winterfall 2012 2012 HOPKINS medicine Comfort Zones Living better in the shadow of serious illness Sometimes, the most intriguing career path is off the beaten one. You may have read in this magazine that Johns Hopkins Medicine is becoming ever more global. Over the last decade, we’ve been engaged in dynamic collaborations with government, health care and educational institutions overseas designed to de- velop innovative platforms for improving health care delivery around the world. To achieve this ambitious mission, we rely on physicians and other health care profes- To apply or to sionals who work onsite in leadership roles at these locations. This is an opportunity learn more, visit to push the boundaries of medicine in a broad-reaching, sustainable way—while hopkinsmedicine.org/ expanding your clinical exposure to complex cases and developing new research and careers and refer to the education projects in close collaboration with Johns Hopkins faculty and interna- requisition number tional colleagues. Questions? Current opportunities on the Johns Hopkins Medicine International [email protected] expatriate team: n Chief Executive Officer (Panama): 38143 n Chief Medical Officer (United Arab Emirates): 38147 n Medicine Practice Leader/CMO (Kuwait): 38541 n Paramedical Practice Leader (Kuwait): 38802 n Physician (Kuwait): 38652 n Project Manager/COO (Kuwait): 38501 n Public Health Professional—MD or MD/PhD (Kuwait): 38591 n Radiology Practice Leader (Kuwait): 38775 n Senior Project Manager/CEO (Kuwait): 38500 EOE/AA, M/F/D/V – The Johns Hopkins Hospital and Health System is an equal opportunity/affirmative action employer committed to recruiting, supporting, and fostering a diverse community of outstanding faculty, staff, and students. All applicants who share this goal are encouraged to apply. FEATURES 14 Defying Death Cells on a seemingly one-way road to dying have come back from the brink—raising tantalizing treatment possibilities. By Christen Brownlee FALL 18 Comfort Zones Palliative care advocates are taking hospice strategies and pushing them “upstream.” By Jim Duffy 2012 24 The Last Word? Paul McHugh and colleagues are on a crusade to radically rethink the manual that has come Volume 35 * no.3 to define psychiatry. By Mat Edelson 30 The Bea Project In his quest to find answers to his daughter’s genetic condition, Hugh Rienhoff ’82 has gone “rogue.” By Sharon Tregaskis “ I’m definitely outside DEPARTMENTS the establishment … 2 LETTERS I’m a gypsy and I Chestnuts about Chesney, and more. prefer that—there’s 4 CIRclING THE DOME so much more freedom The new dean settles in and gets to work, mobile apps that address health needs around to work with different the world, organ donation goes viral, and more. kinds of people in 8 MEDICAL ROUNDS industry, academia, in Seeing is believing, overcoming ageism in kidney transplants, covered stents for mesenteric different companies.” ischemia, from twanging to talking. Hugh Rienhoff ’82, who launched “The Bea Project” to find answers to 12 HOPKINS READER the genetic condition afflicting his Surgeon Marty Makary makes the case for young daughter (below). accountability to improve patient safety. Plus: p. 30 Remembering Victor McKusick, and the hope of psychotherapy. 45 ANNALS OF HOPKINS E. Hunter Wilson ’53 formed bonds to Hopkins Hospital as a medical student that remained unbroken throughout his long career. By Neil A.Grauer CLASS NOTES 36 News from and about graduates. OPINIONS 47 LEARNING CURVE After a decade of reflection, it’s time to move on. By Daniel Munoz ’04 48 POST-OP Toward honoring the traditions that have flourished here—and helping them expand. By Dean/CEO Paul B. Rothman COVER ILLUSTRATION BY JAMES STEINBERG Hopkins MedicinePHOTOGRA P•H Fall BY LE 2012AH F A•STEN 1 | Letters | FROM THE Chesney Chestnuts EDITOR As an applicant for the Class of 1955, I was interviewed BEYOND THE CURE by Dean Chesney. I’d been Johns Hopkins is widely known as a forewarned that if the Dean place where medi- raised his hand to his ear, cal miracles seem to happen every that signified that he’d heard day—a place where enough and was turning off the best minds his hearing aid! But no one told me what that labor (often suc- cessfully) to find treatments and cures meant. for all kinds of difficult illnesses. In Sure enough, as I waxed eloquent about how the words of one administrator here, “Our docs can always pull some rab- I had been inspired to pursue medicine after bit out of a hat.” reading in Microbe Hunters about Metchnikoff ’s And, in fact, we proudly share accounts of these medical magic acts theory that lactobacillus protected the gut in every issue of this magazine. against pathogens, Dr. Chesney arose and With this issue, however, we depart from this curative focus to strolled over to the window, where he raised look at specialists who are delivering his hand to his ear. Taking this as an ominous Hopkins-level excellence along a parallel path. Known as palliative sign, I concluded my remarks and withdrew, care, it’s aimed at treating the and was doubly relieved when I was later in- symptoms of serious illness rather than the disease itself, and it is rapidly formed that I’d been admitted. gaining a foothold here, as you’ll discover in Jim Duffy’s cover story, Dr. Mountcastle states that Dr. Chesney’s one “Comfort Zones.” major fault was not accepting federal funding The timing couldn’t be better, nor the conditions within the field [Annals, Spring/Summer 2012], but then de- of health care more propitious. scribes him as being highly opinionated and Palliative care exists in harmony with medicine’s growing emphasis never laughing. This amused me because Dr. on “patient-centered” care, by Chesney struck me, at least in his later years, offering an individualized approach that relieves pain and suffering and as a reassuring father figure—in contrast to the creates the best possible quality of then young Dr. Mountcastle who was, at least life for patients at any stage of illness. It also saves money, by avoiding for us med students, a brilliant but humorless expensive hospital admissions (and and decidedly fearsome presence! readmissions) and instead keeping patients at home, with their families, It even seems likely that Dr. Chesney was where they can make the most of quite aware of the story about turning off his their time together. Within a medical environment hearing aid during interviews, and just did it like Johns Hopkins, which exalts to satisfy his young interviewees … and maybe the curative power of medicine, the effective delivery of palliative display his quiet wit! care represents a different kind of “success” story: one that is worth sharing, and celebrating. NICHOLAS CUNNINGHAM, MD '55, DR PH ’77 2 • Hopkins Medicine • Fall 2012 | Letters | CONTRIBUTORS EdITOR Sue De Pasquale A graduate of the Rhode Island School of Design, illustrator James CLASS NOTES Neil A. Grauer Steinberg (cover image) has done work for book and CD covers, CONSULTING EdITOR Edith Nichols and for a wide variety of newspapers and magazines, including Time, The CONTRIBUTING WRITERS Christen Brown- New York Times, Forbes, Fortune, The Wall Street Journal, and Reader’s Di- lee, Marjorie Centofanti, Lauren Glenn, gest. In 2001, he designed a postage stamp for diabetes research. Stein- Ellen Beth Levitt, Justin Kovalsky, Linell Smith, berg is based in Amherst, Mass. Shannon Swiger ART DIRECTOR Max Boam Illustrator Nigel Buchanan (“The Last Word,” p. 24) works out of DESIGN David Dilworth, Abby Ferretti PHOTOGRAPHY Mike Ciesielski, Leah Fasten, a large warehouse in Sydney, Australia, with a bunch of other artists. A Monica Lopossay, Chris Myers, Keith Weller lecturer in illustration and design at Australian colleges, Buchanan’s cli- ents include Money Week Paris, The New York Times, MTV, and The Radio ADMINISTRATION Times in London. He is the recipient of a silver medal from the New Paul B. Rothman, Dean/CEO, Johns Hopkins Medicine York-based Society of Illustrators. Ronald R. Peterson, President, The Johns Hopkins Hospital/Health System Sharon Tregaskis (“The Bea Project,” p. 30) is a freelance writer Dalal Haldeman, PhD, MBA, Vice and farmer who lives in New York's Finger Lakes. She's reported on the President, Marketing and Communications politics of federal funding for stem cell research, the role of folic acid in AdVISORY BOARD fetal development, and the ethics of disclosure among genomic investi- Steve Desiderio, MD ’78, PhD ’81 gators and the people who participate in their studies. Her most recent Director, Institute for Basic story for this magazine examined the role of race in quality of care in Biomedical Sciences the emergency department. George Dover, MD, Director, Johns Hopkins Children’s Center David Hellmann, MD ’77 Vice Dean, Johns Hopkins Bayview Argye Hillis-Trupe, MD ’95 Professor, Neurology David Nichols, MD, Vice Dean for Education A New Hospital—And a New History Richard Ross, MD, Dean Emeritus, The Johns Hopkins School of Medicine Thomas Traill, MD, Professor, Medicine Cornelia Trimble, MD, Associate Professor, Leading the Way: A History Gyn/Ob Hopkins Medicine is made possible through the generosity of The Johns Hopkins Medical and Surgical Association, the organization of Johns Hopkins Medicine for every MD or PhD whose training or employment includes Hopkins. William Crawley, MD ’79, President With the opening of a new Johns Hopkins Hospital comes a new history of Johns Hopkins Medicine—the first in Printed in the U.S.A. more than 20 years. ©2012 The Johns Hopkins University and Leading the Way: A History of Johns Hopkins Medicine The Johns Hopkins Health System Corporation offers a lively, lavishly illustrated account of the exceptional achievements of Hopkins physicians, researchers, teach- Hopkins Medicine is published in the fall, ers, and students since 1889, especially the extraordinary, winter and spring by Johns Hopkins Medicine, previously unchronicled expansion and accomplishments 901 South Bond Street, Suite 550, Baltimore, MD 21231.