OF ALPHA OMEGA ALPHA HONOR MEDICAL SOCIETY Autumn 2008 Alphaof Alpha OMEGA Omega ALPHA Alpha HONOR Honor MEDICAL Medical SOCIETY Society AUTUMNSUMMER 20082008

OF ALPHA OMEGA ALPHA HONOR MEDICAL SOCIETY Autumn 2008 ALPHAof Alpha OMEGA Omega ALPHA Alpha HONOR honor MEDICAL medical SOCIETY society AUTUMNSUMMER 20082008

´"YJP7XKFMF ´ ˆJOUPV7` BMHP´ VOUB7ˆ Alpha Omega Alpha Honor Medical Society “Worthy to Serve the Suffering” Founded by William W. Root in 1902

Officers and Directors at Large Editor: Edward D. Harris, Jr., MD Rae-Ellen W. Kavey, MD Editor Emeritus: Robert J. Glaser, MD President Associate Editor and Managing Editor Bethesda, Maryland (in memoriam) Edward D. Harris, Jr., MD Helen H. Glaser, MD Executive Secretary Menlo Park, California Managing Editor Art Director and Illustrator Donald E. Wilson, MD Debra M. Lancaster Jim M!Guinness Vice President Baltimore, Maryland Administrator Designer Ann Hill Erica Aitken C. Bruce Alexander, MD Secretary-Treasurer Birmingham, Alabama Michael V. Drake, MD Editorial Board Irvine, California N. Joseph Espat, MD Jeremiah A. Barondess, MD Faith T. Fitzgerald, MD Eric Pfeiffer, MD Providence, Rhode Island New York, New York Sacramento, California Tampa, Florida David A. Bennahum, MD Daniel Foster, MD Richard C. Reynolds, MD Ruth-Marie Fincher, MD Albuquerque, New Mexico Dallas, Texas Gainesville, Florida Augusta, Georgia John A. Benson, Jr., MD James G. Gamble, MD, PhD William M. Rogoway, MD Douglas S. Paauw, MD Omaha, Nebraska Stanford, California Stanford, California Seattle, Washington Gert H. Brieger, MD Dean G. Gianakos, MD Shaun V. Ruddy, MD Baltimore, Maryland Lynchburg, Virginia Richmond, Virginia Don W. Powell, MD Richard Bronson, MD Jean D. Gray, MD Bonnie Salomon, MD Galveston, Texas Stony Brook, New York Halifax, Nova Scotia Deerfield, Illinois John C.M. Brust, MD David B. Hellmann, MD John S. Sergent, MD Joseph W. Stubbs, MD New York, New York Baltimore, MD Nashville, Tennessee Albany, Georgia Audrey Shafer, MD Charles S. Bryan, MD Pascal James Imperato, MD Medical Organization Director Columbia, South Carolina Brooklyn, New York Stanford, California Marjorie S. Sirridge, MD Robert A. Chase, MD Elizabeth B. Lamont, MD John Tooker, MD, MBA Kansas City, Missouri Stanford, California, and Chicago, Illinois American College of Physicians Jaffrey, New Hampshire Clement B. Sledge, MD Kenneth M. Ludmerer, MD Marblehead, Massachussetts Henry M. Claman, MD St. Louis, Missouri Councilor Directors Denver, Colorado John H. Stone III, MD James B.D. Mark, MD Atlanta, Georgia Robert G. Atnip, MD Fredric L. Coe, MD Stanford, California Chicago, Illinois Jan van Eys, Ph.D., MD Pennsylvania State University J.Joseph Marr , MD Nashville, Tennessee Hershey, Pennsylvania Jack Coulehan, MD Broomfield, Colorado Stony Brook, New York Abraham Verghese, MD, DSc Stephen J. McPhee, MD (Hon.) Eric P. Gall, MD, MACP, MACR Ralph Crawshaw, MD San Francisco, California Stanford, California Chicago Medical School at Rosalind Portland, Oregon Sherman M. Mellinkoff, MD Steven A. Wartman, MD, PhD Franklin University of Medicine Peter E. Dans, MD Los Angeles, California Washington, DC and Science Baltimore, Maryland Robert H. Moser, MD Gerald Weissmann, MD Chicago, Illinois Scott K. Epstein, MD Madera Reserve, Arizona New York, New York Amy Goldberg, MD Boston, Massachussetts Edmund D. Pellegrino, MD David Watts, MD Lawrence L. Faltz, MD Washington, DC Mill Valley, California Temple University School of Medicine Sleepy Hollow, New York Philadelphia, Pennsylvania Student Directors Natalia Berry Dartmouth Medical School Manuscripts being prepared for The Pharos should be typed double-spaced, submitted in triplicate, and conform to the format outlined in the manuscript submission guidelines appearing on our website: www.alphaomegaalpha.org. They are also available Kara Maria Cavuoto from The Pharos office. Editorial material should be sent to Edward D. Harris, Jr., MD, Editor, The Pharos, 525 Middlefield Road, University of Miami Suite 130, Menlo Park, California 94025. Smeeta Sinha, MD Requests for reprints of individual articles should be forwarded directly to the authors. UMDNJ—New Jersey Medical School 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 525 Middlefield Road, Suite 130 © 2008, by Alpha Omega Alpha Honor Medical Society. The contents of The Pharos can only be reproduced with the written Menlo Park, California 94025 permission of the editor. (ISSN 0031-7179) Telephone: (650) 329-0291 Circulation information: The Pharos is sent to all dues-paying members of Alpha Omega Alpha at no additional cost. All correspondence Fax: (650) 329-1618 relating to circulation should be directed to Ms. Mara Celebi, Webmaster, 525 Middlefield Road, Suite 130, Menlo Park, California 94025. E-mail: E-mail: [email protected] [email protected] POSTMASTER: Change service requested: Alpha Omega Alpha Honor Medical Society, Post Office Box 2147, www.alphaomegaalpha.org Menlo Park, CA 94026. Time for change in AΩA Edward D. Harris, Jr., MD

David P. Hill

“We know that AΩA exists, but no one really knows who distinction of election to AΩA in medical school. is a member.” —Recently elected student *UIBTCFFOïîôZFBSTTJODFUIFTPDJFUZXBTGPVOEFE4IPVME not the enormous changes in both the science and therapeu- AΩA’s Board of Directors recently sent a brief ques- tics in medicine as well as in the organization and structure tionnaire to junior AΩA members at many different medical of medical care be factors in having a national honor medical schools. We wanted to find out how much current students TPDJFUZUIBUJTSFMFWBOUGPSUIJTOFXDFOUVSZ on various campuses know about AΩA. The results from one Some of the questions open for debate and consideration question were particularly interesting: include: t 4IPVMEUIPTFFMFDUFEBTNFNCFSTXIPIBWFOPUQBJEEVFT t *T"ώ"BDUJWFBOEWJTJCMFBUZPVSTDIPPM CFDPOUJOVFEBTiBDUJWFwNFNCFSTPG"ώ" *ONBOZQSPGFT- – Yes: . sional societies, nonpayment of dues results in a physician’s – Somewhat: . name being dropped from membership. Failure to play AΩA – No: . dues does not lead to any other classification than “inactive” status, meaning that these “members” receive no further com- These numbers got us thinking . . . if AΩA is perceived as munication from the national office. only “somewhat” visible (“almost like a secret society,” wrote t )PXDBOUIFNBOZ"ώ"QSPHSBNTQSPWJEFEUPDIBQUFST one student) at medical schools, how can we expect the gen- including the Distinguished Teacher Award, Medical Student eral community, our patients, to know of its existence and Service Projects, Visiting Professorship, and Student Essay XPSUI and Poem contests, be announced and publicized beyond the AngiesList.com now ranks doctors. Who are the judges, DIBQUFSTBOEJOEJWJEVBMXJOOFST 'PSFYBNQMF FBDIZFBSBUUIF BOEXIBUBSFUIFDSJUFSJBPGFYDFMMFODF 5IFHMPTTZDJUZQFSJ- AAMC annual awards banquet, the four AΩA Distinguished odicals, such as SF Magazine, already rank Top Doctors each Teachers chosen from faculty nominated by their deans are year. Basically, this is free advertising, often by peers, based on HJWFO˸ïî îîîBXBSET#VUCFZPOEUIPTFQSFTFOUBUUIFEJO- undisclosed criteria. State medical societies, bound by prin- ners, there is rarely any publicity. ciples of impartiality, cannot rank physicians, although their t )PX EP XF JODSFBTF VTF CZ NFNCFST JO QSBDUJDF BOE publications identify those who have been determined, for BDBEFNJBPGUIFTPDJFUZTXFCTJUF one of many reasons, to have been disciplined or judged unfit t 5PDPOUJOVFUPHSPXBOEFYQBOEQSPHSBNT UIFTPDJFUZ for active practice. Nevertheless, those with responsibilities needs more revenue than that generated by dues. Should other for monitoring as well as paying for medical care, including TPVSDFTPGJODPNFCFJEFOUJGJFE insurance companies, federal watchdog organizations, and t )PXDBOJOEJWJEVBMDIBQUFSTJOWPMWF"ώ"NFNCFSTOPU Medicare, expect the highest standards of quality care from POUIFJSDBNQVTFTJODIBQUFSBDUJWJUJFT the nation’s physicians. t $BO QSPHSBNT CF JOTUJUVUFE GPS "ώ" NFNCFST EVSJOH A logical extension of these observations is that a good case UIFJSSFTJEFODZZFBSTUIBUXPVMECFVTFGVMBOEBQQSPQSJBUF can be made for giving ready access to the public of names of QIZTJDJBOTXIPBSFBDUJWFNFNCFSTPG"ώ"*UJTJNQPSUBOU Returning to the results of the questionnaire, responses we feel, to inform the public about the mission and goals of showed that students were both pleased and proud to be AΩA, the only national honor medical society. Our patients elected. Although scholarly achievement is a prime and basic could and should learn that in addition to academic achieve- criterion for election, so are the other components of profes- ment, a student’s commitment to service, professionalism, sionalism, service, and leadership. We, those elected in earlier fairness in dealing with colleagues, compassion, integrity, and years, must be proud of the new generations of AΩA mem- capability of leadership are important criteria for election. bers, and support and encourage them. *OTUFBEPGSFGFSSJOHUPUIFHMPTTZQIPUPJOUIFDJUZNBHB[JOF B patient looking for a primary care or specialty physician could, Please send your questions, comments, and suggestions to at AΩA’s own web site, find those doctors who achieved the me at [email protected].

The Pharos/Autumn 2008 1 The Pharos • Volume 71 In This Issue Number 4 • Autumn 2008

ARTICLES DEPARTMENTS Editorial Access to a healthy lifestyle 1 Time for change in AΩA Edward D. Harris, Jr., MD Not as simple as an apple a day

The physician at the movies Muyibat A. Adelani, MD 38 Peter E. Dans, MD The Savages The Great Debaters The Diving Bell and the Butterfly 4 Reviews and reflections 43 The American Plague: The Untold Story of Yellow Fever, the Epidemic that Shaped Our Bring out your dead? History Reviewed by William Reed, MD W. Roy Smythe, MD Ryan Attema The Best of the Bellevue Literary Page 4 Review Commentary from a teacher of Reviewed by Richard Bronson, MD anatomy 47 Letters Robert A. Chase, MD POETRY 10 September Sunlight 16 Myron F. Weiner, MD Aura Improving the conditions 26 Nancy Lo of confinment Day in a Golden Year End-of-life care in prison Yummy Nguyen 33 Anne Lincoln Adventures in Prostate Alley 46 Henry N. Claman, MD Charged 18 57 Rose Bromberg Morning Rounds 61 Aaron M. McGuffin, MD Symmetry 64 Paula Brady Inside In the ICU at Christmastime Back 69Cover Sarah Cross, MD Back Seeds Page 10 69Cover Leah Gilbert

OF ALPHA OMEGA ALPHA HONOR MEDICAL SOCIETY Autumn 2008 On the cover Please insert small See page 26 In This Issue version of cover

A thank you note AΩA NEWS Colonel Kenneth R. Kemp, MD, FACP, FCCP National and chapter news 50 88th annual banquet and induction ceremony at the University of Texas Medical Branch at 27 Galveston (Alpha Texas) Alpha Omega Alpha 52 Volunteer Clinical Faculty Awards, 2007/2008 Procedure note Jonathan Han, MD Alpha Omega Alpha 53 Administrative Recognition Awards, 2007/2008

Alpha Omega Alpha 29 54 Medical Student Service Project Awards, 2007/2008

Alpha Omega Alpha visiting Nephrologist as kidney donor 55 professorships, 2007/2008 Meyer Lifschitz, MD 2008 Alpha Omega Carolyn 58 L. Kuckein Student Research Fellowships

2008 Alpha Omega Helen 34 60 H. Glaser Student Essay Awards

2008 Pharos Poetry Of books and libraries 60 Competition winners Confessions of a booklover The Pharos, Martin Duke, MD 62 Volume 71

Page 36 Page 29 4 The Pharos/Autumn 2008 Access to a healthy lifestyle Not as simple as an apple a day

Muyibat A. Adelani, MD The author is a 2008 graduate of Vanderbilt University School of Medicine. This essay won an honorable mention in the 2008 Alpha Omega Alpha Helen H. Glaser Student Essay Competition.

here have been many campaigns for lifestyle changes that lead to better health. Examples include the “ A Day” campaign to increase fruit and vegetable intake, Tthe “VERB” campaign to increase physical activity, and the “truth” campaign for smoking cessation. Such changes demon- strably decrease the risk of chronic diseases such as cardiovascular disease, diabetes, obesity, and some cancers. Health care providers therefore aggressively encourage patients to make these changes in their own lifestyles, but any noncompliance with these recommendations is often attributed to apathy. Although patient motivation is important, the ability to comply with these recommendations is also limited by access to the means to fulfill them.1 All patients do not have equal access to the basic requirements for healthy living; the resources available in the immediate environment dictate a person’s potential for health. Minorities and the urban poor have a disadvantage in their pursuit of health. Many studies show that low-income and predominantly minority neighborhoods are less likely to have grocery stores that sell high-quality foods, and are less likely to have safe places for exercise.1–8 These neighborhoods also have more fast food outlets and liquor stores, as well as more advertising for soda, candy, tobacco products, and alcohol than do wealthier neighborhoods.2,4,5,9–11 Minorities and the poor also seem to have worsening health, particularly of chronic “lifestyle” diseases.1–5,11–13 Thus, a major contributor to differences in health among income groups may be the inequities in the local

Carlos Luna Carlos environment, particularly the food environment.

The Pharos/Autumn 2008 5 Access to a healthy lifestyle

Good reviews for the supermarket known as “supermarket redlining,” mirroring the practices of the banking and insurance industries, which denied services Supermarkets that are part of regional or national chains or increased charges to minorities and the poor.1 Many fac- have more high-quality foods, including more fruits, veg- tors, including higher land values, labor and utility costs, less etables, and low-fat items, than nonchain supermarkets or available space for store expansion, low profit margins on per- smaller, independent grocers.2–4,7,12,14,15 Compliance with ishable food items, and increased crime, are cited as reasons healthy diet recommendations seems to depend on the that supermarkets have stayed away from the inner cities.1,17 availability of markets offering wide selections of quality Many feel, however, that, as with other forms of redlining, the foods.4,6,9,14 Allen Cheadle and his coworkers found that supermarket industry’s abandonment of the inner city is based increased selection of low-fat and high-fiber foods in local on stereotypes.1,17 A  Newsweek article quoted an execu- supermarkets was associated with healthier diets among those tive of a Pittsburgh economic development group as saying living nearby.16 Kimberly Morland and colleagues showed that the perception that poor people “all rob and steal” hinders that people who live near supermarkets eat more fruit and many chain supermarkets from pursuing opportunities in vegetables and less fat.9 the inner city.17 Regardless of whether such assumptions are The higher-quality foods offered by supermarkets are widespread, few supermarkets have moved back to the inner less likely to be available in low-income and predominantly cities.1,17 minority neighborhoods because these neighborhoods have Supermarkets in poor and minority neighborhoods—even fewer chain supermarkets.2–5,7 A  study shows that pre- those that are part of a regional or national chain—may still be dominantly African American neighborhoods have about less likely to have healthy selections than their counterparts in half the number of supermarkets that exist in those that are predominantly white suburbs.14 Because supermarkets aver- mostly white,3 while a  study in the Minneapolis-St. Paul age less than one percent net profit on sales,1,17 they do not area found that eighty-nine percent of chain supermarkets carry food items that are unlikely to sell well. It is often argued were located in areas with poverty rates of less than ten that store selection reflects consumer demand.4,18 Perhaps the percent.7 Low-income neighborhoods are also more likely to residents of poor and minority communities are simply not as have smaller, independently-owned grocery stores and conve- interested in fruits, vegetables, and low-fat items. Available nience stores that do not offer the same selection of healthy studies evaluating store selection do not show whether sup- items that larger supermarkets do. A study published in  ply is influenced by demand. Many studies show, however, showed that, while low- income neighborhoods have four that dietary choices—both good and bad—are influenced by times as many food outlets as do wealthier neighborhoods, supply.5,6,9,14,16 When more produce is available in a commu- including independent grocery stores and convenience stores, nity, more fruit and vegetables are consumed.9,14 Alcohol use they have only half as many supermarkets, and fewer produce markets, baker- ies, and other specialty markets.5

Flight of the chains from poor urban areas

Supermarkets are now scarce in poor and minority neighborhoods, after de- serting these areas in the s and s as they followed the middle-class population exodus to the suburbs.13,17 This was compounded in the s by the increasing competition among supermarket chains, with subsequent buyouts and mergers leaving larger, but fewer, players.1,17 Supermarket chains found business easier in suburban locations, where there was more space for growth and less crime; urban areas were left with few stores of their own. As this trend progressed into the s, it became

6 The Pharos/Autumn 2008 follows a similar trend.6,9,10 Thus, grocers are in a position to change the eating habits of their local communities. By and about Muyibat Adelani I am a  graduate of Vanderbilt Economic necessity: underfunding University School of Medicine in Nashville, food budgets Tennessee, and obtained my Bachelor of Science degree from the University of Southern California in Los Angeles, Residents of poor and predominantly minority neigh- California. I am a resident in Orthopaedic Surgery at borhoods not only have less healthy food available, they Washington University in Saint Louis, Missouri. may also pay more for it. Supermarkets tend to have lower prices than local independent grocery stores and convenience stores,3,5,7,13,14,17,19,20 with savings ranging from two to forty-nine percent.1,6,17,19,20 In addition to more buying power, exists about how much this cost disparity is influenced by the supermarkets also offer lower prices by selling more types of higher prices that low-income families face. While some argue products, including cheaper store brand and generic items, that such studies are difficult to interpret due to differences in as well as more economically sized items.7,19,20 The lack of food choices among the two groups, many researchers have supermarkets in poor and minority communities means that found that low-income households adapt to higher prices by people there are less likely to benefit from such cost savings. replacing fruits, vegetables, and dairy products with meats Even in inner city neighborhoods that have supermarkets, and simple carbohydrates.1 Although poor families are likely smaller stores, higher operating costs, and limited com- to pay higher prices for comparable items, they also spend petition lead to higher prices than exist in their suburban less per unit on food than wealthier families by buying more counterparts.1,7,14,19,20 bargain items, store label and generic products, bulk items, Because food is essential and the prices for staples are largely and even lower quality food.19,20 Some researchers believe that constant, it is no surprise that low-income households spend a food item selection does more to lower the cost of food than significantly greater proportion of their income on food than grocery store type and location do to raise food expenditures, do wealthier households. A  United States Department of but it is important to remember that cost plays a significant Agriculture study shows that the poorest twenty percent of role in dietary choices.1,6,14,19 People eat what they can afford the country (average income of ,) spent , per capita to eat. It may be possible to adjust the cost data for bargain, per year on food, compared to , for the wealthiest twenty generic, and bulk item purchases, but it is much more difficult percent (average income of ,).20 Nevertheless, concern to assess sacrifices in quality. What is clear is that low-income families spend disproportionately more on comparable food and must make sacrifices to be able to buy what they need.

A proliferation of unhealthy food options

Poor and minority communities not only have fewer, yet more expensive, food options, they also are bombarded with poor nutritional alternatives, such as fast food restaurants, which are more widespread in poorer and minority neighborhoods.2,4,14 LaVonna Lewis and her colleagues found that . percent of restaurants in largely African American neighborhoods in South Los Angeles were fast food outlets, compared to  percent of restaurants in a comparison area of largely white neighborhoods.2 This study Ryan Attema

The Pharos/Autumn 2008 7 Access to a healthy lifestyle

also found that restaurants in the black neighborhoods were t *O 4PVUI -PT "OHFMFT DPNNVOJUZ HSPVQ "GSJDBO more likely to promote unhealthy food options than restau- Americans Building a Legacy of Health (AABLH) collaborates rants in the white neighborhoods, which were more likely to with faculty from local universities and the county health advertise their healthy menu options, offer foods prepared by department to change the nutrition and exercise factors that healthier methods (i.e., broiled instead of fried), and identify lead to cardiovascular disease and diabetes.11 Working with these healthy options on their menus and provide nutritional the Community Health Councils, AABLH conducted a store information. shelf survey that led to a Neighborhood Food Watch (NFW). AABLH holds local grocers accountable to Standards of What can be done? Quality, including providing top-quality fruit and vegetable selections, supplying fresh meat (including lean meat containing less than three grams of fat per ounce), and offering nonfat and low-fat dairy products.23 The organization also encour- Improving the health of a poor or minority community ages community members to patronize only grocers who have can be catalyzed by improving access to good food, a proj- signed the Standards of Quality agreement and display the ect that should be a community effort. Food availability NFW decal in their store window. studies provide the basic accessibility information,18 and These examples show that neighborhoods, with the help community-based participatory research—defined as health of advocates in government, academia, health care, and promotion research that allows community members to be other sectors, can work to bring healthier food back to their involved in decisions that affect them—is effective in building communities. bonds between researchers and residents, which help efforts Poor and minority communities suffer from unequal access to force change.11 The collaboration of community groups, to the nutritious food options necessary for health. Health local governments, city planners, supermarket officials, and, care professionals must understand this disparity. We must be perhaps, health professionals, in developing customized solu- willing to discuss food availability with our patients, and work tions is the best way to ensure success.13 Neighborhood orga- with them to make changes in their communities. nizations all over the nation have succeeded in getting better food in their communities: References t /FX $PNNVOJUZ $PSQPSBUJPO B OPOQSPGJU DPNNVOJUZ . Eisenhauer E. In poor health: Supermarket redlining and development organization in Newark, New Jersey, worked to urban nutrition. GeoJournal ; : –. bring a supermarket back to Newark after a study it commis- . Lewis LB, Sloane DC, Nascimento LM, et al. African Ameri- sioned in  showed that over ninety percent of residents cans’ access to healthy food options in South Los Angeles restau- of the Central Ward left the city to shop for groceries.21 The rants. Am J Public Health ; : –. organization’s founder, William J. Linder, began discussions . Powell LM, Slater S, Mirtcheva D, et al. Food store avail- with Supermarket General, the parent company of Pathmark, ability and neighborhood characteristics in the United States. Prev to bring the supermarket to his community. After ten years Med ; : –. of planning, securing land, and obtaining financing, New Community, in a joint venture with Supermarket General, brought a ,-square foot Pathmark supermarket to the Central Ward. Not only has this venture allowed Central Ward residents to shop for better foods more conveniently, it also created jobs for local residents, while the joint venture has reinvested a portion of its revenue in other New Community programs. t *OUIFï÷öîTBOEFBSMZï÷÷îT UIFDJUZPG3PDIFTUFS /FX York, experienced a huge decline in the number of its supermarkets.22 When the low-income community of Upper Falls lost its only grocery store, a community partnership called Partners for Food began to lobby for new supermarkets in the area. With widespread support, including from Rochester’s mayor, the group negotiated with Buffalo-based chain Tops to bring four new stores to the city, including one to Upper Falls. The city contributed public money to the cause, al- lowing residents to purchase quality food items in their own neighborhoods again.

8 The Pharos/Autumn 2008 . Baker EA, Schootman M, Barnidge E, Kelly C. The role of J Prev Med ; : –. race and poverty in access to foods that enable individuals to adhere . Sallis JF, Nader R, Atkins J. San Diego surveyed for heart- to dietary guidelines. Prev Chronic Dis ; : A. healthy foods and exercise facilities. Public Health Rep ; : . Moore LV, Diez Roux AV. Associations of neighborhood –. characteristics with the location and type of food stores. Am J Public . Cheadle A, Psaty BM, Curry S, et al. Community-level com- Health ; : –. parisons between the grocery store environment and individual . Morland K, Wing S, Diez Roux A, Poole C. Neighborhood dietary practices. Prev Med ; : –. characteristics associated with the location of food stores and food . Turque B, Rosenburg D, Barrett T. Where the food isn’t. service places. Am J Prev Med ; : –. Newsweek  Feb : . . Chung C, Myers SL Jr. Do the poor pay more for food? An . Wechsler H, Basch CE, Zybert P, et al. The availability of analysis of grocery store availability and food price disparities. J low-fat milk in an inner-city Latino community: Implications for Consum Aff ; : –. nutrition education. Am J Public Health ; : –. . Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality . Kaufman PR, MacDonald JM, Lutz SM, Smallwood DM. Do in the built environment underlies key health disparities in physical the Poor Pay More for Food? Item Selection and Price Differences activity and obesity. Pediatrics ; : –. Affect Low-Income Household Food Costs. Washington (DC): . Morland K, Wing S, Diez Roux A. The contextual effect of United States Department of Agriculture, Economic Research Ser- the local food environment on residents’ diets: The atherosclerosis vice, Agricultural Economic Report ; . risk in communities study. Am J Public Health ; : –. . Kaufman P, Lutz SM. Competing forces affect food prices for . LaVeist TA, Wallace JM Jr. Health risk and inequitable distri- low-income households. Food Review ; : –. bution of liquor stores in African American neighborhood. Soc Sci . New Community Corporation. NCC Success Stories— Med ; : –. Projects. www.newcommunity.org/about_success-projects. . Sloane DC, Diamant AL, Lewis LB, et al. Improving the htmlpathmark. nutritional resource environment for healthy living through com- . National Council for Urban Economic Development. Food munity-based participatory research. J Gen Intern Med ; : for thought: Rochester invests in inner city grocery stores devel- –. opment. Economic Developments ; : –, –. Cited in: . Horowitz CR, Colson KA, Hebert PL, Lancaster K. Barriers Nutrition policy profiles: Supermarket access in low-income com- to buying healthy foods for people with diabetes: Evidence of envi- munities. Prevention Institute; . www.preventioninstitute. ronmental disparities. Am J Public Health ; : –. org/CHI_supermarkets.html. . Zenk SN, Schulz AJ, Israel BA, et al. Neighborhood racial . Community Health Councils, Inc. Community Projects/Op- composition, neighborhood poverty, and the spatial accessibility of portunities for Investment: Neighborhood Food Watch. www.chc- supermarkets in metropolitan Detroit. Am J Public Health ; inc.org/REACH/timeline.cfm. : –. . Zenk SN, Schulz AJ, Hollis-Neely T, et al. Fruit and vegetable The author’s e-mail address is: intake in African Americans: Income and store characteristics. Am [email protected]. Carlos Luna Carlos

The Pharos/Autumn 2008 9 Commentary from a teacher of anatomy

I wholeheartedly agree with Roy Smythe’s premises concerning the importance of manual dissection in the teaching of human gross anatomy. He effectively expresses his opinion concerning the value of students facing the reality of death, gaining a fuller appreciation of human structure, experienc- ing a “rite of passage,” learning by using all senses, and appreciating the sanc- tity of life in a new way. This paper should stimulate further discussion by others involved in curriculum planning. It begs for a comprehensive study with experience data, student as well as faculty opinion, and the value of adjunctive teaching technologies. Currently almost every medical school in the United States and Canada makes use of human cadavers either by student dissection or by faculty/staff prosection demonstrations. Several schools have tried teaching by prosection and, having found it ineffective, have returned to student dissection. A recent survey of European anatomists based on  completed ques- tionnaires showed that sixty-nine percent of teaching anatomists favored student dissection over all other methods.1 Prosection lessons stood a distant second in importance, whereas all other teaching methods scored well below use of cadavers. In the United Kingdom a random survey of  students showed that ninety-eight percent disapproved of removing student dissection from the curriculum, and that dissection was believed to be the most useful method for learning anatomy.2 At Stanford, our student evaluations of teaching methods, including textbooks, lectures, seminars, radiological and living anatomy, computer programs, and use of models, has found dissection well above the others on the list for twenty consecutive years. The importance of social bonding among students, as well as between students and participating faculty, cannot be overemphasized. This is particularly true when faculty members have had clinical experience with patients. Anatomists as a group should insist that continu- ing curriculum changes, administrative fund saving, and the addition of problem-based learning will not threaten the continuation of student dissection early in the medical school experience. Manual dissection time is being effectively reduced by some pre-dissection preparation of cadavers by faculty and staff, and the elimination of memorization of detailed anatomy has allowed adaptation to the necessary reduction in time allotted to the preclinical study of anatomy.

References . Patel KM. Moxham BJ. The relationships between learning outcomes and methods of teaching anatomy as perceived by professional anatomists. Clin Anat ; : –. . Gogalniceaunu P, Palman J, Madani HS. Undergraduate anatomy teaching: A consumer led market. Presented at the annual meeting of the American Association of Clinical Anatomists, Toronto, Ontario.  Jul –. Robert A. Chase, MD (AΩA, Yale University School of Medicine, ) Stanford, Californiaw

From the Stereo Atlas of Human Anatomy by David Bassett. Courtesy of Stanford University The Pharos/Autumn 2008 15 September Sunlight

Dr. Weiner (AΩA, Tulane University School of Medicine, !"##) is clinical professor of Psychiatry and Neurology at the University of Texas Southwestern Medical Center in Dallas. His address is: #"$# Still Forest Drive, Dallas, Texas %#&#&. E-mail: [email protected].

Photographs courtesy of Dr. Weiner (building) and Darrel Harmon (tree).

16 The Pharos/Autumn 2008 The late summer sun arrives in Manhattan, following whining garbage compressors into the streets, rushing trucks and taxis into the avenues; creeping into crevices, decorating doorways, deflecting from dirty windows, stabbing the sidewalks, fading by five. The same sun leaves languidly from Central Park lushly green in the September Sunlight early dark. Leaves glisten from pattery rain, fall and scatter on the ghostly lanes. Pearly pathways shadow and fade long after shafts of light are quietly swept from streets and avenues by gentle, approaching September night. Myron F. Weiner, MD The Pharos/Autumn 2008 17 Aura

A brilliant flash, like a popping light bulb, Or a hand slap across the face. And then numbness comes to the right cheek. No. Not again. A race for the cabinet, fumbling for the bottle. One quick swallow and a cool splash. Afterwards, self-banishment to the basement, Cold and dark and silent. Nancy Lo

Ms. Lo is a member of the Class of !"## at Drexel University College of Medicine. This poem won honorable mention in the !""$ Pharos Poetry Competition. Ms. Lo’s address is: %&%' Barclay Street, Philadelphia, Pennsylvania #(#!(. E-mail: [email protected].

Illustration by Laura Aitken

The Pharos/Autumn 2008 1 A thank you note

Colonel Kenneth R. Kemp, MD, FACP, FCCP The author (AΩA, University of Arkansas, 1987) is the pro- to be done—advance directives, home health care, hospice gram director for the combined Army-Air Force fellowship consideration, business affairs. Much needed to be taken in pulmonary and critical care medicine at the San Antonio care of before he lost the capacity to make rational decisions. AUniformed Services Health Education Consortium. The I wished that I didn’t have to open the conversation, that views expressed here are those of the author and do not somehow it would all go away and he would miraculously get necessarily reflect those of the Army Medical Department or better, but he didn’t and I had to. the Department of Defense. Mr. Clark had a tremendous zest for life. He was tall and somehow appeared remarkably fit for a man with very t was very clear to me that Mr. Clark was slowly deterio- severe COPD. He was a veteran of World War II and the rating and would die of respiratory failure soon. He had Korean Conflict and had spent over twenty years of service come to the emergency department or been admitted to in the Army. During his service to the country, he had been Ithe hospital almost monthly for the last six months for recur- deployed to far-flung areas of the world, while Mrs. Clark rent COPD exacerbations. Despite aggressive treatment he took care of their five children and maintained stability in continued to deteriorate. So the writing was on the wall—my their home. His appearance was always immaculate. He wore patient’s time would not be long. neatly pressed pants and crisply starched shirts, sometimes It has never been easy for me to tell a patient that he accented with natty sweaters and a baseball cap. With the or she faces imminent death—especially one whom I have voice of a man who had literally seen the good and the bad of treated and grown close to over many years. While I dreaded the world, he could spin a yarn to make you laugh or to make the prospect, I had to tell Mr. Clark, who was eighty-six you ponder the realities and mysteries of life. We came to years old, and his devoted wife, to whom he had been mar- know and respect each other. Mr. Clark was my patient—and ried for over sixty years, that he was dying. Things needed my friend.

The Pharos/Autumn 2008 27 A thank you note

He always knew what his medications were. If he didn’t dyspneic. He was even more malnourished than he had been have them written down, he would recall them from mem- a few weeks before. He had no appetite and couldn’t catch his ory, or his wife, who always sat across the room during our breath long enough to swallow. We gave him broad- spectrum examinations, would remind him of exactly what he was tak- antibiotics and supplemental oxygen, but did not intubate ing. Mrs. Clark was ferociously protective of her husband. him. By this time, two of his children, a son and daughter, She was convinced that he always minimized his symptoms. had come to his bedside, along with Mrs. Clark, and they de- She constantly reminded Mr. Clark to “tell the doctor what termined that Mr. Clark would not have wanted to be put on really happened!” She drove him where he needed to go. mechanical ventilation. Mr. Clark’s slow decline, though pain- She kept track of his appointments. She pushed his wheel- ful and difficult to watch, had a silver lining—it had allowed chair when needed. She made sure he had his meals. She him and his family to seriously consider how to manage the kept him looking good. And when the end came closer, she end of his life. Over the weeks and months of their long good- bathed him, lifted him, comforted him, and consoled him. bye, Mr. Clark and his family embraced the good of life and This was no small task, since Mrs. Clark was elderly herself, decided that its prolongation by artificial means would serve but she was from the old school—and felt that no one else only to further suffering. So after his fever came down and his could take care of her husband like she could. They bantered oxygen requirements improved, the ward team sent Mr. Clark back and forth like any couple married for more than sixty home with arrangements for home hospice. years—he would get irritated that she was making a moun- One week later, while I was at home sleeping, my pager tain out of a molehill and she would get irritated that he was went off at : . It was the medical examiner’s office. Mr. trying to do more than he should, but they loved each other Clark had passed away quietly in his sleep and the medical with enviable passion. examiner wanted to know if I would sign his death certifi- Yet this vibrant man had become a shadow of himself cate. “Of course,” I agreed, and as I lay back down before over the last several months. He had become more gaunt, starting the day’s duties, I thought about how Mr. Clark’s and his hair began to get thinner. His breath became more struggles were over. I thought about how much he meant to short, and he lost more and more of his stamina. Mrs. Clark our country, his wife and children, and to me. Though I’ve escalated her diligent care for her husband and I tried des- found it difficult to offer condolences to the families of my perately to change what seemed to be an inevitable course. patients who pass away, I mustered enough strength after He was on supplemental oxygen, anticholinergics, beta ago- two days to call Mrs. Clark. to let her know how much I ap- nists, steroids, mucolytics, and frequent antibiotics. He was preciated being able to participate in the care of her husband. given a nebulizer, an oxygen-conserving device, a motorized A few days later, Mrs. Clark sent me a thank you card. It wheelchair, and numerous other interventions. They made read simply, “Thank you for the care you gave my husband Mr. Clark somewhat more comfortable, but the inexorable and my children’s father over many years.” I still have that process of deteriorating lung function continued unabated. card. It still rests on my desk. So I told him that he was dying. I had to face the sobering From time to time, when faced with the overwhelming reality that there was nothing I could do to reverse or even tasks of patient care, the frustration of medical bureaucracy, slow this process. Medical knowledge and technology give us and the unending requirements of learning and teaching, remarkable capacity to improve the quantity and quality of I will read that thank you note again. Though it is a simple life, but when the ethereal substance of life begins to become message, it gives me strength and causes a warm glow in my a vapor there is nothing that we humans can do. Medicine, heart. It reminds me that when we intersect in life as doc- like life, is limited. When I told him that he would probably tor and patient, we become connected to one another. That not live very much longer, he accepted it with grace and dig- connection cannot be merely a business transaction or a nity. I’m sure he already knew. He just looked at me and said, contractual agreement; it is a covenant of the heart. We must “Yeah Doc. We’ve been thinking about this and we’ve de- care for our patients and their families with our knowledge cided we’re going to get one of those living wills.” He wanted and technical skill—but it cannot stop with that alone; we to know if he needed a lawyer for a living will. His wife asked must also care for them with our hearts. Great men like Mr. about home health care. He asked about hospice. Somehow Clark and his lovely wife deserve no less. in the conversation it seemed that he had come to a resolu- tion, a peace, an acceptance of what lay ahead. Mrs. Clark, The author’s address is: though tearful, also knew that the time she would have with Pulmonary Service her husband would not be long and she seemed reluctantly Department of Medicine ready to allow him to go. Brooke Army Medical Center Not three weeks later, Mr. Clark was hospitalized again. 3851 Roger Brooke Drive This time, he had developed a severe pneumonia. He was un- Fort Sam Houston, Texas 78234-6200 able to communicate effectively. He was extremely weak and E-mail: [email protected]

28 The Pharos/Autumn 2008 Procedure note

Jonathan Han, MD

The author is medical director of Eskimo male with self-inflicted gunshot county hospital where I had trained, the St. Margaret Family Practice wound to the right chest.” our medical staff was quite familiar with Residency Program at the University We were somewhere above the handling traumatic injuries, as life above of Pittsburgh Medical Center. Arctic Circle,  miles from the near- permafrost was rife with adventure and est surgeon, and I had to act. Having misfortune. “The Arctic is unforgiving,” inish the note. just transported him by seaplane to the charge nurse dryly observed as she Because I was so relieved that our outpost hospital, I was filled with greeted us at the door. my patient was still alive, I almost adrenaline-laced expectations that Fforgot to document in his medical re- I could help him. Although our tiny A lot of blood . . . cord the events that had just unfolded. eight-bed hospital resembled a sessile always scary “Patient is an eighteen-year-old MASH unit more than the sprawling Procedure note

As a family physician, I had limited way with terrible finality, like thin ice I scribbled a few mechanical phrases, experience performing operative pro- collapsing under the weight of an un- designed to satisfy my partners and cedures, and my young patient required supervised child. His bright red blood, nursing staff, as well as the potential one that I had never done before. It along with my barely concealed hubris, readership of malpractice attorneys. I was early in my career, and I was not gushed from this new chest wound, fill- described in bland detail the indications afraid to attempt something risky and ing me with a nauseating fear that I had for the procedure, the obtaining of nec- new. Buoyed by romantic notions of mistakenly pierced a major artery and essary consents, and an account of inci- practicing in the Alaskan “bush” coun- killed my patient. sions made, scalpels used, and sutures try, I relished the role of playing the “Everything will be all right,” I told closed. Ending my note, “Patient toler- lone country doc, relying on my guts my patient, and myself, as I busily con- ated emergency thoracostomy without as well as wits to meet the needs of my nected drains, checked intravenous complication,” I signed my name with patients. Harming anyone through my lines and cardiac monitors, feigning an undeservedly confident flourish. I own inexperience, I selfishly rational- calmness as I palpated my own thready should have been humbled by the irony ized, was one of the unavoidable risks pulse. Slowly over thirty minutes, my that my note implied comfortable rou- local folks assumed in living an isolated suppressed panic subsided as his hem- tine instead of the bloody fear I had ex- arctic existence. orrhaging slowed to a trickle. The most perienced just moments before. Instead I took a deep breath, and quickly reassuring sign that my patient would I reveled in my survivorship, nurturing reviewed a surgical textbook that made survive was that the trademark unflap- the hubris that had propelled me into the task appear straightforward enough; pability of the grizzled charge nurse that life- threatening situation in the surely the tidy description of events returned, replacing the uncharacteristic first place, and deferring lessons about would fall into place after the obligatory wide-eyed worry she wore just moments humility to the long night ahead. sterile prep. Bearing down, harder and before. I had been granted a temporary harder, I suddenly pierced his chest cav- reprieve. “SOAP”—the facts that ity with the trocar. All at once, his fas- Finish the note, I reminded myself. disguise emotion? cia and pleura, blood and breath, gave Opening my patient’s medical chart,

Writing with a newly steady hand, telling my side of the story using pro- fessionally sparse language served as another initiation rite into the medical fraternity of “those who see this all the time.” Ritually following the script of the revered SOAP note—an appropriate ac- ronym for the patient’s Subjective com- plaints, Objective findings, Assessment by physician, and Plan of action—I imposed a cleanliness and orderliness on the emotionally soiled and chaotic events that characterize medical encounters. I did not mention any of the distinctly human but clinically less expedient facts, such as the details of my patient’s strained family relationships, poverty, and nearly fatal sense of isola- tion and despair. As we lifted him from stretcher to seaplane just an hour ago, he surveyed the crowd of curious villag- ers who had gathered at the spectacle, and observed without irony, “I didn’t know so many people cared.”

30 The Pharos/Autumn 2008 But my procedure note was not the in my inexperienced hands, I cautioned reassurance, limit- setting, and a tincture place for this reflection, nor for any coolly, “He’s not out of the woods yet.” of time. That surly, recently divorced admission of my own insecurity and Nodding thoughtfully, she thanked me, fellow pacing gingerly in Room , I de- vulnerability to error. I had been trained and quietly padded out of the room. It scribed as the “Grade I ankle sprain.” to translate first- person accounts of didn’t occur to me that trees and forests My medical shorthand focused atten- illness into secondhand reporting, fil- were a long way from the endless barren tion on the acute problem, the patient’s tering away details and creating an alto- tundra where we lived. “complaint,” instead of the complete gether new though not unbiased story I documented this brief conversation person. What salvaged my note to con- following the directive: If it’s not in the in his chart: “Family member aware of vey a deeper human connection was the note, it didn’t happen. Every medical seriousness of his condition.” This cur- closing phrase, “follow-up visit in – role model marching ahead of me— sory statement left the impression that weeks.” The return appointment was attending, resident, or senior medical we had communicated on some signifi- my promise to continue this collabora- student—documented his or her work cant level. However, the unspoken feel- tion between neophyte professional and in the same terse, emotionally- vacant ings and omitted details would have told seasoned amateur, and to attend to his hand. Although every procedure note a more compelling story. Sometimes the angry mood, as well as his injured ankle, I wrote was purportedly about my pa- constraints we impose on ourselves as next time. tient, I was ultimately saying something physicians are revealed not only in these Another piercing sequence of beeps, about me, about the kind of doctor I efficiently shallow notes, but also in the and I was on my way back to the emer- wanted to be: organized in approach, problems we dare to address and act gency room, where I met a teenage male, thorough in thought, and—above all— upon. I briefly recalled the exhilaration sixteen years old, who sustained a “box- correct in judgment. Hundreds of notes I felt knowing my suicidal patient would er’s fracture” of the right hand during a a week would be written in this fashion, survive my first thoracostomy, and now fight with a gang member from a neigh- fragments and roadmaps of patient en- I was grateful for the opportunity to face boring village. Booming bass and tinny counters that define a profession and the challenging problem of his depres- percussion blared from headphones mark change and growth. As long as sion. However, my confidence wield- slung across his neck, as he sized me the patient outcome was good, or at ing scalpels or antibiotics contrasted up and identified my Korean heritage worst unavoidably bad through no fault with the inadequacy I felt taking care solely by looking at my face. It was not of my own, I did not feel compelled to of seemingly more intractable problems just a good guess; he was familiar with a reconcile the differences between the like mental illness, domestic violence, small cadre of Koreans who had immi- story I wrote and the story my patient and substance abuse. Despite my best grated to his village as business owners. and I actually shared. But the discord efforts to provide support, psychiatric These new settlers were resented by the between the acceptably documented referrals, and medications, would he native Alaskans who, in their relative and the movingly undocumented re- continue to abuse drugs or his part- poverty and subsistence existence, felt mained, reminding me the way a phan- ner and drift toward worsening depres- exploited. As I finished splinting his tom limb pain does that the integrity of sion and a repeat of attempted suicide? hand, we exchanged stories—he was connection was missing and needed to Patience and perseverance, not surgical curious about my experiences with rac- be addressed. dexterity, were now required—skills that ism. Enlightened despite the behavior Returning to my patient’s bedside, I he and I would need to develop together of many of his townspeople, he thought was met by a stout Inuit babushka wear- on the path to recovery. it was wrong to discriminate against the ing the ubiquitous mirror sunglasses and My pager interrupted this reverie, local Koreans because of race or socio- puffy, fur-lined parka essential to life in and I moved on through the night shift, economic status. “Those Koreans are the Arctic. After she introduced herself putting out smaller medical fires along just trying to get by like the rest of us,” as the teen’s aunt, we had a conversation the way. It was a blessing to keep busy, he reassured me as he shared stories that rivaled my written note in brevity. to not dwell on doubts and regrets that about bigotry among whites, Eskimos, In the face of the stoic demeanor of would slow me down. Folks with sore and Koreans above the Arctic Circle. many Eskimos, I described the recent throats, community-acquired pneumo- For the first time all night, I felt relaxed events in an unintentionally culturally nias, and other problems I had seen as we talked about similar conflicts I congruent manner. Barely disclosing hundreds of times before were seen and faced growing up in the lower . Here the untold hazards that lay ahead, or treated with ease. All that was really was an opportunity to build a relation- the dangers that he had already faced needed for most of these patients was ship, utilizing skills with which I had

The Pharos/Autumn 2008 31 Procedure note

more confidence than handling scalpels nar gutter splint applied in the usual coldly competent clinician depicted in and trocars. This was an important manner.” my writing—instead, I was a struggling “teaching moment” I could use to help There were many secrets edited out participant, wrestling again with regret, him avoid another fight in the future. of this unsatisfying note, though the whose concern for this patient lay not undisclosed story-line this time was not with mending broken bones but with a The dangers of sharing about fear, inexperience or, as always, blown opportunity for healing. analysis that is uncertainty. Instead, my verbal heavy- An apology was in order. To be faith- not asked for handedness threatened to perpetuate ful to my text, I had to first be faithful to or worsen existing fracture lines within my patient. This reconciliation required a tiny Arctic community. Had I slowed a combination of humble intention and Emboldened by the rapport I thought down enough to let my patient reflect luck, and I could do something about we shared in this moment, flush with on his own about his actions, both he the first contingency only. I carefully confidence in having competently im- and I could have learned a more power- printed my name, legibly, and closed mobilized his fracture with an ulnar gut- ful lesson. Instead, I was now faced with his chart. ter splint, I reminded him that he had the painful challenge of repairing this My shift had come to an end. After just broken his hand during a fight with latest iatrogenic complication, caused unceremoniously signing out patient another teen whose only transgression by my misuse of words sharper than care responsibilities to my caffeinated was membership in a rival gang. “He any trocar. partner, I slid on my parka and headed was just running with a different crowd. Although it felt disingenuous to end out of the hospital into the midnight sun After all we just talked about, don’t you the procedure note describing only the of an Arctic summer. As I shuffled my think that was a bit hypocritical?” medically expedient issue of the boxer’s way home, I spotted a familiar young His response to my verbal interven- fracture, I did not know how to docu- man with a fresh cast on his arm, strad- tion was immediate. “Who are you call- ment my error. No trusty textbook pro- dling one of those ubiquitous balloon- ing a hypocrite, fool?” he spat at me. tocol for “mistake management” was tired all- terrain vehicles. Our eyes met Shaking his newly-casted fist, he strode available for consultation. Important briefly, and when he didn’t curse me or angrily out of the emergency room, our questions remained, immediately self- drive away in a cloud of dust, I inter- brief connection collapsed under the ish: How can I save face in the presence preted his staying as yet another po- brute force of my ill-chosen words. of my peers and community? Only later tential “teaching moment,” this time I had barely begun composing ratio- did the most meaningful question arise: for me. nalizations, stewing in anger and regret, How do I treat my patient as I would “Wait up,” I called as I walked toward when a familiar Eskimo babushka trun- want to be treated, within a relationship him, hoping to set our broken relation- dled up to my side. She was as stoic as complete with honesty, integrity, and all ship right in person, and to write a before, but her anger was unmistakable. the risks of failure and disappointment? healthier ending to his story. “How dare you call my cousin a hypocrite,” she seethed. “That isn’t right.” The need for an Acknowledgment This town was growing smaller by apologetic closure The author would like to thank Royal the minute. Rhodes, PhD, Marilyn Fitzgerald, PhD, and “I’m sorry,” I stammered, sincerely Audrey Young, MD, for their editorial com- but with some smugness as I clung to my Finish the note. ments and support. recent fortunes stabilizing fractures and “We discussed and disagreed upon is- evacuating chest wounds. She shook her sues related to his injury.” My procedure The author’s address is: head knowingly, glaring as she quietly note betrayed a clinical detachment I UPMC New Kensington Family Health left the room, recriminations echoing in desired, as if I were the disciplined phy- Center the footfall of her mukluks. sician who had unerringly exercised 301 Eleventh Street, Suite C Finish the damn note. the correct diagnostic and therapeutic New Kensington, Pennsylvania 15068 “Non-displaced fracture of the right techniques, with good outcomes, for E-mail: [email protected] fifth metacarpal, immobilized with ul- years on end. However, I was not that

32 The Pharos/Autumn 2008 Day in a Golden Year

NPR’s her friend She still knows her grandchildren But not her zip code He toasts her bagel Fries his eggs and checks their pills Life post Katrina Unfamiliar rooms Both are depressed, yet muster Smiles when visited Yummy Nguyen

Mr. Nguyen is an ensign in the U.S. Navy and a first-year medical student at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. This poem won an honorable mention in the !""# Pharos Poetry Competition. Mr. Nguyen’s address is: $%%"% Dovedale Way, Apartment M, Germantown, Maryland !"#&'. E-mail: [email protected].

33 Money invested in a library gives much better returns than mining stock. —William Osler1

36 The Pharos/Autumn 2008 Of Confessions books of a bookloverand libraries

Martin Duke, MD

The author is retired from private practice in cardiology. He suggests, makes it stand out from more conventional-sized was formerly director of Medical Education and chief of volumes on my shelves. Other books inscribed to me over Cardiology at Manchester Memorial Hospital in Manchester, the years have also found a permanent place in my library— Connecticut, and assistant clinical professor of medicine in awards, gifts from patients, friends, and family—books that the Department of Medicine at the University of Connecticut are associated with special memories and mean a lot to me. School of Medicine in Farmington. And so it goes—these books as well as many others—all have found a home. None are likely to be evicted. o provide space for new additions to my library, I have, A few years ago, the author and columnist Ben Macintyre from time to time, tried to give away older volumes on wrote: my shelves to friends, family members, schools, and publicT libraries, or attempted to sell them to used bookstores. Veneration for libraries is as old as writing itself, for a li- But the process of separating myself from these books has brary is more to our culture than a collection of books: it is been far more difficult than expected, and no sooner would I a temple, a symbol of power, the hushed core of civilisation, decide to part with one than I would usually find a compelling the citadel of memory, with its own mystique, social and reason for keeping it. sensual as well as intellectual.3 I have books that I take pleasure in rereading from time to time—like meeting up with old friends.2 These have a lasting This seems to me as good as any other explanation for why claim to a place in my library. Likewise, certain mainstays, for I, and probably many others, take pleasure in our libraries, and example, the Bible, Shakespeare’s works, Bartlett’s Familiar why we have difficulty disposing of our books. For to do so Quotations, Rodale’s The Synonym Finder, and at least two would be tantamount to giving away a part of ourselves. dictionaries, are indispensible companions. Because of my In the late nineteenth century, Frank Dempster Sherman particular interests, I enjoy being surrounded by books on (–) wrote a poem in which he described his image American, English, and medical history, including related of an ideal library.4 The last stanza of this work contains the biographical works. It is not easy to give these up. And as Latin phrase Hic habitat Felicitas—“Here dwells Happiness”: a dedicated Savoyard, two or three well-thumbed collec- tions of Gilbert and Sullivan operettas are evidence of their Such be the library; and take frequent use when listening to and singing along with G&S This motto of a Latin make recordings. To grace the door though which I pass: Although I am retired from clinical practice, the most re- Hic habitat Felicitas! cent edition of The Merck Manual will always be useful as an immediate source of information. However, more meaningful Which is how I feel when sitting in my library, modest as to me is an earlier eighth edition of this work, a gift inscribed it may be, and enjoying the company of my books. Truly, here to me by my parents in  when I was in medical school. I dwells happiness! am sure they felt that it would be helpful over the years—and so it was. References A battered  volume of William Wordsworth’s poetry, . Osler W. Letter of February , . In: Cushing H. The Life now barely held together with tape, contains an inscription of Sir William Osler. Volume II. Oxford: The Clarendon Press; : on its inside cover noting that the book had been awarded . to my mother in  (she was then sixteen years old) for . Duke M. On the pleasures and benefits of rereading books. “enthusiasm and loyalty towards Briton House” at the Cable Conn Med ; : –. Street School in London’s East End. Between its pages is an . Macintyre B. Paradise is paper, vellum and dust. The Times old photograph, one of the few I have of her when she was a (London)  Dec : . young girl. This book, and a copy of The Old Curiosity Shop . Sherman FD. The Library. In: Stedman EC, editor. An Ameri- by Charles Dickens, were formerly in my parent’s home in can Anthology, –. Boston: Houghton Mifflin; : – England prior to World War II. They are now side by side on . a shelf in my library. The Little Oxford Dictionary, given to me in  for win- The author’s address is: ning the potato race on sports day at Golders Hill School in 186 Jerry Browne Road, Apartment 5416 London, survived the turmoil of leaving England during the Mystic, Connecticut 06355 war and has been with me since. Its small size, as the title E-mail: [email protected] The Pharos/Autumn 2008 37 The physician at the movies

Peter E. Dans, MD The Savages expired. Jon is not ready to commit to marriage even though Starring Laura Linney, Philip Seymour Hoffman, and Philip she says his love is demonstrated by his crying every time she Bosco. cooks his eggs in the morning. He insists on driving her to Written and directed by Tamara Jenkins. Running time 114 the airport rather than letting her take a cab. Is he sensitive minutes. Rated R. or what? His field is Theater of the Absurd and he is writing his magnum opus, a biography of Bertolt Brecht, so he refuses his aptly- titled film was recommended to me by a friend to go to Arizona. Then Doris dies in the midst of a manicure, whose opinion I respect. He said that it had a lot of medi- and Wendy and Jon fly out for a quick visit to pay their re- calT content. Starring Linney, Hoffman, and Bosco, how could spects, thinking Dad is settled in a house. It turns out that it go wrong, right? Wrong! Fortunately amnesia of aging is it was Doris’s house and that it isn’t a common law marriage protecting the guilty party. Spending two hours listening to because he signed a “pre-nup without a nup” and the relatives the whines of three thoroughly dislikable people is not what are selling the house. I consider entertainment. All I could think was, Thank God They visit Dad, who is being restrained in the hospital. Dad I don’t review movies for a living; I’d either be brain dead or thinks Jon is a doctor and is told he’s a PhD. A “real” doctor have to be committed. The film begins with views of a sterile Sun City, Arizona, and old people exercising. A home health worker for Lenny Savage’s (Bosco) live-in girlfriend Doris (Rosemary Murphy) refuses to flush the toilet for Lenny, saying he is there only to care for Doris. Lenny goes into the bathroom and writes PRICK on the wall in feces. This pretty much captures his personality and it’s the first chance to GONG the film. His action triggers a call to his alien- ated daughter Wendy (Linney) in New York City, and son Jon (Hoffman) in Buffalo, neither of whom has seen Lenny for twenty years. Wendy is a thirty-year-old unmarried temp who aspires to write a Broadway play titled Wake Me When It’s Over about an abusive father who abandons his children, leaving a depressive Laura Linney, Philip Bosco, and Philip Seymour Hoffman star in The Savages. mother who goes out on a date TM and ©2007 Twentieth Century Fox. All rights reserved. and never returns. Can’t wait to see that one! After returning from work and before she checks her messages, she lets in her shows them Dad’s CAT scan and tells them that he appears to next-door neighbor, Larry (Peter Friedman), an old bald guy have vascular dementia. There are more vapid scenes of old who’s cheating on his wife. She really likes his dog, so when folks singing “You Make Me Feel So Young” and exercising. they have sex (a seemingly gratuitous scene), she stares Meanwhile, Jon flies to Buffalo to hunt up a nursing home. off in the distance and pets the dog while he works Wendy asks if it “smells”; Jon says they all smell and Wendy away. Definitely another GONG point. packs Dad on the plane for a quite unbelievable flight that After dispatching Larry, she finally picks neither of them should have survived. The film’s one good up the message and in a panic calls Jon, a feature is its favorable portrayal of the nurses, orderlies, and self-absorbed academic who is just end- nurse’s aides. The rigid leader of the caregiver education sup- ing a three-year relationship with a port group doesn’t fare as well. She pulls out Eldercare for Polish academic whose visa has Dummies and tells the caregivers to “ask your elder about the

38 The Pharos/Autumn 2008 The Great Debaters old days and stimulate them with old movies from their era.” This leads into Dad’s movie night selection of The Jazz Singer, Starring Denzel Washington, Forest Whitaker, Nate Parker, which is about his old neighborhood on the Lower East Side. and Jurnee Smollett. Wendy and Jon cringe and look back at the black staff when Directed by Denzel Washington. Running time 126 minutes. Jolson puts on blackface. Rated PG-13. There is one ludicrous scene when they take Dad to lunch and try to get his take on advance directives. Jon asks him if he is in a coma, would he want a breathing machine? Thinking he’s in a hotel, Lenny asks “What kind of a question is that?” Jon pushes him and he says, “Unplug me.” Jon asks, “Then what?” Dad responds, “I’m dead, bury me. What are you, a bunch of idiots?” The worst scene is when Wendy pulls the red pillow she had given her Dad away from a demented wheelchair-bound woman who is cradling it. Leaving her agitated and distraught, she gives it to Lenny, who throws it away. Larry visits for an overnight and, in the middle of sex, she sits up and says “I have an MSA, we’re in a motel here in Buffalo. It’s a cliché. You’re having a mid-life crisis cheating on your wife.” He makes a reference to Blue Angel, saying she’s not as young as Marlene Dietrich. Another pseudoliterary dialogue centers on Jon not getting a Guggenheim fellowship on five or six attempts and her saying she got one for her play. Later she admits that she failed on eight attempts. Having failed once myself, I would have felt badly if these losers had gotten one. Like Quentin Tarantino, many screenwriters and audiences of today were brought up on movies, and there is an abun- Denzel Washington in The Great Debaters. dance of film references moviegoers will spot and feel good about. This one has Laurel and Hardy in One Big Noise, considered their worst movie; Richard Widmark in Night and the City; The Wizard of Oz; The Blue Angel; The Jazz Singer; and his film can best be described as Dead Poet’s Society Bette Davis’s famous line in All About Eve on Wendy’s voice- meets Remember the Titans and Akeelah and the Bee. mail. There‘s an embarrassing scene when Wendy goes out for AlthoughT formulaic, with an ending that’s easy to spot from a cigarette with Jimmy (Gbenga Akinagbe), a Nigerian orderly the beginning, it has a number of things going for it, includ- who has asked to read her play and says he likes it. She re- ing two premier actors and an excellent supporting cast. The sponds “You didn’t think it was a bunch of middle-class whin- film is based on the little-known story of the triumphs of the ing. I didn’t want you to think I was one of those middle-class debating team at Wiley College in Marshall, Texas, although Americans.” Then she jumps on the guy, who gently pushes its alteration in one important aspect makes one wonder her away and says he’s in love with his girlfriend. about how much of it is fictionalized. Nonetheless, there are After Wendy returns to New York, Larry stops by and tells important messages, although it’s not clear if those who need her that the dog is going to be euthanized because there are to receive them will be in its audience. no guarantees after surgery on his bad hip and the rehab will The college has a deeply religious foundation—African be long and expensive. They part and he says, “If you want to Methodist Episcopal, AME—although little is made of it ex- indulge in unhealthy compromising behavior, you know whom cept at the beginning. Dr. James Farmer, Sr. (Forest Whitaker), to call.” Six months later, the Theater of New York is rehears- standing behind a lectern, opens the  school year with a ing her play and she asks Jon, who is on his way to Poland, if he prayer, “My Soul is a Witness,” and then the biblical affirma- doesn’t “think it’s self-indulgent and bourgeois.” Jon professes tion: “When I was a child I spoke as a child, I thought like a to like it, although I definitely voted for self-indulgent. The child, reasoned like a child, but when I became an adult, I put film ends with her running along Central Park Lake pulling away childish ways.” As in most colleges of the day, the faculty her true love, the dog, in a rehab harness. Who says there is in loco parentis, and the students are closely supervised, aren’t any more happy endings? Not surprisingly, Linney and with chaperones monitoring dances and dance cards used. In the screenwriter got Oscar nominations. short, the college is a safe haven in the midst of the segregated

The Pharos/Autumn 2008 39 The physician at the movies

Denzel Washington, Jurnee Smollett, Nate Parker, and Denzel Whitaker.

South where Jim Crow laws are strictly enforced. wants to be a lawyer and is the first woman on the debate The second thread involves the message, as articulated team; Hamilton Burgess (Jermaine Williams), a more conser- by charismatic English teacher Melvin B. Tolson (Denzel vative young man who drops out when Tolson’s union activi- Washington) that teachers have the most important job in ties land him in jail; and James Farmer, Jr. (Denzel Whitaker), America: “The education of our people, because education a fourteen-year-old prodigy who has a crush on Booke who is the only way out.” Yet Farmer and Tolson couldn’t be more has a crush on Lowe. different in their approach. Tolson hops on the desk and uses Tolson teaches them about logic and syllogisms, has them the Socratic method teaching about the revolution brewing learn speech in the manner of Demosthenes with a large im- in Harlem involving Langston Hughes and other members of pediment in their mouths, and shows them how to project the Harlem Renaissance. He also is an activist, dressing in old their voices by moving back in stages until he is out of the clothes to join a group of sharecroppers he is helping to union- auditorium. He teaches them something I learned from my ize. Farmer, who speaks seven languages and whose sister is mother, although I’m not sure I learned it well, namely not to only one of “two Negro women practicing law,” is much more denigrate yourself and thereby give your enemies ammunition. reserved. His philosophy is that “We do what we have to do As he puts it, “Would you punch yourself in a street fight? so that we can do what we want to do.” A very principled and Then don’t punch yourself in a word fight. Use humor.” imposing man, he walked from Florida to Boston to attend The team wins all the debates in their conference and then Boston University, graduated summa cum laude, and later challenges white colleges and beats the team from private got a PhD. When he and his family are out for a drive and he United Methodist college Oklahoma City University. Then accidentally kills a white farmer’s pig, he agrees to pay him they “annihilate” the team from prestigious Fisk University, much more than it’s worth and even helps him carry the pig but lose to Howard. Nonetheless, Tolson keeps challenging off the road. white colleges and receives an acceptance from Harvard, The third and major thread involves achieving excellence in which, when it learns that Tolson does the team’s argument debating, a holdover from the nineteenth century. It was very scripting, changes the debate topic the night before the debate. popular in the s and s before television, to which I Tolson, who is on parole, can’t leave Texas, and Lowe, their can attest as a high school debater in the late s and early best debater, is given charge of the team. Instead of debating, s. Tolson selects four out of forty-five candidates from he selects Farmer, who had done poorly against Howard, to a student body of : Henry Lowe (Nate Parker), a brilliant replace him in the debate, which is broadcast nationwide. I but mercurial student who periodically disappears to drink don’t think it would surprise anyone that Wiley wins. So here’s and wench; Samantha Booke (Jurnee Smollett), a woman who the rub. The debate did take place, but the opponent was not

40 The Pharos/Autumn 2008 The Diving Bell and the Butterfly Harvard but the University of Southern California (USC) the reigning national debate champion. When asked why they Starring Mathieu Amalric, Emmanuelle Seigner, and Marie- changed it, Washington in effect said that since Harvard is Josee Croze. the best, it made the achievement that much more impressive. Directed by Julian Schnabel. Running time 112 minutes. Harvard also let them film on campus, a first since . As I Rated PG-13. see it, that’s not just a slight on USC but on the rest of us who didn’t matriculate at Harvard. his outstanding French film is as medical as it gets but The other problem I had was with the scene of the lynch- is far from entertaining and difficult to view in one sit- ing, not because it wasn’t very moving, because it was, and ting.T It is, however, well- suited as an educational tool using not because it might not have occurred, because, despite film clips. The film recounts the story of Jean-Dominique longstanding anti-lynching laws, lynching continued in Texas Bauby (Amalric), aka “Jean-Do”, the forty-two-year-old edi- until . My problem was with how Tolson and his debaters tor of French Elle, whose hedonistic high life of fast cars, fast came upon the scene and were still able to escape. Henrietta women, and gourmet dining comes to a crashing halt when Bell Wells, the person on whom Booke is based, was inter- he sustains a massive near- fatal stroke, leaving him almost viewed by Washington on an excellent DVD special feature completely paralyzed with “locked-in syndrome.” Remarkably, and she does not mention any lynching. The filmmakers also however, due to sheer determination and creativity, as well as quote a letter reputed to have been written by Willie Lynch, the extraordinary caregivers (truly angels of mercy) at a reha- the man who gave the practice its name, which is probably an bilitation hospital, Bauby manages to let his thoughts come Internet hoax. forth from their prison and in one year he produces a book On the plus side, not only do we learn more about James documenting his experience and reflections on life past and Farmer, Sr., and his sister, but also James Farmer, Jr., who co- present. His only means of communicating is by blinking his founded the Congress of Racial Equality seven years later at left eye, one blink for “yes” and two for “no.” His other eyelid the age of twenty-one, and was a close confidant of Martin is sutured shut to protect his cornea, which is not being lubri- Luther King, Jr. He and A. Philip Randolph have not gotten the cated, from becoming seriously infected. credit they deserve for advances in civil rights. The “crawl” at Speech therapist Henriette (Croze) develops a sequence the end says that Tolson became a widely-respected poet, and of letters arranged in descending order of frequency of their also founded the Southern tenant farmers union in  with appearance in everyday French. Then by sheer mind- numbing , members. repetition, she helps him get to the point where he can get Finally, what all the graduates praised was the family at- out sentences, although at one point he signals that it’s too mosphere and the excellent teachers who got degrees at top difficult and he wants to die. Henriette scolds him for letting schools but couldn’t teach there, so came to Wiley. It was down the people who love him, and leaves the room. This clear that the student body was very intelligent and motivated. scene and the subsequent one in which she apologizes and he As I have pointed out elsewhere, although prejudice against half-gloats are well-done. Bauby had a contract to write a book blacks, Jews, Catholics, and women was unjust and a blot on that would be a feminine counterpart of the Count of Monte the nation, in a perverse way it strengthened their respec- Cristo. Celine Desmoulins (Seigner), the mother of his three tive universities and hospitals by concentrating top students, children, convinces him to go through with the book, and calls teachers, doctors, etc., who had limited or no entry to “elite” his publisher, who sends Claude Mendebil (Anne Consigny), a prep schools, universities, and hospitals. As I listened to them, paragon of patience and an attractive woman, as they all seem I couldn’t help thinking of Dr. Robert Beardsley, who had just to be, to work with him. He wakes at  o’clock and by the time completed a PhD in biochemistry at Columbia and taught she arrives at , he is ready to dictate. us the course at Manhattan College in /. When I took The story is viewed through Bauby’s eyes, which the film- first-year biochemistry at Columbia the next year, it was like makers simulate by having the camera angles sometimes go a refresher course, easing my entry into the Ivy League. Once askew and the image become blurred as might happen with access began to be open to these groups, their respective someone who can only see through one eye and who can’t institutions saw a fall-off both in the caliber of teachers and turn his head. Amalric is outstanding in portraying Bauby’s students and the solidarity and bonding that helped nurture paralysis by tensing his muscles so that they don’t move. One everyone to excel and to prove that they belonged. One con- particularly memorable scene involves Bauby’s reaction to a crete example is the fact that, despite its storied tradition, at fly alighting on his nose. What’s most creative is the fact that the time the movie was made Wiley no longer had a debate Amalric is enclosed in a box about ten feet away from others team, so Denzel Washington contributed one million dollars in a scene. He can hear them talking but they can’t hear him, to re-establish it. which leads to some funny repartee, as when the doctor tells him that he will be his friend and Bauby quips (unheard) that he has a lot of friends and to just be a doctor. Or he tells Bauby

The Pharos/Autumn 2008 41 The physician at the movies

ninety-two-year-old father, who says he is also imprisoned alone in a fourth- floor walk-up. He misses his wife, whom he married even though he had many affairs and he thinks that his son should have married the mother of his children. There’s a touching scene in which Bauby fils visits him to shave him and the father expresses pride in his son. However, one wonders why someone so wealthy couldn’t get his father better situated or cared for. Many people of different faiths, including Marie Lopez (Olatz Lopez Garmendia), the other therapist, pray for him daily. Marie takes him to see a priest, but he refuses Communion and a blessing. He balks at her suggestion to go to Lourdes, and we are treated to a thoroughly gra- Marie-Josée Croze is a speech therapist in The Diving Bell And The Butterfly. Photo Credit: Etienne George/Courtesy of Miramax Films. tuitous recounting of how he and Josephine went to Lourdes at her suggestion for “a dirty weekend.” She that they will make his life the best it can be and he mutters, persuades him to buy her a Madonna with red flashing lights “This is life?” that she insists that they keep on in the bedroom, with the re- Telling the story from the patient’s perspective allows the sult that he is unable to have sex and wanders through empty director to break the monotony and introduce scenes from his garishly-lit Lourdes streets that had been filled during the day pre-stroke life. What we learn about Bauby besides his cour- with the sick and dying. age, indomitable will, and wit is that he has led an insensitive At the end we get to see the way the stroke occurred and and self-absorbed life surrounded by people who adored him. progressed, with him thinking he’ll have to cancel the theater According to the film, this continued into his morbid state, tickets for the performance to which he was taking his son on as shown in some very Gallic (but not gallant) scenes. When custody day. It’s eerie that this was what he thought about as the doctor says they will dress him up for a surprise, which is he was descending into a maelstrom. The film’s title comes that his wife is visiting, he is not thrilled and says (unheard), from Bauby positing that he is imprisoned in a diving bell and “She’s not my wife, she’s the mother of my children.” Celine that the two things that are not paralyzed are his inspiration visits regularly and finally overcomes his unwillingness to see and his memory, which, like a butterfly escape the bell. He his children. When Celine asks him if his mistress Josephine died at forty-three of pneumonia, ten days after the publica- (Marina Hands), with whom he lived and who had pledged tion of his book. undying love, has visited, he says, “No.” When Josephine finally calls and asks to speak to him with her out of the room, Dr. Dans (AΩA, Columbia University College of Physicians and Celine says she is the only one there to interpret his responses. Surgeons, 1960) is a member of The Pharos’s editorial board and Josephine asks if he misses her and Celine must interpret his has been its film critic since 1990. His address is: response: “Each day I wait for you,” through bitter tears. Then 11 Hickory Hill Road Bauby sends her out of the room so that they can be alone. Cockeysville, Maryland 21030 Max Von Sydow plays a cameo role as Bauby’s E-mail: [email protected]

42 The Pharos/Autumn 2008 Reviews and reflections David A. Bennahum, MD, and Jack Coulehan, MD, Book Review Editors

though the spread of disease by filth The activities of the Yellow Fever was considered the likely cause.) The Commission are described in consider- epidemic was so severe that Memphis able detail. Prior to this and with the was evacuated except for , per- exception of the discovery of ether as sons, of whom , contracted the an anesthetic agent, the United States disease. The author vividly describes was in the backwater of medical ad- Memphis as a city of corpses, with some vancement, and indeed its physician of the features reminiscent of the great training was far inferior to that ob- plagues of Europe. The mortality rate tainable in Europe or even in Cuba. was variable in different outbreaks, but The Commission conducted autopsies The American Plague: The figures of seventy percent in white per- on persons who died of yellow fever, Untold Story of Yellow Fever, sons and four percent in black persons and conducted carefully devised experi- the Epidemic that Shaped Our are given for one outbreak. The extreme ments disproving filth and fomites as History racial discrepancy in susceptibility and transmitters of the disease. They also mortality is not fully understood, but used human experimentation to dem- Molly Caldwell Crosby the fact that the disease was endemic in onstrate that mosquitos transmitted the Berkley Hardcover, New York, 2006 Africa and probably imported into the disease between humans. Reviewed by William Reed, MD Americas by slave trade suggests that The use of human volunteers for a resistant population had evolved in these experiments is important in the Africa and a highly susceptible popula- history of the protection of human sub- he term “American Plague” was tion was encountered in the Americas. jects in medical experimentation. The once commonly used to describe This story is told by highlighting histori- first volunteers for the mosquito ex- anT epidemic illness that included a large cal individuals and their experiences as periments were from the commission part of North America and Cuba that examples, a technique that brings the itself, but subsequent volunteers were was settled by Europeans. The epidemic epidemic vividly to life. from the ranks of the U.S. Army. The was actually a series of outbreaks oc- A large portion of the book is de- disease had a high fatality rate, but the curring for over a century. An alternate voted to the Yellow Fever Commission, best medical care was provided to the name for the disease was “Yellow Jack,” headed by Major Walter Reed, that was volunteers, and none died. However, but neither term is meaningful to most assigned to Cuba following the Spanish one member of the commission who Americans today. In fact, this histori- American War, after the United States was a physician, Jesse Lazear, observed cally important disease, and its impact occupied Cuba and U.S. soldiers were a mosquito bite him while on a yel- on the Americas, is seldom given much succumbing in high numbers to the dis- low fever ward, and did not stop the attention in the teaching of American ease. The members of the commission— biting. He developed yellow fever and history. This series of events is well de- Walter Reed, Aristides Agramonte, died. All of the volunteers except for scribed by Molly Caldwell Crosby in her James Carroll, and Jesse Lazear—are commission members signed informed well written and absorbing book The described, including their family lives consent papers, a procedure that had American Plague, subtitled The Untold and the effect that this disease had on never been followed before with any Story of Yellow Fever, the Epidemic that them. By this time the mosquito had human volunteer experiments. All told, Shaped Our History. already been identified as the transmit- the number of volunteers infected was The first chapters cover the epidemic ter of malaria, but yellow fever was so small, and the results were considered nature of this disease in the Americas, commonly considered to be a disease to be conclusive after some initial argu- and focus on the huge epidemic in , of filth that the initial suggestion that ment and discussion. After the initial especially its effect on Memphis, the city the mosquito might be the transmitter self-experimentation, volunteers were most stricken by the disease. The cause of yellow fever to humans was met with offered a significant monetary incentive, of the disease and its mode of transmis- derision. The original proposal was by but the first two volunteers declined the sion were not known at the time. (It Carlos Finlay, a Cuban physician who money, and indicated that they wanted would be four more years before was obsessed by the idea, and raised to do this for the sake of the knowledge Koch in Germany proved that a colonies of the mosquito Aedes aegypti to be gained, not for the money. bacterium, the tubercle bacil- for study for twenty years before the Other aspects related to yellow fever lus, could actually cause a Yellow Fever Commission requested covered in the book include descrip- disease; but the germ samples of the mosquito eggs from him tions of the efforts to eradicate mosqui- theory was not well so they could raise mosquitos and test tos in Havana and Panama, and early understood, even the theory. experiments with immunization. After

The Pharos/Autumn 2008 43 Reviews and reflections

the Memphis epidemic, an engineer whose meaning can become clarified named George Waring developed and by the telling. The process of finding had installed a model sewer system for words to express the feeling, and the city that included separate drainage then transcribing those words onto systems for household wastes and rain a page is something like seeking ad- water. This Waring System has become vice from a wise friend; elucidating a a standard feature in the sanitation sys- chaotic thought to readers will often tems of American cities and worldwide. elucidate it to ourselves. . . . Mosquito and other insect control, im- This volume is an anthology of munization, and sanitation are the cur- [such] stories. Whatever else may be rent foundations for the prevention of its lessons, it teaches us the ways in yellow fever and many other infectious which we are bound up together in diseases. The beginnings of a scholarly the presence of illness. approach to medicine in the United . . . . The stories in this book States, and the establishment of the first investment of limited funds. And all guide us toward the paths of under- medical school, Johns Hopkins, are also medical departments are under sig- standing. described. nificant pressures these days, given in- In all these ways, writing is a It would be difficult to read this book creased competition for grant funds means of healing.p13–14 without developing considerable knowl- and falling reimbursement rates for edge about the yellow fever epidemic in services. Hence, the greater surprise Danielle Ofri, an internist as well the Americas, and, as indicated in the that New York University’s Department as writer of wisdom and humor, has subtitle, how the disease contributed to of Medicine not only sponsored the succeeded in establishing this venture shaping the Americas. The text is fol- Bellevue Literary Review, but has now and surrounding herself with a highly lowed by nearly fifty pages of notes in kicked off a new literary press with competent staff. Just look through the which the author describes her sources this anthology, The Best of the Bellevue contents of The Best of the BLR. That of information. The central themes of Literary Review (BLR). Of course, my poets and writers of high stature have this book are likely to be of particular years of training as a medical student contributed to the BLR attests to its interest to infectious disease physicians and then resident at NYU taught me credibility within the world of litera- and those concerned with the ethics of that Bellevue is a fount of creativity in ture. Dr. Ofri and her staff have been human experimentation, but the book medicine, but who knew that its creative given a unique opportunity to establish should also be of interest to anyone energy would extend to the world of a literary journal within the walls of concerned with the history of medicine literature? the oldest public hospital in the United or of the Americas. I remember my father telling me that States, the place of last resort for nearly he was asked to quote from Shakespeare three hundred years! The name Bellevue Dr. Reed is emeritus professor of Medicine and Spenser during his interviews for evokes images of the homeless, huddled in the Division of Infectious Diseases at the admission to medical school. Son of a masses, the tempest-toss’d—to para- University of New Mexico School of Medi- Jewish carpenter, he was the first in his phrase Emma Lazarus—that have been cine. His address is: family to attend college. He considered cared for over the centuries. This noble 317 Hermosa SE the Bard irrelevant, and I cannot repeat heritage informs the editorial policy of Albuquerque, New Mexico 87108 what he thought of the Faerie Queen. the journal. Physicians’ knowledge of literature was The Best of the BLR consists of The Best of the Bellevue valued then. However, during the post- three parts (Initiation, Conflict, and Literary Review World War II era, when science and Denouement) subdivided into ten sec- Danielle Ofri, editor technology took the fore, the relevance tions—Patients, Doctors, Disability, Bellevue Literary Press, New York, 2008 of literature in a medical career was Coping, Connections, Family, Mortality, forgotten and familiarity with the writ- Death, Loss, Aftermath—which cover Reviewed by Richard Bronson, MD ten word eroded. But the pendulum has the cycle of illness, return to health, or (AΩA, New York University, 1965) swung again. As Sherwin Nuland notes loss that one encounters in the illness in his introduction to The Best of the experience. The contributors, an eclectic o think that a literary journal would BLR, group, for illness knows no boundaries, find a publisher in the Chairman include recognized writers and oth- ofT a Department of Internal Medicine! To write is also to share, so that ers less known, established physicians Such a venture must be seen as an one is no longer alone with emotions and those in training, nurses, people

44 The Pharos/Autumn 2008 of that prisoner, who volunteered to and my father with his book spread- who have experienced illness as former breathe eagled patients or their families, novelists, po- the bad air of this world, who sickened on his chest beside her, dozing. ets, professors of English, Peace Corps with the mosquito, but did not die.p77 volunteers, a lawyer, and a psychologist. . . . I’d walk the fields behind And what of the material that consti- their house, the endless avenues of dry tutes this anthology, does it succeed? I found “First Born” by John Grey golden cornstalks leading nowhere and When writing about illness, one must emotionally intense, yet wondered un- away, be careful to avoid the topical piece der what circumstances an expectant . . . Pausing mid-field, I’d turn without emotional impact, the personal father would find himself in an ob- instinctively loss that cannot be generalized. There stetrical waiting room with cancer pa- back toward that slowly stirring is a fine line between genre writing and tients and the elderly. Then, of course, maelstrom a truer, deeper literature. And given its waiting rooms in Australia, the poet’s special purview, has the BLR remained home, may be different from those in of grief. My mother would waken to the true to its origins or has it become just the States. The poignancy of Rachel sound another literary journal? Having read Hadas’s “Forgettery,” the harsh bitter- of a November wind quickening around The Best of the BLR from cover to cover, ness in “Sentence” by Barbara Lefcowitz, the corners of the house and the sun I am convinced of its success, although I and the unexpected in David Shine’s dropping into am surprised at the inconsistency of the “Revelations” all deserve special note. its coin box.pp215–16 material that constitutes “the best.” Compare these fine poems with the emotional flatness of Nikki Moustaki’s In “Living Will,” Holly Posner fanta- I have admired Philip Levine for a “Writing Poems on Antidepressants” sizes a dinner of medical doctors and long time, read him while a resident or David Lehman’s “In the Hospital.” their wives discussing death and the and over many subsequent years, and Contrast these with the sad intensity difficulty of deciding when it’s time to attended his eightieth birthday celebra- and subtlety of Floyd Skloot’s “Midnight go, if one were given the choice. The tion at the Cooper Union recently. His in the the Alzheimer’s Suite”: poem captures a dark humor, ending on poem “Above the Angels” does not let a poignant note. me down. Yet James Tate’s “The Long Lost in the midnight stillness, my Journey Home” carries no emotional mother We ride home in silence, weight and strikes me as a literary ar- rises to dress . . . wondering how we’ll manage not to die tifice of little validity. It cannot com- . . . But the coiling lyric snakes too soon, not to live too long. pare with “Angina,” written by Alicia back on itself . . . p133 Although he loves me I understand Ostriker, who has experienced serious he’ll not be the one to whisper, It’s time, illness herself and written about it in a And the powerful imagery and flow help me load my pockets down with bold, open manner: in Melisa Cahnmann-Taylor’s “How stone.p231 Suffering Goes” hits you in the gut: The flat field of my chest I found Rafael Campo’s “Silence = stretches like a drumskin . . . Her chant is a haunt that echoes Death” blatant and heavy handed. It is from closets of old clothes, old minds once there was a seabed here not representative of his best writing. then a swamp . . . p40 like old monkeys, always moving, Then, we’re silent, counting moments, scratching, knocking on glass.p131 I particularly enjoyed the matched death poems by Linda Pennisi, who captures I also recommend “The Golden Hour,” counting us in all its infiniteness, a mother’s feeling on her daughter’s the title poem of Sue Ellen Thompson’s in all we know that words cannot beginning medical school. “Shobo,” the most recent book, an emotionally com- explain.p243 contribution by physician- poet Dannie plex, evocative work dealing with the Abse, was memorable in its subject mat- terminal illness of her mother. “A Widow at ” by Andrew Merton ter and cadence. “Prisoner,” John Stone’s is a spare poem, too spare for my tastes, multilayered poem, tells a tale of inter- Those final weeks, there was an hour leaving much out. Yet, done well, a est, even though it is somewhat didactic each afternoon when stillness would “tight” poem can be very effective, as in in style: conspire Arlene Eager’s “Postoperative Care.” with autumn light. They would embrace Gray Jacobick’s poem “The Accident” During the past !" years, I have thought my mother in her sickbed suffers from being too didactic, to this often reviewer’s taste.

The Pharos/Autumn 2008 45 Reviews and reflections

The unexpected comes preceded by its But the house did not rise that day; irreversibility it sank. all of us will become patients or will have to cope with the illness or death of the way a bride comes down the aisle.p257 No mass no matter no thing in the bed someone we love. Stories, poems, and in the blankets essays allow a reader to live a different Lisa Rosen’s “In Suicide’s Tracks” life, experience unfamiliar situations in your place.p272 captures well the complex emotions and perspectives.” Has the BLR suc- of loss associated with suicide. Elinor ceeded in bringing together a literature Benedict’s “Helicopters” succeeds in Similarly, the vignettes and short sto- that “elevates and clarifies ordinary mo- merging the exotic with the common- ries are variable in quality, though most ments of intimacy, crisis, and change”? places of war and death. I believe the succeeded very well. Noteworthy con- The answer is unequivocally yes. best poem dealing with loss in the col- tributions are “What Were the White lection is Judy Katz’s “The Weight of Things?” by Amy Hempel, “Fissure” by Dr. Bronson is a member of the editorial Absence.” She achieves a balance of Debra Anne Davis, “MUD” by Thomas board of The Pharos and Director of the metaphor and constraint. McCall, “Love Is Just a Four-Letter Division of Reproductive Endocrinology Word” by David Watts, “Breathe” by at the Stony Brook University Health Sci- I had watched you grow smaller and Caroline Leavitt, “If Brains Was Gas” by ences Center. His address is: smaller, Abraham Verghese, “Psychotherapist at Stony Brook University Medical Center ice chips on your tongue. the Landfill” by Lou Lipsitz, “Surgeon” School of Medicine And as the morphine took you by Sharon Pretti, “The Liver Nephew” Department of Obstetrics, Gynecology here and there . . . by Susan Ito, and “So Much in the & Reproductive Medicine I thought I understood: World Is Waiting to be Found Out” by T9-080 Health Sciences Center lighter and lighter Sariah Dorbin. Stony Brook, New York 11794-8091 you would become, Ronna Wineberg, senior fiction edi- E-mail: richard.bronson@stonybrook. a lightness leading tor of the BLR, notes in the forward to edu to nothing. its Spring  issue, “At some point,

Adventures in Prostate Alley

The PSA was running away, If you’ve ever been curious ‘bout being It’s biopsy time we agreed. dysurious, I yelped (did it help?) and I bled a bit Believe me it isn’t a hoot. But at least I was able to pee. And “What is the status of your meatus”? Isn’t funny, though perhaps a bit cute. The bad news was terse (and it could have been worse). Was it the “cysto” (devised by Mephisto), Now how to get on with my life? Or iodine one-twenty-five, Shall I watch? Shall I wait? Or perhaps Or hormones (aplenty) and prednisone radiate? (twenty) Or should I go under the knife? Which helped me to come out alive? Seeds radioactive seemed most Anyway, you should know, attractive, I’m happy to go And were put in the gland in a trice. With the flow! The pellets indwelling, and as for the Henry N. Claman, MD swelling, Dr. Claman (AΩA, University of Colorado, !"#") is It was solaced by big bags of ice. partly retired from the University of Colorado. He is a member of the editorial board of The Pharos. His address is: Mail Stop B!$%, Denver, Colorado &'($(. E-mail: [email protected].

46 The Pharos/Autumn 2008 Letters to the editor

“These Foolish Things” etc. I heard later that a vaccine was be- A slow attrition of primary care in This is to express my appreciation ing field tested but had to be stopped South Asia for your editorial piece in the Spring since several cases of polio developed Thanks to the generosity of Pharos. I especially noted your com- after administration of the experimen- Professor Richard Sobel of Israel, I hap- ments and selected lines from “These tal vaccine. I later learned that a Dr. pened to read your  issues of The Foolish Things,” one of my most fre- Kolmer developed this vaccine.1,2 Pharos. This was the first time I hap- quently revisited ballads from the times Fast forward, when I started at pened to read your periodical. I work at when music was music. “A tinkling Temple University School of Medicine the KIST Medical College, a new medi- piano in the next apartment . . . Those in , John A. Kolmer, MD, DSc, cal school in the Kathmandu Valley stumblin’ words that told you what my LLD, was chair of Medicine who de- in Nepal, and am keenly interested in heart meant.” It don’t get any better veloped this experimental vaccine. I the medical humanities and the art of than that! also learned that several children of medicine. There have been a number of no- the Temple Medical School faculty re- I enjoyed reading The Pharos. The table renditions through the years. I ceived this experimental vaccine. magazine is well produced and looks currently am enjoying Concord Jazz’s Ms. Williamson’s article indi- at medicine from a different and un- Rosemary Clooney: For the Duration. cated that “certain lots of the vaccine orthodox perspective. I especially liked This has several other fine pieces, in- produced by Cutter Laboratories in the readability and the writing style of cluding “Ev’ry Time We Say Goodbye” California were found to contain small the articles. Poems, short stories, The and “For All We Know.” A piano-only amounts of live virus that had escaped physician at the movies, and Reviews recording of “These Foolish Things” by inactivation. More than fifty California and reflections were especially inter- Jim Haskins on disc one of his Cocktail children and members of their fami- esting. I read with deep interest the Piano series is nice listening. lies developed paralytic poliomyelitis editorial in the Winter  issue shortly after the first inoculations in titled “Endangered species.” The cost Cary Sullivan, MD April .” p14 of medical care is constantly increas- (AΩA, Emory University, ) Dr. Kolmer was certainly a pioneer ing and as said in the editorial in your Atlanta, Georgia and instead of being a footnote to his- Autumn  issue, Americans em- tory, he did not receive the credit he phasize providing the best quality of Credit for Dr. John Kolmer deserved. care for the sick regardless of cost. This The paper in the spring issue of may be true not just in America, but The Pharos, “The Congressional Polio References increasingly in other countries around Vaccine Hearings of : A landmark . Kolmer JA. Immunity and vaccina- the world. in biomedical research” (pp. –), tion in infantile paralysis. Am J Nursing I personally believe that the role of reminded me of a personal experience ; : –. a graduate medical doctor has been on this subject. There was a serious . Kolmer JA. An improved method of consistently underemphasized and polio outbreak in Philadelphia preparing the Kolmer Poliomyelitis Vac- devalued in today’s technological cul- in the early s when I was cine. Am J Public Health Nations Health ture. This is happening not only in the about ten years of age. As ; : –. technologically advanced societies, but I recall, school opening even in developing countries. The ma- Albert J. Finestone, MD, MSc, FACP was postponed, we jority of the illness in a particular com- (AΩA, Temple University, ) were told to avoid munity can be tackled by a graduate Philadelphia, Pennsylvania crowds, movies, doctor. For many of the illnesses even a

The Pharos/Autumn 2008 47 Letters

doctor is not required, and a properly Green for Danger possibility. Lead encephalopathy, trained health care worker will be able Thank you for your wonderful re- though, is unlikely since Goya was a to deliver treatment of an acceptable view of Green for Danger. I’ve never painter to the court and was provided quality. Many countries have success- known anyone else to have seen it and an assistant to mix his pigments. We fully used health care workers to de- was so surprised to see your review. agree that Vogt-Koyanagi-Harada dis- liver health care to rural areas, and to Alistair Sim is most definitely on my ease might be consistent with a few the disadvantaged and underprivileged short list of British actors, and makes features of this illness, but its rarity, es- among the urban population. anything he is in a sheer joy. Another pecially in a Spanish population, makes Unfortunately these days, people that I loved was Stage Fright with Jane it very speculative. even in South Asia are beginning to Wyman. Little is known about Goya’s next turn to specialists and superspecialists I couldn’t agree more about Britain’s major bout of illness, which began in for health care delivery. This leads to Golden Age of Cinema. My husband , when the artist was seventy-three increasing cost of treatment, overtreat- knows that when I’m upset, one thing years of age. It took place during a pe- ment, and overuse and waste of scarce that will calm me down is an old black riod that “the pest” (probably yellow resources. The general practitioner is and white British film, preferably a fever) ravaged Spain. Goya painted his beginning to die a slow, sad, and unla- murder mystery or something of the self-portrait with Dr. Arrieta in  to mented death in South Asia. It is be- Whiskey Galore! genre. commemorate his recovery and thank coming imperative for medical school Thank you again. Arrieta. graduates to specialize. In this part of Jeanne Blaha the world, students join medical school Reference Nevada City, California after twelve years of schooling, and . Ravin JG, Ravin TB. What ailed Goya? graduation is not mandatory. The four P.S. Just so I don’t fly under false Surv Ophthalmol ; : –. and a half years of training are followed colors, my husband is the physician, James G. Ravin, MD by a year of compulsory rotating in- not I. We’re both very proud that his Toledo, Ohio ternship. Internship is a vital period to son, a very recent graduate of Wake gain practical experience. The intern- Forest Medical School, has been asked Tracy B. Ravin, MD ship has become devalued today and to join Alpha Omega Alpha. Melbourne, Florida unfortunately most students regard it as a time to prepare for residency/post- Goya’s illnesses—infectious? Dr. Claman responds to Drs. Ravin graduate entrance examinations. environmental? I overlooked the Ravins’ original Previously a graduating doctor In “Portraits: “Goya and his physi- and perceptive suggestion that Goya’s could carry out minor surgeries, con- cian, Dr. Arrieta,” Winter , Henry earlier illness might have been malaria, duct normal deliveries, and manage N. Claman, MD, discusses the health complicated by cinchonism, leading medical emergencies. These days, our of the famous Spanish artist Francisco to deafness. With regard to cinchona graduates are not confident about even Goya (–). He describes the bark treatment, this would have been handling the simplest of patients. I major illness which struck the artist appropriate for malaria, and possibly personally think that the solution is in when he was in his forties and provides prevented recurrence of the same. strengthening basic medical training a differential diagnosis. We feel that As to an overdose, if this were on a and, as stated in the editorial, improv- malaria is a far more likely possibil- doctor’s orders, the sequela of total ing conditions for general practitioners. ity than any of the entities discussed.1 and permanent deafness would have However, in this part of the world, Malaria was endemic in Spain during been a high price to pay. It might also unlike in the United States, a general the eighteenth and nineteenth centu- confirm Goya’s low opinion of doc- practitioner need not have a post- ries. As late as  more than , tors, as shown in the Los Caprichos graduate qualification. A basic medical cases were reported and there were illustration. Nonetheless, he seemed degree followed by a year of training more than , fatalities. Goya was fa- to be cured of the disease. As the later should suffice. miliar with the best method of treating portrait of him with Dr. Arrieta shows, I really enjoyed your magazine and malaria available during his lifetime, Goya also became cured of his mistrust hope that in coming years you will go cinchona bark, which contains quinine, of his doctors. from strength to strength. and even wrote about its efficacy in Henry N. Claman, MD treating this disease. P. Ravi Shankar, MD (AΩA, University of Colorado, ) We agree that syphilis is not con- KIST Medical College Denver, Colorado sistent with Goya’s signs and symp- Imadol, Lalitpur, Nepal toms and that meningitis is another

48 The Pharos/Autumn 2008 Don’t return it, please! is suffering so, almost all agreeing that in times past, and also to reposition I had informed AΩA some time it’s related to lifestyle issues of the general internal medicine to its rightful ago that my husband had died, but the general internist (read underpaid and place as one of the crown jewels in aca- beautiful key ring arrived today. Shall I overworked). demic medical centers as it once was. return it to you? I offer the following simplistic ap- This salary structure will also mitigate I must confess that I have guiltily proach as a possible solution. This the relentless emphasis on our current enjoyed reading The Pharos that have would be in the context of a national production-based patient care delivery continued to come, rationalizing that single-payer system and is a variation system which has drained the lifeblood since I had worked long hours of nurs- on the model of a retainer practice. from our discipline. ing while Earl was in medical school, I A general internist’s salary structure Michael B. Jacobs, MD might be just a little entitled to them. would be based on the following for- (AΩA, Washington University, ) Of course, that isn’t true, and I apolo- mula: Stanford, California gize for not having sent another letter t "Oi9wDPNQPOFOUIJHIFOPVHI to inform you of his death. to guarantee a reasonably livable wage (something like , to , “Wrongful death” Judith Ginn per year but varying by region of the Thanks for the strong editorial Nashville, Tennessee country). in the Summer issue of The Pharos. t "i:wDPNQPOFOUUPDBSFGPSBO I continue to be amazed that in the Dr. Harris responds to Mrs. Ginn agreed upon, minimum number of twenty-first century people continue to We are sad, indeed, that Earl has patients (e.g.,  to  patients hold these beliefs or, in a more specific died, but we are very pleased that you per physician rather than the cur- context, continue to inveigh against received the key ring and we hope rent requirement of two to three vaccination when it has been shown to that you can use it proudly. We are times that number) and which, im- be such an effective disease preventive. especially pleased that you have en- portantly, would vary based on a More straightforward expositions like joyed reading The Pharos. I estimate physician’s age, training, experience, this might help educate the country. that although its circulation is in the reputation, quality-standards met, and :FBSTBHP *XBUDIFEIFMQMFTTMZBTB range of , copies for each issue, patient-panel mix. The range might woman bled out from a carcinoma of the number reading it is twice that, be something like  per patient for the colon, and neither she nor her fam- considering the pleasure it brings to a newly-minted internist just out of ily would permit me to interfere with friends and relations. The more read- training to  per patient for a sea- therapy. I have never forgotten it. ers the better—especially when one of soned, expert clinician (the doctor’s J. Joseph Marr, MD those worked while a spouse struggled doctor who cares for complex and/or (AΩA, Johns Hopkins University, ) through medical school! PMEFSQBUJFOUT 5IFi:wDPNQPOFOU Broomfield, Colorado would not begin until a threshold en- Edward D. Harris, Jr., MD rollment was reached (e.g., something Editor, The Pharos like seventy-five percent of the goal The thoughts of doctors panel size). Dear Dr. Coulehan, A formula for restoring primary t "i;wDPNQPOFOUBTBQBUJFOUDP I congratulate you on your well- care pay ( to ) to modestly impede written review of Dr. Groopman’s How It is troubling to see that only thir- patient overuse. Doctors Think:PVSQPJOUTBCPVUJUT teen percent of this year’s Stanford t 5IFi: ;wXPVMETFSWFBTBO limitation are certainly of great signifi- graduating medical students chose an incentive for the experienced and ef- cance also in reducing advancing costs internal medicine internship. Certainly ficient physician to see more patients of medical care, if only defensive prac- a substantial number of these trainees and augment his or her income. To tice were less used. Finally, I thought will sub-specialize, further draining keep the rightful emphasis on careful, you were brave to start your review the future supply of general internists. thoughtful, thorough, evidence-based with the personal patient history which Although an appallingly low figure, it’s practice, a cap would be put on the to- is so instructive. in line with a nationwide trend. tal number of patients in a physician’s Leonard S. Sommer, MD There have been innumerable ar- panel. (AΩA, Columbia University, ) ticles and thought pieces as to the My reasons for proposing this are to Key Biscayne, Florida reasons why such an incredibly inter- attract substantially more of our medi- esting and intellectually challenging cal students and residents to the field specialty as general internal medicine of internal medicine, as was the case

The Pharos/Autumn 2008 49 88th annual banquet and induction ceremony at the University of Texas Medical Branch at Galveston (Alpha Texas) On May , , the University of Texas Medical Branch (UTMB), Texas Alpha Chapter of Alpha Omega Alpha celebrated its traditional banquet and new member induction at the historic Hotel Galvez in Galveston, the site of many Texas Alpha AΩA banquets over the past fifty years. Held the night before the School of Medicine graduation, it was attended by student and faculty AΩA members, including the School of Medicine Dean and Provost, Dr. Garland Anderson, and the families of newly-inducted members. The banquet culminated a year of AΩA service activities including: HIV Awareness Production Ball High (October ), D’Feet Breast Cancer Fun Run/Walk (October ), Community Health Screening Fair at local UTMB clinics (February ), coordinating the volunteer effort at the UTMB chapter officers Brian B. Gilmer, Brian C. Quigley, and Galveston County Health Fair (March ), Victoria Gomez with AΩA Executive Secretary Edward D. Harris, Jr. American Cancer Society Relay for Life (April ), and Science Fair judging at local junior highs (April ). student officers Brian B. Gilmer, Victoria Gomez, and In addition to the strong community outreach, students Brian C. Quigley, as well as with other student AΩA and faculty were able to discuss plans for the future at the members and UTMB faculty over the course of his visit. AΩA Spring Faculty/Student Mixer on March , . His purpose was to educate them, AΩA councilor Dr. This year also involved the awarding of an AΩA Student B. Mark Evers, and secretary/treasurer, Dr. Lisa Farmer, Service Award to Allison Wisenthal (Class of ) for her on the activities and fundraising methods of other AΩA project Stay Shady. Stay Shady is a program for dermato- chapters. logic awareness and screening for Galveston youth. The The banquet followed a reception for members and Student Service Renewal Award went to the Teen Health their families, and began with a welcome by Victoria Camp, led by Kristopher Hooten and Brian Gilmer. This Gomez. Following dinner, Brian Gilmer introduced Dr. student-created project promotes health education and Harris, who inspired the audience with his discussion of healthier lifestyles among teenagers in the Galveston com- excellence, professionalism, and mentoring. munity. The evening ended with in induction of new members The highlight of the year was a two-day visit by Dr. by Drs. Evers and Farmer, with Dr. Jack B. Alperin, profes- Edward Harris, Jr., executive secretary of AΩA and edi- sor of Internal Medicine, leading them in the recitation of tor of The Pharos. Dr. Harris met with AΩA / the Declaration of Geneva.

50 The Pharos/Autumn 2008 National and chapter news

New members at the University of Texas Medical Branch at Galveston. Front row, left to right: Adam Richter, Kristopher Hooten, Lauren Layer, Rachel Le, Abby Patel, John Brach, Brian Gilmer. Second row, left to right: Dr. Lisa Farmer, Nisha Patel, Lance Freeman, Sabrina Akhtar, Julie Cummings, Rachel Finehout, Di Lin Parks. Third row, left to right: Jared Herr, Billy Taylor, Ryan Neilan, Barbara Heil, J’Cinda Bitters, Katherine Kintner. Fourth row, left to right: Brian Quigley, Jason Mann, Phillip Wortley, Victoria Gomez, Conner Chan, Ashley Group, Kristen Boyle. Not shown: Leechuan “Andy” Chen, Harold DelasAlas, Chad David Fairchild, Clarisa Ysela Garcia, Jeffery John Houlton, Qaali Abdalla Hussein, Jared Moshe Kasper, Rachel-Elizabeth Lindenborn, John Livingston, Neema Nayeb-Hashemi, Donna Nguyen, Jennier Gail Schopp, Derrick Yuan Sun, Laura Umstattd.

The Pharos/Autumn 2008 51 Alpha Omega Alpha Volunteer Clinical Faculty Awards, 2007/2008

IOWA he Alpha Omega Alpha Volunteer Clinical Faculty Award University of Iowa Roy J. and Lucille A. Carver College of Medicine is presented annually by local chapters to recognize com- Robert Friedman, MD munityT physicians who have contributed with distinction to KENTUCKY the education and training of medical students. AΩA provides University of Louisville School of Medicine a permanent plaque for each chapter’s dean’s office; a plate Jack Hamman, MD with the name of each year’s honoree may be added each year LOUISIANA that the award is given. Honorees receive framed certificates. Louisiana State University School of Medicine in New Orleans The recipients of this award in the / academic year Bernard Landry, MD Louisiana State University School of Medicine in Shreveport are listed below. Donald C. Fournier, MD MARYLAND ALABAMA Johns Hopkins University School of Medicine University of South Alabama College of Medicine Lawrence Pakula, MD Keith Kevin Varden, MD Uniformed Services University of the Health Sciences F. Edward CALIFORNIA Hébert School of Medicine University of California, San Francisco, School of Medicine David H. Rice, MD Linda M. Gaudiani, MD MASSACHUSETTS DISTRICT OF COLUMBIA University of Massachusetts Medical School The George Washington University School of Medicine and Health Paul Hart, MD Sciences Stanley Talpers, MD MICHIGAN University of Michigan Medical School FLORIDA Walter M. Whitehouse, Jr., MD University of Florida College of Medicine Allen Brasington, MD MINNESOTA University of Minnesota Medical School—Twin Cities GEORGIA Jay O. Lenz, MD Morehouse School of Medicine Robert Story, MD NEBRASKA University of Nebraska College of Medicine ILLINOIS Joel Travis, MD Chicago Medical School at Rosalind Franklin University of Medicine and Science NEW JERSEY Jaye Schreier, MD UMDNJ—New Jersey Medical School Anthony Abdulla Al-Khan, MD Southern Illinois University School of Medicine Donald Ross, MD NEW YORK University of Chicago Division of the Biological Sciences Pritzker Albany Medical College School of Medicine Steffani Cotugno, DO Clement Rose, MD Cornell University Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences INDIANA Richard P. Cohen, MD Indiana University School of Medicine Curt R. Ward, MD Mount Sinai School of Medicine of New York University Seymour Gendelman, MD

52 The Pharos/Autumn 2008 New York Medical College Jefferson Medical College of Thomas Jefferson University Kumarie Nandi, MD Fayez El-Gabalawi, MD New York University School of Medicine University of Pittsburgh School of Medicine Douglas Bails, MD Jennifer L. Good, MD State University of New York, Downstate Medical Center College of SOUTH CAROLINA Medicine University of South Carolina School of Medicine Eric S. Siegel, MD Scott J. Petit, MD State University of New York Upstate Medical University College of TENNESSEE Medicine Meharry Medical College School of Medicine Luis Castro, MD Ida Michele Williams, MD Stony Brook University Health Sciences Center School of Medicine Vanderbilt University School of Medicine William B. Smithy, MD John B. Wheelock, MD University of Rochester School of Medicine and Dentistry TEXAS Ralph J. Doerr, MD University of Texas Southwestern Medical Center at Dallas NORTH DAKOTA Southwestern Medical School University of North Dakota School of Medicine and Health Sciences Marvin J. Stone, MD Gordon D. Leingang, MD VIRGINIA OHIO Virginia Commonwealth University School of Medicine Ohio State University College of Medicine James Anderson, MD David T. Applegate II, MD WASHINGTON University of Cincinnati College of Medicine University of Washington School of Medicine Barry Blumenthal, MD Nicholas Hunt, MD PENNSYLVANIA WEST VIRGINIA Drexel University College of Medicine West Virginia University School of Medicine Kenneth M. Granet, MD James E. LeVos, MD

Alpha Omega Alpha Administrative Recognition Awards, 2007/2008

Brenda Hicksenheiser his award recognizes the AΩA chapter administrators Eta, Pennsylvania State University College of Medicine who are so important to the functioning of the chapter. Nominated by Robert Atnip, MD TheT nomination is made by the councilor or other officer of Karen Skibiski the chapter. A gift certificate is awarded to the individual, as Zeta, Northeastern Ohio Universities College of Medicine well as a framed Certificate of Appreciation. Nominated by Dennis Lunne, MD The following awards were made in : Heather Winn Gamma, Northwestern University Feinberg School of Medicine Nominated by Walter Barr, MD Sonia Beasley Beta, University of Maryland School of Medicine Nominated by Gary Plotnick, M.D. Carlene Bryan Beta, Cornell University Joan & Sanford I. Weill Medical College & Graduate School of Medical Sciences Nominated by O. Wayne Isom, MD

The Pharos/Autumn 2008 53 Alpha Omega Alpha Medical Student Service Project Awards, 2007/2008

MINNESOTA egun in  as the Chapter of the Year award, this pro- Mayo Medical School gram was intended to recognize outstanding contribu- The Harvest Classic Road Race, third year tionsB made by an AΩA chapter. In , the program became NEW YORK the AΩA Chapter Development Awards, aimed at encourag- Albany Medical College ing ongoing original and creative programs being carried out Capitol Region Veteran’s Stand Down by AΩA chapters. In , the program again changed to the Columbia University College of Physicians and Surgeons Columbia-Harlem Homeless Medical Partnership (CHHMP) AΩA Medical Student Service Project awards, which became Mount Sinai School of Medicine of New York University an award available to any student or group or students at a Community Health Fair, second year school with an active AΩA chapter. University of Rochester School of Medicine and Dentistry Funds of up to  per year, renewable for a second year Rochester Youth in Motion at  and a third year at , are available to students to NOVA SCOTIA aid in the establishment or expansion of a medical student Dalhousie University Faculty of Medicine service project benefiting a school or its local community. Everest Project, second year One application per year per school is allowed, selected by OHIO the school’s AΩA councilor and dean from the proposals Ohio State University College of Medicine submitted. MD Camp, second year Medical Student Service Projects funded by AΩA during University of Cincinnati College of Medicine the / school year were: MEDVOUC: Expanding and Improving Medical Education out of the Classroom and into the Community, second year ARKANSAS RHODE ISLAND University of Arkansas College of Medicine The Warren Alpert Medical School of Brown University Soaring with Sunscreen SNMA (Student National Medical Assoc) Health Fair CALIFORNIA SOUTH CAROLINA University of California, Irvine, School of Medicine Medical University of South Carolina College of Medicine Skin Cancer Awareness, Education and Detection for Cosmetologists World AIDS Day Program and Allied Health Professionals TENNESSEE ILLINOIS University of Tennessee Health Science Center, College of Medicine Chicago Medical School at Rosalind Franklin University of Medicine Health Education for Inmates in Shelby County, Tennessee and Science Vanderbilt University School of Medicine NVLS Free Clinic Language Specific Materials, second year Partnerships in Dental Health University of Chicago Pritzker School of Medicine, Division of the TEXAS Biological Sciences University of Texas Medical Branch, University of Texas Medical PCSF (Pritzker Community Service Fellowship) School at Galveston University of Illinois at Chicago Stay Shady! The Vision Mission, second year University of Texas Medical Branch, University of Texas Medical KANSAS School at Galveston University of Kansas School of Medicine Teen Medical Academy & Teen Health Camp, second year En Control—Diabetes Education University of Texas Southwestern Medical Center at Dallas Southwestern Medical School MASSACHUSETTS Translator Apprenticeship Program Boston University School of Medicine MEDHEALTH, third year

54 The Pharos/Autumn 2008 Alpha Omega Alpha visiting professorships, 2007/2008

University of Chicago Division of the Biological Sciences Pritzker eginning in , Alpha Omega Alpha’s board of directors School of Medicine Boffered every chapter the opportunity to host a visiting Holly J. Humphrey, MD, councilor professor. Forty-nine chapters took advantage of the oppor- Michael J. Collins, MD, Hinsdale Orthopaedic Associates tunity during the / academic year to invite eminent INDIANA persons in American medicine to share their varied perspec- Indiana University School of Medicine tives on medicine and its practice. Aslam R. Siddiqui, MD, councilor Following are the participating chapters, their councilors, John L. Tarpley, MD, Vanderbilt University School of Medicine and their visitors. KANSAS University of Kansas School of Medicine Jeffrey M. Holzbeierlein, MD, councilor ARKANSAS University of Arkansas College of Medicine The Honorable Louis W. Sullivan, MD, Morehouse School of Anne T. Mancino, MD, councilor Medicine James Patrick O’Leary, MD, Florida State University School of LOUISIANA Medicine Louisiana State University School of Medicine in New Orleans Peter M.C. DeBlieux, MD, councilor CALIFORNIA Loma Linda University School of Medicine Louis Rice, MD, Case Western Reserve University School of Sarah M. Roddy, MD, councilor Medicine Donald Melnick, MD, National Board of Medical Examiners Louisiana State University School of Medicine in Shreveport Jeffrey German, MD, councilor DISTRICT OF COLUMBIA Stuart M. Brooks, MD, University of South Florida School of The George Washington University School of Medicine and Health Medicine Sciences Tulane University School of Medicine Alan Wasserman, MD, councilor N. Kevin Krane, MD, councilor Burton Rose, MD, Harvard Medical School Ellen Pearlman, MD, New York University School of Medicine Howard University College of Medicine Pauline Y. Titus-Dillon, MD, councilor MARYLAND Richard Derman, MD, Christiana Care Health Services University of Maryland School of Medicine Peter E. Dans, MD, councilor FLORIDA Martin J. Blaser, MD, New York University School of Medicine University of Florida College of Medicine Uniformed Services University of the Health Sciences F. Edward Heather Harrell, MD, councilor Hébert School of Medicine Charles Griffith, MD, University of Kentucky College of Medicine Robert E. Goldstein, MD, councilor University of Miami Leonard M. Miller School of Medicine Claudia S. Robertson, MD, Baylor University College of Medicine Alex J. Mechaber, MD, councilor Eliseo Pérez-Stable, MD, University of California San Francisco MASSACHUSETTS School of Medicine Tufts University School of Medicine John Unterborn, MD, councilor University of South Florida College of Medicine Patricia J. Emmanuel, MD, councilor Edward O’Neil, MD, Omni Med Bruce L. Gewertz, MD, Cedars Sinai Medical Center MICHIGAN Michigan State University College of Human Medicine GEORGIA E. James Potchen, MD, councilor Morehouse School of Medicine Frances J. Dunston, MD, councilor Ronald Davis, MD, American Medical Association/Henry Ford Health System Betty S. Pace, MD, University of Texas Southwestern Medical Center at Dallas University of Michigan Medical School Cyril Grum, MD, councilor ILLINOIS Edward D. Harris, Jr., MD, Alpha Omega Alpha Honor Medical Chicago Medical School at Rosalind Franklin University of Medicine Society and Science Eric P. Gall, MD, councilor MINNESOTA Michael Zdon, MD, Chicago Medical School at Rosalind Franklin University of Minnesota Medical School—Twin Cities University of Medicine and Science Charles Billington, MD, councilor Edward D. Harris, Jr., MD, Alpha Omega Alpha Honor Medical Society

The Pharos/Autumn 2008 55 Visiting professorhips, 2007/2008

MISSOURI PENNSYLVANIA University of Missouri—Columbia School of Medicine Jefferson Medical College of Thomas Jefferson University Thomas Selva, MD, councilor Clara A. Callahan, MD, councilor Faith Fitzgerald, MD, University of California, Davis, School of Frederick S. Kaplan, MD and Eileen M. Shore, MD, University of Medicine Pennsylvania School of Medicine University of Missouri—Kansas City School of Medicine PUERTO RICO David Wooldridge, MD, councilor Ponce School of Medicine Emery Wilson, MD, University of Kentucky College of Medicine Ivan Iriate, MD, councilor NEBRASKA Joxel Garcia, MD, US Department of Health & Human Services Creighton University School of Medicine Universidad Central del Caribe School of Medicine William J. Hunter, MD, councilor José Ginel Rodríguez, MD, councilor Gary S. Francis, MD, Cleveland Clinic Foundation Erik A. Larsen, MD, White Plains Hospital Center, New York University of Nebraska College of Medicine University of Puerto Rico School of Medicine Robert Wigton, MD, councilor Esther Torres, MD, councilor Ray Hershberger, MD, University of Miami Miller School of Robert J. Paeglow, MD, Koinonia Health Care Medicine RHODE ISLAND NEW YORK The Warren Alpert Medical School of Brown University Albany Medical College Charlotte Boney, MD, councilor Neil Lempert, MD, councilor Jim Yong Kim, MD, Harvard Medical School William P. Schecter, MD, University of California, San Francisco, SOUTH CAROLINA School of Medicine University of South Carolina School of Medicine Columbia University College of Physicians and Surgeons Charles S. Bryan, MD, councilor John C. M. Brust, MD, councilor John Noble, MD, MACP, Boston University School of Medicine Joseph G. Verbalis, MD, Georgetown University School of TENNESSEE Medicine Meharry Medical College Cornell University Joan and Sanford I. Weill Medical College and Billy Ray Ballard, MD, councilor Graduate School of Medical Sciences Nelson Adams, MD, National Medical Association O. Wayne Isom, MD, councilor University of Tennessee Health Science Center, College of Medicine Richard F. Daines, MD, New York State Health Department Owen P. Phillips, MD, councilor Mount Sinai School of Medicine of New York University Howard A. Brody, MD, PhD, UTMB Institute for the Medical Lisa Bensinger, MD, councilor Humanities Alfredo Quiñones-Hinojosa, MD, Johns Hopkins School of Vanderbilt University School of Medicine Medicine John A Zic, MD, councilor New York Medical College Stanley Cohen, MD, Emeritus Professor, Vanderbilt University William H. Frishman, MD, councilor Lynne M. Kirk, MD, MACP, University of Texas Southwestern TEXAS Medical School The Texas A&M University System Health Science Center College of State University of New York, Downstate Medical Center College of Medicine Medicine Mark L. Montgomery, MD, councilor Arthur H. Wolintz, MD, councilor James Thrall, MD, Harvard Medical School Edward D. Harris, Jr., MD, Alpha Omega Alpha Honor Medical University of Texas Medical Branch, University of Texas Medical Society School at Galveston Stony Brook University Health Sciences Center School of Medicine Bernard M. Evers, MD, councilor Jack Fuhrer, MD, councilor Edward D. Harris, Jr., MD, Alpha Omega Alpha Honor Medical Peter Avery Boling, MD, Medical College of Virginia Society NORTH CAROLINA WASHINGTON Wake Forest University School of Medicine University of Washington School of Medicine K. Patrick Ober, MD, councilor Douglas S. Paauw, MD, councilor Bennett deBoisblanc, MD, Medical Center of Louisiana Rich Simons, MD, Pennsylvania State University NOVA SCOTIA WEST VIRGINIA Dalhousie University Faculty of Medicine Joan C. Edwards School of Medicine at Marshall University Lisa Bonang, MD, councilor Bob L. Miller, MD, councilor Shane Neilson, MD, Erin, Ontario Robert C. Cicco, MD, Temple University West Virginia University School of Medicine OHIO Melanie Fisher, MD, councilor University of Toledo College of Medicine David E. Eibling, MD, University of Pittsburgh School of L. John Greenfield, MD, councilor Medicine Kathleen Franco-Bronson, MD, Cleveland Clinic Foundation

56 The Pharos/Autumn 2008 Charged

While I lie flat on my abdomen my face, puffed like jelly rests on the donut hole of the table. Large dustballs like clusters of silver dandelion hairs float on the floor. I see the tips of her shoes through the hole, pointed toes tap against the tile. She stretches my head, neck, shoulders, arms, as if they were elastic bands. Her hands oil my joints and soft tissues. She attaches electrodes on trigger points: volts my head, neck, shoulders, back. Electrodes attached to wires, to a machine, to another table, to wheels, claw against my skin until the timer rings. Electrodes like magnetic juice Gatorade my cerebellum. Nerve impulses rollercoaster illuminate, race across the synapse line. I am an electrical leaking field, s t r e t c h i n g into configurations, charged like a battery. I don’t move until she repairs me again, a Dr. Frankenstein creating the perfect human. Rose Bromberg

Ms. Bromberg is a published poet who writes poetry about patients’ medical experiences and contributes her time to the Program in Narrative Medicine at Columbia University. Her address is: !"" West #$!th Street, Apartment %&"', Riverdale, New York %"$'%. E-mail: [email protected].

Illustration by Erica Aitken 2008 Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowships

n , the board of directors of Alpha Omega Alpha estab- Randy D’Amico University of Medicine and Dentistry of New Jersey , Robert Wood Ilished five student research fellowship awards to encourage Johnson Medical School and support student research. Since then, the awards have Adaptive Immunology and Immunotherapy of Murine Malignant grown in number and dollar amount. As many as fifty  Glial Tumors awards are made, and  is available for travel to a national Jeffrey N. Bruce, MD, mentor meeting to present the research results. In , the name Siobhan Corbett, MD, councilor of the fellowship program was changed to the Alpha Omega Shaun Desai The George Washington University School of Medicine and Health Alpha Carolyn L. Kuckein Student Research Fellowship awards Sciences in honor of Carolyn L. Kuckein, AΩA’s longtime administra- Prevalence and Severity of Anosmia in the World Trade Center tor, who died in January . Exposed Population Evaluations of the fellowship proposals were made by re- Kenneth Altman, MD, PhD, mentor viewers C. Bruce Alexander, MD; Thomas T. Andersen, PhD; Alan Wasserman, MD, councilor Robert G. Atnip, MD; Joseph A. Califano III, MD; James L. Ashvin Kumar Dewan Baylor College of Medicine Cook, DVM, PhD; N. Joseph Espat, MD; Douglas L. Feinstein, Mechanical Integrity of Spinal Fusion by in situ Endochondral PhD; Ruth-Marie Fincher, MD; Patricia D. Franklink, MD, Osteoinduction MBA, MPH; Eric P. Gall, MD, MACP; Edward D. Harris, Jr., John A. Hipp, PhD, mentor MD; Suzanne Leonard Harrison, MD; Joseph A. Hill, MD, Kristin Angelie Kassaw, MD, councilor PhD; Marc G. Jeschke, MD, PhD; Rae-Ellen W. Kavey, MD; Ha Kirsten Do Zhongyu John Li, MD, PhD; Mirjana Maletic-Savatic, MD, Chicago Medical School at Rosalind Franklin University of Medicine and Science PhD; Gokhan M. Mutlu, MD; Douglas S. Paauw, MD; Don W. ALA-PDT in Treating Actinic Keratosis and Recalcitrant Acne Powell, MD; Donald B. Russell, MD; Shashi K. Salgar, PhD; Vulgaris Donald E. Wilson, MD; and Michael Zawada, PhD. Maria M. Tsoukas, MD, PhD, mentor Eric P. Gall, MD, MACP, councilor Tara Sosa Abraham Ashley S. Doane Loyola University Chicago Stritch School of Medicine Drexel University College of Medicine Costs associated with the management of cutaneous side effects in- Integrated PIK and androgen receptor signaling in a unique molecu- duced by targeted anticancer therapies—a retrospective chart review lar subclass of estrogen receptor-negative breast cancer Mario E. Lacounture, MD, and John F. Shea, MD, mentors William L. Gerald, MD, PhD, mentor John A. Robinson, MD, councilor Allan R. Tunkel, MD, PhD, councilor Adam Asarch David Dorsey Tufts University School of Medicine University of Washington School of Medicine A comparative study of assessment tools used to measure the severity Clinical Outcomes of Endotracheal Intubation in Pediatric Burn of psoriasis Patients Alice Gottlieb, MD, PhD, mentor Sam R. Sharar, MD, mentor John Unterborn, MD, councilor Douglas S. Paauw, MD, councilor Michael R. Bykowski Alexis L. Dougherty University of Pittsburgh School of Medicine University of Texas Medical School at Houston Evaluation of the efficacy of adipose-derived stem cells (ASCs)/infant Role of Syndecan- in Mycosis fungoides and Sezary Syndrome dura mater-derived cells co-culture on osteogenic induction of rat Madeleine Duvic, MD, mentor ASCs: a novel therapy for cranial bone defects in rats Eugene Boisaubin, MD, councilor Joseph E. Losee, MD, FAAP, FACS, mentor Jennifer Earle Carl R. Fuhrman, MD, councilor Albany Medical College Emily Siu Clausen Effect of Ethanol on Axon Guidance in Response to Netrin University of North Carolina at Chapel Hill School of Medicine Tara A. Lindsley, PhD, mentor Examining Hispanic Health Disparities: Comparison of Neil Lempert, MD, councilor Cardiovascular Risk Among Mexican Immigrant Populations and Fanny Mojdeh Elahi their Populations of Origin Mount Sinai School of Medicine of New York University Mauricio Gabriel Cohen, MD, mentor Molecular mechanisms underlying neuronal MuSK functions and Amelia F. Drake, MD, councilor their relationship to memory consolidation Derek Covington Cristina Alberini, PhD, mentor University of Nevada School of Medicine Lisa Bensinger, MD, councilor Chiari I Malformations: A Natural History Study LaKisha Garduño David Sandberg, MD, mentor Meharry Medical College School of Medicine William A. Zamboni, MD, councilor Acetylation and the Transcriptional Activity of the Transcription Factor Nrf Ifeanyi J. Arinze, PhD, mentor B. Ray Ballard, MD, DDS, councilor

58 The Pharos/Autumn 2008 David C. Holt III Elizabeth Le University of Tennessee Health Science Center, College of Medicine University of Maryland School of Medicine Effects of Platelet Rich Plasma on Halting the Progressive Utilization of a novel antibody for detecting soluble -BB and cre- Degeneration of Damaged Intervertebral Discs ation of a humanized IgG with therapeutic potential Karen A. Hasty, PhD, mentor Scott E. Strome, MD, mentor Owen P. Phillips, MD, councilor Bruce E. Jarrell, MD, Gary D. Plotnick, MD, Yvette Rooks, MD, co- Jason Hong councilors Loma Linda University School of Medicine Maxwell B. Merkow Characterization of the phenotypic properties of HIV variants: com- Columbia University College of Physicians and Surgeons parison between breast milk and blood Validation of optimal cerebral perfusion pressure in brain-injured Grace Aldrovandi, MD, mentor patients Sarah M. Roddy, MD, councilor E. Sander Connolly, Jr., MD, mentor Ran Huo John C. M. Brust, MD, councilor University of Miami Leonard M. Miller School of Medicine Ryan D. Moore Effects of Imiquimod and Resiquimod on Malignant Melanoma Vanderbilt University School of Medicine Proliferation, Migration, and Invasion Exostoses of the External Auditory Canal in Whitewater Kayakers Brian Berman, MD, PhD, mentor Robert Labadie, MD, PhD, mentor Alex J. Mechaber, MD, councilor John A. Zic, MD, councilor Maziyar Arya Kalani Jozef Murar Stanford University School of Medicine Northwestern University, The Feinberg School of Medicine Examination of the Expression of Bmi in Tumorigenic Mouse Breast Evaluation of a Biodegradable Nitric Oxide-Eluting Biofilm Cancer Cells Melina R. Kibbe, MD, mentor Michael F. Clarke, MD, mentor Walter Barr, MD, councilor Emmet Keeffe, MD, councilor Robert Kyle Parker Evan Brent Katzel Indiana University School of Medicine University of Rochester School of Medicine and Dentistry Mapping of esophageal cancer utilizing geographic information system The Effects of Inflammatory Mediators on Capsular Contracture in (GIS) technology in the high-risk, endemic area of Kenya the Mouse Model Russell E. White, MD, MPH, FACS, mentor Howard Langstein, MD, FACS, and Regis J. O’Keefe, MD, PhD, men- Aslam R. Siddiqui, MD, councilor tors Whitney Erin Parker David S. Guzick MD, PhD, councilor University of Pennsylvania School of Medicine Kareem Khozaim Modeling Tuberous Sclerosis Complex in Neural Stem Cells University of Cincinnati College of Medicine Peter B. Crino, MD, PhD, mentor The Effect of FGC Severity on the Risk of HIV/AIDS Infection in Jon B. Morris, MD, councilor Western Kenya Kate Pettigrew Hillary Mabeya, MD, and Lisa Ann Haglund, MD, mentors University of Hawaii at Manoa John A. Burns School of Medicine Richard J. Stevenson, MD, councilor Transport Times and Patient Outcome in Hawaii Paul H. Kim Hao Chih Ho, MD, FACS, mentor Wayne State University School of Medicine Mary Ann Antonelli, MD, councilor Evaluation of Collagen Triple Helix Repeat Containing- (Cthrc) Anthony Razzak Gene Expression in Human Articular Cartilage under Stimulated University of Illinois at Chicago and Non-Stimulated conditions with Inflammatory Cytokine Genetic Expression Profile Comparison of Omega- Fatty Acid and Mediators Gemcitabine Treated Pancreatic Cancer Cells C. William Wu, PhD, mentor N. Joseph Espat, MD, MS, mentor Mark B. Edelstein, MD, PhD, councilor Charles A. Owens, MD, councilor Emily King Jillian Lee Rogers Oregon Health & Science University School of Medicine West Virginia University School of Medicine Effects of elevated angiotensinogen expression on fetal programming Developing a Gene Expression-Based Prognostic Model of Breast in mice Cancer Recurrence Terry K. Morgan, MD, PhD, mentor Nancy Lan Guo, PhD, mentor Michele Mass, MD, councilor Melanie Fisher, MD, MSc, councilor Joshua M. Lader Alexander Sailon New York University School of Medicine UMDNJ-New Jersey Medical School Atrial dysregulation of ATP-Sensitive potassium (KATP) channel Progenitor Cell Co-culture in Thick Scaffolds for Vascularized Bone mRNA and protein subunits occurring with hypertension: a recipe Engineering for atrial fibrillation Stephen M. Warren, MD, mentor Gregory E. Morley, PhD, mentor Robert A. Schwartz, MD, MPH, councilor Steven Abramson, MD, councilor

The Pharos/Autumn 2008 59 2008 Student research fellowships

Sophia F. Shakur Robert G. W. Lambert, MB, BCh, FRCR, FRCPC, mentor Johns Hopkins University School of Medicine Adrian B. Jones, MD, councilor Nitric Oxide and the Prevention of Cerebral Vasospasm in the Scott M. Thompson Haptoglobin - Genotype Mayo Medical School Rafael J. Tamargo, MD, mentor Surgical Anatomy of the Musculocutaneous Nerve, the Common Peter E. Dans, MD, councilor Motor Branch and Clinical Application Andrea Shaw Alexander Y. Shin, MD, mentor State University of New York Upstate Medical University College of Judith Salmon Kaur, MD, councilor Medicine Elizabeth Cottrill Weiss Non-Typhi Salmonella Bacteremia Studies at Kilimanjaro Christian University of Arkansas College of Medicine Medical Centre and Mawenzi Hospital Advanced Antimicrobial Therapy in a Staphylococcus aureus Biofilm John Alexander Bartlett, MD, and John A. Crump, MD, mentors Murine Model Lynn Cleary, MD, councilor Mark S. Smeltzer, PhD, mentor Ann DeBord Smith Anne T. Mancino, MD, councilor University of Chicago Division of the Biological Sciences Pritzker Emily Whichard School of Medicine University of California, San Francisco, School of Medicine Towards an online matching mechanism for kidney paired donation Evaluating a Comprehensive Community-Based Tuberculosis Control Giuliano Testa, MD, FACS, mentor Program serving Internally Displaced Persons in Eastern Burma’s Holly J. Humphrey, MD, councilor Chronic Conflict Zone Mark Tait Andrew R. Moss, PhD, and Allison Joy Richard, MD, mentors University of Missouri-Columbia School of Medicine A. Sue Carlisle, PhD, MD, councilor The effect of growth factors on the fibrochondrogenesis of fibroblast- Shelton Wiley Wright like synoviocytes cultured three dimensionally in agarose hydrogels: University of Alabama School of Medicine, University of Alabama at applications for meniscal tissue engineering Birmingham Derek B. Fox, DVM, PhD, DACVS, mentor Immunoprotective role of a T regulatory response to Helicobacter py- Thomas Selva, MD, councilor lori infection in children Rhett Taylor Phillip D. Smith, MD, mentor University of Alberta Faculty of Medicine and Dentistry C. Bruce Alexander, MD, councilor Osteoid Osteoma: Percutaneou Interstitial Laser Photocoagulation vs Open Surgery

2008 Alpha Omega Alpha 2008 Pharos Poetry Helen H. Glaser Student Competition winners Essay Awards he second annual Pharos Poetry competition awards were he twenty-sixth annual Alpha Omega Alpha Helen H. made this year in May. This year’s winners are: Glaser Student Essay awards were made in April of this TFirst prize, : Jenna Le of the Class of  at the year.T This year’s winners are: Columbia University College of Physicians and Surgeons for First prize, : Jesse D. Woodard (AΩA, ), Class of her poem, “My Eye Doctor.”  at the University of South Carolina School of Medicine Second prize, : Paula Brady of the Class of  at the for his essay, “Marat’s Terror.” Columbia University College of Physicians and Surgeons for Second prize, : Gabriel Thompson Cade of the Class of her poem, “Symmetry.”  at the University of North Carolina at Chapel Hill School Third prize, : Radhika Sreeraman of the Class of  of Medicine for “Remembering to Forget.” at the University of California, Davis, School of Medicine for Third prize, : Gregory H. Miday, MD, of the Class her poem, “Bridge.” of  at Ohio State University College of Medicine for Honorable mentions,  each: Nancy Lo of the Class of his essay, “Drinking in Earnest: Alcoholic Paradigms in  at Drexel University College of Medicine for her poem, Hemingway’s For Whom the Bell Tolls.” “Aura”; Leah Gilbert of the Class of  at the University Honorable mentions,  each: Muyibat Adelani, MD, of of North Carolina at Chapel Hill School of Medicine for the Class of  at Vanderbilt University School of Medicine her poem, “Seeds”; Sarah Rose Hartnett, MD, of the Class for her essay, “Access to a Healthy Lifestyle: Not as Simple of  at the Uniformed Services University of the Health as an Apple a Day,” and Anne Lincoln of the Class of  at Sciences for her poem, “An Intern Begs His Suffering Patient the University of Pittsburgh School of Medicine for her essay, for Mercy at  ”; Yummy Nguyen of the Class of  at the “Improving the Conditions of Confinement: End-of-Life Care Uniformed Services University for the Health Sciences for his in Prison.” poem, “Day in a Golden Year.”

60 The Pharos/Autumn 2008 Morning Rounds When on service I must sit and listen Through audible kaleidoscope To glassy eyed interns Mirror colorful stories Of patients admitted The night before Trying to shape them Into medical symmetry From history and exam Rotating and trusting Each shiny piece of information To frame the diagnosis and plan Most pleasing to my eyes. Aaron M. McGuffin, MD

Dr. McGuffin (AΩA, Marshall University, !""!) is a member of the Department of Internal Medicine/Pediatrics at Marshall University. His address is: #$ Derby Lane, Huntington, West Virginia !#%"#. E-mail: [email protected].

The Pharos/Autumn 2008 61 The Pharos Volume 71

Index by author Harris ED Jr. Re “The faculty dining room”: Dr. Harris responds to Dr. O’Connell. Adams BB. Real doctors in the movies. Letter. Summer, . Letter. Winter, . Adelani MA. Access to a healthy lifestyle: Not as simple as an apple a day. Autumn, Harris ED Jr. Minutes of the  AΩA board of directors meeting. National and –. chapter news. Spring, –. Alpha Michigan chapter. The Centennial Celebration of Alpha Omega Alpha at the Harris ED Jr. The plug-in. Summer, –. University of Michigan Medical School. National and chapter news. Summer, Harris ED Jr. Putting a cost on extra days given by drugs: Dr. Harris responds to Dr. –. Singer. Letter. Spring, . Alpha Texas chapter. th annual banquet and induction ceremony at the University Harris ED Jr. “There is nothing more hostile than water turning into ice.” Editorial. of Texas Medical Branch at Galveston (Alpha Texas). Autumn, –. Winter, . Anderson T. Centennial celebration at the University of Minnesota Medical Schoo, Harris ED Jr. Time for change in AΩA. Editorial. Autumn, . Alpha Minnesota. National and chapter news. Spring, –. Harris ED Jr. Wrongful death. Editorial. Summer, . Augsburger J. Dance of the Student Doctor. Poem. Winter, . Haubrich WS. H. L. Mencken looks at the Johns Hopkins quadrumvirate. Spring, Benson JA Jr. Re: “Paralysis Nose Spray.” Letter. Winter, . –. Blaha J. Green for Danger. Letter. Autumn, . Hoffman I. Rice-paddy dialysis. Letter. Winter, . Bomback AS, Klemmer PJ. Jack London’s “chronic interstitial nephritis”: A historical Hubel K. Thanks to Dr. Dans. Letter. Spring, . differential diagnosis. Winter, –. Imperato PJ. Re “Jack London’s Chronic Interstitial Nephritis.” Letter. Summer, –. Brady P. Symmetry. Poem. Autumn, . Isenberg SF. A July Matinee. Poem. Winter, . Bromberg R. Charged. Poem. Autumn, . Isenberg SF. A Moment. Poem. Winter, inside back cover. Bronson R. The Best of the Bellevue Literary Review, by Danielle Ofri, editor. Reviews Isenberg SF. Night Storm. Poem. Spring, back cover. and reflections. Autumn, –. Isenberg SF. Wondering waves. Poem. Spring, . Brown BP et al. See Gunderman RB et al. Iyengar M. My Own Two Eyes. Poem. Winter, back cover. Bryan CS. Caveats re Walter Reed and James Carroll: Dr. Bryan responds to Dr. Jacobs MB. A formula for restoring primary care. Letter. Autumn, . Pierce. Letter. Spring, . Jacobson JA. Final Exam: A Surgeon’s Reflections on Mortality, by Pauline W. Chen. Buchman JU. The captain is the master of his ship. Letter. Spring, . Reviews and reflections. Spring, –. Chase RA. Commentary from a teacher of anatomy. Commentary to Bring out your Kelly KJ. Re “An epiphany—requisite for all physicians.” Letter. Winter, –. dead? Autumn, . Kemp KR. A thank you note. Autumn, –. Claman HN. Adventures in Prostate Alley. Poem. Autumn, . Klemmer PJ et al. See Bomback AS et al. Claman HN. Goya’s illnesses—infectious? environmental? Dr. Claman responds to Lane K. Leukemia. Poem. Summer, . Drs. Ravin. Letter. Autumn, . Lane RM. Thanks to Dr. Dans. Letter. Spring, . Claman HN. Portraits: Goya and his physician, Dr. Arrieta. Winter, –. Langhorne H. Atrial Fibrillation. Poem, Summer, . Coe FL. To a Friend at Sixty, Leaving for a New Job. Poem. Spring, . Lehmann JB. A Summer Sum. Poem. Summer, . Coulehan J. How Doctors Think, by Jerome Groopman. Reviews and reflections. Leong M. First month on the wards. Spring, –. Spring, –. Lifschitz M. Nephrologist as kidney donor. Autumn, –. Cross S. In the ICU at Christmastime. Poem. Autumn, inside back cover. Lincoln A. Improving the conditions of confinement: End-f-life care in prison. Dans PE. Real doctors in the movies. Letter. Summer, . Autumn –. Dans PE. Thanks to Dr. Dans: Dr. Dans responds to Dr. Hubel. Letter. Spring, . Lo N. Aura. Poem. Autumn, . Dans PE. The physician at the movies Mahapatra S et al. See Maharaj S et al. Bella. Spring,  Maharaj S, Mahapatra S. Medical Student Service Project Awards, The Chicago Coma, Summer, – Medical School at Rosalind Franklin University—Health care: A right that must be Diving Bell and the Butterfly, The. Autumn, – shared by all. National and chapter news. Winter, –. Great Debaters, The. Autumn, – Marcus DM. James Harvey Young, PhD (–): Historian of medical quackery. Greatest Show on Earth, The. Winter, – Summer, –. Green for Danger. Spring, – Marr JJ. Quiet places. Summer, –. Juno. Spring, – Marr JJ. “Wrongful death.” Letter. Autumn, . Knocked Up. Spring, – McAneny D. A new member writes. Letter. Summer, . No Way Out, Summer, – McElroy RJ. Re “Consumer-driven health care.” Letter. Winter, . Richard Widmark (December , , to March , ), Summer,  McGuffin AM. Morning Rounds. Poem. Autumn, . Savages, The. Autumn, – Miller SH. Re “Well, death’s been here for a long time.” Letter. Winter, . Shootist, The. Winter, – Mokalla M. Searching for God below the vocal cords. Winter, –. We Are Marshall. Winter, – Moser RH. Happy Accidents: Serendipity in Modern Medical Breakthroughs, by Dantas F. See Davidson JRT et al. Morton A. Meyers. Reviews and reflections. Winter, –. Davidson JRT, Dantas F. Senator Royal Copeland: The medical and political career of a Moser RH. Too Soon to Say Goodbye, by Art Buchwald. Reviews and reflections. homeopathic physician. Summer, –. Winter, –. Del Guercio LRM. Re “An epiphany—requisite for all physicians.” Letter. Winter, . Nasrallah M. Patient encounters—The American University of Beirut: Volunteer Devereux D. Encourage Their Children. Poem. Winter, . Outreach Clinic at Shatila Refugee Camp. National and chapter news. Summer, Devereux D. No colored ribbons for them. Poem. Spring, . –. Duke M. Of books and libraries: Confessions of a booklover. Autumn, –. Neilson S. Campanology. Poem. Spring, . Finestone AJ. Credit for Dr. John Kolmer. Letter. Autumn, . Neilson S. Old Anatomy Textbooks. Poem. Spring, . Finlay-Morreale H. An essay award prize winner writes. Letter. Winter, . Nguyen Y. Day in a Golden Year. Poem. Autumn, . Finlay-Morreale H. And then there were eight. Winter, –. Norbury FB. Re “Paralysis Nose Spray.” Letter. Winter, . Foster HM. All the Mothers Are Busy. Poem. Summer, inside back cover. O’Connell K. Re “The faculty dining room.” Letter. Winter, . Foster HM. Frequent Callers. Poem. Spring, . Papa C. Re “Gout, an American Revolutionary War Statesman, and the Tower of Foster HM. Green Shadows Across a Green Lawn. Poem. Summer, . London.” Letter. Winter, –. Frankenburg F. Is any measurable blood lead level harmful? Letter. Spring, –. Pederson T. The Cancer Treatment Revolution: How Smart Drugs and Other Fuchs B. I’m Putting On My Earrings. Poem. Spring, . Therapies Are Renewing Our Hope and Changing the Face of Medicine, by David G. Gianakos D. Gravy and gratitude in the poetry of Raymond Carver. Winter, –. Nathan. Reviews and reflections. Summer, –. Gilbert L. Seeds. Poem. Autumn, back cover. Pederson T. Meeting Holly Smith, through two generations of his disciples. Letter. Ginn J. Don’t return it, please! Letter. Autumn,  Winter, –. Gregory SR. The Soul of a Doctor: Harvard Medical Students Face Life and Death, by Pierce JR. Caveats re Walter Reed and James Carroll. Letter. Spring, –. Susan Poires, Sachin H. Jain, and Gordon Harper, editors. Reviews and reflections. Plotz C. Re “The faculty dining room”: Dr. Plotz responds to Dr. O’Connell and Dr. Summer, –. Harris. Letter. Winter, . Gunderman RB, Brown, BP. Affliction is a treasure. Spring, –. Rakley S. Radiology Suite. Poem. Summer, . Han J. Procedure note. Autumn, –. Ravin JG, Ravin TB. Goya’s illnesses—infectious? environmental? Letter. Autumn, . Harris ED Jr.  Alpha Omega Alpha Robert J. Glaser Distinguished Teacher Ravin TB. See Ravin JG et al. Awards. Winter, –. Reed W. The American Plague: The Untold Story that Shaped Our History, by Molly Harris ED Jr.  report of the editor of The Pharos. National and chapter news. Caldwell Crosby. Reviews and reflections. Autumn, –. Spring, . Schoenfeld AJ. The private remonstrance of Doctor Botkin, or Pharaoh’s Physician. Harris ED Jr.  report of the executive secretary. National and chapter news. Summer, –. Spring, . Shankar PR. A slow attrition of primary care in South Asia. Letter. Autumn, –. Harris ED Jr. Don’t return it, please! Dr. Harris respons to Mrs. Ginn. Letter. Autumn, Shumer D. A Tribute to Medical Stereotypes. Poem. Winter, . . Silver RM. Captive of art, not disease: Paul Klee and his illness, scleroderma. Winter, Harris ED Jr. It’s not a word I can put into feelings. Editorial. Spring, . –.

62 The Pharos/Autumn 2008 Simpson AR. Medical Apartheid: The Dark History of Medical Experimentation First month on the wards. Leong M. Spring, –. on Black Americans from Colonial Times to the Present, by Harriet Washington. Frequent Callers. Poem. Foster HM. Spring, . Reviews and reflections. Summer, –. Gravy and gratitude in the poetry of Raymond Carver. Gianakos D. Spring, –. Singer JW. Putting a cost on extra days given by drugs. Letter. Spring, . Green Shadows Across a Green Lawn. Poem. Foster HM. Summer, . Smythe WR. Bring out your dead? Autumn, –. H. L. Mencken looks at the Johns Hopkins quadrumvirate. Haubrich WS. Spring, Sommer LS. The thoughts of doctors. Letter. Autumn, . –. Soni LK. The smirk. Winter, –. I’m Putting On My Earrings. Poem. Fuchs B. Spring, . Staff Improving the conditions of confinement: End-of-life care in prison. Lincoln A.  program expenditures by the national office. National and chapter news. Autumn, –. Spring,  In the ICU at Christmastime. Poem. Cross S. Autumn, inside back cover.  Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowships. Instructions for Pharos authors. Staff. Winter, . Autumn, – It’s not a word I can put into feelings. Editorial. Harris ED Jr. Spring, .  Alpha Omega Alpha Helen H. Glaser Student Essay Awards. Autumn,  Jack London’s “chronic interstitial nephritis”: A historical differential diagnosis.  Pharos Poetry Competition winners. Autumn,  Bomback AS, Klemmer PJ. Winter, –. Alpha Omega Alpha Administrative Recognition Awards, /. Autumn,  James Harvey Young, PhD (–): Historian on medical quackery. Marcus DM. Alpha Omega Alpha Medical Student Service Project Awards, /. Summer, –. Autumn,  July Matinee, A. Poem. Isenberg SF. Winter, . Alpha Omega Alpha visiting professorships, /. Autumn, – Letters to the editor Alpha Omega Alpha Volunteer Clinincal Faculty Awards, /. Autumn, Captain is the master of his ship, The. Buchman JU. Spring,  – Carlos Chagas. White RJ. Winter,  Announcing the  Alpha Omega Alpha Robert J. Glaser Distinguished Caveats re Walter Reed and James Carroll Teacher Awards. National and chapter news. Spring,  Bryan CS. Spring,  Announcing the  Pharos Editor’s Prize. National and chapter news. Spring, Pierce JR. Spring, –  Credit for Dr. John Kolmer. Finestone AJ. Autumn,  Instructions for Pharos authors. Winter,  Don’t return it, please! Leaders in American Medicine. National and chapter news. Spring,  Ginn J. Autumn,  Pharos, The. Volume . Autumn, – Harris ED Jr. Autumn,  Richard Bronson, MD, added to the editorial board of The Pharos. National and Essay award prize winner writes, An. Finlay-Morreale H. Winter,  chapter news. Spring,  Formula for restoring primary care, A. Jacobs MB. Autumn,  Winners of the  Pharos Editor’s Prize. National and chapter news. Spring, Goya’s illnesses—infectious? environmental? – Claman HN. Autumn,  Write a Poem, Win . Winter,  Ravin JG, Ravin TB. Autumn,  Sullivan C. “These Foolish Things.” Letter. Autumn,  Green for Danger. Blaha J. Autumn,  Tam JB. She Lay Quietly. Poem. Winter, . Is any measurable blood lead level harmful? Frankenburg F. Spring, – Thomas E. The Ghost Map: The Story of London’s Most Terrifying Epidemic—and How Meeting Holly Smith, through two generations of his disciples. Pederson T. It Changed Science, Cities, and the Modern World, by Steven Johnson. Reviews and Winter, – reflections. Spring, – A new member writes. McAneny D. Summer,  Tomasiewicz H. New Art. Poem. Winter, . Putting a cost on extra days given by drugs Wartman SA. Remembering Alvan. Letter. Spring, . Harris ED Jr. Spring,  Weiner MF. September Sunlight. Poem. Autumn, –. Singer JW. Spring,  Weisse AB. The Phoenix Phenomenon in medical research. Summer, –. Re “An epiphany—requisite for all physicians” White RJ. Carlos Chagas. Letter. Winter, . Del Guercio LRM. Winter,  Wilk JS. Path in the Afternoon. Poem. Winter, . Kelly KJ. Winter, – Williamson S. The Congressional Polio Vaccine Hearings of : A landmark in Re “Consumer-driven health care.” McElroy RJ. Winter,  biomedical research. Spring, –. Re “Gout, an American Revolutionary War Statesman, and the Tower of London.” Papa C. Winter,  Re “Jack London’s Chronic Interstitial Nephritis.” Imperato PJ. Summer, – Re “Paralysis Nose Spray” Index by title Benson JA Jr. Winter,   Alpha Omega Alpha Robert J. Glaser Distinguished Teacher Awards. Harris ED Norbury FB. Winter,  Jr. Winter, –. Re “The faculty dining room”  Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowships. Staff. Harris ED Jr. Winter,  Autumn, –. O’Connell K. Winter,   Alpha Omega Alpha Helen H. Glaser Student Essay Awards. Staff. Autumn, . Plotz C. Winter,   Pharos Poetry Competition winners. Staff. Autumn, . Re “Well, death’s been here for a long time.” Miller SH. Winter,  Access to a healthy lifestyle: Not as simple as an apple a day. Adelani MA. Autumn, Real doctors in the movies –. Adams BB. Summer,  Adventures in Prostate Alley. Poem. Claman HN. Autumn, . Dans PE. Summer,  Affliction is a treasure. Gunderman RB, Brown BP. Spring, –. Remembering Alvan. Wartman SA. Spring,  All the Mothers Are Busy. Poem. Foster HM. Summer, inside back cover. Rice-paddy dialysis. Hoffman I. Winter,  Alpha Omega Alpha Administrative Recognition Awards, /. Staff. Autumn, Slow attrition of primary care in South Asia, A. Shankar PR. Autumn, – . Thanks to Dr. Dans Alpha Omega Alpha Medical Student Service Project Awards, /. Staff. Dans PE. Spring,  Autumn, . Hubel K. Spring,  Alpha Omega Alpha visiting professorships, /. Staff. Autumn, – Lane RM. Spring,  Alpha Omega Alpha Volunteer Clinical Faculty Awards, /. Staff. Autumn, “These Foolish Things.” Sullivan C. Autumn,  –. Thoughts of doctors, The. Sommer LS. Autumn,  And then there were eight. Finlay-Morreale H. Winter, –. “Wrongful death.” Marr JJ. Autumn,  Atrial Fibrillation. Poem. Langhorne H. Summer, . Leukemia. Poem. Lane K. Summer, . Aura. Poem. Lo N. Autumn . Moment, A. Poem. Isenberg SF. Winter, inside back cover. Bring out your dead? Smythe WR. Autumn, –. Morning Rounds. Poem. McGuffin AM. Autumn, . Campanology. Poem. Neilson S. Spring, . My Own Two Eyes. Poem. Iyengar M. Winter, back cover. Captive of art, not disease: Paul Klee and his illness, scleroderma. Silver RM. Winter, National and chapter news –.  program expenditures by the national office. Staff. Spring,  Charged. Poem. Bromberg R. Autumn, .  report of the editor of The Pharos. Harris ED Jr. Spring,  Commentary from a teacher of anatomy. Commentary on Bring out your dead? Chase  report of the executive secretary. Harris ED Jr. Spring,  RA. Autumn, . th annual banquet and induction ceremony at the University of Texas Medical Congressional Polio Vaccine Hearings of , The: A landmark in biomedical Branch at Galveston (Alpha Texas). Alpha Texas chapter. Autumn, – research. Williamson S. Spring, –. Announcing the  Alpha Omega Alpha Robert J. Glaser Distinguished Dance of the Student Doctor. Poem. Augsburger J. Winter, . Teacher Awards. Staff. Spring,  Day in a Golden Year. Poem. Nguyen Y. Autumn, . Announcing the  Pharos Editor’s Prize. Staff. Spring,  Encourage Their Children. Poem. Devereux D. Winter, . Centennial celebration at the University of Minnesota Medical School, Alpha

The Pharos/Autumn 2008 63 Index

Minnesota. Anderson T. Spring, – Centennial Celebration of Alpha Omega Alpha at the University of Michigan Medical School. Alpha Michigan chapter. Summer, – Leaders in American Medicine. Staff. Spring,  Medical Student Service Project Award, The Chicago Medical School at Rosaline Franklin University—Health care: A right that must be shared by all. Maharaj S, Mahapatra S. Winter, – Minutes of the  AΩA board of directors meeting. Harris ED Jr. Spring, – Patient encounters—The American University of Beirut: Volunteer Outreach Clinic at Shatila Refugee Camp. Nasrallah M. Summer, – Richard Bronson, MD, added to the editorial board of The Pharos. Staff. Spring,  Winners of the  Pharos Editor’s Prize. Staff. Spring, – Nephrologist as kidney donor. Lifschitz M. Autumn, –. New Art. Poem. Tomasiewicz H. Winter, . Night Storm. Poem. Isenberg SF. Spring, back cover. No colored ribbons for them. Poem. Devereux D. Spring, . Of books and libraries: Confessions of a booklover. Duke M. Autumn, –. Old Anatomy Textbooks. Poem. Neilson S. Spring, . Path in the Afternoon. Poem. Wilk JS. Winter, . Pharos, The. Volume . Staff. Autumn, –. Phoenix Phenomenon in medical research, The. Weisse AB. Summer, –. Physician at the movies, The. Dans PE Bella. Spring,  Coma, Summer, – Diving Bell and the Butterfly, The. Autumn, – Great Debaters, The. Autumn, – Greatest Show on Earth, The. Winter, – Green for Danger. Spring, – Juno. Spring, – Knocked Up. Spring, – No Way Out, Summer, – Richard Widmark (December , , to March , ), Summer,  Savages, The. Autumn, – Shootist, The. Winter, – We Are Marshall. Winter, – Plug-in, The. Harris ED Jr. Summer, –. Portraits: Goya and his physician, Dr. Arrieta. Claman HN. Winter, –. Private remonstrance of Doctor Botkin, or Pharaoh’s Physician, The. Schoenfeld AJ. Summer, –. Procedure note. Han J. Autumn, –. Quiet places. Marr JJ. Summer, –. Radiology Suite. Poem. Rakley S. Summer, . Reviews and reflections. Bennahum DA, Coulehan J, editors American Plague, The: The Untold Story of Yellow Fever, the Epidemic that Shaped Our History, by Molly Caldwell Crosby. Reed W. Autumn, – Best of the Bellevue Literary Review, by Danielle Ofri, editor. Bronson R. Autumn, – The Cancer Treatment Revolution: How Smart Drugs and Other Therapies Are Symmetry Renewing Our Hope and Changing the Face of Medicine, by David G. Nathan. Pederson T. Summer, – Final Exam: A Surgeon’s Reflections on Mortality, by Pauline W. Chen. Jacobson Everywhere, I look for that perfect, lost shape— JA. Spring, – Dali’s mustache, the Joker’s feline grin, the letter v, The Ghost Map: The Story of London’s Most Terrifying Epidemic—and How It Changed Science, Cities, and the Modern World, by Steven Johnson. Thomas E. a streetlamp fountaining into two globes. A vase Spring, – Happy Accidents: Serendipity in Modern Medical Breakthroughs, by Morton A. with winged arms, the caduceus’ twin snakes, Meyers. Moser RH. Winter, – an archer’s bow, the Libra scales, a crucified body. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, by Harriet Washington. Simpson The doctor says: One ovary is all you’ll need. Just wait. AR. Summer, – How Doctors Think, by Jerome Groopman. Coulehan J. Spring, – But my mother (fertile well past fifty—A good sign The Soul of a Doctor: Harvard Medical Students Face Life and Death, by Susan for you) brings a mirror to what I must sooner face, Poires, Sachin H. Jain, and Gordon Harper, editors. Gregory SR. Summer, – already on my body: a listing column of vertebrae, Too Soon to Say Goodbye, by Art Buchwald. Moser RH. Winter, – Searching for God below the vocal cords. Mokalla M. Winter, –. mismatched breasts, unpaired feet, a greener left eye. Seeds. Poem. Gilbert L. Autumn, back cover. Senator Royal Copeland: The medical and political career of a homeopathic physician. Paula Brady Davidson JRT, Dantas F. Summer, –. September Sunlight. Poem. Weiner MF. Autumn, –. She Lay Quietly. Poem. Tam JB. Winter, . Ms. Brady is a first-year medical student at the Columbia Smirk, The. Soni LK. Winter, –. University College of Physicians and Surgeons. This poem Summer Sum, A. Poem. Lehmann JB. Summer, . won second prize in the !""# Pharos Poetry Competition. Ms. Symmetry. Poem. Brady P. Autumn, . Brady’s address is: $$ Riverside Lane, Riverside, Connecticut Thank you note, A. Kemp KR. Autumn, –. “There is nothing more hostile than water turning into ice.” Editorial. Harris ED Jr. "$#%#. E-mail: [email protected]. Winter, . To a Friend at Sixty, Leaving for a New Job. Poem. Coe FL. Spring, . Time for change in AΩA. Editorial. Harris ED Jr. Autumn, . Tribute to Medical Stereotypes, A. Poem. Shumer D. Winter, . Wondering waves. Poem. Isenberg SF. Spring, . Write a Poem, Win . Staff. Winter, . Wrongful death. Editorial. Harris ED Jr. Summer, .

64 The Pharos/Autumn 2008 In the ICU at Christmastime

White sheet twisted around an ankle, unsensed, but alive, and recorded every hour. Body of noises not its own—whir of fluids, ventilator puff. Returned to the womb, not by cord, but catheter. Floating, enveloped not by membrane, by a different darkness. Hoping for a story of birth, we analyze, intervene, and retreat to the hallway where nurses have smothered each wall in red, gold and green. Sarah Cross, MD

Dr. Cross (AΩA, University of Chicago, !""#) is a resident physician in Obstetrics & Gynecology at Yale-New Haven Hospital, and a member of the editorial board of the Journal of Medical Humanities. Her address is: $%& Willow Street '(, New Haven, Connecticut ")&$$. E-mail: [email protected]. Seeds

utumn’s darkness descends in this season of their lives. My patients brace for winter—the chill of cancer snaps the night. I observe in slow motion, these lives that cycle by, AAnd I am weathered by their struggle as they fight to stay alive. After work I sometimes weep at the suffering I’ve seen, Trapped somewhere between my weakness and the beauty of intimacy. I ask myself each night, “Should I leave or should I stay?” Knowing self-preservation begs us to look the other away. But I take off my white coat, hold their hands and let them cry. We talk of futures, passions, families—whatever wakes them up inside. They’re so much stronger than they seem, these patients who inspire, With vivacious human spirit adding kindle to the fire. Together we warm up winter; hope’s ember sparks the night, And I’m humbled by these lions, their courage and their might. Promises of spring gently bear them through the cold, As seeds of love are planted for what the future holds. For her it’s walls of cards, all begging her to stay. For him, walking laps helps push the pain away. For her, it’s a quilt, sewn with a sister’s love. For him, it’s peace in the spirit that’s above. For her, she holds on to touch her baby’s hands. For him, it’s pure stubbornness that makes him take a stand. Green sprouts of love grow from roots that anchor lives, Giving hope to those who live and peace for those who die. We may use labs and research to calculate their chances, Yet some defy the odds giving medicine its magic. Books can only teach us the science of human art, But experience will show you, hope sets patients apart. I relish in these gifts, the observance of these lives, And I take note of seeds that help my patients fight. Leah Gilbert

Ms. Gilbert is a fourth-year medical student and candidate for a master’s of public health in Maternal and Child Health at the University of North Carolina at Chapel Hill. This poem won honorable mention in the !""# Pharos Poetry Competition. Ms. Gilbert’s address is: $%& Springberry Lane, Chapel Hill, North Carolina !'%$'. E-mail: [email protected].