Harvard medical alumni bulletin

2005·4.7 MB·English

by  Harvard Medical Alumni Association

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ALUMNI BULLETIN
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AND
PRIDE
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PREJUDICE
A
historian uncovers the stories of
—
the courageous young men and
—
one woman who broke the race
barrier at Harvard Medical SchooC
f'Vo
For more then 40 years Robert,
Gross'31 transformed the practi<
surgery, pediatrics, and cardiol<
His innovations included the fir
successful major surgery on the
greatvessels near the heart, with
ligation ofa patentductus arteric
in 1938; the firstcorrective surge
ofcoarctation oftheaorta in 19i
and one of the largest series in
the world of successful open-he
repairs ofcongenital anomaliest
the heart in infants and children
CONTENTS
WINTER 2005 • VOLUME 7S, NUMBER 3
DEPARTMENTS
Letters 3
Pulse 5
Thedebateonresidenthourscontinues,
andtheClassroomofthe Futuredebuts.
President's Report 7
byJosephK.Hurd,jr.
Bookmark 8
A rc\lew by EhssaElyofEscapeFire:
DesignsfortheFutureofHealthCare
Bookshelf 9
Benchmarks 10
Ad\ancesinhearingresearch;suicide 14
amongfemaledoctors;theself correct- Pride and Prejudice
< ingbrain; Nurses" Health Studyfindings Thefirst Harvard Medical School students ofAfrican descent
predated the adventofaffirmative actionbymore than a century.
Class Notes 57 an interview wuh nora nercessian by eve higginbotham
Obituaries 61
Endnotes 64
Amphysician walksfornacure, 24
Taking a History
bvDanielj.Bresskr
Elaborate genealogical researchhelpsone physician link himselfto a
longtraditionofhealers. bvMicHAEL lacombe
32
Crossing the Meridian
1 —
A pediatrician immerses himselfin thestudy ofacupuncture and
connects himself andsomeofhispatients to an ancient legacy.
1 earnest wu
bv
38
What Lies Beneath
.z ^^^^^^B^^^^^^^^^^^^^^l
In workingwith refugees traumatizedbymass violence, amedical
^ student glimpsesthepowerofthe psyche to ra\'age the body.
^y »^ '^Wi^BR^I bV JASON H . WASEY
44
1 / Regarding Henry
Mi.
pp^L Dogged by illfate, afailed musician turned Civil Warherobecomes
&I ^ I^BSSSHH Harvard Medical School'sgenerous, unlikelybenefactor.
\SLk^fi bv JOSEPH B. MARTIN
f
50
Practical Magic
L From remote mountain villages to refugee camps to inner-city
neighborhoods, servicelearningstudents arestretchingthebounds
HMS
ofan education, bv beverly ba llaro
1 Coverphotograph:LaurelKeith'52asaTusheegeeairman,courtesvofStephenN.Keith
^^l^^^^^^^^^^^l
•«-
I
^^^^^^^^^^^^^^^^^^^^^1
^^^^^^^^^^^^^^^^^^^^^H
Harvarr] Medirnl
ALUMNI
U L L E T I N
EDITOR-IN-CHIEF
WilliamIraBennett'68
EDITOR
In This Issue PaulaBrewerByron
ASSOCIATE EDITOR
N ONEOFTHECORRIDORSOFSYMPHONY HALLHANGSANENLARGED Be\erlyBallaro,PhD
photographofthe BostonSymphonyOrchestrawithitsgreatest ASSISTANT EDITOR
JaniceOLear)'
conductor. Serge Koussevitrky. In contrast to the orchestra's
BOOK REVIEW EDITOR
appearance today, two elements in this picture stand out; The seats are ElissaEly'88
arrangeddifferently. Andthey are alloccupied bywhite men, save foralone EDITORIAL BOARD
bassoonist. She was hired in 1945 and was the first woman otherthan a JRuadfyaAelnCnaBmipgboy''9728
harpistto holdachairin the orchestra. ElissaEly'88
AliceElaherty'94
That same yearthe owners ofthe Boston Red Sox first invited African AtulGawande'94
RobertM.Goldwyn'56
Americans to tryout at Fenway Park. TheypassedoverJackie Robinson, PetriKlass'86
\'ictoriaMcEvoy'73
andtheteamwouldnotevenhalfheartedlyintegrateuntil 1959. James O'Connell'82
J.
Bythen Harvard MedicalSchoolwasdoinga slightlybetterjoboffoster- MitNcahneclylTE..ORiaibokli'n79'55
ingequal opportunity. For80years atrickle ofdetermined,brave, andgifted EleanorShore'55
AfricanAmerican men had trained at HMS, andin 1945 the School sawfitto DESIGN DIRECTOR
LauraMcFadden
admitits firstwomen.
ASSOCIATION OFFICERS
Symphony Hall, Fenway Park, andHarvard Medical School all standatthe
JosephK.Hurd,Jr.'64,president
apicesofatrianglein Boston'sgeography,andtheyhavealsobecomefixtures StevenA.Schroeder'64,president-elect1
A.W.Karchmer'64,president-elect2
inthecity's cultural, civic, and moral landscape. Underpressure, eachhas SusanM.Okie'78,vicepresident
PhyUisI.Gardner'76,secretary
becomevisiblyintegrated, but thetopleadershipofeachremainspredomi- KathleenE.Toomey'78,treasurer
—
nantly (orexclusively) whiteandmale asisthecasewithcomparableinsti- COUNCILLORS
tutions alloverthecountry. Whyis this? NancyC.Andrews'87
WesleyA.Curry'76
One can imagine an argument beingmade that the major symphony TimothyG.Eerris'92
GeraldS.Foster"51
orchestras (for example) have white men as conductors at least in part DonnellaS.Green'99
becauseonlywhite menhave thegenetic endowmentto makegreatmusic. LinLdisaaS.I.Hloetzczohnkiis's84'78
Onecanimagineit,butnotwithastraightface. Yetsimilararguments about KaKtehnernientehAL.SKheienleey'6'194
thetemperament andgenetic endowment ofblackpeopleorwomenwanting
DIRECTOR OF ALUMNI RELATIONS
tobephysicianshavebeenmadewithinli\'ingmemory. DanielD.Federman'53
Thehistoricalfact is that cheesytheories about innate inclination and ASSISTANT DIRECTOR OF
ability ha\'e longbeen thefirstrefuge ofthose whowould rationalize the ALUMNI RELATIONS
PatrickRivera
lack ofminorities ineliteinstitutions. Stepbystep, experience haseroded
REPRESENTATIVE TO THE
these theories. The complexionofHMS has changed dramaticallyfrom HARVARD ALUMNI ASSOCIATION
\N'hat it was ageneration ortwo ago, and sohave assumptions about who JoHsaerpohldK.BuHrusrzdt,ajJnr.''7664
can dowhat inmedicine. This issueoftheBulletinjoins theAlumniAssocia-
TheHarvardMedicalAlumniBulletinis
tion incelebrating140yearsofAfricanAmerican achievement, againstgreat publBiossthoend,qWuaArte0r2l1y15atf2b5ySthhaettHuacrkvaSrtrdeet,
odds, at HarvardMedical School. Medical.Alumni.Association.
Phone:[phone]•Fax:[phone]
Email:[email protected]
ThirdclasspostagepaidatBoston.
U,ihany i/u Massachusetts.Postmaster,sendform3579
to25ShattuckStreet,Boston,M.A02115
ISSN0191 7757•PrintedintheU.S.A.
HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005
—
T.ETTEHS^
SECOND OPINIONS FROM OUR READERS
|
6 6 I am keenly aware ofthose situations in which
tests are ordered, not so much to dehver good mented) andequallyormorevalid than
a decision to order the test. Assuming I
medical care, but rather to avoid being second- was within the standard of care, is my
positiondefensibleincourt?
guessed at some hature date, perhaps by ajury" I would like to see an effort to create
laws that support doctors who demon-
-LESTER KLEIN, MD
ft strably consider options but do not
necessarilyactaffirmatively,inplaceof
what seems to be current law, which
retroactively frames doctors for not
doing a certain test or procedure. Per-
haps this suggested doctrine is already
law,inwhichcaseIwouldurgethatitbe
widelypromulgatedamongourpeers.
Goodtoseethat MitchRabkinisstill
inthefray.
LESTER KLEIN, MD
BOCA RArON, FLORIDA
Dejd Vu All Over Again
I was frankly appalled at Mitchell
Rabkin's article in the summer issue. I
havebeen receivingthe Bulletin formore
than 30 years and ha\'e never felt com-
pelled to write a letter to the editor
untilnow.
Dr. Rabkin's ideas are not new. He
essentiallyrecommendscapitation,which
has been tried and failed. His proposal
basically promotes not taking care of
patients so as little as possible of the
capitationisspent. He suggeststhatper-
si\'emedicine;theymustbehuge..Sohow formancereviewsandpatientsatisfaction
Defensive Measures dowe mitigate this situation? surveyscantemperthispitfall.Theproh
I enjoyed the essa)- Mitchell Rabkin '55 Inanswertothis, Iaskyou toconsid- lemisthatthesearcdifficulttodoandare
wrote in the Summer 2004 edition of er my own practice. When I decide not often biased. Dr. Rabkin also suggests
the Bulktin. "Can Humpty Dumpty Be to order a test or procedure that might a benefit from having the primary care
Put Back Together?" As usual, Mitch is be construed as "defen.sive" medicine, I physicianfundreferralstospecialistsout
ahead of the curve in thinking about document my thought process in the ofhiscapitation. This isadisincenti\'eto
these issues. It occurs to me, though, record. For example, if I decide not to referandcanresultinprimarycarephysi-
that the costs associated with legal- orderan intravenouspyelogram, or IVP, cianstreatingbeyondtheirabilities.
defense practices should be addressed I willwrite a note stating: "In this situ- To borrow a simple analogy men-
alongwiththeotherissues. ation an IVP is not warranted." This tioned to me years ago, I suggest that
As a urologist, I am keenly aware of noteprovesIcontemplatedtheIVPbut, Dr. Rabkin capitate his auto mechanic.
those situations in which tests are basedonmyeducation,experience,and When Dr. Rabkin pulls up and tells the
ordered, not so much to deliver good judgment,decidedthetestwasnotwar- mechanic that he suspects his car's
medical care, but rather to avoid being ranted. Now it may turn out that at brakes aren't working well, and the
second gues,sed at some future date, some future date that patient may need mechanicsaysthingsseemfine,assessing
perhaps by ajury. We doctors are con- an IVP, and that IVP may show a renal the car from his desk 20 feet away, wiU
stantlyawareofthepotentiallegalram- cancer. Would I be in trouble? I have Dr. Rabkinfeelsecuredrivinghiscar?
ificationsof"actsofomission."Iamsure reasoned that my decision not to order Asapracticingphysicianratherthan
thereareestimatesofthecostsofdefen the test was soundly ba,sed (and docu an academic, and as a patient advocate.
WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN
^
TXE
L E R S
SECOND OPINIONS FROM OUR READERS
I
1 view Dr. Rabkin's suggestions as As a volunteer counselor for ad\ance medicine emeritus, just celebrated its
unworkable. He is described as "a directi\es,I knowtheyarenotjustforold fiftieth anni\ersar)' as a four-year school.
leaderin medicine," which I am sure he people. Linda Emanuel '84, who wrote It has a distinct Har\ard flavor. Reece
is, but these ideas are neither new nor "The Medical Directive," described how Berryhill, Classof1927,estabUshed it as
sound. I also feel they neither improve she brought up the subject with all her afour-yearschool. Hewassucceededby
care nor benefit the patient. They may, patients, assuring them that her query IsaacTaylor,Classof1945,andthenbyme,
in fact,workinthereverse. was routine and mentioning that she amemberoftheClassof1951. Mysucces-
MICHAEL A. NIERENBERG '/I hadan advancedirective forherself. sorwasStuartBondurant,whotrainedat
PALO ALTO, CALIFORNIA BETSY CARPENTER theBrigham. Manyoftheschool'sfaculty
PORTOLA VALLEY, CALIFORNIA members ha\'e a Har\'ard background,
National Championship andwecanattributesomeofitsfantastic
Thank you for correcting a significant Torch-Borne Trilogy successtothe Harvardlegacy.
omission. Se\eral times in the last few I was most fa\orably impressed by "The Manythanksforthesummerissue.
years both the Bi/!/cti)i and HarvardMaga- Changing Mosaic of Har\ard Medical CHRISTOPHER C. FORDHAM III '5I
zine have made forays into covering School," as Eve Higginbotham '79 CHAPEL HILL, NORTH CAROLINA
the health care deh\-ery crisis. But even described it in the summer issue of the
thoughsomeoftheleadingproponentsof Bulletin, and I applaudtheeffortsofHMS Short and Sweet
a comprehensive, government-sponsored todi\'ersifyitsstudentpopulationaswell The summer issue of the Bulletin
solution are Har\'ard faculty mem- as its faculty and staff. I includes an oath that the Class of2004
bers, that argument has been largely was alsodeUghtedtoseethe crafted to take the place of the one by
—
absent untilnow.PublishingSteffie Hippocrates. It is commendably ide-
Woolhandler's piece in the Summer alistic but its 43 lines make it too
2004 issue of the Bulletin gave tacit long to be remembered. It begins, "I
acknowledgmentofthedocumented, solemnlypledgetoconsecratemylife
growing physician support for to the service of humanity." Such
national health insurance. As we consecration is, in itself, a solemn
careeneverclosertoa"perfectstorm" pledge. One could simply say, "I give
in health care, the Har\'ard tarrdly as myselfto the serviceofhumanity."
well as the public should no longer I suggest consideration of an oath
dismissthisaspoUticalfantasy. that would be a modification of the
JAMES BERNSTEIN '52 "Qualities of a Physician," by Oh\'er
ROCKVILLE CENTRE, NEW YORK WendellHohnes,Classof1836:"Tocure
seldom,torelieveoften,andtocomfort
Final Wishes always." The oath would read: "I give
In the speech Markella Zanni '04 myselftotheserviceofhumanity.With
gave at graduation, as printed in thehelpofnature,Iwillcurewhene\--
the summer issue of the Bulletin. er possible, relie\'e often, and comfort
she recounted an incident in always. IwiUdonoharm. IwiUhonor
which her colleagues inquired, in my teachers by teaching. I wiQ work
reference to a patient in her late forpeaceinmyself,inmyfamily,inmy
eighties, "Did you ask about her community,andinmy\vorld."
end-of-life preferences?" I believe Peace and healing cannot be
that"asensitivemonologueabout separated in a nuclear world and
advance directives" should have amongunderinsuredcommunities.
been part of the care provided by this articlesonthehealthcarefinancingcrisis. GEOFFREY R. PAUL "56
patient's primary doctor well before Iregret thattheprofessionhasnot pro SAN FRANCISCO, CALIFORNIA
this hospitalization. Presumably the ducedgreaterleadershipinassuringasta-
patient had been asked about her ble and workable health care system for The Bulletin welcomes letters to the editor
advance directives upon admission as thepeopleofthiscountry,andIamgladto Pleasesendlettersb\mail(HarvardNledical
requiredbythePatientSelf-Determina- seetheBulletinaddressingthosequestions. Alumni Bulletin,25ShattuckStreet,Boston.
tion Act, so a question about code sta- Parenthetically, the superb medical Massachusetts 02115): fax [phone]); or
tus would be a follow-up to the more schoolattheUniversityofNorthCarolina email (hullctin^hms.hanxird.edu).Letters max
basicend-of-lifepreferences. at Chapel Hill, where I am professor of beeditedforlengthorclarity.
HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005
PTIT.SE
MAKING THE ROUNDS AT HMS
Wake-Up
Call
HRISTINEWEEKS'O3,ASECOND-
year surgical resident at
BrighamandWomen's Hospi Road Work Ahead
tal,foundthetimetotrainfora
marathonandrunitinNovember,despite ^^^^^k **W^ ^^^^^^H '^EI'ICAL INTERNS WHO WORK
^^V^^V
a busy schedule. Such a feat would ha\'e -*^^^^^^^x^9l extended shifts ofat least 24 hours
beendifficulttoimagineinthedayswhen ^^fcJW ^^^^H^^^^i °'^^ more likely to be involved in
residentsmight spendanentireweekend -,i,^^^^^ ^^^^^^^^1 niotor vehicle crashes and near
atthehospitalbeforegoinghomeforafew ^^^^V ^~" ^^^^^B misses, according to a study in the
hours of sleep, .'\lthough Weeks and her January 13, 2005 issue of the
fellow residents still put in an occasional ^^^^^^^^^^ New EnglandJournal ofMedicine.
24-hourshift,forthemostpart,theywork h^^_^^^^m^^^^^^_^^^ _^^^^^^^^HH This evidence adds fuel to
12 hours at a time with 12 hours off ^_MiJ^^ li^^^^^^^^^^^^ the debate over resident hours.
between shifts. "You go home every day The study was conducted by
likeanormalperson,"Weekssays. the Harvard Work Hours, Health,
Times are changing for medical resi- and Safety Group, headed by
dents. Many residency programs have Charles Czeisler at Brigham and
been cutting back hours for years now. Women's Hospital. The researchers
And guidelines imposed in 2003 by the conducted a prospective. Web-
AccreditationCouncilforGraduateMed based survey of 2,737 interns across the country. "From that analysis," Czeisler
ical Education (ACGME) formalized says, "we found that for each extended-duration shift they work per month, there
those changes. Now, residents can a\'er- was a 16 percent increase in the monthly risk of a motor vehicle crash driving
age only 80 hours per week o\'er a four- home from work, and they could be scheduled for as many as ten extended shifts
weekperiod, must take a full day offper per month by current guidelines."
week and at least 10 hours off between The research team for this study, led by Laura Barger, HMS clinical fellow in medi-
shifts, and cannot work more than a 30- cine at Brigham and Women's, also examined whether each subject was more likely to
hourshift,ofwhichthelast6hoursmust experience an incidenton the road after an extended shift. The analysis showed that
notbede\-otedtoclinicalcare. interns had more than double the odds of having a motor vehicle accidenton the com-
When ateamledbyCharlesCzeisler, mute home from an extended shift and more than five times the odds of having a near
the Frank Saldino, Jr., PhD Professor miss than they did after working a shift of 12 hours or fewer.
of Sleep Medicine at Brigham and "The ACGME is the only nationally recognized regulatory body of any kind that
Women's, unveiled data showing that continues to sanction 30-hour shifts," Czeisler says. "Unfortunately, this establishes
internswere more alert and madefewer as a national standard a practice that endangers these trainees as they drive home
serious errors when they worked shifts from work."
of16hoursratherthanthetraditional30,
the question was once more raised of
howseverelytheresidents'hoursshould Keepingresidentsmorealertbyensur- hoursforyears,butnowitishappeningin
becut.Whilethestudy,publishedinthe ingtheyhaveadequatesleepseemslikea the context of stricter educational stan-
October28,2004issueoftheNewEngland no-brainer, but in fact it raises concerns dards and increased financial pressures.
journalofMedicine, was conducted before among many physicians that the change "Thereareeducationalrec[ULrementsthat
the ACGME guidehnes took effect, the to shorter shifts may ultimately harm aregettingtightened upbytheresidency
control schedule it used was similar to patient care. The greatest worry is that trainingcommitteesoftheACGMEwhile
the80-hourworkweekthatisnowman- shortershiftswillcauseerrorsaspatients they are tightening hours," he says.
dated for residents. But the new infor- are handed from one doctor to another, "Medicare is also tightening funding for
mation comes at a time when many interruptingthecontinuityofcare. residents. The hospitals ha\'e to sort out
teaching hospitals are still struggling According to Michael Freed, director allthesecompetinginterests."
withthe recentACGMEguidelines and of graduate medical education at Chil-
arenotpreparedto take steps toreduce dren's Hospital, residencyprogramshave Courtney Humphries IS a science writer
hoursfurther. been moving toward more reasonable forFocus.
WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN
ptit.sk
MAKING THE ROUNDS AT HMS
The Illusive Art of Teaching
room and discussed aspects ofthe case, allows for a safe, "practice-makes-per-
exploring relevant sciences down to the fect" environment. "Students can work
cellularandmolecularmechanisms. The on clinical judgment, communication,
educationalplatformMyCoursesanimat- and action skills as often as needed,"
edmaterialonthelarge-screendisplays, Oriol said. "Adding the 'hands-on' care
including annotated diagrams, radiog- makes the learning indelible. And
raphy, virtual microscopy, and gross instead ofrelyingonchanceencounters
anatomicalspecimens. with patients to teach students about
"Inthisintegratedsetting,wecangi\'e particular diagnoses, the Classroom of
students a lesson in asthma by incorpo- the Future allowsthe studentstoexpe-
ratingbasicandclinicalsciencesasauni- rience a range of clinical cases across
fied whole," said James Gordon, HMS age,culture, andgender."
assistantprofessorofmedicineat Massa- "Fromaneducationalstandpoint,we
chusettsGeneralHospitalanddirectorof wouldlike all medical studentsto have
theG. S. BeckvidthGilbertandKatharine meaningful experiences that represent
S. Gilbert MedicalEducationProgramin the full spectrumofmedicine," Gordon
Medical Simulation. "Here,the tradition- said. "But we cannot guarantee that
al tutorial is enhanced by a customized every student will care for someone
bedsideencounterandcomplementedby with severe asthma, for example. Now,
—
HARVARD MEDICAL SCHOOL'S EFFORTS TO the resources ofthe digitalworld allin with the simulator, students can see
integrate medical simulation into the asinglelearningspace." virtually any patient in the curriculum,
educational process were showcased in Likening medical simulation for stu- ondemand."
a Classroom of the Future exhibit in dents to flight simulation for pilots,
November.Morethan200attendeesfrom NancyOriol79,HMSdeanforstudents, Leah Gourky is a former editorial assistant
theCouncilforHarvardMedicine,the13- said that the Classroom of the Future withFocus.
School Consortium (a group of major
research'centered medical schools), and
theAssociationofAmericanMedicalCol-
leges(AAMC)participatedintheexhibit
as if they were medical students, taking
partinhands-onlearningVkTthanarrayof
innovativeeducationaltechnologies.
The case ofthe day was asthma. The
setup, a blend of a traditional tutorial
room and simulator laboratory, featured
HMS
the usual classroom technology,
including a Web-enabled display moni-
tor,alongwithahospitalbedandpatient
simulatorplacedalongsideatutorialcon-
ference table and chairs. The electronic
patientdisplayedsymptoms,complaining
tothe"doctors"aboutshortnessofbreath.
Participants had to na\Tgate an entire
care episode, conducting a real-time
LQterview and exam, considering differ-
entialdiagnosesandtestresults,institut- MODEL PATIENT: Above: James Gordon (center), HMS assistant professor of
ingatreatmentplan,andcommunicating medicine, instructs students (clockwise from lo>ver left) Sarah Kempe-Mehl,
Karimi Gituma, David Lee, and Henry Delu as they vt^ork with a simulated
with the patient and other providers. patient. Above left: NancyOriol (center), HMS dean for students, and students
Theythenturnedtothetraditionalclass- Wally Bethune (left) and Ben White demonstrate use ofthe simulated patient.
HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005
PRESTDENT\S REPO
Against All Odds
Q HISACADEMICYEARHASBEENFILLEDWITHTRANSI- Inclosingtheday'sevents,JoanReedeextendedhergrat-
tionsforHMS.TheSchool'sfinancialconstraints, itude to those who came to HMS before her, for their
forexample,ledto staffcuts andoffersto senior courage,sacrifice,andperseverance."Itisbecauseofyouthat
administrators to take early retirement. Sadly peoplelikemecanstandheretoday,"shesaid."Westandon
forus,oneofthoseretireeswasNoraNercessian, yourshoulders. Thechallengeforallofusistofindwaysto
associatedeanforalumniprogramsandspecialprojects. continue to \\'ork together to make the past that has ledto
Noradeserx'csmuchofthecreditfororganizingandlead- whereweseeourselvestodayinformthefuture."
ingthe School'salumniofficeduringher17-yeartenure. She Nora'slastofficialactwastocoordinatetherelocationof
left on a high note with the publication ofher most recent the.\lumniOfficefromGordonHalltospaciousnewquarters
work.AgainstAllOdds:TheLegacyofStudentsofAfricanDescent intheLandmarkCenteronPark Drive (theoldSears Build-
at HarvardMedicalSchool BeforeAffirmativeAction, 1850-1968. ing).Reunionplanningandallalumniofficefunctionswillbe
In the book, Nora presents profiles of 85 students of carriedoutfromthislocation. SharingspacewiththeAlumni
African descent dating back to the first matriculants. Fund,the Office ofResource Development, andthe Bulletin
Her fascinating, well-received account is now available inthisnewlocationwillhelpbuildcloserrelationshipsand
online (www.hms.harvard.edu/dcp/againstallodds). encouragecollaborativeopportunities,energies,andideas.
To celebrate the manuscript's publication,Joseph Mar- PatrickRivera,whoworkedcloselywithNoraforsever-
tin, dean of HMS, and Joan Reede, the School's dean for alyears,has assumedleadership oftheoffice. Wecongrat-
"The memories of living alumni of African
"f
descent include some painful experiences, but
the outcomes are cause for celebration."
diversity and community partner.ship, hosted a Diversity ulatehimuponhispromotiontoassistantdirectorofalum-
Town Forum and celebration. Many African American nirelationsandlookforwardtoworkingwithhim.
alumni honored us by returning for the occasion, marking Finally, we have had to accept the fact that Dan Feder-
it as a significant event in the School's history. Mildred man wishes to step down as director of alumni relations.
Jefferson '51, the first female graduate of African descent, Dan has performed magnificent work as director for the
attended, as did a dozen other alumni featured in Nora's past 12 years—^just as he has done in all the roles he has
work and relati\esanddescendantsofsixothers. played on behalfof the School over the past five decades.
In their preface to the book. Dean Martin and Daniel We hope tocontinue tobenefitfromhisbroadknowledge
Federman '53 wrote, "The effort to prepare a complete ofthealumni,hisskillasafundraiser,andhiswisecounsel
record of the .\frican American presence at HMS is com- wellintothefuture. Searchcommitteemembersappointed
plemented by autobiographical contributions from li\ing by the dean and the Alumni Council will announce his
alumni. Their memories include some painful experiences, successorinthespring.
buttheoutcomesarecause forcelebration." Despite the challenges such transitionspose, the Coun-
Gloria Still, a descendant ofJames Thomas Still—who cil'sworkpersists.Wecontinue,forexample,thefocuson
entered HMS in 1867 and was the third verified student of student indebtedness that the past Council president.
—
AfricandescenttograduatefromHMS attendedtheevents Eve Higginbotham'79, initiatedlastyear. The Council has
withthreeotherStillrelatives."Tome,"shetoldthoseassem- authorized a subcommittee to investigate innovative pro-
bled for the celebratory dinner, "the important story is that grams that will benefit students, and Council members
youngpeopleunders—tandthate\'eninthemidstofwhatIcall willbedevelopingaproposaloverthenextyearortwo.
modern-da—y slavery whether it's drugs, alcohol, or under-
education the whole story ofour family is that people, in JosephK.Hurd,jr'64ischairmanoftheDcpcu-tmentofGynecologyat
spiteofad\'ersity,canbefree,canbesuccessful,andcansoar." theLaheyClinicMedicalCentermBurlington,Massachusetts.
WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN
—
BOOKMARK
REVIEWING THE PRINTED WORD
I
Escape Fire Mostofthegoalsseemsosensibleit'shardtofathomwhy
we haven't reached them. Maybe it's because until now no
Designs/ortheFiiiwxojHealthCare one has listed them so cogently: eliminate unnecessary'
byDonaldM. Berwick72(josscy-Bass,2004) admissions, tests, and treatments; streamhne drug—use;
decrease waiting time and in\'entor)' levels; record and
—
IT IS NOT HARD TO FALL IN LOVE WITH A STRANGER. IT IS MORE request information only once; measure aims over time;
arduous,thoughnotimpossible,tofallinlovewithastranger and measure for impro\ement, not judgment. Underneath
—
who is a sobcrminded, bespectacl—ed expert in decision themall,the—unifyinggoal andtheonemostdifficulttoput
analysis and technology assessment a scholar, physician, intopractice iscooperation."Iwantusmorethanamthing
husband,andfatheroffour. Nonetheless,Ibeginwithbias: elsetohelpeachother,"BerwickwTites.It'sthissimplewish,
I aminlovewithsomeoneIhavenevermet,whoishimself slipped naked between statistics and technical terms, that
inlovewith...Quality Improvement. givese\'erythinghewrites suchpassion.
Quality Impro\'ement. The words e\'oke the memory ofa Cooperation: a\isionaryidea.Thestatusquothesedaysis
roomful of annoyed colleagues. We have desolation. Flawed medicaldeliveryisthe
received our biannual QI assignments, personal story we all tell e\entually. Your
proofsofintentionforhospitalre-accredi- medicalspecialtywiUnotsa\"eyourbroth-
tation.Dutifully,resentfully,werexaewthe erfromdehumanizingcareattheendofhis
charts of paper patients. Are the AIMS hfe, andit will not save you, either, when
examinationsup todate?Werepain scale you become apatient. Berwick'sowndis-
measurementsdonepre- andpost-Tylenol tinguished career did not save his father
administration? Results arecollatedinto a (also a physician) from one hunuliation
bargraph.Thereisapointedfingerortwo, after another when he deteriorated from
which are tossed into a pit filled v,Tth Parkinson's disease and a hip fracture. It
otheraccusingfingerspointinginadozen didnot sa\'eBerwick'swifefromonedan-
different directions, and we are free from gerous inefficiency after another when
QIforanothersixmonths. she fell ill with myelitis. The experience,
Then I fell in love with the stranger, he describes, "was often one oftrying to
or at least, with his thinking. EscapeFire: gettheattentionofdecision-makerstocor-
Designs for the Future of Health Care, by recttheir...as.sumptions,"
Donald Berwick 72, collects a decade Berwickwants,morethananythingelse,
of speeches he gave at the Institute for for us to help each other. But stor)' after
Healthcare Improvement's armual forum stor)'makeshelpseemhopelesslyfaraway.
about "this nearly derailed, perilously Onever}'le\'el,itisgrim.YetBerwickisalso
wandering health care industry." The forum began in 1989 abehe\'er,withstatisticstobackhisoptimism.Competitionis
with not even 300 attendees, whom Berwick calls, "hardy motivating,butsoiswhathecalls"theperformanceofsystems
—
souls a fringe element." By 2002, the fringe had gro\\Ti to ofint—erdependency"Hecanpro\eit.Signsofpromiseformed-
3,500,allwearyofanindustryfilledwith"nonsensical,aim- icine inspiring,effecti\'e,sometimeshighlyamusingsigns
less, enervating restructuring, accusation, surveillance, and emergeinfieldsasnonmedicalascarmanufacturing,elemen-
blame" (translation: the Fingers). Instead, Berwick offers a taryschoolsoccercoaching,andsmokejumping.
system ofcare that would be "better, cheaper, and inciden- But change can be fueled only by constant reminders of
tally more satisfying to work within." He does it with such ultimatepurpose.Wearehuman,weinstrumentsofchange,
drama,factualassurance and,when necessary,flagrant silli- and in the end, self-interest wiU improve care deli\'ery: you
ness,thatonlyanidiotwouldnotsignonthe—dottedline. oweittoyourfather,yourspouse,yourchild,andine\itably,
Thesespeechesmakethebestkindofessays readableand yourself. "We have studied enough," Berwick writes. "\\'e
thinkable. Each forms around a core of some list related to knowhow.Nowwemustrememberwhy."
quahty improvement. They arelike a Christmas carol: ele\'en Inoneofthelastspeechesinthebook,Berwickteaseshim-
strategies to improve performance, ten elements of world- self by adding, "You will say that I overinvest my hopes in
classhealthcare,sixideasforchange,fi\'epreconditions,four intrinsichumanmotives."Butthisisnotoverinvestment.This
attributes ofspread. This is a cle\'er strategy. Lists make the ishigh,clearvision:usinggiftsofthemindtohonorthesoul.
unmanageable seem manageable andtheinconcei\'ablepossi-
ble.Theyboilyearsofexperienceandproof-by-trialintofour- Elissa Ely '88 is apsychiatristat theMassachusetts Mental Health
wordphrases.Addatuneandyoustarttosingalong. CenterandtheBostonHealthCarefortheHomelessProgram
HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005