Alpha Omega Alpha Honor Medical Society SPRING 2013 the PHAROS of Alpha Omega Alpha Honor Medical Society Spring 2013

ALPHA OMEGA ALPHA HONOR MEDICAL SOCIETY Alpha Omega Alpha Honor Medical Society SPRING 2013 THE PHAROS of Alpha Omega Alpha honor medical society Spring 2013

“Be Worthy to Serve the Suffering” Alpha Omega Alpha Honor Medical Society Ofﬁcers and Directors at Large Founded by William W. Root in 1902 C. Bruce Alexander, MD President Editor Richard L. Byyny, MD Birmingham, Alabama Ruth-Marie Fincher, MD Editor Emeritus (in memoriam) Robert J. Glaser, MD Immediate Past President Augusta, Georgia Associate Editor and Helen H. Glaser, MD Managing Editor John Tooker, MD, MBA President-Elect (in memoriam) Philadelphia, Pennsylvania Managing Editor Debbie Lancaster Joseph W. Stubbs, MD Secretary-Treasurer Art Director and Illustrator Albany, Georgia Robert G. Atnip, MD Designer Erica Aitken Hershey, Pennsylvania N. Joseph Espat, MD Editorial Board Providence, Rhode Island Douglas S. Paauw, MD Jeremiah A. Barondess, MD Faith T. Fitzgerald, MD Eric Pfeiffer, MD Seattle, Washington New York, New York Sacramento, California Tampa, Florida David A. Bennahum, MD Daniel Foster, MD William M. Rogoway, MD Sheryl Pfeil, MD Albuquerque, New Mexico Dallas, Texas Stanford, California Columbus, Ohio John A. Benson, Jr., MD James G. Gamble, MD, PhD Shaun V. Ruddy, MD Alan G. Robinson, MD Omaha, Nebraska Stanford, California Richmond, Virginia Los Angeles, California Richard Bronson, MD Dean G. Gianakos, MD Bonnie Salomon, MD Stony Brook, New York Lynchburg, Virginia Medical Organization Director John C.M. Brust, MD Jean D. Gray, MD John S. Sergent, MD New York, New York Halifax, Nova Scotia Nashville, Tennessee Carol A. Aschenbrener, MD Charles S. Bryan, MD David B. Hellmann, MD Marjorie S. Sirridge, MD Association of American Medical Colleges Columbia, South Carolina Baltimore, MD Kansas City, Missouri Washington, DC Robert A. Chase, MD Pascal James Imperato, MD Clement B. Sledge, MD Stanford, California, and Brooklyn, New York Marblehead, Massachussetts Councilor Directors Jaffrey, New Hampshire John A. Kastor, MD Jan van Eys, Ph.D., MD Henry N. Claman, MD Baltimore, Maryland Nashville, Tennessee Lynn M. Cleary, MD Denver, Colorado Michael D. Lockshin, MD Abraham Verghese, MD, DSc State University of New York Upstate Medical Fredric L. Coe, MD New York, New York (Hon.) University Stanford, California Chicago, Illinois Kenneth M. Ludmerer, MD Steven A. Wartman, MD, PhD Richard B. Gunderman, MD, PhD Jack Coulehan, MD St. Louis, Missouri Washington, DC Indiana University School of Medicine Stony Brook, New York J.Joseph Marr , MD Gerald Weissmann, MD Ralph Crawshaw, MD New York, New York Alan G. Wasserman, MD Portland, Oregon Stephen J. McPhee, MD David Watts, MD George Washington University School of San Francisco, California Peter E. Dans, MD Mill Valley, California Medicine and Health Sciences Baltimore, Maryland Robert H. Moser, MD Lawrence L. Faltz, MD Madera Reserve, Arizona Coordinator, Residency Initiatives Sleepy Hollow, New York Francis A. Neelon, MD Durham, North Carolina Suzann Pershing, MD Stanford University

Student Directors www.alphaomegaalpha.org Alicia Alcamo, MD The Ohio State University College of Medicine Christopher Clark Manuscripts being prepared for The Pharos should be typed double-spaced, submitted in triplicate, and conform to the format University of Mississippi School of Medicine outlined in the manuscript submission guidelines appearing on our website: www.alphaomegaalpha.org. They are also available Tonya Cramer, MD from The Pharos office. Editorial material should be sent to Richard L. Byyny, MD, Editor, The Pharos, 525 Middlefield Road, Suite Chicago Medical School at Rosalind Franklin 130, Menlo Park, California 94025. University of Medicine & Science Requests for reprints of individual articles should be forwarded directly to the authors. 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, Administrative Ofﬁce Missouri 65251. Periodicals postage paid at the post office at Menlo Park, California, and at additional mailing offices. Copyright Richard L. Byyny, MD © 2012, by Alpha Omega Alpha Honor Medical Society. The contents of The Pharos can only be reproduced with the written Executive Director permission of the editor. (ISSN 0031-7179) Menlo Park, California Circulation information: The Pharos is sent to all dues-paying members of Alpha Omega Alpha at no additional cost. All correspondence relating to circulation should be directed to Ms. Debbie Lancaster, 525 Middlefield Road, Suite 130, Menlo Park, California 94025. E-mail: 525 Middle!eld Road, Suite 130 [email protected] 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] In This Issue

DEPARTMENTS Editorial On the cover

ALPHA OMEGA ALPHA HONOR MEDICAL SOCIETY Alpha Omega Alpha Honor Medical Society 2 AΩA and professionalism in SPRING 2013 medicine—continued See page 32. Richard L. Byyny, MD, editor Cover illustration by Jim M’Guinness.

Alpha Omega Alpha elects 31 honorary members 2013 Medical Student 36 Service Leadership Project award winners

Reviews and reflections 39 Healing Through Humanism: Physician Discussions and Film Presentations for Doctors and Other Caregivers Interested in the Practice of Compassionate ARTICLES Medicine Reviewed by Jack Truten, PhD, A thirty-five-year odyssey of an FCPP Alpha Omega Alpha chapter councilor Pathological Altruism 4 Reviewed by Jack Coulehan, MD William H. Frishman, MD, MACP Alfalfa to Ivy: Memoir of a Harvard Medical School Dean Reviewed by Thoru Pederson, PhD On dying and being alive 100,000 Hearts: A Surgeon’s Memoir 7 Nelson Fausto, MD, and Ann L. De Lancey, PhD Reviewed by Casey Means

INSIDE BACK Letters Diagnosing Darwin 39COVER 12 Sidney Cohen, MD, and Philip A. Mackowiak, MD

The physician at the movies 49 Dr. Dans is on leave. The column A maestro’s heart will return in the Summer issue. 22 Gustav Mahler’s cardiac disease Gregory W. Rutecki, MD POETRY Unraveling My Cousin’s Fatal CVA 21 Henry Langhorne, MD 34 Elizabeth Stier Acacia 32 Stephen Ray Mitchell, MD 2012 donations to Alpha Omega Alpha 44

AΩA and professionalism in medicine— continued

Richard L. Byyny, MD, FACP

he autumn  issue of The Pharos featured my editorial, PROFESSIONALISM IN MEDICINE T“AΩA and Professionalism in Medicine,” in which I em- Responsibilities to patients phasized that the profession of medicine is based on a covenant The care of your patient is your Care for patients in an ethical, of trust—a contract physicians have with patients and society. I first concern responsible, reliable, and would like to continue that thought here. respectful manner Do no harm Respect patients’ dignity, privacy, Serving as a physician and practicing medicine must be and confidentiality based on core professional beliefs and values. One of our No lying, stealing, or cheating, Respect patients’ rights to make fundamental professional precepts is that those entering and nor tolerance for those who do decisions about their care practicing our profession will accept the values of medical Commit to professional Communicate effectively professionalism and learn and demonstrate the aptitude and competence and lifelong learning and listen to patients with commitment to behave professionally. understanding and respect for Physicians work primarily for others—our patients, families, their views communities, and society as a whole. Our success is measured Accept professional and personal Be honest and trustworthy and in human terms, by how well we benefit those under our care responsibility for the care of keep your word with patients and not necessarily in financial returns. Our profession is eval- patients uated and respected because of what we actually do and how Use your knowledge and skills in Maintain appropriate relations we meet our responsibilities. At the core of our professional the best interest of the patient with your patients values is what we do in caring for patients through a healing Treat every patient humanely, Reflect frequently on your care relationship between the physician and patient and, through with benevolence, compassion, of patients, including your values empathy, and consideration and behaviors these cumulative relationships, improving public health. We also have complex professional responsibilities to our medical Social responsibilities and advocacy profession, society, families, and ourselves. Commit and advocate to improve Respect and work with A physician’s work is compassionate and includes a commit- quality of care and access to care colleagues and other health ment to service, altruism, and advocacy. To a large extent, the professionals to best serve the patients’ needs practice of medicine as a profession is self-directed and therefore self-regulating. With the privilege of self-management Commit and advocate for a just Commit to maintaining trust by distribution of finite resources managing conflicts of interest granted us comes professional responsibilities to our patients and society if we are to be worthy of their trust. Upholding these values requires the application of our specialized body of knowledge in fulfilling our duties with honor, integrity, and All medical students and physicians must learn and under- respect for our patients. stand the professional core values in medicine—they are not An integrated patient-centered approach to fulfilling our necessarily intuitively apparent. A growing concern is how to professional responsibilities requires both the science and the train medical students to think professionally. Medical students art of medicine. We use our specialized knowledge of biology, may enter the profession with altruistic ideals, but they need disease, and medicine combined with clinical skills and the to understand that continual adherence to professional values appropriate technology in our “scientific” approach to sickness is a fundamental requirement. A knowledge and understand- and ill health. However, we must also incorporate and under- ing of our core professional values must be combined with stand the equally important illness framework of the patient’s medical school and other professional experiences to result in unique and personal experience with suffering and being sick, a professional attitude and behaviors based on those principles. worried, and anxious. I believe that professionalism is a required core competency In my earlier editorial on professionalism, this table or- for physicians. ganized professionalism in medicine into responsibilities to Although I recognize that there is debate about the impor- patients and social responsibilities and advocacy. tance and value of a physician’s “oath” or “solemn promise,” I

2 The Pharos/Spring 2013 believe that the action of making such a commitment clarifies professionalism and to effectively remediate them when they the professional expectations for all physicians. The making occur would be of immense value to the medical profession. of such a promise is therefore a symbol of the physician’s in- We also recognize that both profession-led regulation and tention to respect and uphold the stated code of professional individual self-regulation are vital to establishing and keeping values and behaviors. the trust of patients, society, and the medical profession. Thus Clear professional values coupled with the commitment to we must develop the knowledge, skills, and methodologies to our patients should result in a consistent professional attitude, address unprofessional behavior. Further, it is clear that current which in turn will result in a set of professional behaviors. interventions or remediation programs for lapses in profes- These include the commitment to: sionalism in medical schools, residencies, and clinical practice t "EIFSF UP IJHI FUIJDBM BOE NPSBM TUBOEBSET EP SJHIU vary widely. The sad fact is that there are no recognized best avoid wrong, and do no harm. practices. t 4VCPSEJOBUFZPVSPXOJOUFSFTUTUPUIPTFPGZPVSQBUJFOUT We defined an important list of topics to be supported and t "WPJECVTJOFTT GJOBODJBM BOEPSHBOJ[BUJPOBMDPOGMJDUTPG funded in the following areas: interest. t )PXEPXFNPTUFGGFDUJWFMZVTFFYJTUJOHEBUBPOQSPGFT- t )POPSUIFTPDJBMDPOUSBDUZPVIBWFVOEFSUBLFOXJUIQB- sionalism and experiences with remediation? tients and communities. t )PXDBOXFHFOFSBUFOFXFWJEFODFUPHVJEFJOUFSWFOUJPOT t 6OEFSTUBOEUIFOPOCJPMPHJDEFUFSNJOBOUTPGQPPSIFBMUI for those who have displayed lapses in professionalism? and the economic, psychological, social, and cultural factors We also concluded that it is time to focus on developing that contribute to health and illness. evidence-based best-practice interventions and remediation to t $BSFGPSQBUJFOUTXIPBSFVOBCMFUPQBZ BOEBEWPDBUFGPS deal with lapses in medical professionalism. the medically underserved. AΩA plans to continue to support individual program t #FBDDPVOUBCMF CPUIFUIJDBMMZBOEGJOBODJBMMZ grants in medical professionalism while also sponsoring a t #FUIPVHIUGVM DPNQBTTJPOBUF BOEDPMMFHJBM second national think tank of experts in the field of medical t $POUJOVFUPMFBSO JODSFBTFZPVSDPNQFUFODF BOETUSJWF professionalism this summer, with a goal to identify current for excellence. best practices. The session’s results will be published and dis- t 8PSLUPBEWBODFUIFGJFMEPGNFEJDJOF BOETIBSFLOPXM- seminated by AΩA so that educators and medical professionals edge for the benefit of others. can learn from the conclusions, adapt and adopt the processes, t 3FGMFDU EJTQBTTJPOBUFMZ PO ZPVS PXO BDUJPOT CFIBWJPST and evaluate their validity. and decisions to improve your knowledge, skills, judgment, AΩA has valued and supported professionalism since the decision making, accountability, and professionalism. society’s founding in . We currently support projects in In July , AΩA sponsored a think tank on medical pro- medical professionalism with the annual Edward D. Harris fessionalism that brought experts in the field of medical profes- Professionalism Award for medical faculty. And AΩA contin- sionalism together to review the status of and challenges in the ues to be a leader in the ongoing development of best practices field. The meeting was based on the assumption that the last in medical professionalism. twenty years have seen good progress in defining professional- With the support of each of you, Alpha Omega Alpha will ism and in devising charters, curricula, assessment strategies, strengthen and grow our profession, ensuring that we continue BOE BDDSFEJUBUJPO DSJUFSJB #VU UIFSF IBT CFFO JOTVGGJDJFOU to be worthy to serve the suffering. evidence to inform best practices in medical professionalism. This is especially true for interventions and remediation strate- Reference gies for those who demonstrate lapses in professionalism and ï 1BQBEBLJT." 1BBVX%4 )BGGFSUZ'8 4IBQJSP+ #ZZOZ3- professional behaviors. Perspective: The education community must develop best practices The outcome of the meeting was our publication, informed by evidence-based research to remediate lapses of profes- i1FSTQFDUJWF 5IF &EVDBUJPO $PNNVOJUZ .VTU %FWFMPQ #FTU sionalism. Acad Med ; : –. 1SBDUJDFT*OGPSNFECZ&WJEFODF#BTFE3FTFBSDIUP3FNFEJBUF Lapses of Professionalism.” 1 $POUBDU%S#ZZOZBU We recognize that lapses in professionalism provide im- .JEEMFGJFME3PBE 4VJUF portant learning opportunities, both for the physician who has Menlo Park, California 94025 lapsed and for the medical community as a whole. The creation E-mail: [email protected] of a knowledge base of best practices to forestall lapses in

The Pharos/Spring 2013 3 A thirty-five-year odyssey of an Alpha Omega Alpha chapter councilor

William H. Frishman, MD, MACP The author (AΩA, Albert Einstein faculty and of the society appointed the induction into AΩA of more than College of Medicine, 1978) is the by the Dean on the recommenda- , students at these two schools. Barbara and William Rosenthal tion of the chapter to serve a term Most of them have gone on to brilliant Professor and Chair of the Department of three years. The councilor may be careers in academic medicine or clini- of Medicine at New York Medical reappointed to successive three-year cal practice. College, and Director of Medicine terms, and is responsible to the school’s I became an AΩA councilor in at the Westchester Medical Center, faculty and the national officers of the the late s, a time that saw ris- Valhalla, New York. He was the coun- society for the operations and well ing opposition among students on cilor of the Kappa New York chap- being of the chapter. The councilor many medical school campuses to ter at the Albert Einstein College of guides the chapter’s election process of the concept of comparative ranking Medicine from 1978 to 1997 and has new members and works with student of students, including the very idea of served as the Iota New York chapter members to plan and conduct chapter an honor society. In , the viability councilor at New York Medical College activities. of the AΩA chapter at Einstein was since 1998. I have served as chapter councilor threatened, with students clamoring to at two medical schools: Albert Einstein dissolve the chapter. In a panic, Dean n June  I will be completing my College of Medicine (Kappa New York) Ephraim Friedman, who had been my thirty-fifth year as an Alpha Omega from  through , and New ophthalmology professor in medical Alpha (AΩA) chapter councilor. York Medical College (Iota New York) school, asked me to address the newly IAccording to the AΩA constitution, from  until now. Over my years as elected AΩA students to try to save the councilor is a member of the councilor, I have helped to officiate in the chapter. I was a thirty-one-year-old

4 The Pharos/Spring 2013 internist-cardiologist and assistant pro- students in the third and fourth years that it occurred late; with the pressures fessor of Medicine, two years out of the of medical school who have excelled of finding house staff jobs, this resulted Army Medical Corps, and a popular academically, demonstrated profession- in the chapter becoming less active. teacher. In my meeting with the stu- alism, and have shown the promise of Electing only seniors also meant that dents, I told them there was nothing becoming leaders in the profession. Einstein had no AΩA student officers wrong with exceptionalism and being When I started at Einstein, a fac- and no chapter continuity other than recognized for a job well done. I gave ulty group of all course leaders, both faculty and house staff. examples from the military, where in basic science and clinical rotations, Thus, when I became councilor at medals and citations are often awarded served as electors. I oversaw the elec- NYMC, I had already recognized the for extreme heroism and for going the tion but was not a voting member. The value to a chapter of electing junior extra mile. I pointed out that the grant- process was fair, in that every student AΩA members, both in chapter activ- ing of an award made all soldiers try to had at least one advocate, but at the ity and continuity. In , the NYMC perform better, and that this was also end class rank was the largest contrib- chapter was awarded the AΩA Chapter true for medical students. uting factor. There was always great of the Year Award because of our ser- The students agreed to keep the difficulty in deciding on the last two or vice efforts. chapter active, and laid out two condi- three students to be elected, as they of- tions for the dean: they stipulated that I ten had academic records quite similar Election of other categories should be the AΩA faculty initiate, and to those just below them. It was here At the same time the chapter in- wanted me to be their AΩA councilor. that we looked at other qualifications, ducts students, it also nominates two They also insisted that the induction such as community service, to set some faculty and two alumni. Faculty who do ceremony be modest in scope, and candidates apart. (Even though we were small group teaching can miss being for many years the AΩA lecture and an active research school, research ac- nominated because they are not known induction ceremony was held in the complishments were not part of our to the entire student class. To bal- school’s auditorium, followed by a din- AΩA election process.) ance the nomination process, students ner at the school’s cafeteria (albeit with Initially, election to junior AΩA choose one faculty nominee and the white linens and flowers on the tables). membership at Einstein was based faculty and administration recommend The AΩA induction speaker during my on basic science grades only, but we another with the students’ consent. first year as councilor was Dr. Edmund quickly learned that some of these Alumni nominees are identified Pellegrino, a noted bioethicist from students performed less well on ward through the Alumni Association Georgetown. rotations. Election of seniors to AΩA and by faculty and students who In , when I moved to New York included information from the third- might be familiar with the nominee’s Medical College (NYMC) to become year clerkship combined with basic accomplishments. chairman of Medicine, world-famous science scores. Every AΩA nominee The chapter has nominated dis- trauma surgeon Louis Del Guercio had to have passed USMLE Part . tinguished individuals for honorary was the AΩA councilor. Within a few Ultimately, we decided to hold one membership. One who was elected by months he stepped down, and given election in the early part of the se- the board of directors of the society to my experience as councilor at Einstein, nior year and to not elect juniors. We honorary membership was Dr. Attilio the dean approved me as his replace- eventually developed a point system Maseri, a noted cardiologist from Italy, ment, just in time to plan the induction formula in which the first two years of and the physician to Pope John Paul II. ceremony. basic science counted for a maximum My experiences as AΩA councilor of one-third of the points, and the Chapter finances at two different medical schools give clinical clerkship year counted for two- Local AΩA chapters do not receive me a unique vantage point from which thirds of the points. A student thus funds for their campus activities from to comment on the roles of the coun- could be elected on a strong clinical the national organization, except for cilor in guiding the chapter, and to of- performance alone, but could not be specific awards programs. At Einstein, fer some perspective on the successes elected on a strong basic science per- the AΩA chapter was supported by the and failures the society has had with its formance alone. At NYMC, the elec- dean, especially to fund the induction various activities, such as student and tion process also uses a point system, banquet and the induction speaker if faculty elections and community ser- giving a greater weight to the clinical we had no AΩA Visiting Professorship vice projects. clerkship year than basic science course grant. At NYMC we do not receive work, even for the third-year elections. direct support from the school be- Student elections The main problem with the Einstein cause we are not an organization that Election to AΩA recognizes election process of only seniors was includes all students. We raise money

The Pharos/Spring 2013 5 A thirty-five-year odyssey of an Alpha Omega Alpha chapter councilor

by assessing all AΩA faculty members presents the Robert J. Glaser I have worked with more than , on campus and the different academic Distinguished Teacher Award at the student inductees, many of whom have departments. These funds support annual meeting of the Association of gone on to the distinguished careers some community service programs on American Medical Colleges. I was a predicted by their election to AΩA. campus sponsored by AΩA and pay recipient of the award in  as I left The president of our university was a for the induction banquet, which is a Einstein to join NYMC. student inductee of mine at Einstein in grand affair. . In addition, I have worked with Other service projects another , students who were not Awards from the national office NYMC’s AΩA chapter also prepares elected to AΩA as undergraduates, AΩA national headquarters sup- the school’s student handbook and a but who have distinguished themselves ports a number of programs on cam- directory of off-campus student elec- and hopefully will be recognized for pus, including the Carolyn Kuckein tives. The chapter also sponsors a suc- their accomplishments by election as Student Research Fellowship and the cessful advisory program for students faculty and alumni members. Later Administrative Recognition Award. The applying for various house staff pro- recognition by AΩA may even be more NYMC chapter coordinator and my ad- grams. The councilor helps to oversee significiant since it reflects a lifetime of ministrative secretary, Carol Ruggiero, these activities, which are undertaken achievement. has received two Administrative independently of the AΩA national Among my accomplishments as Recognition awards for her outstand- office. an AΩA councilor: I saved a chapter ing work at both the Kappa Chapter from being dismantled and helped to of Einstein and the Iota Chapter at Relationships with other societies see that chapter flourish, and I served NYMC, the only coordinator in the on campus and nationwide at another chapter that flourished as country to receive this award for work The Gold Humanism Society re- well. After all these years I think we at two chapters. In previous years we cently instituted a chapter at NYMC. have developed a good election process received the Medical Student Service As AΩA councilor, I work closely with for students and faculty. I watched the Project awards to support a highly suc- the Gold Society’s faculty advisor to great changes in medical education and cessful AΩA tutoring program on cam- plan common programs and to avoid health care that have occurred since pus, and a smoking cessation program redundancy. , and I can reiterate what I told the at local community schools. The AΩA councilor represents his students at Einstein: there is nothing At NYMC, the most popular school’s chapter, but also maintains wrong with receiving a medal for work- AΩA program has been the Visiting frequent communication with other ing hard, aspiring to do your best, and Professorship Program, which has al- chapters and the national headquarters. going the extra distance. Election to lowed us to host a distinguished medi- Chapter councilors serve as sources of AΩA is a great honor and makes all of cal educator, scientist, or health policy information for other councilors, and medicine better at the end. The AΩA leader each year. The visiting professors can mentor new councilors. I served chapters at Einstein and NYMC have have included national and interna- as a Councilor Director on the Board truly raised the academic standards of tional figures; the chapter and councilor of Directors of AΩA from  to each school for all students and faculty. expend much effort in selecting each , and also was the regional coun- I served for six full terms as coun- year’s visiting professor. The visiting cilor for the Northeast region (which cilor at Einstein and was well into my professor gives the valedictory address included the American University in seventh term when I left for NYMC. I at the induction ceremony and banquet Beirut) when that program was in am now completing my fifth term in where NYMC’s third- and fourth-year place. While serving on the Board of the NYMC chapter and wouldn’t mind AΩA nominees are inducted. Directors, I reviewed applications for serving another thirty-five years if the NYMC also elects an individual the Carolyn Kuckein Student Research dean and students will have me. Being for a volunteer clinical faculty award, Fellowships, and, as a past recipient of an AΩA chapter councilor has been usually a small group teacher. These the Glaser Award, have been a mem- one of the best jobs I have had in my individuals are presented at the AΩA ber of the selection committee for the academic medicine career. induction ceremony. We do not elect Distinguished Teacher Award. residents to AΩA, because NYMC has The author’s address is: half a dozen hospital sites for student Final thoughts New York Medical College training, making it difficult to objec- What a grand adventure and privi- Department of Medicine tively select a resident for induction. lege it has been to serve as an AΩA Munger Pavilion, Room 263 The same situation existed at Einstein. chapter councilor at two medical Valhalla, New York 10595 AΩA national headquarters schools over a thirty-five-year period! E-mail: [email protected]

6 The Pharos/Spring 2013 On dying and being alive Courtesy of Dr. De Lancey Courtesy of Dr.

Nelson Fausto, MD, and Ann L. De Lancey, PhD Dr. Fausto was professor in the to Brazil to present a talk. On my ar- that my professional life was finished. Department of Pathology and Senior rival in the United States, I was diag- A doctor insisted that the cause of Advisor to the Dean at the University nosed with HN virus, despite having the renal failure was excess ingestion of of Washington School of Medicine been vaccinated against it. No case Aleve, which Ann had given me while in Seattle. He died in April 2012. had been diagnosed in the Northern keeping the much less toxic Tylenol for Dr. De Lancey is Clinical Professor Hemisphere in the new season, and be- herself for an upcoming operation. Her in the Department of Psychiatry ing the first meant that the labs were feelings of guilt and selfishness were and Behavioral Sciences at the not yet ready to give a rapid diagnosis. paralyzing until friends told her to get a University of Washington, and Training Worse news piled up on top of the grip and focus on what was important: and Consulting Analyst at Seattle bad: renal failure, first acute with a taking care of me. Psychoanalytic Society and Institute. chance of recovery, then with chances These difficulties came on top of diminishing as the weeks went by. We my multiple myeloma, diagnosed in ’m dead, I’m gone.” were anxious and waited for the daily  after several horrendously painful “You couldn’t be gone. I’m talk- report on creatinine levels. But since fractures. During this new hospital- ing with you,” said Ann. following the results in an obsessive ization the multiple myeloma caused I“Oh, never mind. I know I’m dead.” manner did not improve them, we went more fractures of thoracic vertebrae “down the tubes” (so to speak) with

My annus horribilis began in August three four-hour sessions of dialysis each Background: Tlingit soul catcher. Photo by  after my return from a short trip week. Given the time required, I felt Werner Forman/Universal Images Group/Getty Images.

The Pharos/Spring 2013 7 On dying and being alive

unexpected success of the operation, but I realized that I could no longer walk. About a month later, on Thanksgiving morning, the hospital called Ann and asked her to come in immediately because I had been trans- ferred to the ICU. I expected her to arrive within twenty-six minutes. She arrived much later than that. I was frantic. The team greeted Ann with the news that my situation was grave. I had orders to be resuscitated, but they were quite sure I had had an intracra- nial bleed and that she should consider letting me go. Ann asked for time to take off her coat, trying to create some emotional and mental space. She asked them to contact my oncologist before they did anything. They wanted to do a CT scan and MRI. I was later told I was profoundly delirious and by turns either somnolent or extremely agitated. When moved for the CT scan, I had appeared unspeak-

Courtesy of Dr. De Lancey Courtesy of Dr. ably terrified and violently agitated. It was excruciating for everyone to watch. Having seen the consequences of and unbearable bone pain. The pain re- town to find a neurosurgeon to operate. moving me, Ann asked what was to be quired continuous application of meth- She found a neurosurgeon—who was gained for the desired MRI? adone and Fentanyl “lollipops” for the not even on call—who was willing to More data. acute episodes, which if not controlled operate and who appeared at :  as But would the treatment change? produced pain so intense that I cried. if from nowhere. He told us that while “No, not at this point.” In October, during my recovery there were grave risks with the surgery With her heart in her mouth, Ann from these fractures, I began losing (generally a five percent rate of suc- asked them not to do the MRI. sensation in my legs. I asked for a neu- cess), the choice was clear: paralysis of The next four days I was delirious rology consult. On the third day after the lower extremities and lack of con- and never slept. I requested the consult, I could not trol of physiological functions if we did move my lower extremities. I called not proceed immediately. He assured us Ann’s perspective Ann to tell her I was paralyzed from that he felt he could do the operation, During the first forty-eight hours, my waist down. She immediately called but wanted us to be fully aware of the Nelson pleaded with me every few min- my oncologist, who managed to get a risks. I called my family in Brazil to say utes to not let him die. I did everything neurologist there by : . The neu- goodbye and then said goodbye, with I could think of. I stayed by him and rologist did not recommend an urgent much love, to Ann. Surgery began at acknowledged his fear of dying. I tried intervention, but must have contacted : . to tell him what was happening, but of orthopedic surgery, because late that In the afternoon, the surgeon re- course he was delirious and his belief night orthopedic residents recom- ported success to Ann. He explained was that he was dying. mended against operating because of in clear and understandable terms (a The next forty-eight hours he the risks. Aware that the operation had clarity much appreciated by Ann) that begged me to let him die. I reflected on to occur within twenty-four hours for he had prevented the collapse of the all of the measures we were taking to any chance of success and knowing that spinal column using metal rods and keep him alive, and asked myself, What I would not want to live paralyzed, my pins and had removed a tumor from the is for him, and what is for me? I felt oncologist had been calling all around cord. We were both overjoyed with the inexpressible love, fear, tenderness, and

8 The Pharos/Spring 2013 an overwhelming desire to support him. was a group of people attached to each badly they felt about the whole episode. I also felt terribly responsible. other by their waists, with my friend, I told them that those things happen, I now realized that the Living Will the Chair of Medicine, in front. He but that I hoped that the mistake would we had signed was utterly inadequate. was tall and had on an East Coast-style not interfere with their feelings about I wanted any decision to be jointly raincoat. The people were not sad, but themselves. They had clearly learned discussed and ultimately Nelson’s, seemed instead to be laughing as they from it. not mine alone. They told me that he tried to have me join the group. I, on After recovering from this wouldn’t remember all of this, but he the other hand, was desperate, hop- Thanksgiving delirium, I entered a re- remembered everything. ing for them to grab me. I could see hab program but was too weak to con- the end of a train with a caboose and a tinue. When I finally recovered enough, Nelson’s perspective red light behind it. Inside the train was I re-entered and completed the rehab I didn’t see a way out. my beloved sister-in-law who had died program. I could, with great difficulty, “I’m dead. I’m gone.” a few months before. She was saying, walk with a walker. Still, what a luxury “You couldn’t be gone if I am talking “Nelson, come in.” The struggle to catch to be out of the hospital. with you,” said Ann. me went on, apparently, for a long time. Several months later in a routine ap- “Oh, never mind. I know I’m dead.” Every time they tried, the group lost pointment my nephrologist discovered I was suffering from delirium and their grip on me and the train seemed that I was in atrial fibrillation. He ad- hallucinations—four days and nights closer. Finally, I recalled being in the mitted me, supposedly only overnight of tremendous discomfort and furi- hands of the group, looking at the train for a cardioversion the next day. The ous mental activity. During this time, tracks below, and seeing only the red hospital called Ann at :  that many friends passed through my head. lights of the caboose, which was travel- morning to say that I had been found Among the pleasant images, which ing far away. Next, instead of being on without pulse or breath, that they had were few, was eating freshly made do- the train, I was at a lower level of the performed CPR, that I was in the ICU, nuts for breakfast on the porch of our train station waiting with the group for that I was intubated, and to come in. house in East Alstead, New Hampshire. transportation by horse and buggy to The nurse who had done the CPR told It became fixed in my mind that the go somewhere where I could rest. Ann that I had asked for a nebulizer Dean of the Medical School had sent a These memories coincided with treatment, but that since the orders notice: “Dr. Nelson Fausto died of mul- my waking up and insisting that I were for nebulizer treatments only tiple myeloma the night before.” I took was not alive. It took a long time for every four hours they had given me this to be true: I am dead. So I should me to be convinced that I was alive, oral methadone. No one knew exactly not spend effort in trying to breathe or that I could speak, and that I could what happened. Did I have a cardiac become comfortable. I expected that I see earthly things. The hallucinations event? Did I aspirate? Did my panic at would finally be at peace. took place mostly over Thanksgiving not being able to breathe trigger the But I could still see the monitor of weekend when we were reliant on a PEA arrest? Ann got to the hospital in the computer in my room. I thought, I young group of residents and attending twenty-six minutes only to be told that am not completely dead, or I am dying physicians who may not have been as she could not see me. They told her slowly. What poor work people have experienced as the regular attendings. that she would not want to see me as I done in not shutting off the oxygen or They certainly panicked when they saw was. They did not want her in the way. giving me an injection of potassium my condition, and also realized I was a She waited for an hour, alone, worrying. chloride so that I would die quickly! VIP, which meant that everything that The first cardioversion was unsuc- And so the debate continued: Was I could be done would have to be done. cessful, but the second worked. A dead or not? I certainly thought that I The pressure to find a diagnosis caused friend whom I had not seen in sev- was dead and tried to remember what them to consider a cerebral hemorrhage enteen years came in as I was waking one was supposed to feel once dead. I and recommend that I have an MRI. up after the second cardioversion and did not have peace, nor did I see angels As it turned out, the brain scan was the extubation. Ann told me I turned who would pick me up for transport, or entirely normal. After much debate, the bright red. My friend and others in the grab my soul for storage. I told myself consensus was that the whole problem room burst into tears of joy and relief. that probably you see those things only had been caused by an adverse reaction Doctors smiled from ear to ear. I had if you believe in them. If you didn’t, you to the drug Baclofen that I was given no recollection of any of this: just that would be dying alone. as an anti-spasmodic after the spinal at the time of the arrest everything As this near-death or after-death surgery. Days after the episode, the turned black and a curtain closed. state continued, I saw myself in a residents who had given me the drug The nurse who did the CPR had been European-style train station. Facing me came to apologize. They told me how two rooms away at the time I stopped

The Pharos/Spring 2013 9 On dying and being alive

breathing. She told us: “I was nearby for enabled me to say what was in my spiritual experience would happen a purpose.” heart. Instead of talking in hackneyed to me. In the blanket ceremony I felt All of this seemed to be more than ways about going on my “journey,” he protected and connected with some- enough, but there was more. joined me wherever I was—in my house thing beyond what I have could ever Shortly after the cardiac arrest, I in New Hampshire, in music. And from have imagined. It defied description. fell straight backwards on my head there I could find my way to telling him Obviously bad thoughts come all the while on Coumadin, my caregiver three my deepest terrors and greatest hopes. time, but I try to put them in a corner paces away and not at my side. I had What do I make of all of this? Was of my mind and let them escape as a subarachnoid hemorrhage and went it just plain suffering as I tried my best rarely as possible. I do not want to deny to the ICU trauma unit for two weeks. to survive, or was there more to it? reality. I only ask to enjoy it. Everyone was amazed at my will to live For me as a patient/doctor there is the and endure. I was annoyed by all the realization that there are many lay- Afterward cognitive questions, which had noth- ers to treatment. In my semiconscious In an act of heroic courage and ing to do with my cultural background, interior I saw friends and family that quiet dignity, Nelson decided to stop my state of mind, or my educational needed to be addressed; in my semi- treatment. He died April , . From background. conscious exterior I saw Ann becoming the beginning of writing this manu- incorporated into me. Can physicians script to the end (three days before his Reflections on the year understand that patients have an inter- death), working on it contributed to the I’m glad to report that most of the nal and exterior reality that begs to be meaningfulness of his life. As he grew physicians I encountered during my dealt with? sicker, his legacy and ways to continue long hospital stays were open and com- Today I look back and say that I died contributing became more and more municative and were not afraid to ap- twice. With all of the challenges that important to him. proach me. Unfortunately there were a were thrown at me, it is quite remark- Nelson was accomplished and lov- few others who came to “examine” me able that I was able to walk with my ing, always with a particularity to the but stayed several steps from my bed walker and function relatively well most love that made it even more special, with their backs flattened against the days. Unfortunately, more continued to and with a unique use of language and wall, or talked at me in meaningless come; it appears to be a situation with- authenticity of expression that com- generalities. out end. The damage was both physical manded attention. In turn, he was be- At one point I had terrible, intrac- and psychological: why do I see my loved. Having loved and given, he was table diarrhea that was both debilitating father who died many years ago closing loved in return—especially by those and demoralizing. What I needed at a gate on me, telling me that no more with whom he worked closely, family, the time, but did not get, was human people will be admitted? Is my father and friends. Nelson discovered his self connection and even physical touch. I closing the door on me? Is there no in medicine, in pathology, and espe- had terrible trouble breathing. I needed room for me? Nevertheless I am here to cially in the relationships he developed. someone who understood the panic tell you that I am very much alive and But having lost his mother when he was that accompanies gasping for breath; fighting to be alive because I like what one year old, and subsequently losing instead I got someone talking about I have. Out of all of this, new friends his country (becoming a political refu- generic algorithms, or nutty hypotheses have come out of nowhere to join old gee in  to escape retribution from of HIV. Some of the visits from distin- friends and dear family. The old friends the military dictatorship in Brazil), he guished individuals or young learners have always been here, but I never had a hard time accepting the love ev- provided little or nothing for me, in knew that I could relate so well to them. eryone gave back to him. He kept giving spite of the visitors’ great knowledge. These old and new friends have given and contributing. The disease never On the other hand my oncologist me a sense of being a person who could took away his desire to expand and ex- inspired me to go on when I needed be desired and loved. pand others. it most. My nephrologist, who came For the future, I will enjoy what I Nelson’s biggest fear was of dying to the house many times, called many have, because it is just wonderful. We alone. He shared that terror, and in times a day, e-mailed me from an is- recently organized a barn contra dance sharing was not alone. Several physi- land with a total population of , and at our house in New Hampshire and I cians, in particular, went where Nelson conveyed a level of involvement and was honored at a symposium at which needed to go. One he called his brother. caring that sustained both me and Ann I was ceremonially given a blanket by The other, as he said, “dropped out of beyond words. And then there was the a Northwest Native American. I am the heavens from nowhere into his life” psychiatrist who I felt dropped out of not a religious person, but I do believe and changed him profoundly. A third the sky from nowhere and ultimately in spiritual things. I never thought a also saved his life in more ways than

10 The Pharos/Spring 2013 one. And another, thousands of miles who, looking at untended land, could he would endure almost anything.” In away, was an anchor. see how to make the place tamable asking himself why Nelson kept fight- They knew how to treat a person’s and even beautiful. They shared their ing and enduring, he found the answer soul. They listened. They went wher- agonies with Nelson. Together they in Nelson’s quest for freedom: “Nelson ever Nelson went—which often was to wrestled with Nelson’s fate. But while it was a freedom fighter. He fought for their own lives, or music, soccer, Native was Nelson’s immediate fate, they were personal freedom in Latin America. He American art, or seemingly irrelevant strong enough to name, tolerate, and fought for social justice there and in details. But they were wise enough to put into perspective their own. his adoptive country, the United States, know that the seemingly irrelevant hides What sick people want most is a where he joined with those who were the relevant. Soon enough, these con- capacious grasp of their situation, an more vulnerable, who were marginal- versational journeys led Nelson to talk ability to speak the truth, truth tem- ized, or who were from disadvantaged about what mattered to him the most. pered with wisdom and perspective. backgrounds. As he saw his body incar- Nelson wanted his physicians’ secu- Physicians who court dire statistics kill cerated by this devastating disease, his rity, calmness, hopefulness, intelligence, the soul. Physicians who illuminate the mind continued to fight for freedom, authority, and charisma to serve as a re- possibilities give hope. They know the this time his own freedom.” taining wall against his losses, his sense sick need a good wind behind their I would add that I think Nelson of aloneness, his anger that his body sails. wanted to continue to love and be loved had betrayed him, his worry that his A doctor-who-is-the-patient, in and to go on fighting for others, which courage was flagging, and that the ill- particular, is always thinking about in part was the essence of this article. ness would grab him and kill him. Such the what-ifs. He needs a companion. He wanted to give of himself; to render a job is a heavy burden to carry, but Nelson wanted a doctor who could unto physicians something that might some, especially these doctors, these read him, speak to his worries, enjoy help them minister both to themselves friends, held the load when it was pos- him, and appreciate him. These doctors and their patients. sible, and gave it back to Nelson when made Nelson laugh and smile. They All this says everything about what it was time to give it back. loved Nelson’s smile and told him so. the physicians gave to me as well. I The parachuter from the heavens They helped Nelson smile and even think Nelson and I spent most of the picked up on and carried Nelson’s sense laugh at the absurdity of it all. We all last two years of his illness in the hos- that he was crossing a river, but terri- undervalue the importance of mirror- pital. When he was unconscious or fied of it. He did not hide reality, but ing. Nelson had a wistful desire for a delirious, they would speak with me at offered the hope that while he didn’t beautiful relationship with a brother, great length—at all hours of the day or know and wasn’t religious, he could father, man. These physicians groped night or weekend. I regard, as the most not help but think there was something for his spirit, found it, and reflected it precious of gifts, that they shared their good on the other side of the river. I back. Without such recognition Nelson own experiences of family illness and believe that these words, uttered by would have been nothing but his illness. how these life events and the meanings someone Nelson deeply loved and who Nelson wanted these special physician we ascribe to them take up residence. he knew loved him, carried him, even friends to be many things, but he also When I had to face critical decisions as he felt he was drowning. wanted them to admire him, which they about Nelson’s life, they were able to These physicians had empathy. They showed; for there to be a place to meet give perspective and their perceptions knew that people yearn to surrender and play together, which they did. They of Nelson’s desires, creating a pathway their defenses, their ways of protecting understood the importance of surprise for me to find a place of peace and rela- themselves, and wish to expose their and the value of the spontaneity and tive tranquility. deepest longings. They read Nelson’s precariousness of play. As for what Nelson gave me—he prose and poetry. They understood These physicians had something gave me everything. He was everything. that underneath his surface bravery more—something that conveyed the Nelson asked me in his last days lurked the panic inherent in staring prosody of their humanity, a grace, but what a pilot does. I replied that a pilot death and infinity in the eyes. While ev- mostly a willingness to be vulnerable takes us from one place to another and eryone talked about his courage, these and plunge themselves into the other, lands us safely in the new land. This is friends knew more. They knew the losing their own fears. what these special physicians did for keening aloneness of the critically ill. His doctors said that they never had both of us. And Nelson did for me. They joined him in his dark woods, but seen anyone suffer as much as Nelson. pointed out the ways to sequester the During his five-year battle, in the words Address correspondence to Dr. De Lancey: terrifying thoughts and look at other of his physician brother: “He showed 9125 View Avenue NW things, as they groped their way along. such resilience, such desire to live, and Seattle, Washington 98117 They were like landscape architects such tenacious attachment to life that E-mail: [email protected]

The Pharos/Spring 2013 11 12 The Pharos/Spring 2013 Diagnosing Darwin Sidney Cohen, MD, and Philip A. Mackowiak, MD

Darwin’s Rooms, Christ’s College, University of Cambridge, Cambridge, UK Credit: Michael D. Barton. The Pharos/Spring 2013 13 Diagnosing Darwin

Sidney Cohen (AΩA, SUNY Downstate Medical Center College of Medicine, 1964) is professor of Medicine and director of research for the Gastroenterology and Hepatology Division at the Jefferson Medical College of Thomas Jefferson University in Philadelphia. Philip A. Mackowiak (AΩA, University of Maryland, 1992) is professor of Medicine and vice chairman at the University of Maryland School of Medicine and Director of the Medical Care Clinical Center for the VA Maryland Health Care System in Baltimore.

harles Darwin (–) was a virtual invalid for most of his adult life. Until he developed evidence of cardiac dysfunction in his eighth decade, the doc- Ctors who cared for him could find no physical explanation for his chronic complaints and disagreed as to his diagnosis. Since that time, many have pondered the nature of Darwin’s mysterious illnesses and proposed additional diagnoses to an ever-expanding list based on varying interpretations of the detailed description of Darwin’s signs and symptoms that he obsessively recorded in his diaries and letters. Because of the absence of diagnostic laboratory test results, none has been accepted as definitive. Suppose Darwin were alive today and could be subjected to a modern diagnostic evaluation? What would it consist of? What would it conclude? And what is the likelihood that it would lead to a treatment regimen more effective than those applied by his physicians over a century ago?

Darwin’s illnesses1 Except for an upset stomach (mainly during breakfast) in his teens and brief eruptions (of unknown character) of his mouth and hands in his early twenties, Darwin enjoyed excellent health as a youth. During his five-year voyage on the HMS Beagle, from ages twenty-two through twenty-seven, he was frequently seasick, had several self-limited fevers, two instances of food poisoning, an inflamed knee and arm, intermittent boils, heat stroke, and a bout of “Chilean illness.” 1p13 Approximately a year after his return, he had a brief episode of palpitations but otherwise was healthy for eighteen months, when an attack of “gastric flatus” heralded the onset of a vio- lent abdominal disorder that would plague him for the next three decades.1pp14–15 The disorder consisted of repeated, sudden attacks of abdominal pain, nausea, vomiting, and retching, typically occurring three hours after breakfast and most frequent and severe during times of emotional stress.1 p 3 0

Assassin bug. Sinclair Stammers / Science Source.

14 The Pharos/Spring 2013 Courtesy of the National Library of Medicine

The Pharos/Spring 2013 15 Diagnosing Darwin

Courtesy of the National Library of Medicine

During the worst periods, which lasted for years on end, he intolerance, Crohn’s disease, panic disorder with agoraphobia, vomited after nearly every meal. Many of his friends thought repressed anger toward his father, systemic lupus erythemato- him a hypochondriac. Because he seldom regurgitated food, sus, and cyclic vomiting syndrome.1–6 “only acid & morbid secretion,” 1p77 his vomiting did not inter- Darwin received a host of treatments for his gastric dis- fere with his intake or digestion of food, his general nutritional tress, which included small doses of arsenic, calomel, sugar- status, or his professional productivity. His bowel movements free diet, Indian ale, bismuth, hydrotherapy, Croton (an were normal.1p22 extract of flowering plants in the spurge family), mineral acids He was seen by over a score of England’s most prominent (a mixture of muriatic and nitric acids), aloes, lemons, a hy- physicians for these complaints.1p279 Their diagnoses included droelectric chain, pepsin, Condy’s ozinised water (potassium hypochondriasis, excess gastric acid, suppressed gout, hy- permanganate solution), magnesium carbonate of ammonia, perventilation, allergies, and a complication of Chilean fever. phosphate of iron, ice therapy, strychnine, and codeine. Only To this list, the many physicians who since his death have Dr. Gully’s cold water cure (immersion in cold water) seemed pondered the cause of his invalidism have added the following to provide temporary relief of his gastric distress.1pp279–280 diagnoses: Chagas disease, neurasthenia, a refractory anomaly Whereas Darwin’s gastric dysfunction was his most dis- of the eyes, mental overwork, schizophrenia, depressive tressing complaint, he had many others following his years psychosis, chronic appendicitis, a peptic ulcer, chronic cho- abroad. These included insomnia, intermittent palpitations lecystitis, smoldering hepatitis, a diaphragmatic hernia, nar- and headaches, episodes of numbness of the fingertips, a colepsy, hyper-insulinism, arsenicosis, lead poisoning, lactose buzzing noise in the head, stars in the eyes, giddiness and

16 The Pharos/Spring 2013 trembling hands (in his thirties), and weakness and a “touch attacks with heart failure and degeneration of the heart and of pleurisy” (at age fifty-one).1p68 He had unspecified trouble greater blood vessels.” 1pp94–96 with his teeth beginning in his third decade, perhaps related Of the myriad diagnoses offered over the years to explain to his recurrent vomiting. During his fifth and sixth de- Darwin’s long suffering, given the nature of his complaints, we cades, he wept a great deal while suffering with intermittent believe only three merit serious consideration: cyclic vomiting “rheumatism” and “lumbago,” 1pp54,77,110,136 and also “boils and syndrome, hypochondriasis, and Chagas disease. eczema” of the face and hands.1pp31,47,51,71 Interestingly, during his fits of rheumatism and eczema his gastric symptoms Cyclic vomiting syndrome7,8 diminished.1pp74,77,81 Cyclic vomiting syndrome is a little-known, yet surprisingly Darwin’s mother died suddenly of an unknown disorder common and disabling disorder characterized by recurrent when he was eight years old. His father, who lived to the age episodes of nausea, vomiting, and abdominal pain separated of eighty-two, was morbidly obese and, like his own father and by asymptomatic intervals. Migraine headaches are common grandfather, suffered with gout. An older brother struggled (and are often found in family members), as are cardiac ar- with depression before dying at age seventy-seven of unknown rhythmias and other manifestations of dysautonomia (as for cause. Three sisters died at ages fifty-six, sixty-three, and example, Darwin’s palpitations, numbness of his fingertips eighty-eight of unknown causes.1p119 A paternal great-grand- and nervous tics). The intense anxiety precipitated by un- father and grandmother were alcoholic. A maternal uncle and controllable episodes of emesis occasionally induces behavior a paternal half-cousin had digestive problems of unknown mimicking an affective or anxiety disorder (two of the many character or etiology. psychiatric disorders attributed to Darwin) or an endocrine Darwin’s wife, a first cousin, was deeply religious, whereas disorder, such as hypothyroidism or hypoglycemia. he was not; some have speculated that this difference might The syndrome is in essence a diagnosis of exclusion, in have had a role in the origin of his invalidism. They had ten which standard diagnostic tests for recurrent vomiting are children (seven male and three female). Three died young. uniformly negative. Many patients, however, exhibit evidence Five developed hypochondriacal concerns about their health, of mitochondrial dysfunction on examination of body fluid possibly prompted by their father’s expressed conviction that metabolites and muscle biopsy, at least some of whom are his own disorder was hereditary . Four had fluctuating diges- shown to possess a mitochondrial gene mutation designated tive troubles less severe than their father’s,1pp120–121 and several AG. Considerable evidence supports a matrilineal pattern exhibited a “tendency for irregular pulses,” possibly precipi- of inheritance of the disorder, in which case Darwin likely tated by repeated examinations by their father.1p64 inherited it from his mother, a Wedgewood, and his children Darwin was six feet tall and lean as a youth, with a light from their mother, also a Wedgewood. complexion and reddish-brown hair that receded rapidly after Although commonly presenting during the preschool to puberty. He was addicted to snuff, which he used several times early school age years, cyclic vomiting syndrome can begin a day from age eighteen. He drank brandy, wine, and port in any time from infancy to adulthood, with reported ages of moderation. Walking was his only exercise. onset ranging from two to forty-nine years. Darwin’s episodes During his final decade, Darwin’s physical health improved of vomiting began in his teens, when he had an upset stomach markedly, with absence of “serious exacerbations of vomit- mainly after breakfast. In adult patients, episodes are typically ing.” 1p90 However, by his seventh decade, his memory was stereotypical (i.e., similar in duration and character from one beginning to fail. He began to complain of constant attacks of episode to the next) over months to years, with attacks most “swimming of the head” and “some pain in the heart.” 1pp90,93 often arising between midnight and noon. In men, vomiting While rock climbing at the age of seventy-two, he experi- is commonly triggered by noxious stress, pleasant excitement, enced a sudden “fit of dazzling.” The precise character of the and infections, whereas in women, triggers include men- fit is uncertain but likely involved “giddiness and an irregular struation, noxious stress, pleasant excitement, and fatigue. In pulse,” in that he reported these three months later.1p93 He Darwin’s case, episodes of vomiting were frequently triggered then developed a cough, which quinine seemed to alleviate. by noxious stress and pleasant excitement, but were alleviated Shortly thereafter, he developed pre-cordial pain, giddiness, by his skin eruptions. exhaustion, and insomnia. Amyl nitrate provided little relief. The differential diagnosis for cyclic vomiting syndrome Sitting at dinner one evening, he was seized with giddiness is broad. In addition to the alternative diagnoses mentioned and fainted while trying to reach a sofa. Within minutes he above, many others are pursued in the diagnostic evaluation regained consciousness, drank some brandy and seemed to of these patients. In the state of Maryland today, the Hospital recover. He then became nauseated and began vomiting and Services Cost Review Commission (HSCRC)/Medicare- retching violently. This lasted until the next day, when he approved charges for the studies listed in the accompanying again lost consciousness and died. He was seventy-three years table would total , if performed only once, and would and two months old. The cause of death was listed as “angina not include professional fees paid to a primary care provider

The Pharos/Spring 2013 17 Diagnosing Darwin

Diagnostic Evaluations of Patients with Cyclic Vomiting Syndrome7,8 Alternative Diagnosis (Subspecialty Consultation Obtained) Diagnostic Tests Potential Harm Esophageal reflux (gastroenterology) EGD, UGI, PPI trial Bleeding, cardiopulmonary complications of sedation, bowel perforation, aspiration Gastritis/peptic ulcer disease/acholasia EGD (with biopsy), antibody assay and/or stool Bleeding, cardiopulmonary complications of (gastroenterology) antigen or breath test for H. pylori sedation, bowel perforation, aspiration Pancreatitis (gastroenterology) Seum amylase and lipase, endoscopic Bleeding, cardiopulmonary complications of ultrasound sedation, bowel perforation, aspiration Gall bladder disease (gastroenterology, Abdominal ultrasound, endoscopic retrograde Bleeding, cardiopulmonary complications of general surgery) cholangio-pancreatography sedation, bowel perforation, aspiration, pancreatitis Partial bowel obstruction UGI (with small bowel follow through), Bowel perforation, bleeding, radiation exposure, (gastroenterology, general surgery) colonoscopy, abdominal CT scan (with contrast-induced ARF contrast) Pyelonephritis (infectious diseases) Urinalysis, urine culture and sensitivitiy None Appendicitis (gastroenterology, general CBC, abdominal CT scan (with contrast) Radiation exposure, contrast-induced ARF surgery) Delayed gastric emptying Radionucleotide gastric emptying study Radiation exposure (gastroenterology) Porphyria (endocrinology) Urine porphyrins None Plumbism (hematology, nephrology) Whole blood lead concentration None Abdominal epilepsy/migraine (neurology) EEG, head CT (with contrast), and MRI (with Radiation exposure, contrast-induced ARF, gadolinium, anti-migraine drug trial gadolinium-induced nephrogenic sclerosis Crohn’s disease (gastroenterology) EGD, abdominal CT (with contrast), Bleeding, bowel perforation, radiation exposure colonoscopy, capsule endoscopy Systemic lupus erythematosus Assays for antinuclear, anti-double-stranded None (rheumatology) DNA and anti-Sm nuclear antigen antibodies Psychiatric disorder (psychiatry) EEG, head CT (with contrast), and MRI/MRA Radiation exposure, contrast-induced ARF, (with gadolinium) gadolinium-induced nephrogenic sclerosis Chagas disease (infectious diseases) T. cruzi antibody assay None Abbreviations: EGD = esophago-gastric duodenoscopy, UGI = upper gastrointestinal barium study, PPI = proton pump inhibitor, CBC = complete blood count, CT = computed tomography, MRI = magnetic resonance imaging, MRA = magnetic resonance angiography, EEG = electroencephalogram, ARF = acute renal failure.

or subspecialty consultants, or charges associated with emer- laparotomy, pyloroplasty, gastrostomy and jejunostomy, and gency room visits or hospitalizations. fundoplication. In many adult patients, prolonged showers or baths lessen One can only guess how many of these tests and treat- the intensity of attacks. However, in contrast to Darwin’s hy- ments Darwin would receive if he were a patient today. Given drotherapy, which afforded him temporary relief, most current the severity of his gastric disorder and his obsession with patients report benefit from exposure to hot rather than cold it, it is likely that he would be subjected to most, if not all. water. Although no experimentally validated treatment for Although his episodes of vomiting lasted substantially longer the disorder has been established, many are prescribed in an than those delineated in the Rome III diagnostic criteria for effort to relieve the suffering of these patients. They include cyclic vomiting syndrome,9 we believe the preponderance of intravenous hydration, anti-migraine drugs (e.g., amitriptyline, evidence contained in his medical history is more consistent propanolol, cyproheptadine), anxiolytics/antiemetics (e.g., on- with the syndrome than any other diagnosis yet proposed for dansetron, lorazepam, alprazolam), analgesics (e.g., ibuprofen, his “gastric flatus.” If this, in fact, were his problem, none of oxycodone), and H blockers and proton pump inhibitors. the tests and treatments listed above would either diagnose or Emergency room visits are frequent, hospital admissions less cure his ailment. so. Many patients undergo cholecystectomies to no avail; a few are subjected needlessly to appendectomies, exploratory

18 The Pharos/Spring 2013 Hypochondriasis10 parasitologist, proposed Chagas disease as the cause of Hypochondriasis is classified under the somatization dis- Darwin’s prolonged gastric distress, citing a previously un- orders in the American Psychiatric Association’s Diagnostic noticed passage in the Beagle narrative, in which Darwin and Statistical Manual of Mental Disorders, Fourth Edition describes being bitten by “the great black bug of the Pampas,” (DSM-IV).11 It is characterized by an obsessive irrational the principal vector for the infection.2p113 For years this theory fear of having a serious medical condition despite the failure dominated thinking as to the etiology of Darwin’s “gastric of a comprehensive medical evaluation to identify any such flatus,” but has since fallen into disfavor.13 We believe that condition. Although the belief is not of delusional intensity, Darwin might have suffered with Chagas disease but, if so, in attempts at reassurance fail to alleviate the patient’s fear. the form of a cardiomyopathy rather than one of the digestive Unlike Darwin, patients suffering with hypochondriasis mega syndromes proposed. Chagas disease, we believe, might typically are reluctant to acknowledge the role of psychological explain his terminal cardiac dysfunction, perhaps also his factors in causing their symptoms, misinterpret benign physi- gastric disorder, but only indirectly, by predisposing him to cal sensations as evidence of serious illness, tend to respond infection with H. pylori (see below). to reassurance with anger rather than relief, and frequently Chagas disease is caused by the protozoan parasite are functionally severely impaired by the disorder. Darwin, in Trypanosoma cruzi.12 The microbe is transmitted to humans fact, recognized the role of anxiety caused by his revolution- and many other animals mainly by blood-sucking bugs be- ary concepts in precipitating his gastric distress, had physi- longing to the subfamily Triatominae, of which only a small cal sensations that were hardly benign, was a compliant and number are competent vectors. grateful patient, and in spite of his symptoms continued to In March of , Darwin was bitten by one such bug (a great black “Benchuca” bug)2 while residing in the Pampas of DSM-IV Diagnostic Criteria for !"".# Hypochondriasis11 Argentina. More than likely he was bitten repeatedly by such A. Preoccupation with fears of having, or the idea that one has, a bugs during his excursions in both Argentina and Chile, and serious disease based on the person’s misinterpretation of bodily might well have been infected by T. cruzi in the process.2 symptoms. Recent surveys, however, indicate that only a small percent- B. The preoccupation persists despite appropriate medical age of people at risk of T. cruzi infection (i.e., those exposed to evaluation and reassurance. Benchucas harboring the parasite) are actually infected (. C. The belief in Criterion A is not of delusional intensity (as percent), and of those infected, less than half develop clinically in Delusional Disorder, Somatic Type) and is not restricted apparent disease.12 The acute phase of symptomatic infections to a circumscribed concern about appearance (as in Body lasts four to six weeks and is characterized by prolonged fever, Dysmorphic Disorder). malaise, hepatosplenomegaly, lymphadenopathy, and occa- D. The preoccupation causes clinically significant distress or sionally cardiac arrhythmias. Darwin had an attack of “Chilean impairment in social, occupational, or other important areas of fever” in  that lasted from September to November and functioning. could have been a bout of acute Chagas disease. E. The duration of the disturbance is at least ! months. The chronic phase of the disease usually does not manifest F. The preoccupation is not better accounted for by Generalized clinically until ten to thirty years after the initial infection. The Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, digestive form, which develops in only ten to fifteen percent a Major Depressive Episode, Separation Anxiety, or another of chronically infected patients, consists of mega-esophagus, Somatoform Disorder. mega-colon, or both. Darwin never exhibited signs or symptoms of either. The cardiac form of the disease, the most serious and function effectively as husband, father, friend, colleague, and frequent manifestation of chronic Chagas disease, develops in scientist.1pp19,52,71,72 twenty to thirty percent of chronically infected patients. It typi- Like patients with cyclic vomiting syndrome, those with cally produces abnormalities of the cardiac conduction system, hypochondriasis have high rates of visits to physicians, sub- as well as bradyarrythmias, tachyarrhythmias, apical aneurysms, specialty consultations, laboratory tests, and surgical proce- cardiac failure, thromboembolism, and sudden death.12 Thus, dures, all of which lead to high health care costs. Despite such Chagas cardiomyopathy might have been the cause of Darwin’s intense medical attention, their symptoms generally remain terminal cardiac dysfunction and death. However, given his unabated. Although cognitive, pharmacologic, and several age at the time his heart began to fail, his failing memory, and other therapies have been recommended for the disorder, the infrequency with which persons exposed to Benchuca proof of clinical efficacy has yet to be demonstrated for any of bugs develop the chronic form of the disease, it is more likely these treatments. that he died of atherosclerosis of his heart and his brain. In the chronic phase, Chagas disease is diagnosed by demon- Chagas disease12 strating the presence of IgG antibodies against T. cruzi. If alive In October , Professor Saul Adler, a world-renowned today, Darwin would certainly be tested for these and more than

The Pharos/Spring 2013 19 Diagnosing Darwin

likely also have his cardiac and cerebral symptoms extensively of Maryland School of Medicine. We are indebted to Larry Pitrof, Dr. evaluated with an EKG, holter monitor, stress test and cardiac Morton Kramer, and Wayne Millan for their assistance in bringing catheterization, along with a CT scan and MRI of his head. the conference to fruition, to Richard J. Behles for assisting in the Although benznidazole and nifurtimox are effective against literature review and to Dr. Ruth Padel, Darwin’s great-great-grand- acute Chagas disease, they are not recommended for patients daughter, for sharing her personal insight regarding the Darwin fam- with advanced cardiac disease. Cardiac symptoms are man- ily. Neither author has any potential conflict of interest to declare. aged with amiodarone, a cardiac pacemaker and implantable defibrillator, and diuretics and beta blockers, even though References their efficacy has not been confirmed in clinical trials.12 Today, . Colp R Jr. To Be an Invalid: The Illness of Charles Darwin. Darwin, no doubt, would be given many, if not most, of these Chicago: University of Chicago Press; . in managing his cardiac symptoms. . Adler S. Darwin’s illness. Nature ; : –. For reasons yet to be determined, patients with Chagas dis- . Young DAB. Darwin’s illness and systemic lupus erythema- ease are prone to infection with H. pylori,14 which in its acute tosus. Notes Records R Soc London ; : –. phase is associated with vomiting, abdominal pain, and weight . Barloon TJ, Noyes R Jr. Charles Darwin and panic disorder. loss. During the chronic phase of such infections, a small mi- JAMA ; : –. nority of patients develop gastritis, peptic ulcer disease, gastric . Orrego F, Quintana C. Darwin’s illness: a final diagnosis. cancer, or lymphoma. Dr. Barry Marshall, the co-discoverer of Notes Records R Soc ; : –. H. pylori’s role in peptic ulcer disease, believes that Darwin’s . Hayman JA. Darwin’s illness revisited. BMJ ; : gastric distress was caused by the bacterium.15 If so, Darwin’s –. particular disorder more likely would have been a peculiarly . Fleisher DR, Gornowicz B, Adams K, et al. Cyclic vomiting persistent form of H. pylori-induced chronic gastritis (i.e., syndrome in  adults: the illness, the patients, and problems of non-ulcer dyspepsia) than a peptic ulcer, gastric cancer, or management. BMC Med ; : –. lymphoma. Unfortunately, current treatments have little if any . Boles RG, Adams K, Li BUK. Maternal inheritance in cyclic effect on the course of such dyspepsia.16 vomiting syndrome. Am J Med Genetics ; A; –. . Tack J, Talley NJ. Gastroduodenal disorders. Am J Gastroen- Conclusion terol ; : –. According to a descendent of the great man, in Darwin’s  Barsky AJ. The patient with hypochondriasis. N Engl J Med home, “it was a distinction and a mournful pleasure to be ; : –. ill.” 17pS43 Darwin might have been a hypochondriac, as implied . Hypochondriasis (DSM-IV-TR .). In: American Psy- by this statement, and today would be seen by a psychiatrist chiatric Association. Diagnostic and Statistical Manual of Mental in consultation and also subjected to psychological testing. Disorders. Fourth Edition. Washington (DC): American Psychiatric However, we believe he also suffered with cyclic vomiting Association; : –. syndrome, which although severe, never seriously interfered . Rassi A Jr, Rassi A, Marin-Neto JA. Chagas disease. Lancet with his scientific productivity and resolved spontaneously in ; : –. his seventies. We also believe that he died of atherosclerotic . Woodruff AW. Darwin’s health in relation to his voyage to cardiovascular disease. Although his physicians, some of the South America. BMJ ; : –. finest Britain had to offer at that time, could find no physical . Matsuda NM, Miller SM, Evora PRB. The chronic gastroin- abnormality to explain his gastric symptoms, they had only testinal manifestations of Chagas disease. Clinics ; : –. Darwin’s history and physical examination to guide them in . Marshall B. What I know and what I think I know . . : Dar- their evaluations. win’s illness was Helicobacter pylori. http://barryjmarshall.blogspot. If Darwin were alive today, no doubt a wide array of sophis- com///darwins-illness-was-helicobacter-pylori.html. ticated laboratory examinations would be added to his work . Blaser MF. Helicobacter pylori and Other Gastric Heli- up. We believe those directed at his “gastric flatus” would be cobacter Species. In: Mandell GL, Bennett JE, Dolin R, editors. uniformly negative and point to cyclic vomiting syndrome Principles and Practice of Infectious Diseases. Seventh Edition. as a diagnosis of exclusion. We suspect that those directed Philadelphia: Churchill, Livingstone Elsevier; : –. at his terminal cardiac dysfunction would reveal advanced . Sharp D. Forebears and heirs: a sketch. Lancet  (Dar- atherosclerosis of both his heart and his brain. Though a host win’s Gifts supplement): S–S. of treatments would be given, we doubt that any would prove more than marginally better in relieving his suffering or ex- Address correspondence and reprint requests to: tending his life than those administered by his own physicians. Philip A. Mackowiak, MD Medical Service-111 Acknowledgments VA Medical Center This case discussion was presented in an open forum as one of a 10 N. Greene Street continuing series of historical clinicopathological conferences spon- Baltimore, Maryland 21201 sored by the V.A. Maryland Health Care System and the University Email: [email protected]

20 The Pharos/Spring 2013 My Cousin’s Fatal CVA

I wonder, Emily, what you must have felt the moment of your accident (as it’s called), when you were dealt that losing hand while fixing breakfast in the kitchen. In the moment it took millions of neurons to blow their fuses, a cerebral bleed engulfed all you’d ever thought or done, everything you ever knew and loved. Had your pupils, fixed and dilated, watched your ill-fated spirit leave the room? It was so sudden you probably felt nothing, fear and pain known only to the living. Henry Langhorne

CVA = cerebrovascular accident. Dr. Langhorne (AΩA, Tulane Medical School, !"#$) is in private practice at Cardiology Consultants in Pensacola, Florida. His address is: !"!% Seville Drive, Pensacola, Florida &'#%&. E-mail: [email protected]. IllustrationThe Pharos by Erica/Spring Aitken. 2013 1 Autograph score of Gustav Mahler’s Symphony No. 4. De Agostin/Getty Images 22 The Pharos/Spring 2013 A maestro’s heart Gustav Mahler’s cardiac disease

Gregory W. Rutecki, MD

The author (AΩA, University of Illinois, 1973) is professor of Medicine in the Division of Nephrology & Hypertension at the University of South Alabama in Mobile.

I do strongly feel that among the greatest pieces of luck for high achievement is ordeal . . . My idea is this: the artist is extremely lucky who is presented with the worst possible ordeal which will not actually kill him. At that point, he’s in business. Beethoven’s deafness, Goya’s deafness, Milton’s blindness, that kind of thing. —American poet John Berryman, October , 1

hroughout history, creative genius was thought to arise from insanity. Plato called creativity a “divine madness . . . a gift from the gods,” 2 while Aristotle wrote, “No Tgreat genius was without a mixture of insanity.” 2 The creativity of Gustav Mahler, conductor and composer par excellence, has generally been attributed to personal psychological demons. He said of himself,

I am thrice homeless . . . As a native of Bohemia in Austria, as an Austrian among Germans, and as a Jew throughout all the world; everywhere an intruder, never welcomed.3p98

Caricature of Gustav Mahler (Kalischt, 1860 - Vienna, 1911) De Agostini/Getty Images 23 A maestro’s heart

He once bemoaned, Mahler suffered many psychological traumas: eight of his fourteen brothers and sisters died in childhood, his father What grim darkness underlies life! . . . Whence have we abused his mother, and his wife Alma had a protracted extra- come? Whither are we bound? Is it true, as Schopenhauer marital affair with architect Walter Gropius. But the depth says, that I willed this life before I was conceived? Why do of emotions expressed in his music may also have stemmed I fancy I am free, when my character constricts me like a in part from his physical ailments: on February , , he prison? To what purpose is all this toil and suffering? How nearly exsanguinated from hemorrhoidal bleeding and was can cruelty and evil be the work of a loving God? Will death told he might not survive surgery, leading him to draft his own at last reveal the meaning of life?4pp145–46 will;5 after his daughter’s death he was diagnosed with rheumatic heart disease. He died from Streptococcus viridans bacterial endocarditis on May , . Mahler once said,

There is no doubt that our music involves everything human, including the intellect. . . . When we make music we do not paint or tell stories. Music represents the whole human being—feeling, thinking, breathing, suffering.6p239

Stuart Feder, an expert in Mahler’s “musical” psyche, writes,

In attempting to understand as fully as possible Mahler, the man dying, we will have to triangulate his position from the points of view of his mental state, his creative work, and the inevitable progression of physical disease.7

Did Mahler’s cardiac disease, in concert with his neuroses, serve as muse? The composer lived and died at a time when medicine was first beginning to understand human psychology, cardiac disease, and bacterial endocarditis. His experience thus is a case study of the early twentieth century’s approach to diagnosing and treating illnesses of the mind and body.

Mahler’s psychology and his music Composer Paul Hindemith believed that the “mind”—that is, the entity as described by modern psychology—can illuminate the wellspring of musical creativity:

We are on the verge of entering . . . that innermost field in which the very actions of music take place: the human mind. Thus psychology . . . will become the science that eventually illuminates the background before which the musical figures move in a state of meaningful clarity.8pp24–25

Mahler’s works consistently exhibit tension and conflict,9 expressing his moods through musical juxtapositions of dissimilar mental themes. In the composer’s single session with Sigmund Freud in Alma Mahler, née Schindler, 1909. Getty Images , he complained that his music had not achieved

24 The Pharos/Spring 2013 Caricature of Gustav Mahler conducting his Symphony No. 1 in D major. From “Illustriertes Wiener Extrablatt.” November 1900. Getty Images

the respect it deserved because its noblest passages were German composer Karlheinz Stockhausen wrote of Mahler, spoiled by the intrusion of a commonplace melody.10 Mahler told Freud that his father had regularly abused his mother, one In his music the old and the new, the trite and the never severe episode forcing the young Gustav to flee to the street before heard, the naïve and the labored (with every imagin- where a hurdy-gurdy blared out a well-known Viennese song, able shading between each of these extremes) are ranged “Ach, du lieber Augustin.” Mahler realized that tragedy and above, beyond, and alongside each other, as though in an farce were joined in his mind and music from that moment impassioned effort to compress the whole of life into one onward.10 The funeral procession in his First Symphony, for single experience.” 12 example, incorporates the sublime and ridiculous. A hero’s funeral, with its solemn music, is interrupted by a group of Bohemian musicians playing a banal melody.11 Mahler’s cardiac disease Mahler biographer Donald Mitchell writes that Mahler’s Gustav Mahler was diagnosed with rheumatic heart disease compositions frequently in . Three findings support the diagnosis: he frequently suffered from severe pharyngitis, auscultation of his heart re-enacted his traumatic childhood experience . . . the vivid indicated mitral valvular disease, and neurologists have retro- contrast between high tragedy and low farce, sublimated, spectively suggested he exhibited signs of Sydenham’s chorea. disguised and transfigured as it often was, emerged as a Although culture evidence for Group A beta hemolytic leading artistic principle in his music, . . . streptococcus is of course lacking, Mahler’s symptoms in- . . . The conjunction of high tragedy and the com- cluded tonsilitis with a high fever, and a “festering white spot monplace meant that the commonplace itself, in the right and a very bad inflammation.” 13 During an episode of pharyn- context, could be used as a new means of expression; and gitis, biographer Stuart Feder writes, here Mahler remarkably foreshadowed a main trend in oth century art, not only in music, but also in the literary and Engaging the Munich impresario Emil Gutman as “chief visual arts.9 bather,” Mahler swaddled himself in heavy blankets, sweat-

The Pharos/Spring 2013 25 A maestro’s heart

Gustav Mahler and one of his daughters in Vienna, circa 1907. Getty Images

ing heavily for three hours while Gutmann sponged his face tors often adopt after diagnosing a fatal disease. This verdict and eyes with a towel.14p244 marked the beginning of the end for Mahler.3p110

Of their honeymoon trip in , Alma Mahler wrote, Typical of the time, decreased physical activity was prescribed.4,7 Alma Mahler recalled: I was aghast as I saw him rushing up and down the corri- dor—his face as white as a sheet, incapable of uttering a syl- we avoided strenuous walks owing to the ever-present lable. He jumped out at every station and walked about the anxiety about Mahler’s heart. Once we knew he had val- platform, without hat, coat or gloves though it was twenty- vular disease of the heart we were afraid of everything. He two degrees below zero. The Russians, who kept out the cold was always stopping on a walk to feel his own pulse; and he with huge fur caps and gloves, were greatly amused.3pp31–32 often asked me during the day to listen to his heart and see whether the beat was clear, or rapid, or calm. I had been Physicians who examined Mahler’s heart at different times alarmed for years by the creaking sound his heart made—it heard both systolic and presystolic murmurs. The first exami- was particularly loud on the second beat—and I had always nation followed the death of Mahler’s daughter just before her known that it must be diseased. fifth birthday, of what was suspected to be either scarlet fever I had often implored him to give up his long bicycle or diphtheria. In an attempt to reassure his grieving family rides, his climbing and also swimming under water, to about his personal health, Mahler permitted the family doctor which he was so passionately attached. There was nothing to auscultate him. He was told he had a murmur. Alma Mahler of that sort now. On the contrary, he had a pedometer in his wrote that Mahler: pocket. His steps and pulse-beats were numbered and his life a torment.3p129 thinking to make a cheerful diversion and distract us from our gloom said: “Come along, doctor, wouldn’t you like to Later, a “loud systolic (and) presystolic murmur over the examine me too?” The doctor did so. He got up looking very precordium, characteristic of chronic mitral disease,” was serious. Mahler was lying on the sofa and Dr. Blumenthal discovered.17 The latter examination was performed after had been kneeling beside him. “Well, you’ve no cause to be Mahler was suspected of having endocarditis. Since the mur- proud of a heart like that,” he said in that cheery tone doc- mur preceding endocarditis was characterized as a “mitral

26 The Pharos/Spring 2013 Max Reinhardt, Carl Moll, Alma Schindler-Mahler, Gustav Klimt, Anna Moll and Josef Hofmann, in the garden of the Villa Carl Moll in Vienna, 1903. Getty Images

contraction,”17 mitral stenosis was suspected. Later there was As a child, he was afflicted by involuntary movements of also mitral regurgitation. his extremities. These are commonly found in mentally Mahler reserved summers for composing. He took his advanced children and, if neglected, can develop into St. family to lakes in the Salzkammergut region of Austria and Vitus’s dance. That ailment disappears, however, when the followed a self-prescribed ritual,17 taking vigorous walks and child’s mind and body grow and are properly occupied. With engaging in a variety of intensive exercises. After the discovery Mahler, unfortunately, an involuntary twitch persisted in his of mitral valvular disease, however, Mahler’s consultants, “for- right leg throughout his life. bade him to walk uphill, bicycle, or swim.” 3p110 Mahler tried to No sketch of Mahler’s outward appearance is complete downplay the news: without taking into account his much discussed “jerking foot.” . . . When he was walking, one noticed that anything Dr. Hamperl . . . found a slight valvular defect, which is from one to three steps would sometimes fall out of the entirely compensated, and he makes nothing of the whole regular rhythm. Standing still, one foot would tap lightly on affair. He tells me I can certainly carry on with my work just the ground, kicking the spot.15p153 as I did before and in general lead a normal life, apart from avoiding over-fatigue.3p244–245 These descriptions led Francisco Cardoso in a  article in the journal Movement Disorders to conclude that rheumatic Mahler biographer Richard Specht described Mahler’s reac- fever during childhood resulted in both cardiac disease and tions differently: chorea.16 Other biographers mentioned Mahler’s “Saint Vitus Dance” as well.17 Frightened by the carelessly brutal words of a physician, he Mahler evolved into a “cardiac invalid.” His palpitations, a thought of himself as being close to death. In this mood, physical reminder of valvular heart disease, were prominent in everything about life appeared to him to be painfully and family narratives summarizing the Mahler family’s reactions to intensely colored.14p334 his heart disease. He wrote:

Mahler also suffered from a movement disorder, possibly My mental activity must be complemented by physical ac- Sydenham’s chorea. A close friend, Alfred Roller, testified: tivity. The advice you pass on from doctors is of no use to me. An ordinary walk gives me such a rapid pulse and such

The Pharos/Spring 2013 27 A maestro’s heart

palpitations that I never achieve the purpose of walking—to threads—it’s like seaweed.” He was eager to explain, to shine forget one’s body.18 his light abroad. But I could not listen. Dumb with horror, I turned and left him.3p183

Mahler’s endocarditis Mahler himself was less alarmed. The newspaper Neue Freie In , Mahler’s personal physician in New York, Dr. Press in April  reported that Joseph Fraenkel, requested a consultation with Dr. Emanuel Libman, the eminent cardiologist. Dr. George Baehr, then a he positively beamed when Chantemesse told him that he fellow in Pathology and Bacteriology in Libman’s laboratory, was able to confirm Fraenkel’s diagnosis in every particular. recollects: . . . Mahler knows of his condition. He has succeeded in get- ting a full picture from the doctors in America, and what he Sometime in February , Dr. Emanuel Libman was was not actually told his ready perception soon guessed.19 called in consultation by Mahler’s personal physician, Dr. Fraenkel, to see the famous composer and director. Finally, as expected, Mahler worsened. His course was punctu- Apparently Dr. Fraenkel had suspected that Mahler’s pro- ated by monoarticular arthritis, uremia, and heart failure. He longed fever and physical debility might be due to subacute died as a direct result of his endocarditis.17 bacterial endocarditis. . . . Libman was at that time the outstanding authority on the disease. . . . Libman confirmed The treatment of endocarditis in the early twentieth the diagnosis clinically by finding a loud systolic-presystolic century murmur over the precordium characteristic of chronic The treatment of endocarditis in the late nineteenth and rheumatic mitral disease, a history of prolonged low grade early twentieth centuries—in what literally was medical mi- fever, a palpable spleen, characteristic petechiae on the con- crobiology’s infancy—was primitive. Complete cure lay in junctivae and skin and slight clubbing of fingers. To confirm the distant future after the discovery of antibiotics. That gen- the diagnosis bacteriologically, Libman telephoned me to eration recognized that oral flora and tonsillar infections con- join him . . . tributed to endocarditis. “Devitalized teeth” were extracted On arrival I withdrew  c.cm of blood from an arm and tonsillectomy performed when practical.20 At least two vein with syringe and needle, squirted part of it into several therapeutic regimens for endocarditis were developed and bouillon flasks and mixed the remainder with melted agar unsuccessfully tried in Mahler’s era. Analogous to Ehrlich’s media which I then poured into sterile Petri dishes. After  treatment of syphilis, toxic substances such as trivalent arse- or  days of incubation in the hospital laboratory, the Petri nic were injected intravenously. The arsenical of choice may plates showed numerous bacterial colonies and all the bouil- have been “Capp’s sodium cacodylate.” 20 There is no evidence lon flasks were found to show a pure culture of the same to suggest Mahler received arsenic or other related agents. organism which was subsequently identified as streptococcus Thomas Horder, the era’s recognized authority on endocardi- viridans. tis, commented that such “chemotherapy” was “without any As this was long before the days of antibiotics, the bac- permanently good results.” 20 terials findings sealed Mahler’s doom. He insisted on being The second regimen vainly attempted to stimulate a host’s told the truth and then expressed a wish to die in Vienna. immune response using antibodies derived from serum from Accordingly, he and his wife left shortly thereafter for Paris, horses injected with heat-killed organisms.21 There is some where the diagnosis and prognosis were reconfirmed, and evidence that Mahler underwent “serum treatment.” 22,23 then proceeded to Vienna.17 Unscientific as the theory may sound today, the “serum treatment” was based on valid observations and logical reasoning. Another consultant, prominent microbiologist André Thomas Horder realized that the number of bacteria pres- Chantemesse, who pioneered work that later led to success- ent in the blood of persons with endocarditis is greater than ful vaccinations, had a different effect on the Mahlers. Alma symptoms suggested,24 leading to his deduction that the im- wrote: mune response to bacterial antigens in infected individuals is blunted. In fact, oral streptococci seemed to him to be “sap- Chantemesse, who was a celebrated bacteriologist, now rophytic” and therefore less likely to stimulate a vigorous an- made a culture from Mahler’s blood and after a few days tibody response.24 Serum treatment was a plausible, although he came to us in great delight with a microscope in his unsuccessful, attempt to kill bacteria by a stimulated antibody hand. I thought some miracle had happened. He placed response to their antigens. The bench science undergirding the microscope on the table. “Now, Madame Mahler, come what later became a therapeutic method relied on a so-called and look. Even I—myself—have never seen streptococci in “opsonic index.” A classic experiment from that time illustrates such a marvelous state of development. Just look at these the rationale for the therapy.

28 The Pharos/Spring 2013 Alma Mahler at Carnegie Hall, February 21, 1960. Photo by Alfred Eisenstaedt. Time Life Pictures/Getty Images.

Edward C. Rosenow studied a patient with culture-proven the second beat.” 26pp694–95 Dr. Charles Amenta listened for staphylococcal “albus” endocarditis.21 He injected the patient evidence of heart sounds in Mahler’s Ninth Symphony and with  million heat-killed staphylococci and graded the pa- concluded that the opening measures of the Ninth Symphony tient’s neutrophils for their phagocytic activity. There were can be likened to cellos echoing first and second heart sounds many neutrophils with ingested bacteria. A second attempt with a longer horn following the second sound—a murmur demonstrated clumps of bacteria supposedly resisting phago- perhaps. Paraphrasing Bernstein, Amenta commented, cytosis. Rosenow theorized that cultural changes in the resis- tant bacteria had decreased the patient’s ability to opsonize the heartbeat motive only later occurs at the most ominous and kill the pathogenic organism; thus coating the bacteria passages in the first movement—at the start of the develop- with antibodies should increase the ability of a patient’s neu- ment and toward the end of the section. This latter instance, trophils to perform phagocytosis. It was hoped that a serum in the tuba and trombones at maximum force, is perhaps rich in antibodies would therefore cure some. Horder himself the most dramatic and disruptive moment in the movement twice tried special sera from horses injected with streptococci leading directly into a funeral cortege passage.25 to stimulate antibodies in his patients with no benefit.24 After again quantifying their opsonic indexes, he proved to his He posits: satisfaction that typical organisms causing endocarditis are protected from opsonization and phagocytosis despite a sur- What would a mitral stenosis murmur sound like? Exactly feit of specific antibodies. Suffice it to say, Horder repudiated as Alma Mahler stated . . . there would be a “blowing” sound the benefit of serum therapy and Mahler obviously derived no in the much longer time interval following the S sound benefit himself. before the S returns to repeat the rhythm. This is exactly what Mahler writes in the opening measures of the Ninth Mahler’s heartbeat and his music Symphony. The S and S are in the cellos and the longer American composers Leonard Bernstein and Robert blowing sound in the fourth horn.25 Greenberg have suggested that Mahler’s heart disease directly influenced his musical compositions. Bernstein said, “the Amenta concluded his analysis agreeing that the Bernstein opening bars [of Mahler’s Ninth Symphony] are an imitation “heart-beat” theory makes sense in the context of Mahler’s ill- of the arrhythmia of his failing heartbeat.” 25 Certainly the ness as well as for music in general. He writes, composer’s heartbeat was a topic of conversation within his family circle. His wife wrote, “For years, I had been frightened the heartbeat holds a privileged position regarding music. by the whistling sound that could be heard very loudly on Just think of the common terms in both music and the

The Pharos/Spring 2013 29 A maestro’s heart

medicine of the heart: rhythm, beat, pulse. Indeed, it might . Feder S. Gustav Mahler, Dying. Int Rev Psycho-Analysis well be that our universal attraction to musical rhythm is an ; : –. epiphenomenon of our sense of our own heartbeat.25 . Hindemith P. A Composer’s World: Horizons and Limita- tions: The Charles Eliot Norton Lectures –. Cambridge: Heart sounds in music are not unique to Mahler, but rather Harvard University Press; . represent a strong tradition. They exist in Florestan’s Fidelio, . Mitchell D. Mahler and Freud. Naturlaut ; : –. Strauss’s Tod und Verklarung, and Ravel’s La Valse. . Floros C. Gustav Mahler: The Symphonies. Wicker V, Amenta concludes: Wicker J, translators. Milwaukee (WI): Amadeus Press; . . Feder S. Music as Simulacrum of Mental Life. Presented Finally, with Mahler, the heartbeat elements are so sub-  Jan  at the American Psychoanalytic Association. http:// sumed into the art of motivic construction and symphonic internationalpsychoanalysis.net/wp-content/uploads///fe- architecture . . . that there can be absolutely no doubt as to dermusicassimulacrum.pdf. the aesthetic transformation. Mahler did not “document” . Stockhausen K. Introduction. In: De La Grange H-L. Mahler. his heartbeat anymore than he documented a cuckoo song New York: Doubleday; . in his First Symphony. . . . This is also the argument against . Feder S. Gustav Mahler: A Life in Crisis. New Haven (CT): those who would say that Mahler wasn’t highly “accurate” in Yale University Press; . his representation of a heartbeat with a diastolic murmur. . Specht R. Gustav Mahler. Berlin: Schuster & Loeffler; . Well, of course not! . Lebrecht N. Mahler Remembered. London: Faber and Faber; That Mahler opened his symphonic message of farewell . with the representation of his soon-to-be-fatal heart condi- . Cardoso F, Lees AJ. Did Gustav Mahler have Sydenham’s tion should only add an element of poignancy rather than Chorea? Movement Disorders ; : –. seem an intrusion of stark reality into the aesthetic world of . Christy NP, Christy BM, Wood BG. Gustav Mahler and his music, especially in a work like the Ninth Symphony. In the illnesses. Trans Am Clin Climatol Assoc ; : –. essentials, Bernstein was correct.25 . Martner K. Selected Letters of Gustav Mahler. London: Faber and Faber; . . Neue Freie Press  Apr . Coda . Horder T. Eminent Lectures on Endocarditis. BMJ  Apr the somatic autopsy does not answer all the questions . . . : –. What people die with is not the same as what people die . Rosenow EC. Immunological and experimental studies on from. . . . The final illness is a psychosocial as a well as pneumococcus and staphylococcus endocarditis (“Chronic septic medical event, in the same way that a person’s complete endocarditis”). J Infect Dis ; : –. biography is something more than the sum total of medical . Levy D. Gustav Mahler and Emanuel Libman: Bacterial en- and nursing notes during his lifetime. docarditis in . BMJ ; : –. —Avery D. Weisman and Robert Kastenbaum27 . Contrepois A. Towards a history of infective endocarditis. Med Hist ; : –. It is clear that Mahler’s life experiences and physical ail- . Horder TJ. Ulcerative endocarditis and its treatment by ments informed rather than stifled his genius. Through in- vaccine-therapy. The Practitioner ; : –. tense psychological traumas and his ultimately fatal cardiac . Amenta C. The opening of the Mahler Ninth Symphony and disease, Mahler, with the complex and tortured psyche of a the Bernstein “heart-beat” hypothesis. Naturlaut ; : –. true genius, seemed to have found a painful creative spark. . De La Grange H-L. Gustav Mahler. Volume : Vienna Triumph and Disillusion (–). Oxford: Oxford University References Press; . . Plimpton G, editor. Writers at Work. Fourth Series. New . Weisman AD, Kastenbaum R. The Psychological Autopsy: A York: Viking Press; : . Study of the Terminal Phase of Life. New York: Community Health . Neihart M. Creativity, the Arts, and Madness. Roeper Re- Journal; . view ; :–. . Mahler A. Gustav Mahler: Memories and Letters. London: The author’s address is: John Murray; . Division of Nephrology & Hypertension . Walter B. Gustav Mahler. New York: Schocken Books; . 2451 Fillingim Street . Feder S. Gustav Mahler Um Mitternacht. Int R Psycho-Anal Mastin Building, Room 503 ; :–. Mobile, Alabama 36617-2293 . Blaukopf H, editor. Gustav Mahler: Briefe –. Revised E-mail: [email protected] and enlarged edition. Vienna: Publications of the Gustav Mahler Society; .

30 The Pharos/Spring 2013 Alpha Omega Alpha elects honorary members

ndividuals who have contributed substantially to medicine and fields related to medicine, but who are not eligible for membership in AΩA as graduates of a medical school with anI AΩA chapter or as a faculty member of a medical school maintaining an active AΩA chapter, may be nominated for honorary membership by any active member of the society. In  Alpha Omega Alpha’s board of directors extended invitations to the following distinguished physicians and scientists.

Medical School, Chief of the Unit of Genetic Cancer Susceptibility of the International Agency for Research on Cancer in Lyon, France; and Professor of Medicine and Director Slawomir Majewski, MD of the Department of Genetics at Professor Slawomir Majewski is an the University of Bologna School of experienced researcher whose work in Medicine. virology, allergy, dermatology, and on- In , Professor Romeo founded cology is detailed in  full articles and the European School of Genetic  abstracts, papers that have earned Medicine with Professor Victor A. wide recognition. He is of particular McKusick of the Johns Hopkins School prominence for his research on human of Medicine. His contributions to and papilloma virus-linked oncogenesis. He excellence in medical education were has delineated the role of the immune recognized by the American Society of system in the control of human papil- Human Genetics in , when he re- loma virus infections of the skin and ceived the society’s Award for Excellence mucosa as well as the progression of in Human Genetics Education. HPV-associated tumors, molecular and Professor Romeo has published more cellular mechanisms of HPV-associated than  papers in peer-reviewed jour- carcinogenesis, pathogenesis and treat- nals, has served as editor and editorial ment of allergic and inflammatory skin Giovanni Romeo, MD board member of several professional diseases, mechanisms regulating tumor- Professor Giovanni Romeo gradu- journals and other publications, and is induced angiogenesis and the effects of ated cum laude from the University of the founding editor of the European anti-angiogenic compounds, new treat- Bologna School of Medicine and com- Journal of Human Genetics. ment modalities of genital warts and pleted his pediatric residency there. skin cancer, and the immunopathogene- He has been the Group Leader of the sis and treatment of psoriasis and atopic Laboratory of Human Genetics at the dermatitis. His accomplishments have International Institute of Genetics and resulted in membership in the Polish Biophysics, Visiting Scientist in the Academy of Sciences and other acco- Department of Genetics at Stanford lades. Professor Majewski has served as University School of Medicine, promoter in four habilitation theses and Professor of Human Genetics and twenty doctoral ones. He is responsible Director of the Laboratory of Molecular for the residency program in dermatol- Genetics and the Laboratory of Clinical ogy and venereology in his department. Cytogenetics at the University of Genoa

The Pharos/Spring 2013 31 Acacia God created Africa on a whimsical, big Sky-Blue day with spots, finger-paint stripes, long necks, and moving gentle giants—stretching from horizon to horizon. Acacia was placed sentinel to the horizon, anchoring endless blue-sky Africa to the brown, green, yellow, undulating skin of mother earth—the Serengeti. Serengeti grass takes precious water, sun, waste, and gives back life. Fertile, balanced, complete, rich, and life-giving, it hides the weak, the young, and the powerful. Tall, proud people come in awe to this world, loving, caring, living in the grass, moving flocks, fighting, and dying. Succor comes from the sky, from the breast, between the legs of mother giraffe, under the father ostrich, and from death itself. The predator comes with stealth, cunning, and power, And brings death to the old, the weak, the very young, business-like, necessary, and natural. The acacia thorn pierces paw, sole, foot, and Christ’s brow. The sun sets over the horizon, over the acacia and the Serengeti brings hope to Africa.

32 The Pharos/Spring 2013 Man created cities on a desperate cold day in Africa in the Man created war on a stormy, dark day in Africa, image of power, wealth, When tribes and pride and handsome people coveted and efficiency, and millions of God’s children. conspired with leaders born of man’s greed, guns, and hate. The acacia of Nairobi reach modern arms to the African sky and anchor it to Sentinels of the African horizon. Tall proud people cross the concrete and asphalt from horizon to horizon. desert from cultures Kiberra yields birth, life, and irrepressible dignity of which do not nurture life, power, or dignity for mothers, creation, daughters, or children— hidden in waste, mud, metal, and music. driven from their land by war and violence. Succor comes from dying mothers, scraps in the street. Lost Sudanese boys left parents dead or dying and crossed the Enterprising orphans mountains, learn hardness, stealth, and quickness, while longing for to the tar-baby—feeding, protecting, educating them into breast, warmth, and lost men, sucking pride and human love. Waste makes the streets, brings disease, and independence from fierce national bones. catches life-giving water Succor comes from people whose existence, welfare, and splashed from pipes and jugs for precious coins. wealth The predator comes with cunning drugs to hide the pain, depend on the dependence of proud people. squalid, unbelievable rent to live, Sudanese boys become Sudanese men and death comes powerless, loving mothers of dying children. slowly, without dignity. The acacia thorn pierces groin, soul, and Christ’s brow, The predator comes as western wealth squandered with and brings death daily to fathers, mothers, blameless oppression, war, and guns. babies, and hope of all. Child soldiers build kingdoms of hunger, death, and But God lives, and dignity still drives dreams and laughter dependence. in Africa. The acacia thorn pierces pride, independence, family, culture and Christ’s brow. But the sun rises again over Africa, over the horizon, over the acacia and morning brings hope to the Serengeti. Stephen Ray Mitchell, MD

Dr. Mitchell (AΩA, University of North Carolina, Chapel Hill, !"#$) is Dean for Medical Education at Georgetown University School of Medicine. His address is: NW !%$ Med Dent Building, &"%% Reservoir Road NW, Washington, DC '%%(#. E-mail: [email protected]. Illustration by Jim M’Guinness.

The Pharos/Spring 2013 33 Elizabeth Stier The author he resorted to as- is a member of sumption to fill gaps. the Class of 2014 at Knowing Lydia, she was Stanford University, pursuing probably emptying the entire house a degree in Science, Technology & an eternal optimist, “new” was the most of furniture, appliances, knick-knacks, Society. This essay is a remembrance positive descriptor he found applicable. and antiques (her husband included in of her grandfather’s struggle with His wife, Lydia, had brought him to the the latter category) in order to soothe Parkinson’s and Alzheimer’s. “new” place one week ago. Though he one of her frequent bouts of cleaning tried, he could not remember her con- fever. Until she recovered from her ir- ew. He had been grasping for sulting him on the decision. In fact, the rationality, all he could do was wait. the perfect adjective for the more he reflected, the more aware he He imagined his return home: Lydia N better part of seven days. As became of the missing details. Unfazed, proudly describing all the work she had 34 The Pharos/Spring 2013 done, only to unveil the house in the conditions, he began asking the women any desperate grasp for knowledge exact same state as before. He smiled. in white when he could return home. resulted in nothing but the dishearten- For all the fifty years of their marriage, They smiled, looked at him with empa- ing image of an unraveling sweater. each object in their home had always fit thetic eyes, called him “dear” and con- The glow of empathy that once filled snugly in a designated space, reminis- tinued to tie on his bib and spoon-feed the eyes of the women in white gradu- cent of the jigsaw puzzles of which Lydia him the dreaded canned peaches. Being ally dimmed, leaving only the lackluster was so fond. hard of hearing himself from his days glaze of conditioned sympathy. Other Much to his dismay, the days con- flying helicopters in Vietnam, he pitied family members besides Lydia fre- tinued bleeding into one another like the women their deafness. quented the house. Each time they left, a child’s clumsy watercolor painting. Lydia visited every day. She would their lingering gazes, quivering chins, As he became more familiar with the bring some knitting (usually a sweater and moist eyes intimated something house, he could not help but think that for him) and sit beside him while her dark he had yet to accept. Confined to “new” had been an exceedingly inaccu- dexterous fingers clinked the needles his chair as if bound by ropes, optimism rate word. In fact, the house was quite against one another. He was concerned, began to depart, much as memory had. old indeed. The women in white pad- for he knew Lydia only knitted when she He made the decision to become silent, ded across the wooden floors in their needed to distract herself from more hoping that the women in white might sterile little tennis shoes, attending to serious matters. He also noticed that she sense something amiss, and let him others in nearby rooms. He became ac- looked different: sick, strained, more return home. customed to the tinny smell of canned worried than usual. Something very His spirit faded according to plan, peaches, the syrupy aroma that stung serious must be wrong. He asked, but extinguished like the flame of the gas his taste buds somehow preferable she answered with nothing but diver- stove that Lydia would turn off with a to the chemical-laced lemon scent of sion and avoidance, almost as if she loving scold after he had forgotten to Lysol disinfectant that seemed to be was having a conversation with herself. do so. The women in white did notice. in constant use. His whole body grew Sometimes he would extend his hand to So did Lydia. They spent even more stiff from sitting in the wheelchair all stroke her face, wanting to relieve those time at his side, and called in strangers day, and frequently remaining in the closely-knitted lines on her forehead. to make him as comfortable as pos- position through the night. He felt no On these occasions, the omnipresent sible. Why didn’t they understand? He inclination to stand; he might as well women in white would rush forward, was fooling them, he was not actually rest before Lydia put him back to work intercepting his loving gesture. Lydia’s sick! The strangers continually placed a at home. eyes then drowned with sorrow, and cloud of fresh pillows beneath his head Sometimes he caught a glimpse of she would say goodbye, reining in her and tucked comforting blankets tightly another boarder in the house. They all tears as she promised to see him again around him. seemed rather odd. Henry, an ancient the next day. One night, he looked up at Lydia, man nonetheless adept at maneuver- After weeks of confusion, he be- perched loyally at his bedside. He told ing his own wheelchair, continually came infected by doubt. Why did no her of his devious plan to return home, stole his belongings: toothbrush, robe, one answer when he spoke? What was and her smiling eyes let him know that sweatshirts. Henry would roll off with happening at home that so distressed she understood. That comprehension anything in reach, often wearing al- Lydia? These questions had no answers. was all he needed. Closing his eyes, he most nothing but a smug, toothless grin. Instead, the more he reflected, the less let the cloud consume him, dreaming Eden, a woman of equally estimable he discovered he knew. Memories lin- of Lydia, and allowed the final thread age, could be heard babbling nonsensi- gered as a palpable haze in the vault to unravel. cally along with the game show televi- of his consciousness, yet he could not sion channel at all hours of the day, manage to solidify them enough for The author’s address is: only forming coherent words when she extraction. The more effort he put into PO Box 13788 chanted, “Wheel! Of! Fortune!” pursuing his new enemy, Memory, the Stanford, California 94309 Having had his fill of eccentric living more nimbly his adversary fled. Soon, E-mail: [email protected]

The Pharos/Spring 2013 35 2013 Medical Student Service Leadership Project award winners

lpha Omega Alpha is committed to preparing future leaders in Amedicine and health care. Leadership is about making a positive difference, and is learned through education, ob- servation, and experience, and working with leader mentors. Service leadership may develop an excellent opportunity for students to develop as servant leaders. The most effective leaders are well grounded in and committed to positive professional values. The winning projects receive  for the first year,  for the second year, and  for the third year The winners of this year’s award are:

Duke University School of Medicine: The Duke Leadership Education and Development Program Despite a growing need for physician leaders in the U.S. health care system and abroad, very little formal leadership training occurs at the medical student level. Duke University School of Medicine hopes to change that by implementing the Duke Leadership and Education (LEAD) Program, a formal, four-year leadership curriculum for all Duke medical students. Through this program, Duke aims to develop and train future physicians to be more ef- Teams of students, residents, and fellows compete in a communication exercise.

The team members of the Duke LEAD Program, kneeling (left to right): Shannon O’Connor, Jacob Berchuck, Deeptee Jain, Kyle Gibler, Ankit Mehta, MD, and Mitch Bassett. Second row (left to right): Kathy Coyner, MD, John Anderson, MD, Scott Adams, MD, Maureen LeBoeuf, PhD, Stephanie Mayer, MD, Anupam Pradhan, MD, Marty Head, John Feagin, MD, Nicholas Viens, MD, Jane Boswick-Caffrey, Grant Sutter, Judy Seaber, Dean Taylor, MD, and Bobby Murrah, MD.

36 The Pharos/Spring 2013 The SUNY Upstate team for Helping Hands for Forgotten Feet, from left to right, back row: John Kulesa, Austin Meeker, Kyle Devins, John Pizzutti, Rob Handzel. From left to right, front row: Lin Deng, Matt Helm, Tim Kuchera, Dr. Ryan D’Amico, Jess Sassani, Delia Vahey, Leesha Alex, Ericka Steinbrenner. fective agents of change in dynamic and service projects. Faculty mentors will to serve their community while devel- complex health care environments. teach and mentor students in all four oping leadership and advocacy skills The following core competencies years of the curriculum and serve as ad- through a program that brings together represent the desired outcomes of the visers for experiential learning projects. AΩA members and junior medical stu- program. These competencies will be Project team members are: Student dents. evaluated and tracked using faculty leader Kyle Gibler (AΩA, Duke The AΩA chapter has developed a and peer evaluations and feedback: University, ) and student team leadership curriculum to supplement fundamental leadership theory, self- members Marisa Dowling, Parastou HHFF clinical activities. There will management, teamwork, communica- Fatemi, Nimit Lad, and Peter Wei. be four to six scheduled interactive tion, mentorship, health care acumen, Mentor leader Dean Taylor, MD; and lectures each academic year pertain- service, improvement, and innovation. mentor team members Saumil Chudgar, ing to the role of a leader, improving The LEAD Program will span all MD (AΩA, Duke University, ), and communication and leadership skills, four years of medical education. The Devdutta Sangvai, MD, MBA. and the role of advocacy in medi- first and second years will be primarily cine, among other topics. In March, didactic, focusing on lectures, work- State University of New York Dr. Gregory Eastwood, Professor of shops, and small group activities. The Upstate Medical University: Bioethics and Humanities, Professor third and fourth years will be experien- Helping Hands for Forgotten Feet of Medicine, and former President of tial, providing students real-world op- Helping Hands for Forgotten Feet Upstate Medical University, will be portunities to practice newly acquired (HHFF) is a novel program designed speaking to the student body regard- skills through a variety of active lead- by medical students of SUNY Upstate ing defining the role of a leader in a ership roles, including underclassmen Medical University to provide foot clinical context. Participating students mentorship and hospital-based service care and health education to the large will have an opportunity to improve projects. homeless population that frequents the leadership and advocacy skills at each The curriculum will include a di- Syracuse Rescue Mission. The clinical clinic, with fourth-year AΩA medi- verse team of speakers and collabora- goals of this project are: cal students overseeing the clinic and tors, such as individuals from Duke . Conduct semiannual shoe and first-year medical students gaining in- School of Medicine, Duke Fuqua sock drives for the Rescue Mission. creasing amounts of responsibility and School of Business, Duke Corporate . Organize and run a monthly foot experience as the year progresses. Education, the Institute for Healthcare care clinic at the Rescue Mission to pro- HHFF held its first free clinic on Improvement Open School, and the vide medical foot care and offer basic February , . Eighteen patients Feagin Leadership Program. Duke care supplies. received care and treatment for various LEAD Program student leaders will . Conduct foot care education ses- problems ranging from painful calluses have the opportunity to assist in the sions at the Rescue Mission to improve to ankle sprains and poor shoe support delivery of lectures and workshops and the medical literacy and health of this from eight first-year medical students, will also work with organizations within patient population. and two physicians, including two AΩA the hospital and the community to Additionally, this project allows members. We reached capacity and identify opportunities for experiential Upstate Medical University students already have a full patient roster for the

The Pharos/Spring 2013 37 next clinic in March. Project team members are: Student leader Jessica Sassani and student team members Matthew Helm, Stefanos Haddad, and Caitlyn Foote. Mentor leader Susan Stearns, PhD (AΩA, SUNY Upstate University, ) , and mentor team members Lynn Cleary, MD (AΩA, Ohio State University, ); Ruth Weinstock, MD, PhD (AΩA, Columbia University, ); Ryan D’Amico, DPM; and Thomas Helm, MD (AΩA, Albany Medical College, ).

Mercer University School of Medicine Service Leadership Program Foreseeing an era of physician leaders trained to collaborate more closely and advocate more effectively for the needs of the underserved, students at Mercer University School of Medicine Some of the team members of the Mercer University School of Medicine Service (MUSM) will create an experiential Leadership Program. Left to right: Brian Renken, Andres Montes, Mary Kate Claiborne, leadership training program focused Keith Reeves, Tia Bingham. on the development of community- responsive physician leaders. The Insights from faculty, staff, and com- Savannah and The Hearts and Hands project includes the following three munity stakeholders, as well as precep- Clinic (HHC) in Statesboro. Students key components: developing and im- tor and student-led reflections will be will have the opportunity to directly plementing a service-leadership cur- integrated into the curriculum as well. reach Savannah’s underserved urban riculum, developing a community Additionally, students will have the op- patients through CHM and, through mentoring program, and developing a portunity to present their findings at a HHC, to treat underserved individuals student-driven free health care clinic. MUSM service-learning conference. from rural and migrant populations. Leaders of the School of Medicine fore- The Saturday clinic will benefit the see offering this program to the Macon Community mentoring program clinics and the patients by reducing pa- and Columbus campuses as well. In parallel with the leadership cur- tient waiting lists for the clinics. As the riculum development, interested stu- students develop and implement the Service-leadership curriculum dents will have the benefit of building Saturday clinics, the “hands on” lead- During the project period, students mentoring relationships with commu- ership experience will reinforce core will explore leadership curricula im- nity leaders. Through four to six one- competencies developed through the plemented at other medical schools. on-one sessions during the year, the leadership curriculum. Experts will be invited to the Savannah community mentor will help students Project team members are: Student Campus to share their insights on the to understand the plight of the under- team leader Mary Kate Claiborne and content and structure of leadership pro- served, the role of service organiza- student team members Andres Montes, grams—these sessions will be videocon- tions in promoting community health, Godfrey Ilonzo, Alison Smith, Tia ferenced to the Macon and Columbus and the employment of core leadership Bingham, Keith Reeves, Bryan Renken, campuses. Other speakers at monthly skills in practice. and Haresh Soorma. Mentor leader meetings will provide instruction on Martin Greenberg, MD (AΩA, Albany such topics as advocacy, law, and the Student-run medical clinics Medical College, ); and mentor legislative process. The proposed ser- Students will partner with two vol- team members T. Philip Malan, Jr., MD, vice leadership curriculum will include unteer and nonprofit organizations PhD; Marie Dent, PhD, EdS, MBA; defined competencies, delivery meth- that provide free/low-cost health care Robert Shelley, MD; Sarfaraz Dhanji, ods, evaluation approaches, and a dis- for medically underserved individuals: MD; and Miriam Rittmeyer, MD, PhD, semination plan for all three campuses. Community Health Mission (CHM) in MPH.

38 The Pharos/Spring 2013 Reviews and reflections David A. Bennahum, MD, and Jack Coulehan, MD, Book Review Editors

mid-, and late-career viewpoints, to- Mahler, highlighting music as an es- gether with pediatric and adult med- pecially powerful source of spiritual icine perspectives, on the emotional uplift and transcendence of suffer- and psychological challenges of prac- ing. A Wayfarer’s Journey: Listening tice, mostly in the field of oncology. to Mahler—the featured film in these Significantly, several panelists draw on chapters—showcases the thoughts of their own experiences as cancer pa- Mahler-enthusiast and former music tients, notably Dr. David Biro, author of director of the Philadelphia Orchestra, a pair of fine books on the experiences, Christoph Eschenbach. Both Mahler respectively, of illness1 and of pain.2 and the maestro found in music the Chapter , “The Journey to Healing,” solace and creative courage to overcome examines how the suffering of serious the darkest of personal circumstances illness may be transcended or at least and to inspire others—not least physi- transformed. Between his cancer di- cians—in the redemptive art of active agnosis and his early death, Dr. Peter listening. Pointing to the great com- Morgan is shown discovering that re- poser and his renowned conductor, the newed devotion to teaching and mod- panelists urge physicians not to retreat eling the art of close attentiveness to from patients in their darkest hour but, Healing Through Humanism: patients’ suffering ultimately helps him Virgil-like, to guide patients through Physician Discussions transcend his own. Before and after that darkness. With such guidance, they and Film Presentations for this featured film, panelists explore in argue, a kind of spirit-resurrection may Doctors and Other Caregivers some detail the importance of empathy be possible, whether from the stress Interested in the Practice of for each patient’s singular plight to the and fatigue of clinical oncology or from Compassionate Medicine self-insight, affiliation, and resiliency the experience of terminal illness itself. that such connection builds. This chap- Finally, this segment asserts that since A 5-DVD Teaching Series. Written, ter also highlights Drazen’s method of the costs of medical training to one’s produced, and directed by Ruth Yorkin infusing her documentaries with inter- personal life and selfhood can be steep, Drazen. Viewing time: 4 hours. spersed illuminative artworks, including trainees should try hard to retain or New York, Ruth Yorkin Drazen music, painting, poetry, photography, develop interests outside the profession Productions, 2011 sketching, and sculpture, as well as that can provide much needed suste- filmed scenes from nature, history, and nance of spirit. Reviewed by Jack Truten, PhD, FCPP biography. Chapter , “All Real Living Is Chapter , “Sharing the Experience,” Meeting,” focuses on the life and philos- n her five-DVD teaching opus, further mines the insights of physi- ophies of Viktor Frankl in the film The Healing Through Humanism, re- cians’ personal experiences of living Choice Is Yours and its central concept doubtableI nonagenarian documentary with cancer by presenting six such sto- of transcendence not only of suffer- filmmaker Ruth Drazen presents a pro- ries. Collectively conceived as situated ing, but through suffering. According fusion of humane thought and artistic “on the edge of being,” these narratives to Frankl—himself a victim of severe expression to illuminate the interde- give voice to doctors’ and patients’ twin deprivation and loss—we must decide pendence of clinician and patient well- concerns about the limits of treatment through our encounters with tragedy being. Drazen’s target audiences—senior and the fear of failure, as well as how how to either preserve or tarnish our physicians and their trainees—will find poor communication about these top- human dignity. For oncologists in par- in these artfully produced and nimbly ics can paralyze all involved. To ne- ticular, who routinely face trauma and edited films provocative and persuasive glect such discussions, of course, is to tragedy, this chapter offers the pos- evidence that the arts and humanities, if confirm what dying patients and their sibility of a sustainable philosophical given the chance, offer a unique power families fear most—abandonment in pathway to professional and personal to heal broken bodies and spirits. their pain and anguish—and so panelists purpose. The panelists’ concluding mes- Each of the five DVD-chapters in here recommend a more humane, open sage echoes Frankl’s: the art of medicine, this series features a central film partnership with patients in their pain fully and expertly practiced, amounts to presentation flanked by discus- treatment and palliative care. a life full of meaning or, in its unique sion among a panel of phy- Chapters  and , “The Search for capacity for transcendence, “super- sicians. Panelists were Inner Strength” and “Confronting meaning.” carefully selected to Despair” look for their joint inspira- In its encyclopedic inclusion of the represent early-, tion to the life and work of Gustav arts and humanities and its in-depth

The Pharos/Spring 2013 39 Reviews and reflections

consideration of how in tandem they incompatible with Darwinian principles. can alleviate the suffering of doctors Proposed mechanisms like kin selection and patients alike, this instructional and reciprocal altruism can account for DVD-set argues persuasively for its own some acts of altruism, but only if the inclusion across all medical training recipients are close relatives, or persons curricula. These curricula, however, likely to provide you with benefits in are already densely packed and we hear return. But what about “pure” altru- little in response to the two oncology ism, like providing substantial help to fellow panelists who wonder when they strangers, or risking your life to uphold can ever find the time to integrate these a moral principle? Whatever its origin, medical humanities dimensions and however, altruistic motivation is not practices into their daily work. As the only well-established among humans, fellows themselves point out, however, but is almost universally considered certain attendings of their acquaintance admirable, a virtue to be nurtured and somehow manage to integrate and praised. model these very approaches in all their But does altruism ever run amok? patient-encounters and so it is to those Can someone become an “altru-ma- senior clinical educators that this exem- niac,” thus turning a virtue into a vice, from a wide variety of perspectives. plary instructional DVD-set should be or a pathology? Perhaps there is a com- Chapter , for example, examines the marketed. pulsive, addictive, guilt-ridden “dark relationship between survivor guilt and side” of altruism that we rarely acknowl- pathological altruism, which, the au- References edge. In Pathological Altruism, a collec- thors argue, is mediated through empa- . Biro D. One Hundred Days: My Un- tion of essays edited by Barbara Oakley, thy. An over-empathetic response to the expected Journey from Doctor to Patient. Ariel Knafo, Guruprasad Madhavan, suffering of others, often triggered by New York: Vintage; . and David Sloan Wilson, a number of surviving a catastrophe in which many . Biro D. The Language of Pain: Find- eminent psychologists, neuroscientists, lives were lost, creates guilt, which then ing Words, Compassion, and Relief. New psychiatrists, anthropologists, and legal leads to excessive altruistic behavior: York: Norton; . scholars explore these questions. Under e.g., a Twin Towers survivor ignores certain conditions, they claim, altruism her own family to devote herself to sup- Dr. Truten is a medical education consul- “can be the back door to hell.” p4 port services for families of deceased tant and directs the Narrative Profession- The book provides a number of victims. Other essays consider the re- alism program for residents, fellows, and closely related definitions for patho- lationship of pathological altruism to faculty at the Hospital of the University of logical altruism, of which Homant and self-addiction and self-righteousness Pennsylvania. His address is: Kennedy’s is representative. Altruism is (Chapter ), personality disorders (), 422 Penn Road pathological when: eating disorders (), victimization (), Wynnewood, Pennsylvania 19096 t *U JT ϰ ϰ VOOFDFTTBSZ PS VODBMMFE and even suicide martyrdom (). E-mail: [email protected] for. These essays are generally educa- t 5IF BDUPS JT MJLFMZ UP DPNQMBJO tional, provocative, and well worth read- Pathological Altruism about the consequences of the altruism, ing. I finished the book with a renewed Edited by Barbara Oakley, Ariel Knafo, yet continues doing it anyway. appreciation of the mind’s complexity Guruprasad Madhavan, and David t 5IF WBMVFT PS OFFET XJUIJO UIF and having learned about several new Sloan Wilson altruist that motivate the behavior may developments in psychology and genet- themselves be irrational, or symptoms ics. I learned, for example, that cultural New York, Oxford University Press, of psychological disturbance. differences in social behavior are associ- 2011 t 5IF BMUSVJTN JT PG OP SFBM CFOFGJU ated with cultural differences “in allele p193 Review by Jack Coulehan, MD ( , to anyone. frequency of serotonin transporter- AΩA p291 University of Pittsburgh, 1969) Not all of these features need be polymorphic region v variants.” I present for altruism to be pathologi- also discovered Williams syndrome, a cal. Thus, the diagnosis is a matter of fascinating genetic condition in which rom an evolutionary perspective, judgment, based on a preponderance of affected persons are compulsively so- altruism is a tough nut to crack. For evidence. ciable, caring, and hyper-empathic.p116 decadesF biologists have argued over the Given this somewhat loose construct, Likewise, the discussion in Chapter  origin of a trait that seems, prima facie, the book’s authors approach the topic about the association between altruism

40 The Pharos/Spring 2013 and the pathological obedience (i.e., time. I strongly recommend it for the Harvey Cushing had no surgical equal at “I’m just following orders) that can lead reader who enjoys intellectual debate his zenith, but was profoundly unsuited to genocide was both provocative and and discovering leading-edge ideas. for institutional leadership. On rare oc- sobering.p225 casions an individual may excel at all Nonetheless, I came away from Dr. Coulehan is a book review editor for three, perhaps best exemplified in our Pathological Altruism with an uneasy The Pharos and a member of its editorial time by Joseph Goldstein, whose clini- feeling that the concept itself is mis- board. His address is: cal expertise in familial hyperlipidemias leading. Bernard Berofsky captures my Center for Medical Humanities, was combined with extraordinary skill biggest concern with the title of his es- Compassionate Care, and Bioethics in the laboratory and a powerful but say, “Is pathological altruism altruism?” HSC L3-80 selfless domain of leadership, both at his (Chapter ) To me, the simplest and State University of New York at Stony home institution and in American bio- clearest answer is no. If altruistic moti- Brook medical science. After reading Alfalfa to vation becomes distorted by psychiatric Stony Brook, New York 11794-8335 Ivy, I am inclined to place Joseph Martin disorders to the extent that it no longer E-mail: [email protected] in the same pantheon of leaders who produces (real) altruistic behavior, isn’t have made a difference not only in their it more reasonable to attribute the dys- medical specialty, but also biomedical function to those disorders, rather than science in general. inventing a “dark side” of altruism? If I In the first part of this autobiogra- experience a compulsion to help others, phy, Dr. Martin pays great tribute to even though they don’t need my help, his parents and childhood in Alberta, or my help will be futile, or I may harm Canada. Readers anxiously wanting to myself in the process, it makes sense to get to his later career may feel this part consider this a manifestation of obses- of his journey is overdone but, make no sive-compulsive disorder. If I experience mistake, family and upbringing were a need to donate my life savings to char- critical to his success. The author obvi- ity because of overwhelming guilt and ously cherishes the moral values and feelings of worthlessness, personality work ethic imparted by his parents, as disorder and clinical depression seem well as the mechanical skills he gained more likely culprits than pathological growing up on a farm. A photograph altruism. The concept itself, at least on page  shows Martin adjusting a as I understand it, appears to violate stereotactic instrument during his early Occam’s razor without providing sig- research career in Montreal. While his nificant theoretical or practical benefits. hands are so large as to jump off the In addition to this conceptual issue, page, one has a sense of how his earlier I’m also uneasy about the rhetorical Alfalfa to Ivy: Memoir of a agrarian experience shaped them, and implications of adopting this new term. Harvard Medical School Dean the man. In a society that glorifies greed and The author describes his career odys- self-interest, altruistic behavior seems Joseph B. Martin (AΩA, University of sey with engaging detail. For example, increasingly threatened with marginal- Alberta, 1960) many readers will enjoy learning about ization. Yes, we still approve of giving University of Alberta Press, Edmonton, the extraordinary role that Montreal modest assistance to others, but we Alberta, 2011 played, and continues to play, in the tend to be skeptical of self-effacement Reviewed by Thoru Pederson, PhD modern era of neurology. The author’s and heroic sacrifice. The use of “patho- description of his training in Montreal, logical altruism” is likely to enhance accompanied by a site map of the city’s this trend by seeming to make excessive utobiographies of physician- key medical institutions, illuminates the altruism a sickness in itself. This is evi- scientists occupy a subset within politics that prevailed there, as well as his dent, for example, in an essay by Arum theA clade. Their focus may range from personal experiences. Martin’s recruit- Gandhi, Mohandas Gandhi’s grandson, the pure medical career, to the inter- ment to Harvard Medical School and the in which he defends his grandfather face between clinic and lab, or in some subsequent Boston-Montreal battle to against the charge of pathological altru- cases, to the triangulation of those two sign him make fascinating reading. ism (Chapter ). domains with academic leadership. The One of the most stirring chapters in Nonetheless, this is one of the most ferocious William Welch excelled at the the author’s distinguished career was his provocative books I’ve read in a long latter more than with his bedside skill. seminal role in the new era of genetic

The Pharos/Spring 2013 41 Reviews and reflections

linkage analysis of human disease. As knowledgments run to six pages, nearly Chair of Neurology at Mass General, twice the length of his foreword. he assembled a center- without-walls When I attended the memorial sym- to search for the gene(s) that predis- posium for my friend Judah Folkman on pose to Huntington’s Disease. Led the Avenue Louis Pasteur at Harvard by James Gusella, a young geneticist Medical School a few years ago, the Martin recruited, in amazingly short well-appointed auditorium in which the order (three years) the team closed in event was held was named for Joseph on the chromosomal neighborhood of Martin. As the day went on, I reflected a locus linked to the disease. Not only on the lives of Drs. Folkman and Martin, did this prescient work pave the way to two great men of medicine, and felt that subsequent identification of the gene, both were present on the stage that day. it also demonstrated how this linkage Like Folkman, Joseph Martin raised approach could be applied more gener- the gold standard of medical science ally. In due course, this approach led to and leadership, and his autobiography the identification of many other disease brings us that story in a most down- predisposition or causative genes. Dr. to-earth, yet memorable style. Martin can be considered both composer and conductor of the overture to Dr. Pederson is the Vitold Arnett Profes- Says who? Well, Denton Cooley himself, this grand symphony. sor in the Department of Biochemistryand in his new autobiography, , Hearts. Though it describes his scientific Molecular Pharmacology at the University The sentiment is not meant to be work in some detail, an overriding of Massachusetts Medical School. His ad- boastful. Rather, it is one of Cooley’s theme of this autobiography is leader- dress is: many practical reflections on the chang- ship. Martin reviews his career ascent University of Massachusetts Medical ing culture of medicine that he’s seen in modest, but realistic, tones, express- School in his seventy-year career as one of the ing gratitude for the opportunities Department of Biochemistry and Mo- world’s most famous and accomplished that came his way, while documenting lecular Pharmacology heart surgeons. Cooley entered cardiac his successful leadership roles at the 377 Plantation Street surgery in its germinal stages, when now- University of California, San Francisco, Worcester, Massachusetts 01605 standard concepts like prosthetic valves, and later at Harvard, where his tenure as E-mail: [email protected] cardiopulmonary bypass, and heart cath- Dean of the Medical School was highly eterization were but a distant twinkle in acclaimed both on campus and from 100,000 Hearts: A Surgeon’s the imaginations of visionary MDs. Low- afar. Joseph Martin’s influence on medi- Memoir hanging fruit crowded the trees of early cal education went very far beyond the cardiac surgery; “firsts” were waiting to Denton A. Cooley (AΩA, Johns guild of neurology. Hopkins University, 1944) be grabbed by the bold hands of surgeons In addition to being engagingly in emergent situations. written, the book is enriched by many Briscoe Center for American History, Cooley writes of one of these mo- photographs of family, colleagues, and Austin, Texas, 2012, 300 pages ments: “the aorta had ruptured, and events. Of special pleasure to me was Reviewed by Casey Means there was a pool of blood that spurted the superb index, which academic auto- so high, it hit the operating room light. biographies sometimes lack, to the great Dr. Ward immediately thrust his left frustration of the avid reader. It is also of mbitious cardiothoracic surgeons hand into the patient’s chest and blocked interest to note that, in keeping with his are out of luck: there will never be the opening with his left index finger. humility and character, the author’s ac- anotherA surgeon like Denton Cooley. ϰ ϰ IF UVSOFE UP NF BOE TBJE AJUT ZPVS

42 The Pharos/Spring 2013 operation now. See what you can do to and business leaders were older, stressed his daily schedule, waking at   every get my finger out of the hole.’ ” p73 Out men—the prime demographic for cardio- day of the week, working at the hospi- of necessity, Cooley sliced a piece of the vascular pathology—Cooley had many tal till : , and returning home to patient’s muscle to patch the aorta. With high-profile patients who were quick to write between   and midnight. This the blood deluge momentarily tempered, repay him with lavish invitations and dedication allowed him to author , he thought rapidly about how to proceed, gifts. What is quite likeable about Cooley scientific papers, and for the “Cooley and then decided to briefly clamp the is his appreciation of these perks. The team” to perform over , heart aorta so that he could remove the muscle intimate dinners in the home of Princess surgeries. He refrains from lingering on patch and approximate the sides of the Grace, Lamborghini adventures through the difficulties that may have driven a rupture directly. In that rushed moment, the back roads of Belgium with the coun- less resilient physician to burnout: the Cooley became the first to perform a try’s royal family, golf and waterskiing bureaucratic politics surrounding the direct aneurysm repair. with the Philippine president, full-page founding of his Texas Heart Institute, the Cooley takes the reader back to his cover photos in Time magazine, med- high mortality rates of his early surgeries, beginnings as a medical student and als bestowed by U.S. Presidents. Cooley the lawsuits filed against him by patients resident during WWII, when partial gas- genuinely enjoyed these experiences, and he cared deeply for, his brush with bank- trectomies were performed under local describes them with detail and delight. ruptcy, his daughter’s suicide. Instead, anesthesia, calcified valves were broken What Cooley’s autobiography fails he mentions these struggles to highlight open with a forceful finger inserted into at is in serving as a how-to guide for the positive aspects of his life, including the heart, and some surgeons did not becoming a world-renowned surgeon. his love for his wife and his passion for wear gloves because rubber was in short Indeed, Cooley displayed numerous sports, which served to bolster his un- supply. He walks the reader through traits of any successful leader: a will- wavering ability to cope. his personal experience as a trailblazer ingness to work long hours, risk-taking Amidst the shiny sterility and low in nearly every major development in behavior, self-reflection, and ambition. mortality of the modern OR, Cooley’s heart surgery since the inception of the But much of becoming Denton Cooley book reminds the medical profession of field. Cooley’s distinction lies in the sheer was the luck of being in the right place at the bold and messy history of surgical number of “firsts” he was a part of: the the right time; events that can be inspir- discovery. Through Cooley’s reflections, first successful heart transplant, the first ing to read about but difficult to emulate. readers can see that in putting their own successful CEA, the first ruptured AAA In his story, medical school admissions hearts into their work, patient-care, and excision, the first pulmonary embolec- letters, supportive mentors, surgical op- research, they too have the potential to tomy, some of the first CABGs. Many portunities, and substantial donations touch ,. of the medical terms used in day-to-day for his research seem to manifest from practice in any hospital lead directly back thin air, not consonant at all with the Ms. Means is a third-year medical student to Cooley’s OR. cutthroat two-percent acceptance rates at Stanford University. She is a section edi- Indeed, for the modern physician- common to today’s medical schools and tor for H&P, Stanford’s student-run medi- scientist who may spend years charac- grant awards. Cooley is aware of his cal humanities journal, and has been an terizing a single protein in a single type good fortune, and addresses it in his final organizer of Stanford’s medical humanities of heart cell, Cooley’s stories will incite a Summing Up chapter, noting that he’s conference Medicine and the Muse. She lust for that perfect milieu of lawlessness “always believed the key to my success plans to be a surgeon. and lack-of-alternatives that allowed for was that I recognized the opportunities E-mail: [email protected] high-risk rapid surgical progress and the put in front of me and acted on them. development of heroic reputations for in- And acting on them usually involved re- dividual surgeons like Michael DeBakey ally hard work.” p202 and Cooley. And hard work he did, without a trace Since many of the world’s political of self-pity or regret. Cooley outlines

The Pharos/Spring 2013 43 2012 donations to Alpha Omega Alpha

hank you to our members who donate to the society. Your Tcontributions, in addition to dues, help us to both support and expand our national programs for medical students, faculty, and residents. We greatly appreciate your support! Members are listed in alphabetical order. The induction year and school at which the member was inducted are noted in parentheses.

A Mark Lee Appler ( Wake Forest School Linda M Balogh ( Wayne State University Irving P Ackerman ( Columbia University of Medicine of Wake Forest Baptist Medical School of Medicine) College of Physicians and Surgeons) Center) Leonard C Bandala ( University of Illinois Kent R Adamson ( University of Minnesota George Foster Armstrong Jr ( Duke University College of Medicine) Medical School) School of Medicine) Francine M Baran ( Drexel University College Jonathan Scott Adkison ( University of South Dominic D Aro ( New York Medical College) of Medicine) Alabama College of Medicine) Robert F Ashman ( Columbia University Jodi M Barboza ( University of Arkansas for Sean Agbor-Enoh ( Johns Hopkins University College of Physicians and Surgeons) Medical Sciences College of Medicine) School of Medicine) Arnold R Atkins ( Tulane University School Edward S Barnes ( Mount Sinai School of Jeffrey D Ager ( Saint Louis University School of Medicine) Medicine) of Medicine) Robert G Atnip ( University of Alabama Margaret M Barnes ( Temple University Chloe Gray Alexson ( University of Rochester School of Medicine) School of Medicine) School of Medicine and Dentistry) Nelly Auersperg ( University of Washington Florence C Barnett ( Medical College of Kwame Sarpong Amankwah ( State School of Medicine) Georgia at Georgia Health Sciences University) University of New York Upstate Medical Kirk O Austin ( Mercer University School of Lynn Ellen Barrett-O’reilly ( University of University) Medicine) Alabama School of Medicine) Akshay N Amin ( University of Maryland Richard C Austin ( Weill Cornell Medical Charles P Barsano ( Chicago Medical School School of Medicine) College) at Rosalind Franklin University of Medicine & Valerie Ammann ( University of Medicine Francisco Aviles-Roig ( University of Puerto Science) and Dentistry of New Jersey—Robert Wood Rico School of Medicine) Wallace E Bash ( Indiana University School of Johnson Medical School) Eric W Ayers ( Wayne State University Medicine) Louis F Amorosa ( University of Medicine School of Medicine) Jerome V Basinski ( Saint Louis University and Dentistry of New Jersey—Robert Wood School of Medicine) Johnson Medical School) B James G Bassett ( Drexel University College Clay M Anderson ( University of Missouri— Amy C Bacchus ( University of Texas Medical of Medicine) Columbia School of Medicine) Branch School of Medicine) James A Bastron ( University of Iowa Roy J Tom Anderson ( Medical College of Clark Bailey III ( University of Kentucky and Lucille A Carver College of Medicine) Wisconsin) College of Medicine) Elizabeth A Bayliss ( University of Colorado Ellen Andrews ( Meharry Medical College) David Nelson Bailey ( Yale University School School of Medicine) Jared L Antevil ( University of Virginia School of Medicine) Eileen A Bazelon ( Drexel University College of Medicine) Samir K Ballas ( American University of of Medicine) Ronald I Apfelbaum ( Hahnemann Medical Beirut School of Medicine) Joseph B Beaird ( University of Alabama College) School of Medicine)

44 The Pharos/Spring 2013 Sharon P Beall ( Medical College of Georgia Victor D Bowers ( USF Health Morsani George H Caspar ( Oregon Health & Science at Georgia Health Sciences University) College of Medicine) University School of Medicine) David M Bear ( Harvard Medical School) Mark S Box ( University of Missouri— Charles A Castle ( University of Virginia Richard A Beison ( Indiana University School Columbia School of Medicine) School of Medicine) of Medicine) Stephen J Brabeck ( University of Minnesota Mary Cavill Hough ( University of California, David J Bender ( University of Minnesota Medical School) San Francisco, School of Medicine) Medical School) Barbara H Braffman ( Albert Einstein College Assaad Alfred Chahine ( Saint Louis Alan H Bennett ( Albany Medical College) of Medicine of Yeshiva University) University School of Medicine) N Barry Berg ( State University of New York Jennifer Brainard ( Ohio State University Susan B Chamberlain ( Wayne State Upstate Medical University) College of Medicine) University School of Medicine) Teresa G Berg ( University of Nebraska Mellena D Bridges ( Medical College of Nancy L Chapin ( Boston University School College of Medicine) Georgia at Georgia Health Sciences University) of Medicine) Gretchen Glodé Berggren ( University of Roy D Brod ( Temple University School of David G Chase ( University of California, Nebraska College of Medicine) Medicine) Davis, School of Medicine) James Joseph Bergin ( University of Kansas James E Brodhacker ( Saint Louis University Marvin H Chasen ( Ohio State University School of Medicine) School of Medicine) College of Medicine) Frank W Berry Jr ( Meharry Medical College) James O Brookins II ( Meharry Medical Jane L Chen ( University of Maryland School Sidney R Berry ( University of Tennessee College) of Medicine) Health Science Center College of Medicine) Donald D Brown ( University of Iowa Roy J Allan J Chernov ( University of British Edgar Betancourt Cintron ( University of and Lucille A Carver College of Medicine) Columbia Faculty of Medicine) Puerto Rico School of Medicine) James T Brown ( University of Illinois College Francis A Chervenak ( Jefferson Medical Robert F Betts ( University of Rochester of Medicine) College of Thomas Jefferson University) School of Medicine and Dentistry) Karen T Brown ( Boston University School of Peter C Chilian ( University of Colorado David A Bianchi ( George Washington Medicine) School of Medicine) University School of Medicine and Health Noel Anderson Brownlee ( Wake Forest Mahmoud Choucair ( American University of Sciences) School of Medicine of Wake Forest Baptist Beirut School of Medicine) Joseph N Biase ( University of Medicine and Medical Center) James H Christy ( Emory University School Dentistry of New Jersey—Robert Wood Johnson Richard D Buchanan ( Vanderbilt University of Medicine) Medical School) School of Medicine) John P Christy ( Washington University in St Michael C Bidgood ( University of Neilly Ann Buckalew ( University of Louis School of Medicine) Washington School of Medicine) Pittsburgh School of Medicine) Bernard J Clark ( Georgetown University Robert F H Birch ( University of New Mexico Terrence J Bugno ( Northwestern University School of Medicine) School of Medicine) The Feinberg School of Medicine) John A Clark ( University of British Columbia Edgar R Black ( Raymond and Ruth Perelman Jeffrey M Bumpous ( University of Louisville Faculty of Medicine) School of Medicine at the University of School of Medicine) Blair Clementson ( University of South Pennsylvania) Petra Burke Ramirez ( University of Puerto Carolina School of Medicine) Reaford Blackburn Jr ( University of Louisville Rico School of Medicine) James A Clifton ( University of Iowa Roy J School of Medicine) John K Burkus ( Yale University School of and Lucille A Carver College of Medicine) Thomas P Bleck ( Rush Medical College of Medicine) Emily D Cline ( Indiana University School of Rush University Medical Center) John Burton ( Johns Hopkins University Medicine) Gary F Bloemer ( University of Louisville School of Medicine) Douglas A Coe ( University of Missouri— School of Medicine) Louis A Buzzeo ( Tufts University School of Kansas City School of Medicine) Linda K Blust ( Medical College of Medicine) Kenneth L Cohen ( University of Iowa Roy J Wisconsin) Patricia J Byrns ( University of Colorado and Lucille A Carver College of Medicine) Richard Boccio ( Wayne State University School of Medicine) Mark D Cohen ( Indiana University School of School of Medicine) Medicine) Ernie Bodai ( University of California, Davis, C Francis R Colangelo ( Jefferson Medical School of Medicine) Mark A Caldemeyer ( Indiana University College of Thomas Jefferson University) Henry J Boehm Jr ( University of Texas School of Medicine) Ruth A Conn ( University of Hawaii, John A Medical Branch School of Medicine) Jeffrey P Callen ( University of Louisville Burns School of Medicine) William E Bolton ( University of Illinois School of Medicine) Paul V Connaughton ( Medical College of College of Medicine) Marie A Capitanio ( Drexel University Wisconsin) Stuart Bondurant ( Albany Medical College) College of Medicine) Donald P Connelly ( University of Minnesota Vivien Boniuk ( Dalhousie University Faculty Michael A Carducci ( Wayne State University Medical School) of Medicine) School of Medicine) William F Conway ( University of Chicago Cynthia Moore Bonner ( University of Luis Carlos Castillo ( Meharry Medical Division of the Biological Sciences The Pritzker Alabama School of Medicine) College) School of Medicine) Christopher A Bonnet ( University of Robert E Carney ( University of Washington Jack E Cook ( University of Colorado School Pittsburgh School of Medicine) School of Medicine) of Medicine) Frederick J Bonte ( University of Texas Gene A Carpenter ( University of Michigan Thomas G Cooney ( Oregon Health & Southwestern Medical Center at Dallas Medical School) Science University School of Medicine) Southwestern Medical School) Francisco Carpio ( Universidad Central del Andrew Coronato ( New York Medical Susan B Boutilier ( University of California, Caribe School of Medicine) College) Davis, School of Medicine) Laura R Carucci ( State University of New Robert F Covert ( USF Health Morsani York Upstate Medical University) College of Medicine)

The Pharos/Spring 2013 45 2012 donations to Alpha Omega Alpha

Mark A Craig ( Louisiana State University John M Dorsey Jr ( Wayne State University Steven L Fillmore ( University of Oklahoma School of Medicine in New Orleans) School of Medicine) College of Medicine) Morton C Creditor ( Columbia University Neal Jude Duhon ( Louisiana State University Robert Stephen Fisher ( Temple University College of Physicians and Surgeons) School of Medicine in New Orleans) School of Medicine) Paul C Cronce ( Duke University School of Russell Dale Dumire ( Uniformed Services Sherold Fishman ( University of British Medicine) University of the Health Sciences F Edward Columbia Faculty of Medicine) Richard L Cronemeyer ( University of Kansas Hébert School of Medicine) Scott L Flugman ( University at Buffalo State School of Medicine) Lael Conway Duncan ( University of University of New York School of Medicine & Judith Ellen Crowell ( University of Miami Washington School of Medicine) Biomedical Sciences) Leonard M Miller School of Medicine) W Christopher Duncan ( Baylor College of Alexander Alb Fondak ( Georgetown Nathaniel D Curl ( University of Iowa Roy J Medicine) University School of Medicine) and Lucille A Carver College of Medicine) Ramon S Dunkin ( Indiana University School Debra C Ford ( Howard University College of Thomas Joseph Curran Jr ( Keck School of Medicine) Medicine) of Medicine of the University of Southern Lawrence A Dunmore Jr ( Howard University James G Fordyce ( Wayne State University California) College of Medicine) School of Medicine) Samuel Cykert ( Indiana University School of Gerald W Dunn ( University of California, Mario D Forte ( University of Washington Medicine) Los Angeles David Geffen School of Medicine) School of Medicine) Samuel C Durso ( Baylor College of Medicine) F Gordon Foster ( University of Colorado D James S Dyer ( Jefferson Medical College of School of Medicine) Nicholas A Danna III ( Louisiana State Thomas Jefferson University) Harris E Foster ( University of Miami Leonard University School of Medicine in New Orleans) M Miller School of Medicine) Robert B Daroff ( Case Western Reserve E Burt N Fowler ( University of Oklahoma University School of Medicine) Daniel I Edelstone ( University of Pittsburgh College of Medicine) Stuart Davidson ( University of California, School of Medicine) Barbara J Fox ( University of Cincinnati San Francisco, School of Medicine) John E Edwards ( University of California, College of Medicine) Alonzo J Davis IV ( The Brody School of Irvine, School of Medicine) Raul G Franceschi ( University of Puerto Rico Medicine at East Carolina University) Arnold H Einhorn ( Albert Einstein College of School of Medicine) J Calvin Davis III ( University of Nebraska Medicine of Yeshiva University) Marvin G Frank ( Virginia Commonwealth College of Medicine) Martin H Ellbogen Jr ( Creighton University University School of Medicine) Joseph H Davis ( State University of New School of Medicine) Martha N Franz ( Wright State University York Downstate Medical Center College of Allan S Emery ( Wayne State University Boonshoft School of Medicine) Medicine) School of Medicine) Richard B Fratianne ( Case Western Reserve Paul J Davis ( Albany Medical College) Benjamin P Eng ( Eastern Virginia Medical University School of Medicine) Catherine DeAngelis ( Johns Hopkins School ) Erling W Fredell ( Stanford University School University School of Medicine) Calvin T Eng ( University of California, San of Medicine) Craig L Dearden ( Texas Tech University Francisco, School of Medicine) Lawrence E Freedberg ( New York University Health Sciences Center School of Medicine) Paul R Ennis ( Keck School of Medicine of the School of Medicine) Peter J Dehnel ( University of Minnesota University of Southern California) Barbara K Freeman ( Case Western Reserve Medical School) Jeanne A Epstein ( Drexel University College University School of Medicine) Louis R M Delguercio ( New York Medical of Medicine) Kathleen Brelsford French ( Boston College) Christopher Thomas Erb ( University of University School of Medicine) Mahlon R Delong ( Emory University School Illinois College of Medicine) Richard A Freiberg ( Harvard Medical School) of Medicine) Richard W Erbe ( University of Michigan Scott L Friedman ( Mount Sinai School of Mariellen Dentino ( Indiana University Medical School) Medicine) School of Medicine) Angel F Espinosa-Lopez ( University of Marcia P Ostrowski Fries ( University of John R Denton Jr ( University of Alabama Puerto Rico School of Medicine) Massachusetts Medical School) School of Medicine) Richard H Evans ( University of Chicago Arthur H L From ( Indiana University School Ellen S Deparedes ( Virginia Commonwealth Division of the Biological Sciences The Pritzker of Medicine) University School of Medicine) School of Medicine) Conrad Fulkerson ( University of Missouri— Sabrina Fraser Derrington ( University of Columbia School of Medicine) California, Davis, School of Medicine) F Daniel E Fulmer MD ( Medical University of Dinah Fedyna ( Northeast Ohio Medical Ernest E Deshautreaux ( Tulane University South Carolina College of Medicine) University) School of Medicine) Scott A Fulton ( Wayne State University Arthur L Fein ( Wake Forest School of Anthony J Deutsch ( University of Tennessee School of Medicine) Health Science Center College of Medicine) Medicine of Wake Forest Baptist Medical David L Deutsch ( University of Illinois Center) G College of Medicine) Seymour H Fein ( New York Medical College) Paul J Gaglio ( University of Medicine and Vincent Donnabella ( University of Medicine Lenora I Felderman ( New York Medical Dentistry of New Jersey—New Jersey Medical and Dentistry of New Jersey—New Jersey College) School) Medical School) Michael R Ferrell ( University of Colorado Wm Ted Galey ( Oregon Health & Science Thomas A Donohue III ( University at School of Medicine) University School of Medicine) Buffalo State University of New York School of Anthony L A Fields ( University of Alberta Eric P Gall ( University of Arizona College of Medicine & Biomedical Sciences) Faculty of Medicine and Dentistry) Medicine) Herbert I Dorfan ( University of Pittsburgh Rose S Fife ( Indiana University School of Edward Murray Gardiner ( University of School of Medicine) Medicine) Ottawa Faculty of Medicine)

46 The Pharos/Spring 2013 Renee Garrick ( Rush Medical College of Mary A Greene-McIntyre ( Meharry Medical G Ken Hempel ( University of Texas Rush University Medical Center) College) Southwestern Medical Center at Dallas Jeffrey Roger Garst ( Loyola University William B Greenough III ( Harvard Medical Southwestern Medical School) Chicago Stritch School of Medicine) School) Marlene A Henning Sachs ( Geisel School of James C Gay ( Emory University School of Dorothy R Gregory ( University at Buffalo Medicine at Dartmouth) Medicine) State University of New York School of Charles Michael Herndon ( University of New Rainer G Gedeit ( Loyola University Chicago Medicine & Biomedical Sciences) Mexico School of Medicine) Stritch School of Medicine) Leanne Rita Griffin ( Georgetown University Michelle M Herron ( University of Rochester Paul W Gerard ( University of Cincinnati School of Medicine) School of Medicine and Dentistry) College of Medicine) Matthew R Grimm ( Louisiana State Michael L Hess ( University of Pittsburgh Dale N Gerding ( University of Minnesota University School of Medicine in New Orleans) School of Medicine) Medical School) Wilfred Guerra ( Saint Louis University Guy M Hicks Jr ( Tulane University School of Richard L Gerety ( University of New Mexico School of Medicine) Medicine) School of Medicine) Robert Allen Gustafson ( West Virginia Humberto A Hidalgo ( Tulane University Carmen A Giacomantonio ( Dalhousie University School of Medicine) School of Medicine) University Faculty of Medicine) Brett B Gutsche ( Raymond and Ruth Eve J Higginbotham ( Morehouse School of Samuel R Giamber ( Raymond and Ruth Perelman School of Medicine at the University Medicine) Perelman School of Medicine at the University of Pennsylvania) Jeffrey Walter Hill ( University of Nebraska of Pennsylvania) Glenn Peter Gwozdz ( Weill Cornell Medical College of Medicine) Charles Eugene Giangarra ( Marshall College) James F Hindson ( Case Western Reserve University Joan C Edwards School of Medicine) University School of Medicine) Jill Gilbert ( University of Alabama School of H Henry D Hirsch ( University of Miami Medicine) Lillian Haddock-Suarez ( University of Puerto Leonard M Miller School of Medicine) Edward B Gilmore ( Harvard Medical School) Rico School of Medicine) Larry Hobson ( Meharry Medical College) Gordon D Ginder ( Johns Hopkins University Jeffrey M Haines ( University of Medicine and Patrick J Hogan ( Georgetown University School of Medicine) Dentistry of New Jersey—New Jersey Medical School of Medicine) Donald E Girard ( Oregon Health & Science School) Kenneth E Holtzapple ( University of University School of Medicine) Mitchell L Halperin ( McGill University Louisville School of Medicine) Robert A Gisness ( Sanford School of Faculty of Medicine) Daniel L Hood ( Wright State University Medicine The University of South Dakota) Melanie S Halvorson ( University of Alabama Boonshoft School of Medicine) Brian P Gleason ( University of Alabama School of Medicine) Alan R Hopeman ( University of Minnesota School of Medicine) Edwin H Hamilton ( Meharry Medical Medical School) Martin C Glover ( University of Alabama College) Norman Horns ( University of Minnesota School of Medicine) William K Hamilton ( University of Iowa Roy Medical School) James E Goddard Jr ( University of Pittsburgh J and Lucille A Carver College of Medicine) Mary F Hotchkiss ( Ohio State University School of Medicine) Peter R Handley ( Wayne State University College of Medicine) Rebekah Ann Godeaux ( Louisiana State School of Medicine) Kathryn T Howell ( University of Colorado University School of Medicine in New Orleans) Robert A Hardesty ( Loma Linda University School of Medicine) Phil Gold ( McGill University Faculty of School of Medicine) Philip J Huber Jr ( University of Texas Medicine) Clarke T Harding ( Temple University School Southwestern Medical Center at Dallas Norman J Goldberg ( McGill University of Medicine) Southwestern Medical School) Faculty of Medicine) Joseph E Harlan Jr ( Wake Forest School Ronald M Hughes ( Emory University School Francisco Gonzalez-Scarano ( Northwestern of Medicine of Wake Forest Baptist Medical of Medicine) University The Feinberg School of Medicine) Center) Nadene D Hunter ( Tulane University School Jean Ricci Goodman ( Georgetown University Michael S Harris ( University of Texas of Medicine) School of Medicine) Southwestern Medical Center at Dallas Robert E Hyatt ( University of Rochester Gary G Gordon ( State University of New Southwestern Medical School) School of Medicine and Dentistry) York Downstate Medical Center College of Marc I Harwood ( Temple University School Vera C Hyman ( Medical University of South Medicine) of Medicine) Carolina College of Medicine) Ronald A Gosnell ( University of Minnesota J Michael Hatlelid ( Washington University in Medical School) St Louis School of Medicine) I Lisa J Gould ( University of Illinois College of Jeannine Hatt Phelps ( University of Texas Anthony L Imbembo ( Columbia University Medicine) Medical Branch School of Medicine) College of Physicians and Surgeons) Garth K Graham ( Harvard Medical School) Donald R Hawes ( Indiana University School Ricky L Irons ( University of Alabama School Mark T Grattan ( University of California, of Medicine) of Medicine) San Francisco, School of Medicine) Helen Hays ( University of Alberta Faculty of John A Irvine ( Keck School of Medicine of Alan R Green ( New York Medical College) Medicine and Dentistry) the University of Southern California) Jacob B Green III ( University of Texas Carl Anderson Hedberg ( University of Luis A Izquierdo-Encarnacion ( Universidad Medical Branch School of Medicine) Illinois College of Medicine) Central del Caribe School of Medicine) William Kevin Green ( University of South Alexandra S Heerdt ( Jefferson Medical Alabama College of Medicine) College of Thomas Jefferson University) J Elizabeth Ann Jaben ( University of Nebraska Burton H Greenberg ( University of Illinois James J Heffernan ( Boston University School College of Medicine) College of Medicine) of Medicine) Edgar B Jackson Jr ( Case Western Reserve Andrew B Greene Jr ( Meharry Medical David Joseph Heinsch ( Medical College of University School of Medicine) College) Georgia at Georgia Health Sciences University)

The Pharos/Spring 2013 47 2012 donations to Alpha Omega Alpha

Murray S Jaffe ( University of Cincinnati Jack D Kerns ( University of Iowa Roy J and William R Lane Jr ( Medical College of College of Medicine) Lucille A Carver College of Medicine) Georgia at Georgia Health Sciences University) William R Jewell ( University of Illinois Ernest A Kiel ( Louisiana State University Loree M Larratt ( University of Alberta College of Medicine) School of Medicine in Shreveport) Faculty of Medicine and Dentistry) Sukhjit S Johl ( University of California, Los Thomas W Kiernan ( University of Medicine Christopher E Larson ( University of Angeles David Geffen School of Medicine) and Dentistry of New Jersey—New Jersey Pittsburgh School of Medicine) Kevin W Johnson ( Jefferson Medical College Medical School) Carl B Lauter ( Wayne State University of Thomas Jefferson University) John C Kincaid ( Indiana University School of School of Medicine) Richard W Johnson ( State University of New Medicine) Aaron Lazare ( University of Massachusetts York Downstate Medical Center College of Lynn H Kindred ( University of Kansas School Medical School) Medicine) of Medicine) Elma I LeDoux ( Tulane University School of Tom M Johnson ( University of North Dakota Hal D Kipfer ( Indiana University School of Medicine) School of Medicine and Health Sciences) Medicine) Edward J Lefeber Jr ( University of Texas Michael N Johnston ( University of Alabama William C Kirby ( Indiana University School Medical Branch School of Medicine) School of Medicine) of Medicine) Nancy Ann Leitch ( University of Minnesota Charles Cabell Jones ( Medical University of Nora B Kirschner ( Georgetown University Medical School) South Carolina College of Medicine) School of Medicine) Deborah Lenart ( Wright State University Frank E Jones Jr ( Meharry Medical College) Adam P Klausner ( State University of New Boonshoft School of Medicine) Herbert C Jones ( Indiana University School York Upstate Medical University) John E Lent ( Georgetown University School of Medicine) Bruce Paul Klein ( West Virginia University of Medicine) Kim I Letzer Josen ( Wayne State University School of Medicine) Robert W Letton Jr ( University of Kentucky School of Medicine) Lawrence N Koenig ( Louisiana State College of Medicine) David A Josephson ( Medical College of University School of Medicine in Shreveport) Stephen M Levine ( Jefferson Medical College Georgia at Georgia Health Sciences University) Bruce M Koeppen ( University of Chicago of Thomas Jefferson University) Division of the Biological Sciences The Pritzker Richard A Levinson ( University of Illinois K School of Medicine) College of Medicine) Sigmund Benham Kahn ( Raymond and Ruth Evan R Kokoska ( Washington University in Seymour H Levitt ( University of Colorado Perelman School of Medicine at the University St Louis School of Medicine) School of Medicine) of Pennsylvania) Ronald J Korthuis ( University of Missouri— Stuart M Levitz ( New York University School Elaine S Kamil ( University of Pittsburgh Columbia School of Medicine) of Medicine) School of Medicine) H S Kott ( University of Virginia School of Richard G Lewis ( University of Virginia Charles F Kane ( Raymond and Ruth Medicine) School of Medicine) Perelman School of Medicine at the University Gregory Alan Kozeny ( Loyola University Richard S Lewis ( The Brody School of of Pennsylvania) Chicago Stritch School of Medicine) Medicine at East Carolina University) Saul J Kaplan ( University of Alabama School Robert A Krall ( Jefferson Medical College of Berdine Ann Li ( Drexel University College of of Medicine) Thomas Jefferson University) Medicine) Raymond B Karasic ( Johns Hopkins Janet P Kramer ( Drexel University College of Frank Joseph Liggio ( University of Medicine University School of Medicine) Medicine) and Dentistry of New Jersey—New Jersey Donald J Kastens ( University of Oklahoma Robert A Kreisberg ( Northwestern University Medical School) College of Medicine) The Feinberg School of Medicine) Thomas J Limbird ( Meharry Medical Jeffry Adam Katz ( Case Western Reserve Francis L Kretzer ( Baylor College of College) University School of Medicine) Medicine) Alexander L Lin ( Northwestern University James P Kauth ( Medical College of Joan Margaret Krikava ( University of The Feinberg School of Medicine) Wisconsin) Minnesota Medical School) Daniel V Lindenstruth ( University of Michael J Kearns ( University of California, Paul A Krogstad ( Tulane University School Maryland School of Medicine) Irvine, School of Medicine) of Medicine) Steven Lipper ( Boston University School of Angela B Keating ( University of Minnesota Ellen R Kruger ( New York University School Medicine) Medical School) of Medicine) Rebecca M Lipscomb ( Eastern Virginia Richard P Keeling ( Tufts University School Marcus A Krupp ( Stanford University School Medical School ) of Medicine) of Medicine) George I Litman ( Northeast Ohio Medical Edward J Keenan ( Oregon Health & Science Mary L Kumar ( Case Western Reserve University) University School of Medicine) University School of Medicine) James P Logerfo ( University of Rochester John M Keller ( Chicago Medical School at School of Medicine and Dentistry) Rosalind Franklin University of Medicine & L Richard A Losada ( New York Medical Science) John C Laidlaw ( University of Toronto College) Barbara A Kelly ( Tufts University School of Faculty of Medicine) Christopher J Loughlin ( Wake Forest School Medicine) Kimberly F Lairet ( University of Nebraska of Medicine of Wake Forest Baptist Medical James A Kenning ( Jefferson Medical College College of Medicine) Center) of Thomas Jefferson University) Randy Joseph Lamartiniere ( Louisiana State Donald Bruce Louria ( University of Medicine Irwin J Kerber ( University of Texas University School of Medicine in Shreveport) and Dentistry of New Jersey—New Jersey Southwestern Medical Center at Dallas Donald H Lambert ( University of Vermont Medical School) Southwestern Medical School) College of Medicine) Alvin S Lovell ( Howard University College of William F Kern ( State University of New Gary L Lamson ( University of Minnesota Medicine) York Downstate Medical Center College of Medical School) Amanda Luchsinger ( Medical College of Medicine) Wisconsin)

48 The Pharos/Spring 2013 Jacob K Luder ( University of Kansas School William G McCuen ( Wake Forest School Jose Maria Miramontes ( University of of Medicine) of Medicine of Wake Forest Baptist Medical California, San Francisco, School of Medicine) Denis R Lunne ( Northeast Ohio Medical Center) Dace B Mitchell ( University of California, University) Karen Smith McCune ( University of San Francisco, School of Medicine) Christopher Lutman ( Ohio State University California, San Francisco, School of Medicine) Bernadine A Moglia ( Pennsylvania State College of Medicine) Lewis H McCurdy III ( University of Alabama University College of Medicine) Jon E Lutz ( Hahnemann Medical College) School of Medicine) Lester Mohler ( Ohio State University College Timothy J McDonald ( Emory University of Medicine) M School of Medicine) George Carl Mohr ( Harvard Medical School) Giles F MacDonald ( University of Alberta K Robert McIntire ( University of Virginia Rose M Mohr ( Drexel University College of Faculty of Medicine and Dentistry) School of Medicine) Medicine) David B Macmillan ( University of Iowa Roy J Cherrie McKitterick ( University of Texas Alicia A Moise ( University of Texas and Lucille A Carver College of Medicine) Medical Branch School of Medicine) Southwestern Medical Center at Dallas George E Maha ( Saint Louis University Morgan Lee McLemore ( The University of Southwestern Medical School) School of Medicine) Texas School of Medicine at San Antonio) Alvin Mok ( University of California, San Vernon J Maino ( Stanford University School John T McManus ( Medical College of Francisco, School of Medicine) of Medicine) Wisconsin) Wally O Montgomery ( University of Harry Maisel ( Wayne State University School George N McNeil Jr ( Columbia University Louisville School of Medicine) of Medicine) College of Physicians and Surgeons) Walter Joseph Moore ( Medical College of John C Maize ( University of Michigan John P McNulty ( Tulane University School Georgia at Georgia Health Sciences University) Medical School) of Medicine) Russell R Moores ( University of Arkansas for Richard T Mamiya ( Saint Louis University David R McNutt ( Ohio State University Medical Sciences College of Medicine) School of Medicine) College of Medicine) Deborah L Morris ( University of North William G Manax ( The University of Harold L McPheeters ( University of Carolina at Chapel Hill School of Medicine) Western Ontario—Schulich School of Medicine Louisville School of Medicine) Harold Moskowitz ( State University of New & Dentistry) David Michael Medina ( University of York Downstate Medical Center College of Peter C Mancusi-ungaro ( University of Arizona College of Medicine) Medicine) Miami Leonard M Miller School of Medicine) David P Mehfoud Jr ( Virginia Donn G Mosser ( University of Kansas School Monica M Manga ( University of Texas Commonwealth University School of Medicine) of Medicine) Medical School at Houston) Anthony S Melillo ( Medical College of Judd W Moul ( Jefferson Medical College of Markesh K Manocha ( Louisiana State Wisconsin) Thomas Jefferson University) University School of Medicine in Shreveport) Victor D Menashe ( Oregon Health & Science Joseph C Muhler ( Loyola University Chicago Stuart L Marcus ( Albert Einstein College of University School of Medicine) Stritch School of Medicine) Medicine of Yeshiva University) Moss H Mendelson ( Eastern Virginia Daniel T Murai ( University of Hawaii, John A Eric S Marks ( Wake Forest School of Medical School ) Burns School of Medicine) Medicine of Wake Forest Baptist Medical J Wayne Meredith ( Wake Forest School Kenric Murayama ( University of Hawaii, Center) of Medicine of Wake Forest Baptist Medical John A Burns School of Medicine) Lawrence F Marshall ( University of Michigan Center) Dale P Murphy ( Ohio State University Medical School) John F Mermel ( George Washington College of Medicine) Dorothy J Martin ( University of Tennessee University School of Medicine and Health James A Murphy ( Hahnemann Medical Health Science Center College of Medicine) Sciences) College) M Richard Maser ( Raymond and Ruth Michael H Metzler ( Albany Medical College) John F Murray ( Keck School of Medicine of Perelman School of Medicine at the University Joseph P Meurer ( Oregon Health & Science the University of Southern California) of Pennsylvania) University School of Medicine) Robert F Murray Jr ( Howard University Guy G Massry ( Keck School of Medicine of Ernest Mhoon ( University of Chicago College of Medicine) the University of Southern California) Division of the Biological Sciences The Pritzker Allan W Mathies Jr ( University of Vermont School of Medicine) N College of Medicine) William Micheo ( University of Puerto Rico Nagendra Nadaraja ( University of Rochester Gary R May ( University of Alberta Faculty of School of Medicine) School of Medicine and Dentistry) Medicine and Dentistry) Kristi J Midgarden ( University of North Deborah Marie Nalty ( University of Colorado Bette G Maybury ( Indiana University School Dakota School of Medicine and Health School of Medicine) of Medicine) Sciences) Vamsidhar R Narra ( Michigan State John E Mazuski ( University of California, Los Michael A Mikhail ( The University of Toledo University College of Human Medicine) Angeles David Geffen School of Medicine) College of Medicine) Clyde L Nash Jr ( Case Western Reserve August C Mazza ( University of Cincinnati Adam Edward Mikolajczyk ( University of University School of Medicine) College of Medicine) Chicago Division of the Biological Sciences The James J Navin ( Creighton University School John B McAndrew ( University of Nebraska Pritzker School of Medicine) of Medicine) College of Medicine) James P Miller ( Hahnemann Medical William H Nealon ( University of Texas Leo J McCarthy ( University of Nebraska College) Medical Branch School of Medicine) College of Medicine) Paul T Milloy ( Northwestern University The Christopher P Nelson ( Raymond and Ruth Paul L McCarthy ( Georgetown University Feinberg School of Medicine) Perelman School of Medicine at the University School of Medicine) Richard E Mills ( Medical University of South of Pennsylvania) James T McCreary ( University of Illinois Carolina College of Medicine) William P Newman III ( Louisiana State College of Medicine) Robert E Mines Jr ( Meharry Medical College) University School of Medicine in New Orleans)

The Pharos/Spring 2013 49 2012 donations to Alpha Omega Alpha

Wilberto Nieves-Neira ( University of Puerto Taral N Patel ( Mount Sinai School of Rees Pritchett ( Weill Cornell Medical Rico School of Medicine) Medicine) College) Mark R Norwid ( Saint Louis University Abhijit S Pathak ( Temple University School John Anthony Prodoehl ( Drexel University School of Medicine) of Medicine) College of Medicine) Patricia A Norwood ( Louisiana State Roman L Patrick ( Duke University School of Richard P Propp ( Albany Medical College) University School of Medicine in Shreveport) Medicine) Robert W Putsch III ( University of Colorado Robert A Novelline ( Boston University Richard D Patten ( University of Maryland School of Medicine) School of Medicine) School of Medicine) Edward R Nowicki ( Jefferson Medical Carl A Paulsen ( Albany Medical College) Q College of Thomas Jefferson University) Steven Z Pavletic ( University of Nebraska Cid S Quintana-Rodz ( University of Puerto College of Medicine) Rico School of Medicine) O David Fredrick Pawliger ( University of James G O’Brien ( Michigan State University Florida College of Medicine) R Jeremy Steven Raab ( Eastern Virginia College of Human Medicine) Niloufar Paydar-Darian ( Chicago Medical Medical School ) M Patrick O’Meara ( Harvard Medical School at Rosalind Franklin University of Maya L Ramirez ( University of Michigan School) Medicine & Science) Medical School) James A O’Neill ( Saint Louis University George J Pazin ( University of Pittsburgh Alexander W Ramsay ( Medical University of School of Medicine) School of Medicine) South Carolina College of Medicine) S S Obenshain ( University of New Mexico Alan Pechacek ( University of Iowa Roy J and Michele G Ramsdell ( University of Michigan School of Medicine) Lucille A Carver College of Medicine) Medical School) Samuel A Ockner ( University of Cincinnati Rita Pechulis ( Jefferson Medical College of Daniel Ranch ( University of Nevada School College of Medicine) Thomas Jefferson University) of Medicine) Charles J Odgers ( Temple University School William A Peck ( University of Rochester James M Raver ( University of Maryland of Medicine) School of Medicine and Dentistry) School of Medicine) Milford S Ofstun ( University of Wisconsin Catherine Peimann ( New York Medical David A Rawitscher ( University of Texas School of Medicine and Public Health) College) Medical School at Houston) Bruce W Olin ( University of North Dakota Steven J Peitzman ( Drexel University College Andrea O Ray ( Hahnemann Medical School of Medicine and Health Sciences) of Medicine) College) Donald P Olson ( University of California, Manuel A Penalver ( University of Miami James I Raymond ( University of Pittsburgh Davis, School of Medicine) Leonard M Miller School of Medicine) School of Medicine) John D Olson ( University of Iowa Roy J and Jerry O’Don Penix ( Tulane University School John Richard Raymond ( Duke University Lucille A Carver College of Medicine) of Medicine) School of Medicine) Alice Amy Onady ( Wright State University Judith S Perdue ( Virginia Commonwealth Douglas A Rayner ( New York Medical Boonshoft School of Medicine) University School of Medicine) College) Ralph M Orland ( University of Illinois Miguel Perez-Arzola ( Ponce School of Joanna B Ready ( Medical College of College of Medicine) Medicine and Health Sciences) Wisconsin) Roger M Orth ( Tulane University School of Joseph K Perloff ( Louisiana State University Morris Reichlin ( Washington University in St Medicine) School of Medicine in New Orleans) Louis School of Medicine) James W M Owens ( University of Meira Marna Pernicone ( USF Health Larry Rhodes ( West Virginia University Washington School of Medicine) Morsani College of Medicine) School of Medicine) Calvin E E Oyer ( Indiana University School Stacey L Peterson-Carmichael ( University Virginia A Rhodes ( Ohio State University of Medicine) of North Carolina at Chapel Hill School of College of Medicine) Medicine) Dan R Richards ( University of Cincinnati P Stuart I Phillips ( Louisiana State University David Paar ( West Virginia University School College of Medicine) School of Medicine in New Orleans) of Medicine) Harold G Richman ( University of Minnesota William D Platt ( Medical College of Samuel Packer ( State University of New York Medical School) Wisconsin) Downstate Medical Center College of Medicine) David J Rickles ( University of California, Los Richard A Plessala ( Saint Louis University Antolin J Padilla Morales ( University of Angeles David Geffen School of Medicine) School of Medicine) Puerto Rico School of Medicine) James A Riley ( Oregon Health & Science Michael Franc Plott ( Georgetown University Jean Pakter ( New York University School of University School of Medicine) School of Medicine) Medicine) Jeffrey M Rimmer ( University of Vermont John Howard Poehlman ( University of James W Pancoast ( Virginia Commonwealth College of Medicine) Maryland School of Medicine) University School of Medicine) Jack L Ritter ( Baylor College of Medicine) Bernard Pollara ( Albany Medical College) David A Parks ( Saint Louis University School Jon H Ritter ( University of Minnesota Richard Sean Ponce ( University of California, of Medicine) Medical School) San Francisco, School of Medicine) Clifton L Parnell III ( University of Arkansas Terry N Rivers ( University of South Alabama Maria Carol Poor ( Indiana University School for Medical Sciences College of Medicine) College of Medicine) of Medicine) Thomas C Passo ( Indiana University School Edward N Robinson ( Wake Forest School Jerome B Posner ( Weill Cornell Medical of Medicine) of Medicine of Wake Forest Baptist Medical College) Manish Surendra Patel ( Eastern Virginia Center) Alvin C Powers ( University of Tennessee Medical School ) Jerome C Robinson ( Washington University Health Science Center College of Medicine) Shilpa J Patel ( University of Vermont College in St Louis School of Medicine) Josephine Pressacco ( University of Toronto of Medicine) Bradley M Rodgers ( Johns Hopkins Faculty of Medicine) University School of Medicine)

50 The Pharos/Spring 2013 Michelle E Rodriguez ( University of Texas Linda J Scarazzini ( Temple University School Barry Smith ( Geisel School of Medicine at Medical School at Houston) of Medicine) Dartmouth) Robert F Rohner ( State University of New Norbert D Scharff ( Jefferson Medical College Brenda C Smith ( Marshall University Joan C York Upstate Medical University) of Thomas Jefferson University) Edwards School of Medicine) Jesse Roman ( University of Louisville School James F Schauble ( Johns Hopkins University Ethelee R Smith ( Washington University in of Medicine) School of Medicine) St Louis School of Medicine) John C Rose ( Georgetown University School Roger W Schauer ( University of North James V Soldin II ( University of Minnesota of Medicine) Dakota School of Medicine and Health Medical School) David I Rosen ( State University of New York Sciences) David B Soll ( Chicago Medical School at Upstate Medical University) Gerold L Schiebler ( University of Florida Rosalind Franklin University of Medicine & Robert Rosen ( Hahnemann Medical College) College of Medicine) Science) John W Ross ( Emory University School of Mary E Schlegel ( Mount Sinai School of Irwin Solomon ( University at Buffalo State Medicine) Medicine) University of New York School of Medicine & Harry L Roth ( University of California, San Mary W Schley ( Yale University School of Biomedical Sciences) Francisco, School of Medicine) Medicine) Joel B Solomon ( State University of New Agnes J Rovnanek ( Drexel University College David E Schmitt ( University of Miami York Downstate Medical Center College of of Medicine) Leonard M Miller School of Medicine) Medicine) Mark E Rowin ( University of Texas Medical Paul G Schmitz ( Creighton University School Christopher J Sonnenday ( Vanderbilt School at Houston) of Medicine) University School of Medicine) Robert J Rubin ( Baylor College of Medicine) Aaron P Scholnik ( Chicago Medical School Mary E Soper ( Indiana University School of Robert T Rubin ( University of California, San at Rosalind Franklin University of Medicine & Medicine) Francisco, School of Medicine) Science) Mary Ann South ( Baylor College of Arthur L Ruckman ( Louisiana State Lynne M Schoonover ( University of Virginia Medicine) University School of Medicine in Shreveport) School of Medicine) William T Speck ( Wake Forest School of Elizabeth S Ruppert ( Ohio State University Mary F Schottstaedt ( University of Medicine of Wake Forest Baptist Medical College of Medicine) California, San Francisco, School of Medicine) Center) Richard D Ruppert ( Ohio State University Robert David Schreiner ( Vanderbilt Emily Spencer Lukacz ( University of College of Medicine) University School of Medicine) Michigan Medical School) Richard L Russell ( University of California, Evelyne Albrecht Schwaber ( Albert Einstein Jerry D Spencer ( University of Kansas School San Francisco, School of Medicine) College of Medicine of Yeshiva University) of Medicine) Ben F Rusy ( Temple University School of Heidi B Schwarz ( University of Rochester Wayne C Spiggle ( University of Maryland Medicine) School of Medicine and Dentistry) School of Medicine) Edward D Ruszkiewicz ( Saint Louis Victor F Scott ( Howard University College of Vikki A Stefans ( Jefferson Medical College of University School of Medicine) Medicine) Thomas Jefferson University) Gregory W Rutecki ( University of Illinois David J Sedor ( Hahnemann Medical College) Marc Peter Steinberg ( USF Health Morsani College of Medicine) Thomas F Sellers Jr ( Emory University College of Medicine) William H Ryan III ( University of North School of Medicine) Michael P Steinberg ( Washington University Carolina at Chapel Hill School of Medicine) Ronald A Semerdjian ( Northwestern in St Louis School of Medicine) University The Feinberg School of Medicine) Mark J Stephan ( University of Colorado S Michael Geren Seneff ( University of School of Medicine) William P Sadler ( Johns Hopkins University Missouri—Columbia School of Medicine) Byron Stinson ( Ohio State University College School of Medicine) George F Sengstack ( George Washington of Medicine) Richard Sadovsky ( State University of New University School of Medicine and Health John D Stobo ( University at Buffalo State York Downstate Medical Center College of Sciences) University of New York School of Medicine & Medicine) A W Shafer ( University of Kansas School of Biomedical Sciences) Jean A Saigh ( University of Nebraska College Medicine) Rose Mary Sutton Stocks ( University of of Medicine) Reza Shahim ( University of Arkansas for Tennessee Health Science Center College of John Saiki ( University of New Mexico School Medical Sciences College of Medicine) Medicine) of Medicine) Steven P Shelov ( Medical College of Edwin Mercer Stone ( Baylor College of Calvin C Sampson ( Howard University Wisconsin) Medicine) College of Medicine) James W Shepard ( Temple University School Stephanie Ann Storgion ( University of Jorge L Sanchez ( University of Puerto Rico of Medicine) Tennessee Health Science Center College of School of Medicine) Neil H Shusterman ( Jefferson Medical Medicine) Maria De Lour Santaella ( University of College of Thomas Jefferson University) Robert C Stough ( Raymond and Ruth Puerto Rico School of Medicine) Gregorio A Sicard ( University of Puerto Rico Perelman School of Medicine at the University Suzanne Satterfield ( University of Tennessee School of Medicine) of Pennsylvania) Health Science Center College of Medicine) William Sigmund ( West Virginia University Carla S Streepy - ODay ( Case Western Dana Savici ( State University of New York School of Medicine) Reserve University School of Medicine) Upstate Medical University) Stephen J Sills ( Albany Medical College) Thomas Joseph Strick ( Medical College of Michele Smallwood Saysana ( Indiana Omega C Logan Silva ( Howard University Wisconsin) University School of Medicine) College of Medicine) Jack Strom ( Ohio State University College of Raymond Scalettar ( State University of New Laura J Simon ( University of Illinois College Medicine) York Downstate Medical Center College of of Medicine) Lawrence S Sturman ( Northwestern Medicine) James S Simpson III ( Medical College of University The Feinberg School of Medicine) Georgia at Georgia Health Sciences University)

The Pharos/Spring 2013 51 2012 donations to Alpha Omega Alpha

Michael Preston Subichin ( Northeast Ohio Mark C Tsai ( University of Pittsburgh School Richard P Wenzel ( University of Virginia Medical University) of Medicine) School of Medicine) Armando Susmano ( Rush Medical College of Olga Maria Tudela ( Universidad Central del Steven Judson Westgate ( University of Rush University Medical Center) Caribe School of Medicine) Florida College of Medicine) Claude R Swayze ( University of Toronto Shane C Wheeler ( University of Colorado Faculty of Medicine) U School of Medicine) Edward Rowe Sweetser ( Georgetown Hans W Uffelmann ( University of Missouri— William M Whetsell ( University of Miami University School of Medicine) Kansas City School of Medicine) Leonard M Miller School of Medicine) Eberhard H Uhlenhuth ( Johns Hopkins Robert A Whisnant Jr ( Virginia T University School of Medicine) Commonwealth University School of Medicine) John I Takayama ( New York University Abhineet Uppal ( University of North Robert K White ( Louisiana State University School of Medicine) Carolina at Chapel Hill School of Medicine) School of Medicine in Shreveport) Filemon K Tan ( University of Texas Medical Richard A Widman ( University of Iowa Roy J School at Houston) V and Lucille A Carver College of Medicine) Nancy Van Vessem ( Saint Louis University Donald J Tanis ( University of Medicine and William E Wilcox ( University of South School of Medicine) Dentistry of New Jersey—Robert Wood Johnson Alabama College of Medicine) Elizabeth Vazquez ( University of California, Medical School) Rodney E Willard ( Loma Linda University San Francisco, School of Medicine) Anthony S Tavill ( Case Western Reserve School of Medicine) Armand Versaci ( The Warren Alpert Medical University School of Medicine) Temple W Williams Jr ( Baylor College of School of Brown University) Claudia Paula Taylor ( University of Medicine) John M Vierling ( Stanford University School California, San Francisco, School of Medicine) Kay Williams-kirchler ( University of of Medicine) Larry D Taylor ( University of Arkansas for Alabama School of Medicine) Frederick M Vincent Sr ( Michigan State Medical Sciences College of Medicine) Cathleen Doane Wilson ( University of University College of Human Medicine) John Teichgraeber ( The Warren Alpert Vermont College of Medicine) Nicholas A Volpicelli ( Temple University Medical School of Brown University) Charles J Wilson ( University of Texas School of Medicine) John F Teichgraeber ( University of Texas Medical Branch School of Medicine) Roberto L von Sohsten ( Drexel University Medical School at Houston) Robert K Wilson ( University of Alabama College of Medicine) Siegmund Teichman ( Loma Linda University School of Medicine) School of Medicine) Curtis B Winters ( Keck School of Medicine Sonia R Teller ( University of Louisville W Thomas A Wade ( Indiana University School of the University of Southern California) School of Medicine) of Medicine) Benjamin Wolfson ( Jefferson Medical John L Thistle ( Temple University School of Bryan L Walker ( Medical University of South College of Thomas Jefferson University) Medicine) Carolina College of Medicine) Joseph H L Worischeck ( Saint Louis Deborah M Thompson ( Howard University Henry K Walker ( Emory University School University School of Medicine) College of Medicine) of Medicine) Harry M Woske ( University of Medicine and Linda Ruth Thompson ( University of Katherine Jean Walsh ( University of Florida Dentistry of New Jersey—Robert Wood Johnson Virginia School of Medicine) College of Medicine) Medical School) Mark E Thompson ( Wright State University D Ross Ward ( University of Mississippi Boonshoft School of Medicine) School of Medicine) Y Joseph R Thurn ( University of Minnesota Letah Yang ( Louisiana State University Howard F Warner ( Temple University School Medical School) School of Medicine in New Orleans) of Medicine) A Judson Tillinghast ( Louisiana State Jame S T Yao ( Northwestern University The Janet G Warner ( Wayne State University University School of Medicine in New Orleans) Feinberg School of Medicine) School of Medicine) Kathleen G Todd ( Washington University in David L Yarian ( Washington University in St Alan A Wartenberg ( Medical College of St Louis School of Medicine) Louis School of Medicine) Wisconsin) Tracy Ann Tomac ( Texas A&M Health Francis E Yates ( Stanford University School Edwin B Watkins Jr ( University of Nebraska Science Center College of Medicine) of Medicine) College of Medicine) John C Toole Jr ( Emory University School of Abideen O Yekinni ( Indiana University Linley E Watson ( University of Kansas Medicine) School of Medicine) School of Medicine) David Lane Topolsky ( Hahnemann Medical Chun Keung Yip ( Albert Einstein College of David M Watts ( Uniformed Services College) Medicine of Yeshiva University) University of the Health Sciences F Edward Robert D Toto ( University of Illinois College Mihae Yu ( University of Hawaii, John A Hébert School of Medicine) of Medicine) Burns School of Medicine) Ray L Watts ( Washington University in St Robert C Trautwein ( Tufts University School Louis School of Medicine) of Medicine) Thomas R Weber ( Ohio State University Z Susan P Trawick ( Emory University School Elias T Zambidis ( University of Rochester College of Medicine) of Medicine) School of Medicine and Dentistry) Nolan Weinberg ( University of Minnesota Charles S Tressler ( Hahnemann Medical Charles J Zelnick ( University of Cincinnati Medical School) College) College of Medicine) Michael Weinrauch ( Mount Sinai School of Justin James Trevino ( Wright State University Cecile Marie Zielinski ( Creighton University Medicine) Boonshoft School of Medicine) School of Medicine) Russell Weisman Jr ( Case Western Reserve Philip C Trotta ( Saint Louis University University School of Medicine) School of Medicine) Mell B Welborn Jr ( Emory University School Ronald E Trunsky ( Wayne State University of Medicine) School of Medicine)

52 The Pharos/Spring 2013 Letters to the editor

have an annual report from University “What difference can a student Hospital in  not only showing make?” African-American patients but also pro- Dr. Gunderman’s touching story viding the opening statement: “For years (Winter , pp. –) of how a this institution has served the people of medical student contributed so impor- this State, irrespective of creed, color, or tantly to the emotional well-being of a financial status.” patient reminded me of why I always We appreciate the opportunity to tell medical students they are part of make this important clarification. the team, not just onlookers. As a third-year medical student Joseph R. Shiber, MD I was sent to perform a history and (AΩA, University of Maryland, ) physical examination on a man admit- Jacksonville, Florida ted for aortic valve replacement. He had very pale and wrinkled skin, which Milford M Foxwell Jr. MD I learned in retrospect was called ala- (AΩA, University of Maryland, ) The Immortal Life of Henrietta baster skin. He also gave a history of Baltimore, Maryland Lacks progressive headache, impaired sexual We read the review of the compelling dysfunction, fatigue, cold intolerance, book The Immortal Life of Henrietta “Pure and wholesome” and more recently difficulties with Lacks in the Autumn edition of The I read, with great interest, the postural hypotension. I remembered Pharos (pp. –) with great interest Winter  article “Pure and being taught the sequence “go to but wish to make a point of clarification. Wholesome” about cholera in New Alaska”—gonadal, thyroid, then adrenal Dr. Griffith states that “In  . . . she York City (pp. –). I always knew insufficiency—from pituitary tumors, went to Johns Hopkins, the only hos- that Robert Koch (–) was a so examined his visual fields and found pital in the region that accepted black true genius, but I had no idea that he that he had a bitemporal field defect. patients.” We disagree, since University had discovered the cholera bacillus in I advised the resident that his surgery Hospital, as it was then known, cared  when he was, according to this should probably be postponed, and he for African-American patients at that article and my calculation, just one should be investigated for a pituitary time. Actually, we believe that the year old! Koch actually discovered tumor. Subsequent investigations con- University of Maryland Hospital has the cholera organism between August firmed a pituitary adenoma and pan- not ever refused care to patients of any –January . To be historically hypopituitarism that very likely would race or ethnicity since it was initially accurate, however, credit really behave resulted in his demise had he un- opened as The Baltimore Infirmary in longs to the Italian physician Filippo dergone his valve replacement without ; the name was changed in  Pacini who described Vibrio cholerae endocrine support. to University Hospital and then re- (now Pacini ) in his  article Medical students can make a differ- named the University of Maryland “Microscopical observations and path- ence in more ways than one. Medical Center in . There ological deductions on cholera.” J. David Spence, MBA, MD is historical documentation John D. Bullock, MD, MPH, MSc (AΩA, University of Western Ontario, of African-American pa- (AΩA, Wright State University, ) ) tients being admitted Wright State University Boonshoft Western University and Robarts to The Baltimore School of Medicine Research Institute Infirmary in the Dayton, Ohio London, Ontario s and we