Towne (1970 University of California, Irvine) John H. Bair (1983 Northeast Ohio Medical University) Justin James Trevino (1987 Wright State University Boonshoft School of Susan A. Ballagh (1986 David Geffen School of Medicine at University of Medicine) California, Los Angeles) Robert S. Waldbaum (1961 Columbia University) Evan A. Ballard (1977 University of Utah) Thomas A. Waldmann (1954 Harvard Medical School) James O. Ballard (1968 University of Maryland) Thomas T. Ward (1971 University of Washington) Linda M. Balogh (1994 Wayne State University) William S. Warden (1962 Duke University School of Medicine) Jeremy Baran (2010 Uniformed Services University) Barry K. Waters (1981 Baylor College of Medicine)

The Pharos/Spring 2016 67 2015 Honor roll of donors

Jacob J. Barie (1965 Albert Einstein College of Medicine of Yeshiva Mark F. Clapper (1984 Uniformed Services University) University) Joseph C. Cleveland (1990 University of Washington) Peter Barland (1959 Albert Einstein College of Medicine of Yeshiva Brian T. Clista (1992 University of Pittsburgh) University) Douglas A. Coe (2007 University of Missouri-Kansas City) Robert W. Barnett (1978 Ohio State University) James U. Collins (1965 Wayne State University) Konrad Nils M. Barth (1988 Columbia University) Nancy M. Compton (1984 University of Virginia) Barbara W. Bayldon (1984 Temple University) Donald P. Connelly (1971 University of Minnesota) Edward J. Bayne (1973 Virginia Commonwealth University) Charles D. Connor (1979 University of Alabama at Birmingham School David M. Bear (1971 Harvard Medical School) of Medicine) Michael Scott Beckenstein (1987 Eastern Virginia Medical School) John H. Cook (1977 Yale University School of Medicine) David J. Bender (1956 University of Minnesota) Thomas G. Cooney (1991 Oregon Health & Science University School of Alan H. Bennett (1963 Albany Medical College) Medicine) William M. Bennett (1976 Oregon Health & Science University School Lynn V. Coulter (1983 Medical College of Georgia at Georgia Regents of Medicine) University) Steven C. Bergin (1974 Medical College of Wisconsin) Stephen D. Covington (1971 University of California, San Francisco) Ronald A. Bergman (1979 American University of Beirut) Cris G. Cowley (1976 University of Utah) Lisa M. Bernhard (1985 Louisiana State University School of Medicine in Ralph Lee Cox (1986 University of Louisville) New Orleans) Jeremiah Edward Crabb (1979 University of Kansas) Robert F. Betts (1964 University of Rochester School of Medicine and D. Scott Crouch (2001 Southern Illinois University) Dentistry) John A. Crouch (1971 University of Kansas) Joseph N. Biase (1989 Rutgers Robert Wood Johnson Medical School) Thomas Joseph Curran (1987 University of Southern California) Charles Billington (1978 University of Kansas) Robert I. Cutcher (1957 University of Michigan) Robert F. H. Birch (1986 University of New Mexico) Arthur F. Dalley (2003 Vanderbilt University) Nancy E. Bizzell (1980 Emory University) Carolyn B. Daul (1979 Tulane University) Dennis D. Black (1978 University of Tennessee Health Science Center) Stuart Davidson (1965 University of California, San Francisco) Edgar R. Black (1976 Raymond and Ruth Perelman School of Medicine Alonzo J. Davis (1992 East Carolina University Brody School of at the University of Pennsylvania) Medicine) Eugene C. Bloom (1960 University of Miami) Margaret D. Davis (1984 Ohio State University) Bruce Scott Bochner (1982 University of Illinois) Bruce E. Day (1972 University of Alabama at Birmingham School of Ernie Bodai (1988 University of California, Davis) Medicine) Jennifer Brainard (1994 Ohio State University) Lloyd A. Dayes (1959 Loma Linda University) Laura J. Brand (1991 Raymond and Ruth Perelman School of Medicine at Peter R. De Marco (1962 Creighton University) the University of Pennsylvania) Catherine DeAngelis (1990 Johns Hopkins University) Karen Jean Brasel (1990 University of Iowa) Robert C. Dean (1987 University of South Alabama College of Medicine) Albert E. Breland (1963 University of Mississippi) Robert W. Decker (1981 University of California, Davis) Paul F. Brenner (1997 University of Southern California) Peter J. Dehnel (1981 University of Minnesota) Gary Brigham (1990 University of Illinois) Joseph B. Delcarpio (2005 Louisiana State University School of Medicine Charles D. Brooks (2004 Texas Tech University) in New Orleans) David A. Browdie (1963 Case Western Reserve University) Mayo R. Delilly (1977 Howard University) Mary Lynn Brown (1984 Geisel School of Medicine at Dartmouth) George Dermksian (1954 Weill Cornell Medical College) Terrence J. Bugno (1982 Northwestern University) Sabrina Fraser Derrington (2004 University of California, Davis) Daniel F. Burian (1996 University of Pittsburgh) Ernest E. Deshautreaux (1953 Tulane University) Dale Robin Burwen (1988 Tufts University School of Medicine) John Diorio (1973 Albany Medical College) Karyn Leigh Butler (2005 University of Cincinnati) Carol R. DiRaimondo (1980 Vanderbilt University) Rafael A. Calabria (1964 University of Puerto Rico) Dale Distant (1992 State University of New York, Downstate Medical) Philip L. Calcagno (1965 Georgetown University) Center Linda Palmon Calhoun (1985 Georgetown University) Dayna Gwinup Diven (1985 University of Texas Medical Branch) Michael A. Carducci (1987 Wayne State University) Cathleen Doane-Wilson (1980 University of Vermont) Nathan Eric Carnell (1986 University of Maryland) Karen B. Domino (1978 University of Michigan) Francisco Carpio (1992 Universidad Central del Caribe) Kimrie M. Donovan (1993 Case Western Reserve University) Sion William Carter (1987 University of South Florida) William Droegemueller (1959 University of Colorado) James Louis Caruso (1988 University of Illinois) Diane Marie Drugas (1987 Rosalind Franklin University of Medicine and Veronica M. Catanese (1979 New York University) Science) Nicholas C. Cavarocchi (2013 Sidney Kimmel Medical College) Thomas E. Duncan (1968 Tulane University) William G. Cheadle (1987 University of Louisville) Steven S. Dunlevie (1998 University of North Carolina) David M. Chess (1981 Creighton University) George D. Edwards (1976 Louisiana State University Health Sciences Charles H. Chodroff (1980 Weill Cornell Medical College) Center Shreveport) Gary Alan-Hue Christenson (1985 University of Minnesota) Arnold H. Einhorn (1975 Albert Einstein College of Medicine of Yeshiva Lucy Civitello (1979 New York Medical College) University)

68 The Pharos/Spring 2016 Jimmie L. Eller (1962 Indiana University) Michael D. Hagen (1975 University of Missouri) Sarah Louise Elmendorf (1987 Albany Medical College) Betty M. Hahneman (1951 Northwestern University) Charles H. Epps (1972 Howard University) Michael John Halls (1976 University of Western Ontario Faculty of Richard W. Erbe (1962 University of Michigan) Medicine and Dentistry) Susan P. Erisman (1984 Temple University) Tibor J. Ham (1975 Virginia Commonwealth University) Angel F. Espinosa-Lopez (1997 University of Puerto Rico) Edwin H. Hamilton (1999 Meharry Medical College) Janine Evans (1983 Temple University) Michael Stephen Hanemann (2014 Louisiana State University School of Russell D. Evett (1956 Virginia Commonwealth University) Medicine in New Orleans) James P. Felberg (1996 University of New Mexico) Mohamad I. Haque (1998 University of Illinois) Patrick J. Fernicola (1989 Georgetown University) Jim Hardin (1974 University of Mississippi) Scott A. Fields (1989 Oregon Health & Science University School of William D. Hardin (1989 Tulane University) Medicine) Joseph E. Harlan (1976 Wake Forest School of Medicine) James Walter Finch (1981 University of South Florida) Lawrence L. Harms (1982 University of Nebraska) Barbara K. Finck (1986 University of California, San Francisco) Bryan Harris (2002 University of Utah) Delbert A. Fisher (1953 David Geffen School of Medicine at University of Michael S. Harris (1966 University of Texas Southwestern Medical California, Los Angeles) Center at Dallas) Lorne W. Flather (1954 University of British Columbia Faculty of Catherine C. Hart (1979 Raymond and Ruth Perelman School of Medicine) Medicine at the University of Pennsylvania) Nancy C. Flowers (1992 University of Tennessee Health Science Center) John D. Hartigan (1963 Creighton University) Debra H. Ford (1985 Howard University) Sami A. Hashim (1954 University at Buffalo, School of Medicine and Burt Fowler (1975 University of Oklahoma College of Medicine) Biomedical Sciences) Hugh M. Foy (1994 University of Washington) David P. Haswell (1984 State University of New York Upstate Medical Paul B. Francis (1966 University of Tennessee Health Science Center) University College of Medicine) Marvin G. Frank (1964 Virginia Commonwealth University) Daniel E. Hathaway (1968 University of Wisconsin School of Medicine Davidson L. Freeman (2005 Medical College of Georgia at Georgia and Public Health) Regents University) J. Michael Hatlelid (1999 Washington University in St. Louis School of Nicole Frei (1994 University of Cincinnati) Medicine) Atis K. Freimanis (1993 Michigan State University College of Human Donald R. Hawes (2005 Indiana University) Medicine) Helen Hays (1987 University of Alberta Faculty of Medicine and Arthur H. L. From (1962 Indiana University) Dentistry) A. Brent Fruin (2003 Boston University School of Medicine) Jackie Hayes (1987 University of Mississippi) Robert A. Fuhrman (1966 Rosalind Franklin University of Medicine and James J. Heffernan (1976 Boston University School of Medicine) Science) David Joseph Heinsch (2010 Medical College of Georgia at Georgia William B. Furgerson (1955 University of Louisville) Regents University) Preston Scott Gable (1989 University of Minnesota) Jeffrey Held (2001 University of Maryland) Robert P. Gannon (1959 Medical College of Wisconsin) Ross Heller (2014 Rosalind Franklin University of Medicine and William Gardner (2013 Northeast Ohio Medical University) Science) James C. Gay (1978 Emory University) Marlene A. Henning Sachs (1997 Geisel School of Medicine at Craig John Gerard (1985 Wake Forest School of Medicine) Dartmouth) Richard L. Gerety (1976 University of New Mexico) James E. Henry (1971 University of Tennessee Health Science Center) Khalil Ghanem (2014 Johns Hopkins University) Raymond A. Herber (1957 Loma Linda University) Charles Eugene Giangarra (2010 Marshall University School of Albert E. Hesker (1964 University of Missouri) Medicine) Michael L. Hess (1967 University of Pittsburgh) Edward B. Gilmore (1965 Harvard Medical School) Eric A. Higginbotham (1996 University of Texas Medical School at Nephtali R. Gomez (2004 Loma Linda University) Houston) Francisco Gonzalez-Scarano (1975 Northwestern University) James F. Hindson (1969 Case Western Reserve University) Kimberly Gooch (1979 University of Iowa) Douglas M. Hinson (1988 George Washington University) Janardhana Rao Gorthi (2014 Creighton University) Larry Hobson (1994 Meharry Medical College) Ronald A. Gosnell (2000 University of Minnesota) Derek Keith Holcombe (1987 University of South Carolina) Lisa J. Gould (1990 University of Illinois) James W. Holcroft (1968 Case Western Reserve University) Amy D. Graham-Carlson (2007 University of Texas Medical School at James M. Holland (1986 Northwestern University) Houston) John Leonard Holmes (1987 Oregon Health & Science University School Lawrence Step Greenberg (1969 University at Buffalo, School of of Medicine) Medicine and Biomedical Sciences) Noel Holtz (1969 University of Cincinnati) Mary A. Greene-McIntyre (1983 Meharry Medical College) Ronald R. Holweger (1977 Loma Linda University) William B. Greenough (1957 Harvard Medical School) Daniel L. Hood (1984 Wright State University Boonshoft School of Amanda Guedes de Morais (2009 James H. Quillen College of Medicine Medicine) of East Tennessee State University) Alan R. Hopeman (1950 University of Minnesota) Gabriel Habib (1980 American University of Beirut) Richard B. Horenstein (1997 Sidney Kimmel Medical College) Jacob I. Haft (1961 Columbia University) Simon Horenstein (1947 University of Illinois)

The Pharos/Spring 2016 69 2015 Honor roll of donors

Martin I. Horowitz (1962 George Washington University) Janet P. Kramer (1997 Drexel University College of Medicine) Mary F. Hotchkiss (1988 Ohio State University) Edward S. Kraus (1975 Northwestern University) L. Michael Howell (2008 University of North Dakota School of Medicine Frederick T. Kraus (1955 Washington University in St. Louis School of and Health Sciences) Medicine) Philip J. Huber (1993 University of Texas Southwestern Medical Center Joan Margaret Krikava (1986 University of Minnesota) at Dallas) Kimberly T. Krohn (1996 University of North Dakota School of Christine D. Hudak (1991 Ohio State University) Medicine and Health Sciences) Joseph E. Huggins (1971 University of Toronto Faculty of Medicine) James C. Kudrna (1976 Northwestern University) William E. Hughes (1984 University of South Alabama College of Kimberly F. Lairet (2003 University of Nebraska) Medicine) Randy J. Lamartiniere (1987 Louisiana State University Health Sciences Edgar W. Hull (1964 Yale University School of Medicine) Center Shreveport) Nadene D. Hunter (1944 Tulane University) Charles T. Langford (1966 University of Tennessee Health Science John D. Hutcherson (1959 Vanderbilt University) Center) David B. Hyman (1978 University of Illinois) Christopher E. Larson (1986 University of Pittsburgh) Ricky L. Irons (1980 University of Alabama at Birmingham School of Carl Patrick Laughlin (1955 University of Maryland) Medicine) E. Clifford Lazzaro (1997 State University of New York, Downstate Michael G. Ison (1996 University of South Florida) Medical Center) Timothy D. Jacob (1988 Temple University) David G. Leibold (1975 University of Texas Health Science Center at San Christopher L. Jenkins (1989 Virginia Commonwealth University) Antonio) O. Wheeler Jervis (1989 University of Illinois) Nancy Ann Leitch (1990 University of Minnesota) Tamison Jewett (2010 Wake Forest School of Medicine) L. James (Jim) Lemmen (1980 University of Michigan) James R. Johnson (1980 University of Minnesota) Jack L. Lesher (1980 Medical College of Georgia at Georgia Regents Tom M. Johnson (1984 University of North Dakota School of Medicine University) and Health Sciences) Raymond L. Lesonsky (1960 University of Southern California) Herbert C. Jones (1962 Indiana University) Antoinette T. Levasseut (1987 University of Illinois) Robert E. Jones (1975 University of Utah) David C. Levin (1997 Sidney Kimmel Medical College) Kirk G. Jordan (1990 University of Texas Medical Branch) Ralph Levin (1949 Louisiana State University School of Medicine in New Michael J. Joyce (1975 University of Louisville) Orleans) Richard L. Kalla (1960 University of Pittsburgh) Stuart M. Levitz (1979 New York University) Donald B. Kamerer (1995 University of Pittsburgh) Neal A. Lewin (1973 State University of New York, Downstate Medical Robert J. Kania (1977 Loyola University, Stritch School of Medicine) Center) Gary J. Kanter (1993 Rutgers Robert Wood Johnson Medical School) Edmund J. Lewis (1960 University of British Columbia Faculty of Michael Kashgarian (1972 Yale University School of Medicine) Medicine) Leonid Katz (1999 University of California, Davis) J. Leonard Lichtenfeld (1971 Allegheny University of the Health Richard P. Keeling (1972 Tufts University School of Medicine) Sciences) Scott Kellermann (1996 Tulane University) Charles J. Lightdale (1965 Columbia University) Thomas J. Kelly (1994 Rush Medical College) Vivian Lim (1985 University of Texas Health Science Center at San Rose M. Kenny (1969 Sidney Kimmel Medical College) Antonio) William F. Kern (1979 State University of New York, Downstate Medical Daniel V. Lindenstruth (1964 University of Maryland) Center) Kenneth A. Litwin (1995 MCP Hahnemann School of Medicine) Ernest A. Kiel (2005 Louisiana State University Health Sciences Center Stewart A. Lonky (1970 State University of New York, Downstate Shreveport) Medical Center) Thomas Dudley Kimble (2014 Eastern Virginia Medical School) Richard A. Losada (1983 New York Medical College) Kathryn E. Kindwall (1979 Weill Cornell Medical College) Alvin S. Lovell (1958 Howard University) Thomas M. King (1981 University of Minnesota) Malcolm J. Low (1978 Albany Medical College) Margaret Ann Kirkegaard (1988 University of Minnesota) James E. Lowe (1973 David Geffen School of Medicine at University of Michael Scott Kissen (2013 New York Medical College) California, Los Angeles) Jeffrey S. Klein (1983 State University of New York, Downstate Medical Maureen Helen Lowery (2009 University of Miami) Center) Barry B. Lowitz (1987 Rosalind Franklin University of Medicine and Lanning B. Kline (2012 University of Alabama at Birmingham School of Science) Medicine) Jonathon Card Lowry (1988 Sidney Kimmel Medical College) Steven Knezevich (1984 Rush Medical College) Amanda Luchsinger (1993 Medical College of Wisconsin) John Knudsen (1986 Texas A&M University) Jon A. Machayya (2005 University of North Dakota School of Medicine Daniel G. Kohm (1983 Saint Louis University) and Health Sciences) Evan R. Kokoska (1994 Washington University in St. Louis School of Sidney D. Machefsky (1977 Vanderbilt University) Medicine) Thomas C. Mahl (1984 University at Buffalo, School of Medicine and Stephen S. Kornbluth (1979 Albany Medical College) Biomedical Sciences) Martin A. Koschnitzke (1986 University of Texas Medical Branch) Cynthia Major (1997 Meharry Medical College) Karthik Joshua Kota (2013 State University of New York, Upstate William G. Manax (1958 University of Western Ontario Faculty of Medical University College of Medicine) Medicine and Dentistry)

70 The Pharos/Spring 2016 Peter C. Mancusi-Ungaro (1967 University of Miami) Michael W. Neumeister (2003 Southern Illinois University) Michael B. Marchildon (1968 Stanford University School of Medicine) J. Paul Newell (1965 University of Western Ontario Faculty of Medicine Charmaine Martin (2011 Texas Tech University) and Dentistry) Stephen James Martin (2010 Howard University) Alfred L. Nicely (1961 Ohio State University) Gabriel A. Martinez (1990 Ponce School of Medicine) Howard John Noack (1992 Pennsylvania State University College of M. Richard Maser (1957 Raymond and Ruth Perelman School of Medicine) Medicine at the University of Pennsylvania) Jacqueline A. Noonan (1966 University of Vermont) Alfonse T. Masi (1954 Columbia University) Silas P. Norman (1995 Wayne State University) Allan W. Mathies (1960 University of Vermont) Patricia Norwood (1983 Louisiana State University Health Sciences Warren F. Matthews (1954 University of Michigan) Center Shreveport) K. Jane Mayberry-Carson (1995 James H. Quillen College of Medicine of Ana Elizabeth Nunez (2014 Drexel University College of Medicine) East Tennessee State University) Robert A. Nussbaum (1986 Icahn School of Medicine at Mount Sinai) John E. Mazuski (1981 David Geffen School of Medicine at University of Megan Joy Olejnicak (2009 University of Minnesota) California, Los Angeles) Isoken Nicholas Olomu (2010 Michigan State University College of Mary Anne McCaffree (1971 University of Oklahoma College of Human Medicine) Medicine) Ray A. Olsson (1981 George Washington University) Peter A. McCranie (1959 Emory University) Thomas K. Olwin (1952 Oregon Health & Science University School of Layton McCurdy (1982 Medical University of South Carolina) Medicine) Jane E McGowan (2014 Drexel University College of Medicine) George A. Ordway (1998 University of Texas Southwestern Medical K. Robert McIntire (1959 University of Virginia) Center at Dallas) Kenneth McIntosh (1962 Harvard Medical School) Mark B. Orringer (1966 University of Pittsburgh) John T. McManus (1983 Medical College of Wisconsin) Brian D. Owens (1976 Temple University) W. Kendall McNabney (1987 University of Missouri – Kansas City) Donald Paglia (1987 David Geffen School of Medicine at University of John P. McNulty (1950 Tulane University) California, Los Angeles) Joan Younger Meek (1986 University of Kentucky) Shilpa J. Patel (1998 University of Vermont) Matthew G. Meldorf (1993 Johns Hopkins University) Richard D. Patten (1991 University of Maryland) Kristin R. Melton (1995 University of Nebraska) George J. Pazin (1963 University of Pittsburgh) Victor D. Menashe (1967 Oregon Health & Science University School of Elizabeth K. Peck (2001 Texas Tech University) Medicine) Steven J. Peitzman (1971 Drexel University College of Medicine) David J. Mendelson (1963 University of Pittsburgh) John H. Penuel (1993 University of Miami) Mark J. Mendolla (1989 Rutgers New Jersey Medical School) Gerald J. Pepe (2005 Eastern Virginia Medical School) Boyd E. Metzger (1958 University of Iowa) Judith S. Perdue (1981 Virginia Commonwealth University) Kristi J. Midgarden (1997 University of North Dakota School of F. Xavier Perez (2000 Meharry Medical College) Medicine and Health Sciences) Nancy J. Pettinari (1980 Geisel School of Medicine at Dartmouth) Edward Martin Miller (1968 Temple University) Veronica R. Petty (1984 University of Minnesota) Henry S. Miller (2000 Wake Forest School of Medicine) Luke Patrick Philippsen (1981 Indiana University) Stephen Ray Mitchell (1976 University of North Carolina) Stuart I. Phillips (1959 Louisiana State University School of Medicine in William J. Mitchell (1966 Yale University School of Medicine) New Orleans) David J. Moeller (1981 University of Texas Medical Branch) William C. Pierce (1987 David Geffen School of Medicine at University David Mohr (1975 Baylor College of Medicine) of California, Los Angeles) Alicia A. Moise (1981 University of Texas Southwestern Medical Center Rolland D. Pistulka (1957 Creighton University) at Dallas) Richard A. Plessala (1960 Saint Louis University) Ty A. Montgomery (1996 Indiana University) Tod R. Podl (1996 Case Western Reserve University) Wally O. Montgomery (1989 University of Louisville) John Pollina (1994 University at Buffalo, School of Medicine and Edward L. Morris (1974 University of Maryland) Biomedical Sciences) Harold Moskowitz (1959 State University of New York, Downstate Maria Carol Poor (1985 Indiana University) Medical Center) Jennifer A. Levin Popovsky (1995 Temple University) Billy R. Mosley (1960 University of Alabama at Birmingham School of John D. Port (1994 University of Illinois) Medicine) Samantha B. Pozner (1997 Drexel University College of Medicine) Judd W. Moul (1982 Sidney Kimmel Medical College) Allan V. Prochazka (1978 University of Chicago) John Joseph Moynihan (1980 Georgetown University) David B. Propert (1957 Sidney Kimmel Medical College) Raghu Mukkamala (1996 James H. Quillen College of Medicine of East Robert W. Putsch (1964 University of Colorado) Tennessee State University) Cid S. Quintana-Rodz (1984 University of Puerto Rico) Martha M. Munden (1987 Medical University of South Carolina) Eric J. Ramirez-Diaz (1997 Universidad Central del Caribe) Reginald F. Munden (1989 Medical University of South Carolina) John Edward Ratmeyer (1988 State University of New York, Downstate John B. Murphy (1980 State University of New York, Downstate Medical Medical Center) Center) Sekou Robertson Rawlins (2010 State University of New York Upstate Virginia B. Neaville (1985 University of Arkansas) Medical University College of Medicine) Leslie J. Neilson (1995 Oregon Health & Science University School of Joanna B. Ready (1984 Medical College of Wisconsin) Medicine) Stots B. Reele (1971 Baylor College of Medicine)

The Pharos/Spring 2016 71 2015 Honor roll of donors

Larry G. Reimer (1975 University of Colorado) Judith K. Shabert (1981 University of Hawaii) Eve Hart Rice (1988 Icahn School of Medicine at Mount Sinai) Monica Ann Shaw (2006 University of Louisville) Jack L. Ritter (1975 Baylor College of Medicine) Omega C. Logan Silva (1990 Howard University) John F. Roberts (1964 University of Colorado) Robert E. Silverman (1978 Washington University in St. Louis School of Joe C. Robinson (1977 University of South Luther D. Robinson (1995 Medicine) Howard University) Peter H. Simkin (2003 University of Massachusetts Medical School) Aylin Rodan (2004 University of California, San Francisco) and Adrian Matthew Edward Simmons (1985 Creighton University) Rothenfluh Charitable Fund Vishwas Anand Singh (2005 Drexel University College of Medicine) Susan J. Roe (1983 University of Texas Medical School at Houston) Thomas Nichols Skelton (1980 University of Mississippi) Cathy G. Rosenfield (2013 Tufts University School of Medicine) Barry Smith (2011 Geisel School of Medicine at Dartmouth) Anne E. Rosin (1994 University of Wisconsin School of Medicine and J. Joshua Smith (2013 Vanderbilt University) Public Health) Michael C. Smith (1994 Rush Medical College) Michael C. Rowbotham (1978 University of California, San Francisco) Ronald Hudson Smith (1961 University of Rochester School of Medicine Kathleen T. Rowland (2004 Rush Medical College) and Dentistry) Thomas C. Rowland (1959 Medical University of South Carolina) Lawrence Arthur Solberg (1974 Saint Louis University) Michael B. Rozboril (1976 University of Illinois) Joel B. Solomon (1962 State University of New York, Downstate Medical Irwin Ruben (1970 University of Illinois) Center) Richard Michael Ruddy (1976 Georgetown University) Carl R. Sonder (1965 Temple University) Elizabeth S. Ruppert (1977 Ohio State University) Paul M. Southern (1959 University of Texas Southwestern Medical Ben F. Rusy (1975 Temple University) Center at Dallas) Joseph J. Ruzbarsky (1977 Sidney Kimmel Medical College) James C. Spann (1990 University of Arkansas) Patricia A. Ryan (1992 Medical College of Wisconsin) Mark A. Spee (1980 Wayne State University) John H. Sadler (1986 University of Maryland) Jerry D. Spencer (1971 University of Kansas) Richard Sadovsky (2009 State University of New York, Downstate Erik C. Stabell (1982 Rush Medical College) Medical Center) Charles A. Stanley (1969 University of Virginia) Emery M. Salom (2003 University of Miami) John F. Stapleton (1976 Georgetown University) Philip Samuels (1982 Texas Tech University) Franklin J. Star (1958 University of Chicago) Mark Sands (1989 Northwestern University) Lawrence Emil Steinbach (1990 Sidney Kimmel Medical College) Paul E. Sangster (1973 University of Arizona) Steven H. Stokes (1980 University of South Alabama College of Paula J. Santrach (1983 University of Minnesota) Medicine) Michele Smallwood Saysana (2010 Indiana University) Richard K. Stone ( 1966 New York Medical College) Raymond Scalettar (1991 State University of New York, Downstate Stephanie Ann Storgion (2010 University of Tennessee Health Science Medical Center) Center) Roger W. Schauer (1996 University of North Dakota School of Medicine Robert C. Stough (1979 Raymond and Ruth Perelman School of and Health Sciences) Medicine at the University of Pennsylvania) Debra Lu Schell (1985 Loma Linda University) Thomas Joseph Strick (1985 Medical College of Wisconsin) Eugene R. Schiff (1977 University of Miami) Hal M. Stuart (1956 Wake Forest School of Medicine) Brian J. Schiro (2004 Louisiana State University School of Medicine in Dorothy E. Stubbe (1984 University of Arizona) New Orleans) Albert Suarez-Dominguez (2013 University of Puerto Rico) Bruce M. Schlein (1963 State University of New York, Downstate Michelle L. Surbrook (1995 University of Tennessee Health Science Medical Center) Center) David E. Schmitt (1978 University of Miami) Mark A. Swancutt (1991 University of Texas Southwestern Medical Paul G. Schmitz (1982 Creighton University) Center at Dallas) Stephanie Schneck (1987 Temple University) M. Monica Sweeney (2013 State University of New York, Downstate Jared Patrick Schober (2014 Loma Linda University) Medical Center) Schwab Charitable Gift Fund Ronald Swendris (1984 University of Michigan) John C. Schwartz (1978 Saint Louis University) Aileen M. Takahashi (1996 New York Medical College) Lawrence Roger Schwartz (2003 Wayne State University) Girma Tefera (1996 Howard University) George F. Scofield (1955 University of Alabama at Birmingham School of Sonia R. Teller (1997 University of Louisville) Medicine) Nina L. J. Terry (1989 University of Alabama at Birmingham School of Michael Craig Scott (1987 Medical College of Georgia at Georgia Medicine) Regents University Manisha S. Thakur (1997 James H. Quillen College of Medicine of East Ajovi Scott-Emuakpor (1991 Michigan State University College of Tennessee State University) Human Medicine) David Federick Thomas (1959 Indiana University) James Leo Sebastian (1992 Medical College of Wisconsin) Deborah M. Thompson (1982 Howard University) Kristen M. Seitz (1998 Oregon Health & Science University School of Linda Ruth Thompson (1966 University of Virginia) Medicine) Michael O. Thorner (1990 University of Virginia) Diane A. Semer (1990 East Carolina University Brody School of Joseph R. Thurn (1983 University of Minnesota) Medicine) Tracy Ann Tomac (1990 Texas A&M University) Carl A. Sferry (1976 Northwestern University) Esther A. Torres (1996 University of Puerto Rico)

72 The Pharos/Spring 2016 Robert C. Trautwein (1980 Tufts University School of Medicine) Barnett Zumoff (1992 State University of New York, Downstate Medical Susan P. Trawick (1979 Emory University) Center) Gary L. Treece (1970 University of California, Irvine) Patricia T. Turner (1975 Louisiana State University School of Medicine in $51–$100 donation New Orleans) James L. Vacek (1976 Creighton University) Shahab Fareed Abdessalam (2006 Ohio State University) Gail Hodgdon Valentine (1966 Drexel University College of Medicine) Robert T. Adlam (1979 Medical College of Wisconsin) Anthony J. Van Norman (2007 West Virginia University) Stephen D. Adler (1968 Stanford University School of Medicine) Arvydas Vanagunas (2012 Northwestern University) Anupam Agarwal (2013 University of Alabama at Birmingham School of Robert M. Vanecko (1984 Northwestern University) Medicine) Jeffery Dean Vaught (1988 Indiana University) Arthur S. Agatston (2009 New York University) Elizabeth Vazquez (1982 University of California, San Francisco) Robert E. Alessi (1959 State University of New York Upstate Medical Cathleen M. Veach (1995 Oregon Health & Science University School of University College of Medicine) Medicine) Kenneth S. Alpern (1988 University of Texas Medical Branch) Curtis F. Veal (1980 Medical College of Georgia at Georgia Regents Ruben Alvero (1989 Uniformed Services University) University) Ellen Andrews (1984 Meharry Medical College) Jerome J. Vernick (1961 Sidney Kimmel Medical College) M. Dewayne Andrews (1970 University of Oklahoma College of J. Leonel Villavicencio (1990 Uniformed Services University) Medicine) Frederick M. Vincent (1991 Michigan State University College of Human Robert John Andruss (1989 University of Minnesota) Medicine) Massimo Arcerito (2008 University of Washington) Guy R. Voeller (1981 Tulane University) Nicholas B. Argento (1985 University of Maryland) Lauren Marie Wahl (2014 University of Mississippi) Arthur K. Asbury (1958 University of Cincinnati) Howard Dennis Waite (1966 Ohio State University) Bruce E. Baker (1965 State University of New York Upstate Medical May M. Wakamatsu (1983 Case Western Reserve University) University College of Medicine) Henry K. Walker (1974 Emory University) Jodi M. Barboza (1998 University of Arkansas) Hugh D. Walker (1959 Creighton University) Harry M. Barnes (1975 University of Alabama at Birmingham School of Howard F. Warner (1951 Temple University) Medicine) Janet G. Warner (1993 Wayne State University) Margaret M. Barnes (1981 Temple University) Alan A. Wartenberg (1972 Medical College of Wisconsin) Florence C. Barnett (1992 Medical College of Georgia at Georgia Robert Andrew Waugh (1988 Duke University School of Medicine) Regents University) Eric James Weaver (1996 Sidney Kimmel Medical College) Patricia A. Barnwell (1980 University of Louisville) Thomas R. Weber (1971 Ohio State University) Lisa K. Barrett (1962 Indiana University) Martin H. Weiss (1977 University of Southern California) Michael Barza (1964 McGill University Faculty of Medicine) William R. Welborn (1967 Vanderbilt University) Jerome V. Basinski (1962 Saint Louis University) Donald Robert Westerhausen (1985 University of Minnesota) John B. Bass (1968 Tulane University) Lennox S. Westney (1996 Howard University) Kimberly A. Bazar (1993 Duke University School of Medicine) Christopher E. White (1997 University of Texas Health Science Center at Jimmie L. Beasley (1973 University of Tennessee Health Science Center) San Antonio) Richard A. Beison (1958 Indiana University) William E. Wilcox (1977 University of South Alabama College of Melvin E. Belding (1962 University of Colorado) Medicine) Richard E. Bensinger (1969 Johns Hopkins University) Mary Alissa Willis (2006 University of Mississippi) Nathan A. Berger (2002 Case Western Reserve University) James M. Wilson (1967 Medical College of Georgia at Georgia Regents Michael C. Bidgood (1971 University of Washington) University) Cary M. Bjork (1972 University of Colorado) Samuel K. Wirtschafter (1957 University of Southern California) Thomas P. Bleck (1976 Rush Medical College) Philip Witorsch (1961 New York University) H. Allan Bloomer (1953 Medical College of Wisconsin) Kenneth A. Woeber (1984 University of California, San Francisco) William M. Boehme (1969 Albany Medical College) Gerald A. Wolff (1960 Washington University in St. Louis School of George T. Bolton (1989 George Washington University) Medicine) Julia Bonilla (1999 Universidad Central del Caribe) Earle G. Woodman (1957 Boston University School of Medicine) L. Bradford Boothby (2007 Boston University School of Medicine) Joseph H. L. Worischeck (1987 Saint Louis University) Karen R. Borman (1977 Tulane University) Brandon Wesley Wright (2010 Texas Tech University) Mark Walter Bosbous (2005 Medical College of Wisconsin) Walter Alan Wynkoop (1995 Temple University) J. Larry Boss (1997 Medical College of Georgia at Georgia Regents Dean T. Yamaguchi (1976 Tulane University) University) Linda S. Yazvac (1979 West Virginia University) John D. Bower (1961 Virginia Commonwealth University) Jinny K. Yoo (1997 University of Virginia) Mark S. Box (1986 University of Missouri) Charles J. Zelnick (1979 University of Cincinnati) Susan E. Braley (1986 University of Cincinnati) Bella Zubkov (1991 University at Buffalo, School of Medicine and Lois Lester Bready (1988 University of Texas Health Science Center at Biomedical Sciences) San Antonio) David A. Zuehlke (1972 Wayne State University) Ronald A. Broadwell (1989 Loma Linda University) Mary J. Brogan (1983 Georgetown University)

The Pharos/Spring 2016 73 2015 Honor roll of donors

Michael D. Brogan (1977 Ohio State University) Mary Anne Curtiss (1985 University of Cincinnati) Donald D. Brown (1965 University of Iowa) Byron D. Danielson (1990 University of North Dakota School of Karen T. Brown (1979 Boston University School of Medicine) Medicine and Health Sciences) John Caleb Browning (2001 University of Texas Medical Branch) Robert B. Daroff (1983 Case Western Reserve University) Kenneth Brummel-Smith (2014 Florida State University) Ezra C. Davidson (1957 Meharry Medical College) John S. Buchignani (1964 University of Tennessee Health Science Sheldon J. Davidson (1963 Albert Einstein College of Medicine of Center) Yeshiva University) Susan C. Bunch (1983 University of Louisville) Paul J. Davis (1994 Albany Medical College) Andrew D. Bunta (1988 Northwestern University) Patricia Monique de Groot (2003 University of Texas Medical Branch) Joanna McCormick Burch (1995 University of South Florida) David J. de Harter (1968 University of Wisconsin School of Medicine Charles S. Burger (1965 Case Western Reserve University) and Public Health) Robert E. Burney (1960 University of Miami) Javier De la Torre (2004 Universidad Central del Caribe) Sidney N. Busis (1945 University of Pittsburgh) Alan J. Deangelo (1998 Virginia Commonwealth University) Louis A. Buzzeo (1972 Tufts University School of Medicine) Craig L. Dearden (1982 Texas Tech University) Enrico Caiola (1994 University at Buffalo, School of Medicine and Neilson Thoma Debevoise (1956 George Washington University) Biomedical Sciences) Mary P. Defrank (1989 Oregon Health & Science University School of Mark A. Caldemeyer (1987 Indiana University) Medicine) Henry S. Campell (1960 Duke University School of Medicine) Jonathan D. Dehner (1968 Georgetown University) George J. Caranasos (1962 Johns Hopkins University) Carol C. DeLine (1976 Louisiana State University School of Medicine in Dennis J. Card (1966 Georgetown University) New Orleans) Donald J. Carek (1956 Medical College of Wisconsin) E. Daniel DeLoach (1999 Medical College of Georgia at Georgia Regents Kelley S. Carrick (1995 University of South Florida) University) Charles B. Carter (1963 Medical University of South Carolina) Marlene DeMaio (1985 Allegheny University of the Health Sciences) Kenneth L. Casey (1961 University of Washington) Abigail E. Dennis (2004 University of Rochester School of Medicine and Penny Z. Castellano (1984 Emory University) Dentistry) John C. Cate (1967 University of Tennessee Health Science Center) Mariellen Dentino (1973 Indiana University) Benedict S. Caterinicchio (1957 New York Medical College) Jaishankar Devapiran (1995 James H. Quillen College of Medicine of Robert J. Cates (1971 Indiana University) East Tennessee State University) Sandeep Chandra (1992 Meharry Medical College) Sabatino S. Di Censo (1957 Creighton University) Thomas A. Chapel (1966 Wayne State University) David Dichek (1983 David Geffen School of Medicine at University of Nancy L. Chapin (1983 Boston University School of Medicine) California, Los Angeles) John F. Chardos (1998 Medical University of South Carolina) Jack T. Dillon (1975 University of Michigan) Marvin H. Chasen (1973 Ohio State University) Scott M. Dinehart (1983 University of Texas Medical Branch) John A. Cheek (1982 Ohio State University) Ronald Dobson (1973 University of New Mexico) Lindy Lee Cibischino (1990 Rutgers New Jersey Medical School) John M. Dorsey (2002 Wayne State University) Carolyn Clancy (2010 University of Massachusetts Medical School) Bonnie B. Dorwart (1966 Temple University) Bernard J. Clark (1954 Georgetown University) James Craig Dowdy (1983 University of Louisville) David A. Clark (1972 State University of New York Upstate Medical John C. Draeger (1974 University of Louisville) University College of Medicine) Stephen P. Dretler (1962 Tufts University School of Medicine) Wayne M. Clark (1984 Oregon Health & Science University School of Charles Dreyer (2013 University of Texas Medical Branch) Medicine) John Drozdick (1995 Allegheny University of the Health Sciences) David R. Clarke (1969 University of Colorado) Pamela Drummond-Ray (2000 Northeast Ohio Medical University) Cynthia C. Clarkson (2003 West Virginia University) Andre J. Duerinckx (2010 Howard University) Clifford C. Cloonan (1983 Uniformed Services University) Lawrence A. Dunmore (1955 Howard University) Mark D. Cohen (1979 Indiana University) Bryan K. Dunn (2009 East Carolina University Brody School of Francis R. Colangelo (1984 Sidney Kimmel Medical College) Medicine) Daniel J. Combo (1959 Creighton University) Denis Paul Dupuis (1985 Boston University School of Medicine) ConocoPhillips Matching Gift Fund J. William DuVal (1976 Virginia Commonwealth University) William F. Conway (1981 University of Chicago) Raymond Dyer (1978 University of Virginia) Robert W. Coombs (1981 Dalhousie University Faculty of Medicine) Daniel I. Edelstone (1997 University of Pittsburgh) William C. Cooper (1960 Duke University School of Medicine) John E. Edwards (1979 University of California, Irvine) Bernard J. Cordes (1963 Medical College of Wisconsin) Theodore C. Eickhoff (1957 Case Western Reserve University) Kevin Mich Coughlin (1983 State University of New York Upstate Richard R. Ellis (1971 University of Illinois) Medical University College of Medicine) Roy D. Elterman (1973 University of Miami) Sol I. Courtman (1950 Tulane University) Benjamin P. Eng (2001 Eastern Virginia Medical School_ James K. Crager (2003 Marshall University School of Medicine) Calvin T. Eng (1984 University of California, San Francisco) James L. Craig (1956 University of Tennessee Health Science Center) Charles J. Engel (1971 University of Michigan) Richard L. Cronemeyer (1976 University of Kansas) Daniel A. Eventov (1958 University of Southern California) Carolyn A. Cunningham (1966 Indiana University) Steven M. Falowski (2004 Rutgers Robert Wood Johnson Medical William A. Curry (1975 Vanderbilt University) School)

74 The Pharos/Spring 2016 L. Christine Faulk (1997 University of Kansas) Daniel Gottovi (1965 University of Rochester School of Medicine and Kimberly N. Feigin (1997 University of Rochester School of Medicine Dentistry) and Dentistry) Joanne Gottridge (1980 Case Western Reserve University) Seymour H. Fein (1974 New York Medical College) Daniel O. Graney (1993 University of Washington) Donald I. Feinstein (1972 University of Southern California) Mark T. Grattan (1978 University of California, San Francisco) Vincent R. Fennell (1964 David Geffen School of Medicine at University David Wayne Gray (1987 University of Illinois) of California, Los Angeles) Jacob B. Green (1964 University of Texas Medical Branch) Anthony M. Filoso (1971 Wayne State University) Burton H. Greenberg (1960 University of Illinois) Chris J. Finch (1993 University of Texas Medical School at Houston) Harold L. Greenberg (1965 University of Miami) George C. Finch (1983 University of North Carolina) Thomas J. Grogan (1979 University of Cincinnati) Faith T. Fitzgerald (1969 University of California, San Francisco) Stuart A. Groskin (1996 State University of New York Upstate Medical Jonathan Flescher (1983 Albert Einstein College of Medicine of Yeshiva University College of Medicine) University) Roland P. Guest (1976 University of Mississippi) Maria Eugenia Florian-Rodriguez (2010 University of Puerto Rico) Guido Guidotti (1956 Washington University in St. Louis School of Neal Alan Foman (1992 Albany Medical College) Medicine) Alexander Alb Fondak (1972 Georgetown University) Thomas F. Gumprecht (1975 University of Washington) Maryann Forciea (1974 Duke University School of Medicine) Elizabeth Corey Gwinn (Wayne State University) Robert Armour Forse (2014 Creighton University) Clayton R. Haberman (1949 University of Wisconsin School of Medicine James Lemuel Foster (2001 Mercer University School of Medicine) and Public Health) Barbara J. Fox (1979 University of Cincinnati) Nawaz Hack (2013 University of Kentucky) Alvin L. Francik (1963 University of Illinois) Mariam Hakim-Zargar (2001 University of Louisville) Ronald D. Franks (1970 University of Michigan) George S. Hammond (1983 University of Texas Medical Branch) Sarah G. Frazier (2000 Case Western Reserve University) Gerald J. Harkins (1996 Pennsylvania State University College of Erling W. Fredell (1954 Stanford University School of Medicine) Medicine) Kristen E. Frederiksen (1994 University of Rochester School of Medicine Elaine M. Harrington (1992 University of Kansas) and Dentistry) Alan A. Harris (1967 University of Illinois) Lawrence E. Freedberg (1968 New York University) Emily Jo Harrison (2013 Louisiana State University School of Medicine Barbara K. Freeman (2004 Case Western Reserve University) in New Orleans) Susan L. Freeman (2012 Temple University) David Andrew Hart (2009 Wright State University Boonshoft School of Fuad S. Freiha (1965 American University of Beirut) Medicine) Marsha D. Fretwell (1974 Weill Cornell Medical College) R. Mark Hatfield (1988 Marshall University School of Medicine) Scott L. Friedman (1979 Icahn School of Medicine at Mount Sinai) Kristen Michelle Hawthorne (2006 Medical University of South Sandra Adamson Fryhofer (1999 Emory University) Carolina) Conrad Fulkerson (1968 University of Missouri) John J. Hayes (1984 Rush Medical College) Scott A. Fulton (1989 Wayne State University) Van B. Hayne (1974 University of Alabama at Birmingham School of Edmund F. Funai (1992 New York Medical College) Medicine) Warren Wm. Furey (1960 Northwestern University) L. Julian Haywood (1981 Howard University) Marthe Ann Gabey (1988 Virginia Commonwealth University) Nan Alison S. Hayworth (1985 Weill Cornell Medical College) John V. Gaeuman (1958 Ohio State University) Kenneth D. Herbst (1970 University of Southern California) Wm. Ted Galey (1996 Oregon Health & Science University School of Robert A. Herman (1972 Tufts University School of Medicine) Medicine) Mark Reginald Hill (2003 East Carolina University Brody School of John A. Galloway (2004 University of Nebraska) Medicine) S. Raymond Gambino (1952 University of Rochester School of Medicine Scott C. Hobler (1992 University of Toledo College of Medicine) and Dentistry) Marian Osborne Hodges (1987 Oregon Health & Science University Walter J. Gaska (1964 State University of New York Upstate Medical School of Medicine) University College of Medicine) Robert Cary Holladay (1987 Louisiana State University Health Sciences Harris J. Gelberg (1973 New York Medical College) Center Shreveport) Dale N. Gerding (1967 University of Minnesota) Denise O. Holmes (1980 Case Western Reserve University) Carl J. Gessler (1981 University of Arkansas) Steven B. Holsten (2016 Medical College of Georgia at Georgia Regents Kathleen D. Gibson (1993 University of Washington) University) Richard F. Gillum (1969 Northwestern University) Michael J. Holte (1985 University of North Dakota School of Medicine Robert A. Gisness (1979 University of South Dakota) and Health Sciences) Thomas P. Giudice (1993 University of South Carolina) George A. Hong (1997 Virginia Commonwealth University) James E. Goddard (1957 University of Pittsburgh) Sharon L. Hostler (1985 University of Vermont) Harold L. Godwin (1973 University of North Carolina) Jeffrey Houpt (1989 Emory University) Daniel A. Goldstein (1981 Johns Hopkins University) Jane E. Howard (1982 University of Florida) Brian M. Gordon (1993 State University of New York Upstate Medical Robert Smith Howard (1987 University of Kentucky) University College of Medicine) Teresa Ann Howard (1990 University of Kentucky) Gary G. Gordon (1958 State University of New York, Downstate Medical Vernon B. Hunt (1971 University of Pittsburgh) Center) Maj. Gen. Edward J. Huycke (1953 University of Kansas)

The Pharos/Spring 2016 75 2015 Honor roll of donors

Vera C. Hyman (1968 Medical University of South Carolina) Seth Russell Krawitz (2002 Wake Forest School of Medicine) Rebecca N. Ichord (1979 George Washington University) Diana L. Kruse (1976 University of Wisconsin School of Medicine and Michel N. Ilbawi (1969 American University of Beirut) Public Health) Robert Roy Ireland (2006 University of South Carolina) Harold L. Kundel (1959 Columbia University) M. Zuhdi Jasser (1992 Medical College of Wisconsin) Kenneth M. Kurokawa (1962 University of California, San Francisco) Joseph V. Jeffords (1953 Medical University of South Carolina) William J. Kurtz (2003 University of North Dakota School of Medicine Jon C. Jenkins (1963 University of Tennessee Health Science Center) and Health Sciences) David H. Johnson (1975 Medical College of Georgia at Georgia Regents Donald H. Lambert (1977 University of Vermont) University) Russell M. Lane (1955 University of Rochester School of Medicine and Jennifer K. Johnson (1999 University of Kansas) Dentistry) Laura A. Johnson (1997 University of Texas Medical School at Houston) John C. LaRosa (1965 University of Pittsburgh) Bruce W. Johnston (1990 University of Minnesota) Christopher E. Larson (1986 University of Pittsburgh) Jason Jones (1995 Ohio State University) Francis Y. Lau (1964 Loma Linda University) Jeffrey N. Jones (1994 University of Tennessee Health Science Center) Ruth A. Lawrence (1949 University of Rochester School of Medicine and Judith K. Jones (1965 Baylor College of Medicine) Dentistry Mark Leonard Jones (1989 University of Utah) Walter P. Ledet (1967 Louisiana State University School of Medicine in O. W. Jones (1957 University of Oklahoma College of Medicine) New Orleans) Steven R. Jones (1985 Allegheny University of the Health Sciences) Susan P. LeDoux (2007 University of South Alabama College of Andrea H. Kachuck (1986 University of Southern California) Medicine) Charles J. Kahi (2001 Indiana University) Clara Nan-hi Lee (1996 Yale University School of Medicine) Elaine S. Kamil (1973 University of Pittsburgh) J. Fletcher Lee (1960 Duke University School of Medicine) Charles F. Kane, M.D. Charitable Gift Account (1945 Raymond and Ruth James E. Legrand (1973 University of Illinois) Perelman School of Medicine at the University of Pennsylvania) Robert F. Lemanske, Jr. (1975 University of Wisconsin School of Bertram D. Kaplan (1973 Sidney Kimmel Medical College) Medicine and Public Health) Peter Kappel (2002 University of California, Irvine) Alexander N. Lenard (1995 Temple University) Kennard J. Kapstafer (1960 Creighton University) Milton A. Lennicx (1968 University of Alabama at Birmingham School Krishnan Kartha (1986 State University of New York, Downstate of Medicine) Medical Center) Peter F. Leonovicz (1996 Creighton University) Donald J. Kastens (1981 University of Oklahoma College of Medicine) Jenny Rose Lessner (2008 University of Washington) Jeffry Adam Katz (2002 Case Western Reserve University) Neil D. Levine (1987 Virginia Commonwealth University) Rae-Ellen W. Kavey (1972 State University of New York, Downstate Paul A. Levine (1967 Boston University School of Medicine) Medical Center) Robert J. Levine (1957 George Washington University) Michael J. Kearns (1980 University of California, Irvine) Richard A. Levinson (1957 University of Illinois) Lloyd J. Kellam (1981 University of Virginia) Ernest C. Levister (2014 Howard University) Thomas F. Kelly (1985 University of Nevada School of Medicine) Jonathan S. Lewin (1985 Yale University School of Medicine) Alan Kenien (2013 University of North Dakota School of Medicine and Richard G. Lewis (1967 University of Virginia) Health Sciences) Theophilus Lewis (2001 State University of New York, Downstate James A. Kenning (1973 Sidney Kimmel Medical College) Medical Center) Vikas Khurana (1998 State University of New York, Downstate Medical Robert A. Liebelt (1957 Baylor College of Medicine) Center) George I. Litman (2007 Northeast Ohio Medical University) Amy Benay Killen (2003 University of Texas Southwestern Medical Silvio H. Litovsky (2014 University of Alabama Birmingham School of Center at Dallas) Medicine) John C. Kincaid (1975 Indiana University) Patrick J. Loehrer (2004 Indiana University) Donald W. King (1949 State University of New York Upstate Medical James P. Logerfo (1968 University of Rochester School of Medicine and University College of Medicine) Dentistry) Lorraine C. King (1999 Sidney Kimmel Medical College) Thomas A. Lohstreter (1979 University of Minnesota) Dean Mark Kirkel (2009 George Washington University) Donald Bruce Louria (1987 Rutgers New Jersey Medical School) Cheryl M. Klenow (1992 University of Minnesota) Lisa Renee Lowry (1989 Tulane University) Diane J. Klepper (1963 University of Kansas) Debra Lynn Luczkiewicz (2006 University at Buffalo, School of Brian James Klika (2009 Rosalind Franklin University of Medicine and Medicine and Biomedical Sciences) Science) Kenneth Marc Ludmerer (1986 Washington University in St. Louis Scott D. Klioze (1995 Eastern Virginia Medical School) School of Medicine) Bruce M. Koeppen (1977 University of Chicago) Frank C. Lynch (1990 Pennsylvania State University College of Lial L. Kofoed (1977 University of Washington) Medicine) Jeffrey I. Komins (1970 Allegheny University of the Health Sciences) Samuel N. Macferran (1983 University of Arkansas) John W. Kosko (1980 Case Western Reserve University) Emmett R. Mackan (1986 Texas A&M University) Nicholas T. Kouchoukos (1961 Washington University in St. Louis George E. Maha (1953 Saint Louis University) School of Medicine) James Mailhot (1964 Georgetown University) Robert A. Krall (1976 Sidney Kimmel Medical College) Hish S. Majzoub (1960 American University of Beirut) Kurt Alan Kralovich (1989 Northeast Ohio Medical University) Timothy J. Malone (1979 University of Kansas)

76 The Pharos/Spring 2016 Alberto Manetta (1997 University of California, Irvine) Michael E. Moore (1980 Rutgers Robert Wood Johnson Medical School) Dean S. Mann (1992 University of Miami) Walter Joseph Moore (2005 Medical College of Georgia at Georgia Raymond A. Manning (1968 Howard University) Regents University) Jeffrey Derrick Manord (1993 University of Alabama at Birmingham Alexandra Moretti Morrison (2001 Indiana University) School of Medicine) Mark B. Morrow (1980 Northwestern University) M. Ashraf Mansour (2012 Michigan State University College of Human Leonard Carl Moses (1987 Albany Medical College) Medicine) Susan Louise Mullaney (1995 University of California, San Francisco) Harriet B. Mantell (1948 Northwestern University) Daniel T. Murai (1998 University of Hawaii) Stuart L. Marcus (1983 Albert Einstein College of Medicine of Yeshiva Leila Mureebe (1992 Drexel University College of Medicine) University) Dale P. Murphy (1971 Ohio State University) Richard A. Marder (1980 David Geffen School of Medicine at University David R. Murray (1985 University of Illinois) of California, Los Angeles) John F. Murray (2000 University of Southern California) David A. Margileth (1971 Baylor College of Medicine) Kathleen A. Murray (1983 Indiana University) Charles Markle (1964 State University of New York Upstate Medical Christopher Muth (2010 Indiana University) University College of Medicine) Jeffrey L. Myers (1981 Washington University in St. Louis School of Lawrence F. Marshall (1968 University of Michigan) Medicine) Robert J. Marshall (1967 West Virginia University) Nagendra Nadaraja (1963 University of Rochester School of Medicine William Gene Marshall (1977 University of Kentucky) and Dentistry) Suzanne Martens (1995 Medical College of Wisconsin) John B. Nanninga (1996 Northwestern University) Dorothy J. Martin (1968 University of Tennessee Health Science Center) Prashant K. Narain (2001 Virginia Commonwealth University) Clinton E. Massey (1979 Medical College of Georgia at Georgia Regents Burdette Nelson (1955 Stanford University School of Medicine) University) David Nelson (1993 University of California, Davis) W. F. Matthews (1933 University of Michigan) David L. Nelson (1962 Washington University in St. Louis School of Michael T. Mattingly (1992 Creighton University) Medicine) William E. Mayher (2002 Medical College of Georgia at Georgia Regents Don G. Nelson (1964 University of Illinois) University) Donald Nelson (1974 University of Iowa) Christopher G. Mazoue (1996 Louisiana State University School of Mary Jo Nelson (1976 University of Cincinnati) Medicine in New Orleans) Stephen R. Neumann (1996 University of Texas Medical Branch) Anthony J. Mazzarelli (2001 Rutgers Robert Wood Johnson Medical Ronald Lee Nichols (1983 Tulane University) School) L. Wiley Nifong (1996 University of Rochester School of Medicine and Joanne K. Mazzarelli (2005 Rutgers Robert Wood Johnson Medical Dentistry) School) Franklin C. Norman (1955 University of Michigan) Paul L. McCarthy (1969 Georgetown University) Weston Thomas Northam (2013 Eastern Virginia Medical School) Lewis H. McCurdy (1996 University of Alabama at Birmingham School Edward R. Nowicki (1965 Sidney Kimmel Medical College) of Medicine) Samuel A. Ockner (1984 University of Cincinnati) Rob McCurdy (1993 Wayne State University) Dennis M. O’Connor (1971 Creighton University) Victor G. McDonald (1950 University of Kansas) Peter D. O’Connor (2003 Uniformed Services University) William W. McGuire (1974 University of Texas Medical Branch) Sarah Olenick (1989 Loyola University, Stritch School of Medicine) George N. McNeil (1970 Columbia University) John Olson (1995 University of Iowa) Gerald J. McShane (1973 University of Illinois) Ralph M. Orland (1984 University of Illinois) Rhonda L. Mejeur (1996 Michigan State University College of Human Mark L. Ostlund (1981 University of Minnesota) Medicine) Stephanie Anne Otis (1978 Washington University in St. Louis School of Victor N. Meltzer (1975 Northwestern University) Medicine) Richard A. Menin (1970 Temple University) Kaye Kip Owen (1987 Texas A&M University) Merck Give Back Employee Giving Program James W. M. Owens (1997 University of Washington) Robert A. Metzger (1963 Creighton University) Dwight K. Oxley (1962 University of Kansas) Joseph P. Meurer (1974 Oregon Health & Science University School of Calvin E. Oyer (1952 Indiana University) Medicine) Luis R. Santiago Pagan (1993 University of Puerto Rico) Carol F. Meyer (1966 Medical College of Georgia at Georgia Regents George Palma (1977 University of California, Davis) University) Nancy Laraine Palmer (1986 Rutgers New Jersey Medical School) Joseph L. Meyer (1992 Baylor College of Medicine) Edward A. Panacek (1980 University of South Alabama College of Donald J. Mielcarek (1968 Saint Louis University) Medicine) Lysbeth C. Miller (1979 University of Texas Health Science Center at San Eugene H. Paschold (1977 Wake Forest School of Medicine) Antonio) Richard B. Patterson (1969 Wake Forest School of Medicine) Francis D. Milligan (1957 Johns Hopkins University) Jason R. Pearce (2008 University of Texas Medical School at Houston) Anna L. Mitchell (1992 University of Michigan) Alan Pechacek (1967 University of Iowa) Jonathan S. Mittelman (1978 Rosalind Franklin University of Medicine Marc R. Peck (1962 Raymond and Ruth Perelman School of Medicine at and Science) the University of Pennsylvania) David K. Monson (1981 University of Iowa) William A. Peck (1960 University of Rochester School of Medicine and Eleanor D. Montague (1950 Drexel University College of Medicine) Dentistry)

The Pharos/Spring 2016 77 2015 Honor roll of donors

Miguel Perez-Arzola (1993 Ponce School of Medicine) Arvey I. Rogers (1973 University of Miami) Richard A. Pervos (1982 Rosalind Franklin University of Medicine and John R. Rogers (1960 Medical College of Wisconsin) Science) Milton W. Roggenkamp (1952 Indiana University) Angela R. Peterman (1980 Wake Forest School of Medicine) Robert F. Rohner (1965 State University of New York Upstate Medical Samuel R. Pettis (1978 Howard University) University College of Medicine) Chester M. Pierce (1967 University of Oklahoma College of Medicine) Wanda Ronner (2012 Raymond and Ruth Perelman School of Medicine John R. Pierce (1977 University of California, San Francisco) at the University of Pennsylvania) Sophie H. Pierog (1963 Medical College of Wisconsin) Arthur E. Rosenbaum (1962 University of Miami) Phillip M. Pinell (1992 Baylor College of Medicine) Jay H. Rosenberg (1968 Rosalind Franklin University of Medicine and Beth M. Piraino (1976 Drexel University College of Medicine) Science) Etta Driscoll Pisano (2003 Duke University School of Medicine) Joel Rosenberg (1973 Tulane University) James C. Pitts (1970 University of Kansas) Robert C. Rosenquist (1977 Loma Linda University) James Rolland Pochert (1979 Wayne State University) Charles B. Ross (1983 University of Kentucky) Cynthia A. Point (1984 West Virginia University) Philip T. Rowan (1990 New York University) Albert J. Polito (1989 New York University) Arthur L. Ruckman (1978 Louisiana State University Health Sciences Todd A. Ponsky (2004 George Washington University) Center Shreveport) James L. Pool (1971 University of Oklahoma College of Medicine) Shaun J. Ruddy (1960 Yale University School of Medicine) Manny David Porat (2005 Temple University) Eric Ruschman (1990 University of Kentucky) Jerome Posner (1978 Weill Cornell Medical College) Gregory Duncan Rushing (2008 Eastern Virginia Medical School) Alvin C. Powers (1979 University of Tennessee Health Science Center) Gregory W. Rutecki (1973 University of Illinois) Patrick Hugh Pownell (1986 University of Texas Southwestern Medical Joseph F. Ruwitch (1966 Washington University in St. Louis School of Center at Dallas) Medicine) William J. Preston (1962 University of Oklahoma College of Medicine) William H. Ryan (1977 University of North Carolina) Lawrence A. Price (1966 McGill University Faculty of Medicine) Richard Saitz (1987 Boston University School of Medicine) John Anthony Prodoehl (1990 Drexel University College of Medicine) Kym A. Salness (1975 Temple University) Lawrence J. Prograis (1975 Meharry Medical College) Ibrahim S. Salti (1962 American University of Beirut) Wallace Dale Prophet (1978 University of Alabama at Birmingham Bonnie M. Samuelson (1994 University of Wisconsin School of Medicine School of Medicine) and Public Health) Mark J. Puccioni (2001 University of Nebraska) Jorge L. Sanchez (1965 University of Puerto Rico) Eugene A. Quindlen (1969 University of Virginia) Pedro G. Sanchez (1984 Tufts University School of Medicine) Deborah A. Acosta Ramirez (1998 University of Puerto Rico) John F. Sarwark (2000 Northwestern University) Petra Burke Ramirez (2001 University of Puerto Rico) David Satcher (1969 Case Western Reserve University) Karen Rampton (2005 Washington University in St. Louis School of Robert F. Scheible (1971 Washington University in St. Louis School of Medicine) Medicine) Aidan A. Raney (1973 University of Southern California) Jerome J. Sheldon (University of Miami) Brian H. Rank (1979 University of Minnesota) Heinrich G. Schettler (1975 Baylor College of Medicine) Elizabeth R. Ransom (1989 Wayne State University) Gerold L. Schiebler (1963 University of Florida) W. Kimryn Rathmell (2014 University of North Carolina) Arthur D. Schiff (1980 Emory University) Scott L. Rauch (1986 University of Cincinnati) Daniel Richard Schimmel (2006 Rush Medical College) James I. Raymond (1973 University of Pittsburgh) Scott Schlauder (2004 Ohio State University) Robert W. Rebar (1971 University of Michigan) Charles L. Schnee (1990 Tufts University School of Medicine) Robert A. Reed (1962 Emory University) Lynne M. Schoonover (1978 University of Virginia) Virginia A. Rhodes (1988 Ohio State University) Herman J. Schultz (1952 University of Texas Medical Branch) Madison F. Richardson (1969 Howard University) Jennifer Lindwall Schwab (1998 University of Massachusetts Medical John R. Richert (2003 University of Rochester School of Medicine and School) Dentistry) Frank Schwalbe (1955 Emory University) Harold G. Richman (1953 University of Minnesota) M. Roy Schwarz (1962 University of Washington) Louis Ernest Ridgway (1984 Tulane University) Michael Scoppetuolo (1979 Rosalind Franklin University of Medicine Nancy J. Rini (1999 State University of New York, Downstate Medical and Science) Center) John Laird Seaich (1969 Creighton University) Jon H. Ritter (1986 University of Minnesota) Jackie R. See (1983 University of California, Irvine) Terry N. Rivers (1982 University of South Alabama College of Medicine) Charles J. Seigel (1966 University of Pittsburgh) Ralph W. Roach (1976 University of Toledo College of Medicine) Dan G. Sewell (1993 Washington University in St. Louis School of Albert D. Roberts (1954 University of Texas Southwestern Medical Medicine) Center at Dallas) Jack Shannon (2002 Texas Tech University) Andrew Bayard Roberts (1990 Drexel University College of Medicine) Mark Grant Shapiro (2003 Baylor College of Medicine) Jerry W. Robinson (1983 Medical University of South Carolina) Mark M. Sherman (1966 Weill Cornell Medical College) Evelio Rodriguez (1995 Albany Medical College) Kevin C. Shilling (1995 Georgetown University) Jill M. Roehr (1993 Eastern Virginia Medical School) Louis and Carole Shlipak Philanthropic Fund of the Dallas Jewish Alan K. Rogers (1980 Baylor College of Medicine) Community Foundation

78 The Pharos/Spring 2016 Joseph Sidikaro (1977 University of Texas Medical School at Houston) Morgan VanDerHorst–Albaugh (2006 Northeast Ohio Medical Brett H. Siegfried (1998 University of Pittsburgh) University) Robert E. Silverman (1978 Washington University in St. Louis School of Jilda N. Vargus-Adams (1995 Yale University School of Medicine) Medicine) Nancy Van Vessem (1982 Saint Louis University) Laura J. Simon (1970 University of Illinois) Charles James Vanhook (1985 University of Wisconsin School of Barry P. Skeist (1971 Sidney Kimmel Medical College) Medicine and Public Health) John R. Slavik (1982 University of Texas Southwestern Medical Center Pamela D. Varner (1976 University of Alabama at Birmingham School of at Dallas) Medicine) Catherine Butku Small (2008 New York Medical College) R. Edward Varner (2007 University of Alabama at Birmingham School Stephen R. Smalley (1990 University of Missouri – Kansas City) of Medicine) Charlene Smith (1982 University of Texas Health Science Center at San Vincent P. Verdile (2001 Albany Medical College) Antonio) James V. Vest (1975 University of Missouri) Robert A. Sofferman (1966 University of Maryland) Nicholas A. Volpicelli (1988 Temple University) Annemarie Sommer (1964 Ohio State University) Merle L. Wade (2001 University of Alabama at Birmingham School of Fred L. Speck (1977 University of Texas Medical Branch) Medicine) Brian Robert Stafeil (2007 Medical College of Wisconsin) Howard Dennis Waite (1966 Ohio State University) Richard L. Stein (1982 Case Western Reserve University) Nancy E. Warner (1973 University of Southern California) Jonathan A. Stelling (1991 University of Nebraska) Ray L. Watts (1980 Washington University in St. Louis School of Michael K. Stephens (1967 Tulane University) Medicine) Edwin Mercer Stone (1985 Baylor College of Medicine) Paul D. Webster (1956 Wake Forest School of Medicine) Mary S. Stone (1982 Baylor College of Medicine) Nancy J. Weigle (2000 George Washington University) Douglas J. Straehley (1979 University of Hawaii) Jeffrey Scott Weiss (1995 Uniformed Services University) Kristin Kirk Strange (1994 University of South Carolina) Hunter Wessells (1987 Georgetown University) Dwight G. Straub (1962 University of Utah) Hunter Wessells and Bokgi Choi Charitable Gift Fund Arthur J. L. Strauss (1957 Columbia University) James M. West (1983 University of Tennessee Health Science Center) Carla S. Streepy-O’Day (1978 Case Western Reserve University) Steven Judson Westgate (1980 University of Florida) Richard R. Streiff (1979 University of Florida) Christopher White (2003 Southern Illinois University) Colin Sumners (2006 University of Florida) John P. Whitecar (1963 Sidney Kimmel Medical College) Sakiko Suzuki (2009 Wayne State University) Warren D. Widmann (1960 Yale University School of Medicine) Ronald F. Swanger (1961 Temple University) Edward M. Williams (1958 Saint Louis University) William H. Swanson (1959 University of Washington) Temple W. Williams (1958 Baylor College of Medicine) Leonard E. Swischuk (1958 University of Alberta Faculty of Medicine Charles B. Wilson (1953 Tulane University) and Dentistry) Dana E. Wilson (1962 Case Western Reserve University) Elizabeth K. Tam (1978 University of California, San Francisco) Keith Michael Wilson (2013 University of Cincinnati) Calvin T. Tanabe (1963 Oregon Health & Science University School of Robert K. Wilson (1961 University of Alabama at Birmingham School of Medicine) Medicine) Ann Taylor (1995 University of Utah) Janet Salome Winston (1988 University at Buffalo, School of Medicine Paul E. Teschan (1947 University of Minnesota) and Biomedical Sciences) Abraham Thomas (1994 University of Illinois) Curtis B. Winters (1983 University of Southern California) Mack A. Thomas (1983 Louisiana State University School of Medicine in Roy Witherington (1952 Medical College of Georgia at Georgia Regents New Orleans) University) Dennis P. Thompson (1960 University of Illinois) Greg P. Wittenberg (1994 University of South Dakota) Peter K. Thompson (1964 University of Texas Medical Branch) James F. Wittmer (1957 Washington University in St. Louis School of Lawrence M. Tierney (1976 University of California, San Francisco) Medicine) Sigrid L. Tishler (1963 Yale University School of Medicine) David J. Wlody (2013 State University of New York, Downstate Medical Clifton P. Titcomb (1978 Georgetown University) Center) John C. Toole (1969 Emory University) Marla Wolfson (2012 Temple University) Robert Tozzi (1983 Rutgers New Jersey Medical School) Hal B. Woodall (1975 Wake Forest School of Medicine) Trent L. Tredway (1997 Rush Medical College) Gordon Lee Woods (2014 Texas Tech University Health Sciences Jack W. Trigg (1957 University of Alabama at Birmingham School of Center) Medicine) Donna Ailport Woodson (2010 University of Toledo College of Robert G. Trinity (1963 Saint Louis University) Medicine) Philip C. Trotta (1968 Saint Louis University) Harry M. Woske (1975 Rutgers Robert Wood Johnson Medical School) Eberhard H. Uhlenhuth (1951 Johns Hopkins University) Louis D. Wright (1982 Medical University of South Carolina) Donald A. Underwood (1975 Case Western Reserve University) Mary C. Yankaskas (1986 Rutgers Robert Wood Johnson Medical James G. Urban (1960 University of Wisconsin School of Medicine and School) Public Health) Jame S.T. Yao (1989 Northwestern University) Phyllis A. Vallee (1984 Albert Einstein College of Medicine of Yeshiva Philip A. Yazbak (1994 Geisel School of Medicine at Dartmouth) University) John D. Yeast (1973 University of Missouri) Mihae Yu (1979 University of Hawaii)

The Pharos/Spring 2016 79 2015 Honor roll of donors

Jason D. Zagrodzky (1991 University of Texas Southwestern Medical Robert M. Railey (1973 University of Kansas) Center at Dallas) Paul G. Robertie (1984 Medical College of Georgia at Georgia Regents Robert A. Zajac (1980 Louisiana State University School of Medicine in University) New Orleans) David R. Rovner (1954 Temple University) Robert Felix Zelis (1964 University of Chicago) Mustasim N. Rumi (1995 University of Rochester School of Medicine Jon D. Zolton (1970 University of Illinois) and Dentistry) Michael P. Zygmunt (1972 Loyola University, Stritch School of Medicine) A. John Rush (1999 University of Texas Southwestern Medical Center at Dallas) Efrain A. Sanchez–Rivera (1992 Universidad Central del Caribe) $101–$250 donation James F. Schauble (1954 Johns Hopkins University) David F. Alstott (1963 Indiana University) Austin A. Schlecker (1950 New York University) Louis F. Amorosa (1979 Rutgers Robert Wood Johnson Medical School) James S. Simpson (1974 Medical College of Georgia at Georgia Regents James E. Arnold (1977 University of Texas Health Science Center at San University) Antonio) Brian D. Solberg (1993 University of Maryland) Leonard C. Bandala (1984 University of Illinois) Wayne C. Spiggle (1993 University of Maryland) Joshua A. Becker (1957 Temple University) Joseph W. Stubbs* (1978 Emory University) Mellena D. Bridges (1990 Medical College of Georgia at Georgia Regents David E. Tamas (1981 Medical College of Georgia at Georgia Regents University) University) James E. Brodhacker (1964 Saint Louis University) Larry D. Taylor (1978 University of Arkansas) Louis Maximilian Buja (1967 Tulane University) Mark E. Thompson (1981 Wright State University Boonshoft School of James G. Chandler (1957 Stanford University School of Medicine) Medicine) James H. Christy (1970 Emory University) Jan K. Turcotte (1974 Medical College of Wisconsin) Lynn M. Cleary* (1978 Ohio State University) Marianna Vas (1961 University of Vermont) Ralph M. Colburn (1965 Northwestern University) Kent Dewayne Walker (1989 Tulane University) Glendon G. Cox (1980 University of Kansas) Mell B. Welborn (1962 Emory University) Walter P. Craig (1969 Tulane University) Matthew E. Wells (1998 Rutgers Robert Wood Johnson Medical School) Angel F. Espinosa-Lopez (1997 University of Puerto Rico) Robert A. Whisnant (1961 Virginia Commonwealth University) Arno H. Fried (1980 Meharry Medical College) Daniel Scott Woolley (1997 Rutgers Robert Wood Johnson Medical Floyd A. Fried (1961 University of Chicago) School) David Galbis-Reig (1999 Virginia Commonwealth University) Gates Foundation Matching Gift Fund Stephen Ryan Gawne (1983 University of Illinois) $251–$500 donation J.D. Guillory (1958 Louisiana State University School of Medicine in Adrian K. Almquist (1972 University of Nebraska) New Orleans) David C. Ballard (1974 Medical College of Georgia at Georgia Regents William G. Hayden (1967 Stanford University School of Medicine) University) Alexandra S. Heerdt (1986 Sidney Kimmel Medical College) Bruce G. Bartlow (1970 Northwestern University) Judith B. Hellman (1989 Columbia University) H. Mead Cavert (1950 University of Minnesota) Val G. Hemming (2001 Uniformed Services University) Samuel Goodloe (1968 Howard University) Robert B. Hinton (2002 Mercer University School of Medicine) Jeff L. Johnson (1993 University of Texas Medical Branch) Laura Lucille Howard (2005 Tulane University) Grant V. Rodkey (1942 Harvard Medical School) Craig L. Iwamoto (2001 University of Nevada School of Medicine) Michael B. Jacobs (1966 Washington University in St. Louis School of * 2015 AΩA Board Member Medicine) Charles F. Kane (1945 Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania) If we have inadvertently left anyone off this list, please Angeline A. Lazarus (1997 Uniformed Services University) accept our apologies. We truly appreciate every gift and Edward J. Lefeber (1966 University of Texas Medical Branch) Holly K. Brown Lenard (1994 Columbia University) ensure that it is used appropriately in support of our George A. Lentz (1956 University of Maryland) twelve programs and awards. Geo T. McKnight (1959 Louisiana State University School of Medicine in New Orleans) Francis D. Milligan (1957 Johns Hopkins University) Alpha Omega Alpha is a tax exempt 501(c)(3) or- Jose Maria Miramontes (1989 University of California, San Francisco) ganization. To donate, please visit our website at Howard B. Norton (1953 Medical University of South Carolina) alphaomegaalpha.org. Travis Novinger (2012 University of South Carolina) Rita Pechulis (2002 Sidney Kimmel Medical College) Susan O. Pintado (1981 Louisiana State University Health Sciences Center Shreveport) Mary Ellen Pizza (1989 University of Toledo College of Medicine) David F. Preston (1998 University of Kansas)

80 The Pharos/Spring 2016 Ill, Us Irritants of love, living in the sift of a beloved person: nothing against the growing numbness in my body. Things float across my line of sight. I am too tired in the evening to speak, let alone to be the woman you want. I catch the musk and the fullness of you, and then beneath it, my own sweetish smell of illness. I wonder if I did this to myself. I wonder if I broke, aching so deeply. I lost feeling in my mouth and my arm for an hour: what I mourned was kissing you, my hand on your cheek. Antonina Palisano

Antonina Palisano holds an MFA in poetry from Boston University. Her work has appeared in The Massachusetts Review, Washington Square Review, Bellevue Literary Review, and other publications, including the World to Come collection producted for Jewish Currents’ Raynes Poetry Prize. Her poem For H was recently selected by Tracy K. Smith for the Best New Poets 2015 anthology. She has taught creative writing at the high school and college levels, and lives in Medford, Massachusetts. Illustration by Erica Aitken. © Photo Edvard March/Corbis The Pharos/Spring 2016 1