4 - Alpha Omega Alpha

THE
PHAROS
OF ALPHA OMEGA ALPHA SPRING 2009
HONOR MEDICAL SOCIETY

THE
PHAROS
of Alpha Omega Alpha honor medical society Spring 2009
Alpha Omega Alpha Honor Medical Society
Founded by William W. Root in 1902
Editor: Edward D. Harris, Jr., MD
Editor Emeritus: Robert J. Glaser, MD
Associate Editor and Managing Editor
(in memoriam)
Helen H. Glaser, MD
Managing Editor Art Director and Illustrator
Debra M. Lancaster Jim M!Guinness
Administrator Designer
Ann Hill Erica Aitken
Jeremiah A. Barondess, MD
New York, New York
David A. Bennahum, MD
Albuquerque, New Mexico
John A. Benson, Jr., MD
Omaha, Nebraska
Gert H. Brieger, MD
Baltimore, Maryland
Richard Bronson, MD
Stony Brook, New York
John C.M. Brust, MD
New York, New York
Charles S. Bryan, MD
Columbia, South Carolina
Robert A. Chase, MD
Stanford, California, and
Jaffrey, New Hampshire
Henry M. Claman, MD
Denver, Colorado
Fredric L. Coe, MD
Chicago, Illinois
Jack Coulehan, MD
Stony Brook, New York
Ralph Crawshaw, MD
Portland, Oregon
Peter E. Dans, MD
Baltimore, Maryland
Scott K. Epstein, MD
Boston, Massachussetts
Editorial Board
Lawrence L. Faltz, MD
Sleepy Hollow, New York
Faith T. Fitzgerald, MD
Sacramento, California
Daniel Foster, MD
Dallas, Texas
James G. Gamble, MD, PhD
Stanford, California
Dean G. Gianakos, MD
Lynchburg, Virginia
Jean D. Gray, MD
Halifax, Nova Scotia
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Pascal James Imperato, MD
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St. Louis, Missouri
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Stanford, California
J.Joseph Marr , MD
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San Francisco, California
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Madera Reserve, Arizona
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Washington, DC
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Tampa, Florida
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Gainesville, Florida
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Richmond, Virginia
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Deerfield, Illinois
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Nashville, Tennessee
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Stanford, California
Marjorie S. Sirridge, MD
Kansas City, Missouri
Clement B. Sledge, MD
Marblehead, Massachussetts
Jan van Eys, Ph.D., MD
Nashville, Tennessee
Abraham Verghese, MD, DSc
(Hon.)
Stanford, California
Steven A. Wartman, MD, PhD
Washington, DC
Gerald Weissmann, MD
New York, New York
David Watts, MD
Mill Valley, California
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“Worthy to Serve the Suffering”
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President
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Baltimore, Maryland
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David P. Hill
Editorial
Marat and Harvey, revolutionaries
Edward D. Harris, Jr., MD
Revolution is defined in several ways. One is the forcible
overthrow of a government or social order in favor
of a new system. This type of revolution invariably
occurs over a short period of time. “Marat’s Terror” by Jesse
Woodard (pp. 17–24) describes the troubled but powerful life
of physician/ polemicist Jean-Paul Marat and his role in the
French Revolution. His fiery doctrines were quenched suddenly
when Charlotte Corday stabbed him while he bathed.
Revolutions in medicine and the medical sciences
are less radical and follow a second definition: a dramatic
and wide- reaching change in the way something
works or is organized and in people’s ideas
about it, a transition from one paradigm to another.
Today’s physicians and scientists are familiar with
this type of revolution. We have experienced the
discovery of penicillin, streptomycin, and cortisone;
the development of vaccines against poliomyelitis
and other infectious scourges; the definition of the
structure of DNA, the translation of the genetic
code, and the establishment of methods to synthesize
DNA; the initiation and growth of transplant
surgery; the technical advances informing CT, MRI,
microarrays, and stem cell biology; and the slower
but no less important revolutions in public health.
We relish the exploration of the unknown.
Why did it take more than 1500 years, from
the first to the seventeenth century, for empiric
observations to enable understanding of the circulation?
Galen, in the first century AD, adopted the
Hippocratic theory of the four humours: blood, phlegm, and
yellow and black bile, and the importance of having balance
among them to ensure good health. Although reported to be
conceited, cruel, and vindictive, he cannot be blamed for the
blind allegiance to his teachings that persisted for centuries.
Those who followed Galen failed to use the tools they had—
eyes, brain, and hands—for at least two reasons: first, human
dissection was prohibited, and second, it was philosophers
and the clergy who for many centuries determined the truths
of life for the people. Most significant among those who led
thought was Aristotle. Bertrand Russell writes that ”it was two
thousand years before the world produced any philosopher
who could be regarded as approximately his equal.” 1 It was
Aristotle who gave science to mankind. He observed, and
deduced logical conclusions. Consider his realization that
no drop of water has been added to nor taken from the earth
and its atmosphere since creation: “This is a cyclic world, says
our philosopher: the sun forever evaporates the sea, dries up
rivers and springs, and transforms at last the boundless ocean
into the barest rock; while conversely the uplifted moisture,
gathered into clouds, falls and renews the rivers and the seas,”
writes Will Durant. 2 Aristotle observed that life was growing
steadily in complexity and power, with increasingly specialized
function. Indeed, he was on the verge of deducing the theory
of evolution. Why then was Aristotle not the one to define the
physiology of the circulation, that the heart (not the brain)
pumped blood through arteries, and that blood flowed back
to the pump through thinner vessels, the veins? He certainly
had each of the tools—eyes, a brain, and hands—needed to
do this.
William Harvey based his
theory of the circulation of the
blood on a series of simple experiments
in which he studied
venous blood flow using
a tourniquet and digital compression.
His famous book,
“Ecercitatio anatomica de motu
cordis,” published in 1628, illustrates
these experiments and
elucidates the observations he
made and deductive reasoning
he used to arrive at this theory.
Traditionalists following in the
footsteps of Galen attempted
to reject Harvey’s conclusions,
but uniformly failed to find
weaknesses in either his experiments
or deductions because
to deny a single part of
Harvey’s theory would be to reject the whole, and this was
impossible. Nevertheless, many tried!
The revolution sparked by Harvey’s new paradigm brought
much new knowledge from diverse sources. For example,
Antoine van Leeuwenhoek built an instrument, the microscope,
that would be a revolution in itself. Leeuwenhoek’s
microscope revealed the presence of red blood cells and, more
importantly, the hair-thin anastomoses between the blood
vessels that he named “capillaries,” a discovery that linked the
veins and arteries to complete the elements of the circulation
that Harvey had outlined.
Scientific revolutions continue to evolve in both intensity
and sophistication, combining the resources of eyes, brains,
and hands to bring biological science to the heights it has
reached today, with more to be ascended tomorrow.
Courtesy of the National Library of Medicine
References
1. Russell B. History of Western Philosophy. London: George
Allen & Unwin; 1974: 173.
2. Durant W. The story of philosophy. New York: Simon and
Schuster; 1953: 53.
The Pharos/Spring 2009 1

The Pharos • Volume 72
Number 2 • Spring 2009
1 Editorial
Marat and Harvey,
revolutionaries
Edward D. Harris, Jr., MD
38
42
DEPARTMENTS
The physician at the
movies
Peter E. Dans, MD
Man on Wire
3:10 to Yuma (1957)
3:10 to Yuma (2007)
Reviews and reflections
Geriatric Bioscience: The Link
Between Aging and Disease
Reviewed by Denise Zwahlen-
Minton, MD
Life in the Balance: A
Physician’s Memoir of
Life, Love, and Loss with
Parkinson’s Disease and
Dementia
Reviewed by Jack Coulehan,
MD
The Light Within: The
Extraordinary Story of a
Doctor and Patient Brought
Together by Cancer
Reviewed by Jack Couelhan,
MD
50 Letters
Page 4
In This
Drinking in earnest
Alcoholic paradigms in Hemingway’s
For Whom the Bell Tolls
A little drink now and then . . . often leads to more
Gregory H. Miday, MD
Remembering to forget
A student’s mind dashing back and forth in time
Page 12
ARTICLES
4
Gabriel Thompson Cade
12
Marat’s terror
A physician-assisted revolution
Jesse D. Woodard
17
Page 17

Issue
New medical terms
The plague of medical transcription services
James G. Gamble, MD, PhD, Theresa Pena, RN,
and Lawrence A. Rinsky, MD
26
Completing the circle
Retreading an otherwise fine tire
Larry Zaroff, MD, PhD
30
The half-tico, half-gringorobot
What a difference a snake meant
Lindsey Finklea
32
Page 26
Page 30
Page 32
Please insert small
version of cover
47
54
POETRY
16
On the cover
See page 26
National and chapter news
Announcing the 2009 Alpha
Omega Alpha Robert J. Glaser
Distinguished Teacher Awards
Minutes of the 2008 meeting of the
board of directors
Alpha Omega Alpha elects
honorary members
Burning Books
Manuel Martinez-Maldonado, MD,
MACP
25 Marionette
Jason David Eubanks, MD
29
35
36
45
46
49
Four Season Haiku
Steven F. Isenberg, MD
Seeing Patients
Alan Blum, MD
Empty memory album
discarded by the curb
Ben K. Azman, MD
Babette B. Caraccio, MD
James Foy, MD
Helene Hubbard, PhD, MD
Christopher M. Papa, MD
Office Hours
Steven F. Isenberg, MD
The World Is Sleeping
Michael R. Bykowski
I Am the Patient
Suzanne Minor, MD
Significant Other, Late in
53 Life
Eric Pfeiffer, MD
INSIDE
BACK 24 COVER
AΩA NEWS
Full Nelson
Jason David Eubanks, MD

Drinking
in
earnest
Gregory H. Miday, MD
Alcoholic paradigms in Hemingway’s
For Whom the Bell Tolls
The author is an intern in Internal Medicine at Washington
University in St. Louis. This essay won third prize in the
2008 Alpha Omega Alpha Helen H. Glaser Student Essay
Competition.
A
cold crisp glass of Cava while watching the bullfights.
Absinthe, emerald green poured over sugar, shared
between young lovers. And cocktails—before reading,
before dining, before dancing, before everything. Scenes
from Hemingway are inexorably bound to drinking, so it is no
surprise that his work may inform us on the topic of alcoholism.
The pages of his fiction are figuratively soaked in booze
and, in many cases, probably literally as well. The descriptions
of distinct and complex alcohol- related behaviors range from
abstention to healthy social imbibing to pathologic, chronic,
and relapsing alcoholism. Hemingway describes the disease
with such vividness and clarity that medical professionals
might benefit from studying the models presented in his novels.
The author once remarked, “I’m trying in all my stories to
get the feeling of the actual life across—not just to depict life—
or to criticize it—but to actually make it alive. So that when
you have read something by me you actually experience the
thing.” 1p153 He succeeds, and his pen strokes illustrate both the
full-blown end-stage alcoholic and early alcoholism, as well
as the many gradations between the alcohol abusive problem
drinker and the alcohol dependent. His works capture the
diverse symptoms and complications of pathologic drinking,
going beyond the pathology well known to medical students:
neuropathy, cirrhosis, encephalopathy, delirium tremens, etc.
These organic consequences of alcoholism, while medically
important, are dangerously late manifestations of the disease.
Hemingway conveys the subtle and sometimes not so subtle
nuances of the alcoholic, including but not limited to comorbid
psychopathology, personality changes, “craving,” isolation,
obsessive thinking, and compulsive behavior.
Another compelling reason to regard Hemingway’s fiction
as a potent source for understanding alcoholism is the concept
of “autopathography” put forth by Dr. Stephen Moran, which
describes “a type of literature in which the author’s illness
is the primary lens through which the narrative is filtered.” 2
Papa pours a shot…
Photo by Tore Johnson/Pix Inc./Time Life Pictures/Getty Images.
4 The Pharos/Spring 2009

The Pharos/Spring 2009 5

Drinking in earnest
For Whom the Bell Tolls (1943).
Paramount Pictures/Photofest.
Because Hemingway was himself an alcoholic who never
conquered denial, his writings are all the more convincing on
the subject. If his purpose in For Whom the Bell Tolls was to
give the reader, in Aristotlean terms, a poetic understanding
of the human condition, he was uniquely well equipped to do
so with regard to addiction. 3 In dramatic irony, the disease
about which Hemingway so adeptly wrote was not recognized
by his own alcoholic mind, and ultimately played a role in his
suicide. 4p75
For Whom the Bell Tolls focuses on three characters—
Robert Jordan, Pablo, and Pablo’s wife Pilar—who are avatars
of the three common types of alcohol user: abusive, dependent,
and healthy. In addition to providing a tripartite model
for ethanol- related behavior, For Whom the Bell Tolls marks
a literary departure of the author: “Instead of omission, of
suggestiveness by implication, Hemingway adds and becomes
explicit, pausing to develop the many facets of a situation or a
personality. . . . He has devoted nearly five hundred pages to
seventy hours of action.” 3p151 The wealth of detail is ideal for
examining character pathology.
Pablo: Drinking his way through
For Whom the Bell Tolls
The year is 1937 and the Spanish Civil War is raging. Robert
Jordan, rugged, handsome, and equipped with two packs
of explosives, finds himself in the picturesque mountains
of central Spain behind enemy lines, charged with assisting
the International Brigade in its fight against Franco and the
Fascists. An American college professor turned anti- fascist
dynamiter, his primary task is to destroy a bridge near Segovia.
We are introduced to Robert as he surveys the target bridge.
During his reconnaissance, Robert meets Pablo, the leader of
a guerilla unit harbored in the same mountains.
Pablo, played by
Akim Tamiroff.
Paramount Pictures/Photofest.
Pablo cuts a formidable figure, rough and tough talking,
perched on his stolen steed with a carbine rifle over his shoulder.
He is proud and authoritative, and from the remarks of
his compatriots it appears that his braggadocio was earned
through bravery and valiant if violent deeds—“ ‘Pablo . . .
has killed more people than cholera . . . more than the bubonic
plague.’ ” 5p26 It also seems, however, that something
has changed in the past several months. Pablo has become
muy flojo—very flaccid—according to Anselmo, an older
6 The Pharos/Spring 2009

gentleman who has agreed to help Robert explode the bridge.
Anselmo explicitly remarks that Pablo drinks too much. In his
drinking Pablo has become sad and desperate, preferring the
company of his horses to humans. Living in a fantasy world,
he seems fixated on finding an escape from the seeming dead
end of war and life as a fugitive. Robert can see Pablo’s sadness,
and thinks, “That sadness is bad. That’s the sadness they
get before they quit or before they betray. That is the sadness
that comes before the sell-out.” 5p12
Pablo’s condition reeks of late-stage alcoholism. Throughout
the rest of the novel we will see him display six of the seven
DSM-IV criteria for substance dependence: tolerance, withdrawal,
increased intake, excessive time devoted to the substance,
major activities given up because of substance use,
continued use despite consequences, and failed attempts to
abstain. Three of these are required for diagnosis; Pablo never
tries to abstain. 6 In chapter 14, when Robert returns in the
afternoon to the guerrillo camp, he finds Pablo thoroughly
intoxicated.
“I have been drinking all day waiting for the snow.” 5p179
. . . .
“I am drunk,” Pablo said with dignity. “To drink is
nothing. It is to be drunk that is important. Estoy muy
borracho.” 5p211
Here Pablo displays knowledge of his increased tolerance
and obsession with drinking, a self diagnosis. In this chapter
he also displays the Jekyll-and-Hyde personality changes not
mentioned in the DSM-IV but common in alcoholics. When
drunk the alcoholic is prone to drastic mood swings. Pablo,
for instance, is combative with Robert, accusing him of being
Scottish and wearing kilts. He proposes a snowball fight
and eventually provokes the gypsy Agustín, who strikes him
repeatedly in the face. Unconvinced his drinking is the cause
of any of his problems, Pablo simply remarks, “ ‘An intelligent
man is sometimes forced to be drunk to spend his time with
fools.’ ” 5p215
The dipsomaniac is a genuine monomaniac, with alcohol
being a powerful object of desire, hatred, and many of the
alcoholic’s thoughts. Pablo’s monomania is especially evident
during one encounter with Robert. Each man has a cup of
wine, but Pablo’s eyes
were looking at the wine bowl as though he had never seen
one before. . . .
Pablo looked from the wine bowl to Anselmo’s face as he
drank and then he looked back at the wine bowl. 5p331
“Listen, Inglés,” Pablo spoke directly to the wine bowl.
. . . . “I have admired thy judgment much today, Inglés,”
Pablo told the wine bowl.” 5p332
Alcohol has become the center of his life.
By and about Gregory Miday
Raised in beautiful Cincinnati
by a brilliant psychiatrist and an
astute epidemiologist—my mother
and father—I have always had an
interest in understanding mental illness
and the societal impact of psychiatric disorders.
While my primary passion is for internal medicine, I
have not wanted to neglect my other passions: art, history,
literature, and music. My bachelor’s degree from
Northwestern University is in Art History.
Throughout medical school I made a point to continue
reading nonmedical literature for both pleasure
and intellectual fulfillment. I have known people who
struggled with substance disorders, and the idea for
this essay struck suddenly while reading Hemingway’s
oeuvre.
I am an intern at Washington University in St. Louis
in Internal Medicine. I plan to continue to explore the
connections between the humanities and medicine.
The key will be finding the time to do so!
The alcoholic can be a
powerful leader
Pablo’s position as group leader is no contradiction. Early
ethanol abusers may possess an “alcoholic charm” that makes
them attractive members of society. This has been viewed as
a true compensatory reaction by the ill person to mask the
disease. For example early-stage alcoholics are on average
better dressed and groomed than nonalcoholics. 4p36 Also, in
another type of subconscious autoregulation, the alcoholic
may display a high degree of egoism. It is hypothesized that
this develops as the alcoholic realizes he no longer has control
over his drinking. This powerlessness over alcohol manifests
itself as a desire to have control in other arenas. The combination
of charisma and drive for ego satisfaction (derived
from the acquisition of sex, money, power, respect, etc.) often
places alcoholics in “egocentric” positions and occupations.
Thus alcoholics are often writers, actors, politicians (with an
estimated prevalence of thirty percent compared to ten percent
in the general U.S. population), and, in this case, de facto
commanders of guerrilla factions. 4p9
The deceptive compensation can sometimes last decades,
The Pharos/Spring 2009 7

Drinking in earnest
but will eventually fall apart assuming the drinker does not
quit drinking or go into spontaneous remission. As the disease
progresses, the alcoholic neglects his health and appearance,
develops bizarre personality traits, and is frequently inebriated
at inappropriate times. As with Pablo, the untreated
severe alcoholic tends to become antisocial, losing his own
self- respect and the esteem of his peers. The late-stage exhausted,
or “bottom,” alcoholic demonstrates intense emotional
reactions to alcohol, including, according to Dr. Jorge
Valles: moodiness, irritability, impatience, excessive sensitivity,
intolerance, compulsiveness, procrastination, suspiciousness,
jealousy, remorsefulness, irresponsibility, hostility, loneliness,
deceitfulness, and confusion. 7 Watch as Pablo pathetically
caresses a horse in a drunken stupor, whispering sweet nothings,
“ ‘Thou lovely white-faced big beauty. . . . Thou dost
not insult nor lie nor not understand. Thou, oh, thee, oh my
good big little pony.’ ” 5p63–64 Listen as Pablo’s wife reprimands,
“ ‘Borracho!’ ” 5p32 the colorfully loaded term for “drunkard” in
Spanish, then verbally castrates him in front of his new guest
and declares herself the true leader. Feel what Pilar means
when she describes her husband awaking in sobs, “ ‘as though
there is an animal inside that is shaking him,’ ” 5p90 and finally
states, “ ‘But now he is finished. The plug has been drawn and
the wine has all run out of the skin.’ ” 5p89
Gary Cooper plays Robert Jordan.
Paramount Pictures/Photofest.
Let us now focus on protagonist Robert Jordan. Upon
first meeting Pablo’s troops and accompanying them to their
cave hideaway, a large wineskin is produced and drink offered:
“Robert Jordan drank it slowly, feeling it spread warmly
through his tiredness.” 5p20 He then drinks another cup of wine
with dinner. After dinner, he dips for a third cup. There is an
attractive young woman in the cave, Maria, recently orphaned
and brutalized by the facissimos and saved by Pablo’s group.
Robert has felt a “thickness” in his throat since laying eyes on
her, and it is noted that this feeling remains despite the third
cup of wine. While some healthy alcohol users will have a
drink to boost confidence and lower inhibitions, the deliberate
and mindful attempt to self- medicate by using alcohol as
an anxiolytic is a characteristic of problem drinking. Robert
later drinks a fourth cup of wine. When he asks about a fifth
cup Pablo denies him, claiming the wine is near finished (we
later find this is not true but another instance of alcoholic
mendacity to keep more for oneself). In response Robert asks
for a cup of water instead. But not to worry, Robert has no
intention of quitting so early. He empties half the water and
then withdraws a flask from his belt, from which he slowly
pours absinthe, mixing it with the water. A gypsy queries,
“ ‘What drink is that?’ ” Replies Robert, “ ‘A medicine . . . It
cures everything. If you have anything wrong this will cure
it.’ ” 5p50 As he drinks he experiences a pleasant feeling of
euphoric recall, picturing a beautiful Parisian evening as “he
tasted that opaque, bitter, tongue- numbing, brain- warming,
stomach- warming, idea- changing liquid alchemy.” 5p51 After
he finishes his second absinthe, “making a warm, small, fumerising,
wet, chemical- change- producing heat in him,” 5p57 he
passes his cup for more vino. That makes six drinks, not that
anybody’s counting.
A drinking problem? Or just a man
who likes drinking?
The rate and quantity of consumption in this scene are
characteristic of someone who may have a drinking problem.
In addition, when Robert steps outside the cave, he notes that
he is surprisingly clear despite the alcohol. Increased tolerance
and adaptive changes such that one may not feel or appear
intoxicated after six quick drinks are also signs of a possible
alcohol problem. It is important to distinguish the person
with alcohol abuse from the alcoholic. While addiction runs
on a continuum and should be considered on an individual
basis, science has shown that alcohol abusers and alcoholics
are usually distinct entities. The first will have some problems
due to drinking. He will have guilt and will have suffered adverse
consequences from alcohol use but will not demonstrate
physiologic withdrawal upon abstaining. Nor will he have the
same degree of cravings and obsessive thinking and compulsive
behavior that the alcoholic experiences. While his life is
not centered about procuring and ingesting alcohol, and he
may be normal in all other facets of life, he has a pathologic
relationship to alcohol. Even if he continues to drink heavily,
however, he probably will not become an alcoholic. The
8 The Pharos/Spring 2009

est evidence for the differentiation comes from adoption
studies. One sibling of alcoholic parentage adopted by a nonalcoholic
family has the same risk of becoming alcoholic as a
sibling (about twenty percent) reared in the alcoholic home.
Children of nonalcoholics adopted by alcoholic families have
a significantly higher chance of being abusive drinkers, but not
of becoming alcoholic. The implication is that alcoholism is a
disease with strong genetic origins, while problem drinking
may be mostly determined by environmental factors. 8
The likely ethanol- abusive Robert Jordan drinks more or
less continuously throughout the rest of the novel. On day
two, when he visits El Sordo, another guerilla leader nearby,
the two talk over several whiskeys. It is not yet noon. Morning
drinking, especially after a previous night of drinking, can
be repugnant to healthy drinkers, but welcomed by problem
drinkers and alcoholics as the best cure for a hangover and
morning jitters. Later, as Pilar is getting to know Robert and
inquiring about his interests, she states, “ ‘You like to drink, I
know. I have seen.’ ” He responds, “ ‘Yes. Very much. But not
to interfere with my work.’ ” 5p91 A problem drinker’s problem
is almost invariably evident to others before it is self- evident.
A moment of clarity for Robert, when he surely realizes his
reliance on alcohol, comes towards the end of the novel as he
lies on the ground wounded, anticipating what will likely be
his own death.
Then he remembered that he had the small flask in his
hip pocket and he thought, I’ll take a good spot of the giant
killer . . . But the flask was not there when he felt for it.
Then he felt that much more alone because he knew there
was not going to be even that. I guess I’d counted on that,
he said. 5p467
In contradistinction to Robert and Pablo, Pilar exemplifies
the normal, healthy drinker. In the initial scene at the cave,
when Robert offers her a cup of wine, she declines, “ ‘Not until
dinner,’ she said. ‘It gives me heartburn.’ ” 5p32 The next morning,
when offered whiskey: “ ‘I don’t want any,’ Pilar said and
covered her glass with her hand.” 5p142 Then, offered wine instead,
she answers, “ ‘No. Water.’ ” 5p142 Pilar does enjoy a glass
of wine with food, and in her stories she reminisces on the
delight of a cold beer in the afternoon, but during the novel
she never has more than two drinks at a time and possesses
the ability to take it or leave it without much thought or worry,
the hallmark of the normal drinker.
Alcoholism—Genetic pathways
in the brain
The “Big Book” of Alcoholics Anonymous describes alcohol
as “cunning, baffling, powerful!” 9p58–59 and from both a
Ingrid Bergman plays Pilar.
Paramount Pictures/Photofest.
medical and lay perspective it is. One of the most fascinating
aspects of the drug—the crux of the reason why Pablo, Pilar,
and Robert are so different—is that alcohol is selectively addicting.
In the United States, about nine percent of people who
drink will become problem drinkers, with a smaller subset of
those becoming alcoholic. The alcoholic who never takes a
first drink will never suffer from the disease! 10 Ethanol affects
almost all people similarly in its initial stages. It is first a stimulant—people
become talkative and carefree. People drink for
this initial favorable response. These universal reactions are
not limited to humans, and as Anselmo points out in chapter
3: “The gypsies believe the bear to be a brother to man because
he has the same body beneath his hide, because he drinks
beer.” 5p40 Alcohol is later a sedative, but subsequent reactions
vary greatly, and are different among different types of alcohol
users. Normal, healthy drinkers will experience adverse affects
after several drinks, including sedation and sometimes nausea
and unease. They will naturally slow down or stop ingesting,
hence Pilar’s heartburn. Alcoholics also metabolize alcohol
differently, and their central nervous system responses, especially
processes in the deep, primitive brain structures, are
also different, though this is still not well understood. With
ingestion of one-half to an ounce of alcohol, both alcoholics
and nonalcoholics experience not only “euphoria, relaxation,
and [a sense of] well being,” but also improved “concentration,
memory, attention span, [and] creative thinking.” 11p52 These
improvements quickly disappear in the nonalcoholic as blood
The Pharos/Spring 2009 9

Drinking in earnest
alcohol levels rise, but they are persistent in the alcoholic up to
much higher levels of ethanol intake. 11 Most importantly, alcoholics,
despite signals indicating they should cease drinking,
lack the ability to do so. It is this lack of control, and the inherent
unpredictability of whether they will drink to intoxication,
that most specialists believe to be the sine qua non of alcoholism.
10 The abusive drinker reacts similarly to the alcoholic in
many ways, and will binge drink, but will never experience
total loss of control over drinking. It is impossible to separate
the abusive drinker from the early alcoholic. In For Whom the
Bell Tolls, Robert Jordan is a problem drinker, but one cannot
say whether or not he will develop alcoholism.
The purging of the fascists from Avila, a story within a
story told by Pilar, provides the most poignant and deeply
affecting passage in the novel. Alcohol plays a prominent
role in the drama and deserves special attention. The narrative
describes the storming of Avila by Pablo’s guerilla force.
After executing the fascist soldiers, the fascist civilians are
collected from around the city and packed into the town hall,
the Ayuntamiento. A line of townspeople forms, making an
aisle from the building to the edge of a high cliff. One by one
the fascists are forced to walk the line, where they are brutally
clubbed and finally flung over the precipice. The killing
of each fascist is described in detail, and in the lines of the
townspeople we see anger, fear, guilt, pride, and, not to be ignored,
a lot of drunkenness. As the scene unfolds, Hemingway
uses a musical, sonatesque composition of melody, harmony,
and counterpoint. Resounding through the drama is the major
key of death and reprisal, the vertically melodic crescendo of
each killing, and the harmonic minor key composed of the
quotidian aspects of the scene strung together compositionally
by the alcohol that saturates the crowd. 12 Pilar says at first only
a few townspeople are drunk, the “ ‘useless characters who
would have been drunk at any time.’ ” 5p104 As tension builds,
they begin
“. . . handing around bottles of anis and cognac that they
had looted from the bar of the club of the fascists, drinking
them down like wine. . . . Those who did not drink from the
bottles of liquor were drinking from leather wineskins that
were passed about.” 5p115
After the first fascist is flung to his death by a hesitant crowd
the alcohol and strong emotions begin to affect the people in
the lines. When Don Guillermo is brought out pleading for
mercy he is struck on the head and rolls about
“. . . while the drunkards beat him and one drunkard jumped
on top of him, astride his shoulders, and beat him with a
bottle.” 5p118
Pilar observes,
“Two men had fallen down and lay on their backs in the
middle of the square and were passing a bottle back and
forth between them. One would take a drink and then
shout, ‘Viva la Anarquia!’ lying on his back and shouting
as though he were a madman. . . .
“A peasant who had left the lines and now stood in the
shade of the arcade looked at them in disgust and said, ‘They
should shout, “Long live drunkenness.” That’s all they believe
in.’ ” 5p120
Pilar, having dealt with an alcoholic husband, is bitter but
also wise. She recognizes the ability of alcohol to foment mob
behavior and to cause normally sane and sensitive people to
commit heinous acts. While watching the commotion a man
presses against her,
“His breath on my neck smelled like the smell of the
mob, sour, like vomit on paving stones and the smell of
drunkenness . . .
“As I watched, this man turned away from the crowd
and went and sat down and drank from a bottle and then,
while he was sitting down, he saw Don Anastasio, who was
still lying face down on the stones, but much trampled now,
and the drunkard got up and went over to Don Anastasio
and leaned over and poured out of the bottle onto the head
of Don Anastasio and onto his clothes, and then he took a
matchbox out of his pocket and lit several matches, trying to
make a fire with Don Anastasio. But the wind was blowing
hard now and it blew the matches out and after a little the
big drunkard sat there by Don Anastasio, shaking his head
and drinking out of the bottle and every once in a while,
leaning over and patting Don Anastasio on the shoulders of
his dead body.” 5p122–23
Pilar has at once illustrated both “alcoholic insanity” and the
existential futility that seems to plague the alcoholic. As her
story draws to an end and the last of the fascists are killed,
Pilar concludes, “ ‘It would have been better for the town if
they had thrown over twenty or thirty of the drunkards . . .
and if we ever have another revolution I believe they should
be destroyed at the start.’ ” 5p127
There is much disagreement regarding diagnosis and treatment
of alcoholism (and addiction in general), and science has
yet to elucidate many aspects of this complicated condition.
In Great Britain, the concept of alcoholism as a disease is less
widely accepted. 13 But Ernest Hemingway, a highly intelligent
drinker given to solipsistic reverie in his writing, unwittingly
unravels some of the mysteries of alcohol use and abuse in
this novel. By separating out the three most common types of
drinkers, who comprise the majority of the adult U.S. population,
he provides us with entertaining and informational
guides to recognizing and characterizing ethanol behavior.
Alcoholism is a unique disease with broad consequences not
10 The Pharos/Spring 2009

just for the alcoholic, but for family, friends, and society at
large. The indirect victims of this disease are often hurt and
angry, and rightly so. The most powerful condemnation of
alcoholism in this novel comes from the afflicted wife Pilar,
who acidly exclaims:
“Of all men the drunkard is the foulest. The thief when
he is not stealing is like another. The extortioner does not
practice in the home. The murderer when he is at home can
wash his hands. But the drunkard stinks and vomits in his
own bed and dissolves his organs in alcohol.” 5p208
Alcoholics: Often not recognized
and inadquately managed
But the real outrage of alcoholism, and a heavy burden
on the medical profession, is that it is under- recognized,
under- researched, and under- treated. Statistics tell the story:
A recent study of over 40,000 subjects representative of the
U.S. population demonstrated a lifetime prevalence of alcohol
abuse of 17.8 percent and alcohol dependence of 3.8 percent.
Less than a quarter of those with alcohol dependence received
any treatment at all. 14 Unlike in the days of the Spanish Civil
War, there now exist FDA- approved drugs for the treatment
of alcoholism. Other pharmaceuticals are in the pipeline,
and successful rehabilitation therapies ranging from psychotherapy
to twelve-step programs abound. Hopefully, by taking
a multidisciplinary approach that may even include looking to
American literature, the problem may be investigated more
thoroughly and better addressed. The next time you read a
novel, or examine a new patient, keep a vigilant eye for the
alcoholic, because his disease is deadly but treatable, and he
needs your help.
References
1. Hemingway E. Ernest Hemingway: Selected Letters, 1917–
1961. Baker C, editor. New York: Charles Scribner’s Sons; 1981.
2. Moran ST. Autopathography and depression: Describing the
“Despair Beyond Despair.” J Med Humanit 2006; 27: 79–91.
3. Hovey RB. Hemingway: The Inward Terrain. Seattle (WA):
University of Washington Press; 1968.
4. Graham J. The Secret History of Alcoholism: The Story of
Famous Alcoholics and Their Destructive Behavior. Shaftesbury,
Dorset (UK): Element; 1996.
5. Hemingway E. For Whom the Bell Tolls. New York: Scribner;
2003.
6. Substance Use Disorders: Substance Dependence. In: First
MB, editor. Diagnostic and Statistical Manual of Mental Disorders.
Fourth Edition, Text Revision (DSM-IV-TR, 2000). Washington
(DC): American Psychiatric Association; 2000.
7. Valles J. From Social Drinking to Alcoholism. Dallas (TX):
Tane Press; 1969.
8. Goodwin DW, Schulsinger F, Møller N, et al. Drinking
problems in adopted and nonadopted sons of alcoholics. Arch Gen
Psychiatry 1974; 31: 164–69.
9. Alcoholics Anonymous World Services, Inc. Alcoholics
Anonymous: The Story of How Many Thousands of Men and
Women Have Recovered from Alcoholism. Fourth edition. New
York: Alcoholics Anonymous World Services; 2001.
10. Goodwin DW. Alcoholism: The Facts. Third edition. Oxford
(UK): Oxford University Press; 2000.
11. Milam JR, Ketcham K. Under the Influence: A Guide to the
Myths and Realities of Alcoholism. Seattle (WA): Madrona Publishers;
1981.
12. Williams W. The Tragic Art of Ernest Hemingway.
Baton Rouge (LA): Louisiana State University
Press; 1981.
13. Heather N, Robertson I. Problem Drinking.
Third edition. Oxford (UK): Oxford University Press;
1997.
14. Hasin DS, Stinson FS, Ogburn E, Grant BF.
Prevalence, Correlates, Disability, and Comorbidity
of DSM-IV Alcohol Abuse and Dependence in
the United States. Arch Gen Psychiatry 2007; 64:
830–42.
The author’s address is:
4961 Lacleded Avenue, Apartment 111
St. Louis, Missouri 63108
E-mail: miday01@aol.com
The cat drinks water…
Photo by Tore Johnson/Pix Inc./Time Life Pictures/Getty Images.
The Pharos/Spring 2009 11

Gabriel Thompson Cade
The author (AΩA, University of South Carolina, 2008) is
a candidate for an MD/MPH in the Class of 2011 at the
University of North Carolina at Chapel Hill. This essay won
second place in the 2008 Alpha Omega Alpha Helen H.
Glaser Stu dent Essay Competition.
I
have always loved the quiet intensity of the operating
room, the concerned focus of the operating team. The
room was bright and busy. There were beeps and there
were flashes. I held my arms up and stood where they told me
to, and someone helped me with my gloves and apron. We
were all anonymous in our green drapes, but committed to a
common cause. The room smelled clean through my mask,
smelled like alcohol, antiseptic, and conditioned air. It was a
little cold, but comfortable in the layers of aprons. The fetal
heart monitor chirped enthusiastically, a strong, regular rate.
I kept standing where they told me to, I held the clamp where
they pointed. I talked like a second-year medical student to
my preceptor and the assisting physician who was, coincidentally,
the assisting physician on the C- section of my own
birth. It felt very safe, like everything had been thought of.
The operation went smoothly and I didn’t faint, or screw
anything up. There was more blood than I had expected but
it was so incredible to dive into the mesenteric maze of the
human abdomen, to push aside this organ, that organ. Hidden
in the folds of this gastric mess was this incredible treasure,
this pearl. And once located, it was a very short time before
you were holding a brand new baby. And there I was, holding
a new person, with so much life ahead of him.
The baby already looked beautiful. He looked curious. He
looked strong. I could hear his dad laughing when we came
out of the room. I could hear his mom, also laughing, behind
us—her enthusiasm boosted by anesthesia. Their baby had
entered into the world with love and attention all around him.
When I handed him on to the nurse I thought of all the possibilities
in store for this child.
There was another feeling at the edge of my consciousness,
a single tenterhook from something forgotten, but that
notion was overrun by this fresh awe. This was not the first
Rememberi
baby I’d held but it felt like it was. I felt so elated I was going
to be a doctor. I was going to help take care of babies. I was
going to help take care of pregnant women. I was going to
have a front-row seat to the biological wonders of human existence.
This was awesome. This was why I sought out medicine.
Of course, this excitement was only possible because I
had remembered to forget about Africa.
Trying to make a difference in a
hopeless world
I’m watching the baby today. I watch the baby clench his
shriveled hands. I watch his wrinkled pink claws wave blindly
through the space around him and inevitably into his mouth.
I watch him turn his tiny head away while I’m washing him.
He doesn’t say anything, he just clenches his eyes even tighter
and turns away. He doesn’t even like the warm water I’m using
today. Often we don’t even have any water.
I watch him drink tepid formula. He spits it up or, slightly
worse, he immediately passes the wet payload through to his
diaper. I have to cut the diapers in half to fit him. He weighs
four pounds, and when I hold him he almost fits between my
wrist and my elbow. He makes sounds but he doesn’t really
12 The Pharos/Spring 2009

ng to forget
cry. I listen to his heart but it doesn’t make any more sense
to me than his occasional verbal sputters. I’ve only seen him
open his eyes once in the week since his birth. He has thick
and dark hair for his size, and it mats in tangled patches when
he’s sweating. He sweats all the time. I sweat all the time.
Zambia feels so hot lately. The baby smells like milk and baby
powder and he attracts flies. I’m watching him die, so I try to
pay attention to everything, I try to remember everything. I
also try to forget everything.
Sarah says he should have a name. I don’t want to give him
a name.
The baby sleeps with us some nights. He doesn’t move
much at night, and his breathing is so quiet it sounds like
two pieces of paper rubbing together. It is almost completely
lost in the awful whine of the mosquitoes, so if he is sleeping
we have to listen closely to be sure he is breathing. When he
doesn’t sleep I sing to him. Sometimes I ask him not to die.
Sometimes I ask him to stop suffering and die. We didn’t really
adopt him, but his mother died at the clinic. She was the
outside party in an extramarital affair. The teenage children
of that family beat her to death when she showed up seven
months pregnant. She lived long enough only to deliver her
premature son. It probably doesn’t even make things any
Illustration by Erica Aitken. Photo credit: Left, Flying Colours Ltd. Center, Roadsworth. Right, AFP/Getty Images.
worse that he was born with her HIV infection, but I think
about it because of the father, and the rest of his family.
In the last week, when I see pregnant women or babies, I
want to cry. Sometimes I do. I’m sad, of course, and also I feel
very angry. I feel angry because I feel very helpless. I don’t
know what I’m doing with these patients. I don’t know what
I’m doing with this baby. I don’t know how to make a difference.
I especially don’t know how to make a difference when
the world around me looks so hopeless. And I don’t know
how, once I leave here, I will ever close my eyes and not see
the images of this world around me.
Lesson for a student: There is healing
strength in understanding death
We left the clinic a little earlier than usual and drove together
to the hospital where we would meet one of my mentor’s
oldest patients, moving from hospital care to hospice
care. Although my preceptor worked with pregnant mothers
and pediatrics, the bulk of his practice was in the wider world
of family medicine. He took great pride in treating as many
as four generations of a family. He had pictures in his office
of patients he has delivered and is now still treating in their
twenties. With a patient population spanning such a spectrum
of age, he was in a position to witness those great beginnings
as well as to counsel those coming towards the great
endings of their lives.
The patient we were going to see had had a lifetime of reasonably
good health and activity, now culminating in a week
of shallow breaths and the feeling of pressure on her heart.
To me this was one of the great hallmarks of the medical profession:
the role of the physician at the end of life. What can
you do to ease the frightening transition into noncorporeal
existence? What tools of sympathy and empathy can you conjure
up to achieve an effect of soothing compassion? What do
you say to the family? What do you say to yourself about your
abilities to preserve life?
I wanted to save most of my questions until after our
meeting with this patient and her family, but I talked a little
The Pharos/Spring 2009 13

Remembering to forget
to my preceptor during the ride over.
“How often do you have to do this?”
“Not that often, but a few times a year.”
“Do you talk about religion or faith?”
“Sometimes, if the family brings it up.”
“Does it get easier or does it get harder the more you do
it?”
“It feels like the first time every time, which is neither easy
nor hard.”
I stopped after the third question because the answer
surprised me. How did you forget a patient’s death on your
watch? Aren’t you thinking about the last patient you had to
coach into biological collapse? Aren’t you thinking about the
first patient you saw run out of breath, run out of road, run
out of time? Can you really just internalize those moments
and move on? When you participate in this, perhaps the most
intimate of patient interactions, how do you bottle up the
necessary emotional context and go forward?
The patient’s room was filled. Filled with the cards and
flowers from church and community friends. Filled with the
bodies of family members and closer friends. They perched
on chair armrests looking at our patient. They sat on the
other, empty bed, looking out the window, trying to avoid
the nature of the room and what it meant, what our presence
there meant. Everyone spoke quietly to each other and
loudly to the woman lying in the bed. She looked pale, a sort
of ashen gray hue hung off of every exposed bit of flesh. Her
breathing was wet and labored, but she looked very calm, she
looked very happy even, surrounded as she was by life, by the
products of her own life. She raised an old hand to the doctor,
and the skin sagged indifferently below the thin arm bones.
She smiled at him and they held hands for a minute as they
talked.
We asked everyone but the woman’s husband and their
two children to step outside. The room felt bigger but it was
still fragrant and full with the warmth and affection of the
other visitors. I stood in a quiet corner near the door and
tried not to invade the personal nature of the atmosphere.
The conversation was not unexpected and before we even
began there were quiet tears from the husband and daughter.
The son didn’t cry. He seemed almost indifferent to the proceedings,
but I recognized that as its own form of angry remorse,
covered extensively in medical school psychology and
interview- training books.
My doctor spoke calmly and confidently to the patient
and her family. He lamented the limitations of medical care
but stressed the generous magnitude of his patient’s life. He
pointed to all the love he had seen coming into the room and
what a reflection it was of a fulfilling existence. He told the
patient he was sorry. He told the family he was sorry, and
that he couldn’t adequately understand what they were going
through, and he was sorry for that, too. He answered all of
their clinical questions. He deflected most of their spiritual
questions but encouraged them to seek those answers with
someone more capable. He said he could put them in touch
with support groups and that he, himself, would be available
to them for questions they had and assistance they needed
until she passed on.
The family seemed moved by the sincerity of the doctor’s
words. I was moved, too. The daughter hugged him. The husband
hugged him. The woman put up her gray arm again, and
the doctor held her hand and smiled warmly at her. Despite
their tears, the family looked calm. She still looked calm. She
smiled at him, she even smiled at me, the intruder in her last
sanctum of hope. I smiled back, meek but as warm as I could
muster.
I thought to myself, I won’t ever forget this, what it looked
like to face death with serenity. I won’t forget the importance
of these moments for a doctor. I won’t forget the healing
strength in understanding the role of death in life, and in
sharing that understanding with patients.
Memories of deaths, deaths in a faraway
world
It’s really the hardest when the death piles up. It even
sounds funny to me when I say it, but I mean it quite literally.
We usually only lose one patient per day. There’s usually only
one night of crying and wailing from wives and daughters and
mothers. There are only three shelves in the stagnant cold of
our morgue, three steel cots slide out of the metal bunk bed.
We usually only need to keep bodies in the morgue for one
day before the families come and relocate the remains. You
don’t see death when it slips quickly in and out. But when
death hangs around, when it lounges in the corner of the
ward, casting its eye over thirty beds of potential escorts, you
can’t avoid it.
Those three drawers represent our ability to distance the
patients, and ourselves, from death. One hundred feet of
separation from life to death. Those drawers represent the
comfortable capacity of the morgue, but occasionally we are
forced to exceed this expected occupancy limit.
We move the bodies quietly at night, trying not to awaken
other patients, who already cling with such fragility to rest
and peace. We even try not to wake up the families. The
women always scream or sing or wail out loud in any of the
seventy-two dialects used near the clinic. We move the bodies
and then we move the families. They can wail outside.
Tonight I am already awake when the night nurse comes
and raps on my window just after midnight. Three women
have been howling and sobbing outside of the morgue since
that afternoon. My bed is also one hundred feet from the
clinic. One hundred feet from the clinic, one hundred feet
from the morgue; I feel like I don’t ever leave. When she raps
on my window I am sure Philipo is dead. I have spent weeks
watching him die.
14 The Pharos/Spring 2009

HIV- positive, like everyone, paralyzed from the waist
down from a tuberculosis infection in his spine. By the time
Philipo came to us he had already spent months immobilized
in bed, and the sore across his lower back was as large as a
compact disc, and exposed the lower rungs of his spinal column
and his pelvic bones. Every day I clean the dead tissue
away. I almost fainted the first time I did it. I felt the temperature
rise in the room. A bead of sweat gathered on my
forehead and I watched it run down over my eye and gather
again at the end of my nose. I leaned forward, and when that
didn’t feel right I leaned backwards, collapsing onto the bed
behind me where I was able to grab my breath and regain my
composure. Since then I have been able to work quickly and
confidently in tending his wounds—more sores on each hip
also expose the heads and insertion of his femurs.
In the last week, Philipo has begun to regain feeling in his
back. I hoped he would die before it fully returned. His wife
stopped visiting him, his children never came. He looks at
pictures in my National Geographic while I work on him and
he points at things he’s never seen before, places he would
like to go. I like Philipo and I care about him, but we are unable
to speak to each other. Even with his little English, and
my little Nyanja, we are never really connecting with each
other. Even with perfect communication I think I would not
know what to say.
Rearranging bodies in the morgue
I am already dressed so it is easy to slip out of bed and
away from Sarah to head back to the clinic. Philipo doesn’t
weigh anything but he is tall, and even with both of us it is a
little difficult. The nurse helps me move him out of his bed,
across the dirt courtyard, and onto the floor of the morgue.
The women there wail even louder as we walk by with Philipo
wrapped in his own bed sheet. The nurse leaves me and
heads back to the clinic, closing the door behind her, muting
the shrill shrieking from outside and leaving me instead with
the deafening silence of the cooler and its inhabitants.
When I open the bottom drawer I am not surprised to see
the top of a dark head facing me out of the void. The second
drawer is also taken. The third drawer is full. I hate when this
happens. Now I have to reach in and rearrange the bodies.
I have to push one of the bodies up against the side of the
drawer and then I will have to shove in Philipo, a little bit at
a time.
His legs dangle and drag on the floor. Alone with me in the
dim light he feels heavier than he did crossing those hundred
feet. The body already on the drawer rocks over when I am
halfway done and bottlenecks any progress. I practically have
to climb over Philipo to push the other body away, and then
it is a continuous balance to keep the one from overturning
the other. Philipo feels soft, and even a little warm. He smells,
By and about Gabriel Cade
I was raised on a small goat farm in
the mountains of North Carolina where
my father was a family physician and
my mother an ICU nurse. To avoid a
hereditary career in medicine, I dropped out of college
and wandered, walking 2200 miles along the
Appalachian Trail, waiting tables and writing for a
newspaper in Hollywood, climbing rocks and rafting
in New Zealand, and fighting sand fleas and strangers
on “Survivor: Marquesas.” A disjointed collection
of skills and experiences ultimately led to Zambia,
where I worked with my twin sister in a small AIDS
hospice and orphanage. The experiences in Zambia
and other parts of Africa convinced me to return
to finish my undergraduate education and pursue a
medical degree at the University of North Carolina at
Chapel Hill School of Medicine.
well, like Africa, like dirt and work and sunshine and dry
grass and death. He makes the body next to his seem even
more repulsive than usual. It is cold and clammy and stiff, and
smells only like death.
In this moment, I realize that the capacity of the morgue
to comfortably house death has been tied to the capacity of
my own heart to do the same. I realize I am so sick of death.
I am so sick of it. I even try to throw it up, to purge myself of
the aching in the pit of my stomach. I even try to scream. I try
my own wailing to trounce the sorrow and pain around me.
Nothing comes. There’s nothing there. I already feel so emptied
by this work, by this never-ending work. I don’t want to
see any more death. I don’t want to wait for any more patients
to die. I don’t want to be there to help move the body.
Philipo’s legs still stick out of the cooler. It looks grotesque.
I yell at the four bodies. I won’t give them tears, just anger. I
am so angry at them all for dying and leaving me to deal with
their death. I’m angry that when I do sleep I dream of bodies
piled on bodies, and that when I look at patients still alive in
the clinic I can close my eyes and see them dead. I hate that
the dead cling to the inside of my eyelids. I’m so angry that I
can’t do anything to stop it and that, no matter how angry I
get, I will just have to do this again tomorrow night.
When I am home, someday, back in my home in America,
am I going to wake up expecting that rap on my window?
Am I going to sleep again and dream again?
The author’s address is:
118 Milton Avenue
Chapel Hill, North Carolina 27514
E-mail: gcade@med.unc.edu
The Pharos/Spring 2009 15

Dr. Martinez-Maldonado (AΩA, Baylor, 1973) is executive vice president for research
and professors of Medicine and Pharmacology and Toxicology at the University
of Louisville. His address is: Office of Research, Room 200 Jouett Hall, University of
Louisville, Louisville, Kentucky 40292. E-mail: m0mart01@louisville.edu.
Burning Books
Fire engine alarms woke up the stars.
Red lights
Glared on our window panes.
We weren’t sure what to expect,
The sky so bright,
The heat searching for a way into our library.
Over the fence leapt the first firemen—
Axes in hand, superhero helmets
Askance at the sight
Of the spectacle shimmering over their
heads.
More sirens, men on the roof and on ladders
Watering the walls, creating a fall
Of liquid ambers.
Once lame hoses snaked over asphalt
Wet with morning dew, distended
Like boa constrictors after a snack.
Their id numbers
Furiously overheated when the building,
Crackling like an immense popcorn bag,
Tumbled noisily into the uneasy silence
Of the morning light.
It fell away from our shattered windows
Redolent of might,
Aided by the cleverness of promethean
Physicians with their water rays,
Who saved Cecil, Harrison, Dickinson,
Whitman, Pablo Neruda, Juan Ramón,
And, among many others, Richard Wright
And Richard Bright—
From the burn.
Manuel Martinez-Maldonado, MD, MACP

Jesse D. Woodard
arat’s terror
The author (AΩA, University of South Carolina, 2008) is
a member of the Class of 2009 at the University of South
Carolina School of Medicine. This essay won first prize in
the 2008 Alpha Omega Alpha Helen H. Glaser Student
Essay competition.
When the prominent French revolutionary Joseph-
Emmanuel Sieyes was asked what role he had
during the French Revolution, he responded “J’ai
vecu.” (“I survived.”) Thousands could not make that claim
during the tumultuous decade from 1789 through 1799. The
period was marked by fear, intrigue, and violence, and no life
more closely paralleled the revolution than that of Jean-Paul
Marat. During a decade of hostility he was L’Ami du Peuple
(The Friend of the People), and even as his cries of Liberté,
égalité, fraternité! rang through the streets of Paris, Marat’s
assassination in 1793 showed that history is less a triumph of
ideology than a series of tragic human atrocities.
Marat, in his own time, was known as a madman, a fanatical
demagogue, and the murderer of thousands. A mysterious
skin disease earned him the stigma of a leper, but he is also
remembered as a doctor, a frustrated scientist, and the subject
of the period’s most memorable painting. The scene of
his death in 1793 was immortalized in Jacques-Louis David’s
masterpiece Death of Marat. The indelible depiction shows
a Christ-like Marat lying dead in his bath, the evidence of his
murder in plain view. Upon its completion, the painting was
carried through the streets of Paris in tribute and Marat was
worshipped as a god.
Joseph Boze (1744–1826): Jean Paul Marat (1744–1789). French
revolutionary. 1793. Painting.
Location: Musée de la Ville de Paris, Musée Carnavalet, Paris, France. Photo credit: Alfredo
Dagli Orti, Bildarchiv Pressicher Kulturbesitz/Art Resource, NY.
The Pharos/Spring 2009 17

Marat’s terror
History, though, designates him a villain. The years after
his death are remembered as La Grande Terreur (The Great
Terror), during which as many as forty thousand were guillotined
in the streets of Paris, and Marat is remembered as “the
father of all the horrors which followed his horrible reign.” 1p87
Why did this physician abandon his role as a healer to become
a revolutionary? What was his strange skin condition? And
what led The People’s Friend to be disinterred, cursed, and
burned in effigy only months after his ceremonial burial in
the Pantheon?
Marat—the physician and philospher with
massive ego and ambition
It’s only in Paris that people have eyes for Marat. In the
other departments, he is regarded as a monster.
—Charlotte Corday 2p738–39
The Industrial Revolution of the late eighteenth century
made necessary an elaborate division of labor, dividing commerce
into distinct operations. Such was not the case early in
the century, when men of means and education dabbled in
varied branches of knowledge. John Locke studied philosophy,
became a physician, and wrote an influential political treatise.
Voltaire critiqued French society from England, Goethe
reigned in Germany, and Franklin in America; all were versatile
in a number of fields.
Such was the life to which Jean-Paul Marat aspired. Born in
Neuchâtel, Switzerland, in 1743, he was the son of a Calvinist
father and a Swiss mother.
Marat early applied himself to the study of philosophy, political
theory, and physics, and he confessed an ungratified appetite
for recognition. “From my earliest years I was consumed
with a love of glory,” he wrote, “a passion which often changed
its object in the divers periods of my life, but which has never
left me for a moment.” 1p89
In 1771 Marat published his Essay on the Human Soul,
which was followed the next year by a larger treatise entitled
A Philosophical Essay on Man. The work was a curious examination
of the soul in terms of anatomy and medicine, and
contended that the seat of the soul was in the meninges:
Experience likewise daily confirms it; the slightest inflammation
of the meninges occasions a delirium, and a
temporary insanity. The irritation of the nerves by the fumes
of wine from drinking to excess, or by the fumes of tobacco,
is followed by . . . the loss of reason; this never happens to
any other part of the head. 3p251
Unlike the speculations of John Locke, Thomas Hobbes,
and Jean Jacques Rousseau, Marat’s work was greeted with
bitter ridicule in England and with contempt by the sacred as-
sembly of the Philosophes in France. Undeterred, he resumed
publication but continued to receive only a tepid reception in
intellectual circles. The response convinced him that he was
being persecuted.
Marat left the ridicule of England and sought to create
a new reputation in France. He was reported to have cured
a women dying of tuberculosis and gained a reputation as
the “Doctor of the Incurables.” His arrogance was evident in
his “Essay on Gleets,” which boasted that no case of gonorrhea
was beyond his ability to cure. 4 He secured an honorary
doctorate from Saint Andrews in Scotland and received a
position as physician in the household of the Comte d’Artois,
the king’s brother. Though his experiments in electricity and
optics earned him visits from Benjamin Franklin and serious
discussion in scientific papers, he failed to win membership in
the Académie des sciences. The glory he sought escaped him,
and he never forgave the academy for his rejection, in later life
blaming it for his frustrations.
In time, he began to neglect his patients and commit
himself to his laboratory work. “I devote only two out of
twenty-four hours to sleep,” he wrote during this time, “and
only one to my meals and domestic necessities.” 5pxxi Soon
he was spending all his means on experiments and physics.
Despite his enthusiasm, in 1784 he received a rejection from
the academy after submitting a paper on Newton’s optics, and
was also rebuffed by the Spanish Academy at Madrid. He became
convinced that his genius was unappreciated and his list
of enemies expanded. The jealousies and intrigues, imaginary
or real, became necessary to support his sinking self- esteem.
Marat resigned his position, or was asked to resign, as physician
to the king’s brother. The devouring ambition that drove
him to work twenty hours a day was now turned to a new
enterprise: the politics of the French Revolution.
After 1789 and the storming of the Bastille . . .
anarchy in Paris
Marat rose to prominence among the commoners of Paris
relatively early in the Revolution. As a disciple of Jean-Jacques
Rousseau, the France that Marat envisioned was based on
the Enlightenment notion of the “equality of man.” He sought
to bring this about by rejecting the divinely appointed rule
of King Louis XVI and establishing a new polity based on
Rousseau’s social contract.
Marat was an extremist, while the majority of France was
wary of abolishing the monarchy altogether. Faced with national
bankruptcy, a constitutional monarchy was established
in which Louis XVI remained on the throne while true authority
rested with the Legislative Assembly. These representatives
were a house split into two factions: the moderate Girondins,
seeking to protect the constitutional monarchy, and the radical
Jacobins, eager for a republic without church, nobility, or
a king.
18 The Pharos/Winter 2008

Marat’s daily rants against the aristocracy earned
him the disdain of the privileged and the adoration of
the poor. “To pretend to please everyone is mad,” 2p734 he
wrote. His allegiances to the Jacobins were well known.
He hated the monarchy, and his rhetoric against the
throne galvanized the rebellion.
In the years following the storming of the Bastille
in 1789, anarchy descended on Paris. With the deposition
and capture of Louis XVI in 1792, the notion of a
constitutional monarchy was quickly abandoned and the
hope of a republic spread through Paris. During this unstable
time, the balance of power shifted from the failed
Legislative Assembly to the Paris Commune, a body composed
not of politicians, but of the working class. Many of
the delegates were members of France’s most unpredictable
faction, the “sans- culottes.” The term meant “without
culottes,” the knee breeches worn by the privileged. The
Paris Commune wielded merciless authority and had no
more vocal leader than Jean-Paul Marat.
1792—Purge of
counterrevolutionaries by the
Paris Commune
The revolutionary government survived an early threat
in September 1792. With the Prussian army marching on
Paris, and faced with insurrection at home by those loyal
to the imprisoned king, the Commune sought to rid the
city of any trace of “counterrevolution.” Thousands of
the accused were arrested, imprisoned, and beheaded
on charges of rebellion during the bloody September
Massacres. Others were set free, only to be raped, castrated,
or disemboweled at the hands of mob violence.
Hearts were ripped from the chests of men and eaten.
The head of Princesse de Lambelle, the maid of honor
to Marie Antoinette, was placed on a pike and paraded
beneath the temple fortress where the royal family was
held captive. Blame for these atrocities rested with no
single man, but reputation placed the crimes at the feet
of Marat.
Marat’s newpaper—its appeal
to the poor commoners
Marat’s influence began simply. In early September
1789, he initiated publication of a newspaper that became
Jacques Louis David (1748–1825): Jean Paul Marat, politician
and publicist, dead in his bathtub, assassinated by Charlotte
Corday in 1793. Oil on canvas, 165 x 128 cm.
Location: Louvre, Paris, France. Photo credit: Erich Lessing/Art Resource, NY.
his signature in Paris, L’Ami du Peuple. It was here,
among the common soldiers of the French Revolution,
that he finally found the acceptance he sought. The paper
was controversial from its first issue, marrying philosophical
and political doctrine with violence, suspicion,
and conspiracy. Marat openly denounced France’s most
prominent men as traitors based on presumption:
In order to judge men, you always need proof positive,
clear, and precise. For me, their inaction or their silence
on great occasions is sufficient. In order to believe in
a conspiracy, you demand judicial evidence; for me, it
is enough to see the general course of events, the relationships
between enemies of liberty, the comings and
goings of certain agents of power. 6p158
Not surprisingly, Marat found himself with few political
allies. Attempts were made to weaken his influence by
the circulation of false L’Amis with exaggerated diatribes
and bloodthirsty language. Ironically, Marat attacked
these spurious writings as being too tame to be his own.
Cut off the thumbs of the aristocrats who conspire
against you, split the tongues of the priests who have
preached servitude.
To secure the public tranquility two hundred thousand
heads should be cut off. 5pxxii
This rhetoric did not go unnoticed, and Marat fled to
London. His subsequent return to Paris found four journals
in circulation claiming to be his L’Ami. Undeterred,
Marat wrote “I warn honest men not to play with the
‘People’s Friend,’ any more, as he is never likely to be their
dupe.” 7p26
Marat’s blistering, pruritic,
painful skin disease—what
was it?
I saw him at one time address himself to Louvet; and, in
doing so, he attempted to lay his hand on Louvet’s shoulder,
who instantly started back with looks of aversion,
as one would do from the touch of a noxious reptile,
exclaiming, “Ne me touchez pas!” (“Don’t touch me!”)
—John Moore 8p389
Marat’s journalism was a clandestine affair. Though
he was well known throughout France, the location
of his publishing house changed often and was kept
secret from his political enemies. Several times he was
forced to abandon his publication for fear of arrest. He
19

Marat’s terror
once reportedly avoided capture by hiding in the famously
filthy sewers of Paris, an event recorded in Victor Hugo’s Les
Miserables as Jean Valjean’s “descen[t] into the sewer is to enter
the grave . . . in which we find vestiges of all the cataclysms
from the shell-fish of the deluge down to the rag of Marat.” 9p64
Around this time, Marat began referencing the skin condition
that would later confine him to a daily medicinal bath, the
scene of his assassination in 1793. He described his condition
as an “inflammatory illness, the fruits of the long nights I have
given myself over in order to defend freedom.” 10 History notes
that the lesions were blistered, painful, pruritic, and initially located
primarily in the perineum, later becoming widespread.
Speculators have often assumed an infectious etiology,
the result of his escape through the sewers. Marat, however,
first noted the skin condition in 1788, two years before his
flight. 11 Others argue that this event never occurred and that
Marat simply hid in the attic of his friend. Thus, while his
experience with the miasmas of Paris might have aggravated
his condition, it cannot be assumed that the primary etiology
was infectious.
In an attempt to alienate him from mounting public support,
Marat’s opponents claimed he suffered from either leprosy
or syphilis. These diagnoses are, however, inconsistent
with his symptoms. The lesions of leprosy are patches of diminished
sensation accompanied by peripheral neuropathies.
Furthermore, while little is known about the epidemiology of
leprosy during this period, an examination of some five thousand
skulls in Paris’s eighteenth- century catacombs, France’s
largest mass grave at the time, reported no skulls with lepromatous
bony changes. 12 This finding suggests that the prevalence
was sufficiently low to consider the diagnosis rare. Little
in this description suggests secondary syphilis, either, which
classically presents as a transient, nonpruritic rash, involving
the palms and soles.
Several historians have assumed he suffered from scabies.
Indeed scabies does itch. This, however, was one of the few
infections for which accurate diagnosis and treatment was
available at the time, and it is unlikely that Marat, a physician,
would have allowed that disease to progress. 13
Psoriasis and seborrheic dermatitis have been the most
consistently offered diagnoses. While certainly not the classic
presentation of either, both are known to affect the groin.
At least one investigator offers the diagnosis of dermatitis
herpetiformis, a cutaneous manifestation of gluten- sensitive
enteropathy. 13 The role of bread in revolutionary France bears
mentioning, as the rising cost of grain was, in many ways, the
inciting event of the peasant uprising. History remembers,
perhaps incorrectly, Marie Antoinette’s infamous response to
the lack of bread with the famous reply, “Let them eat cake.”
The diagnosis of hidradenitis suppurativa (HS) neatly accounts
for Marat’s symptoms and should be added to the possible
differential diagnoses. HS is an occlusive disease of the
follicles classically located in the groin and axilla. In males, it
commonly arises during early adulthood, and pruritis may be
an early symptom. HS has a highly variable course, but abscess
formation and draining sinus tracts are the norm. The lesions
are often secondarily infected. If untreated, the disease can
become quite debilitating, and patients may find themselves
unable to walk or sit comfortably.
A complex psychiatric illness that
fueled Marat’s revolutionary fervor
Some argue that investigation should focus on Marat’s
psychiatric state. Dermatological manifestations of psychiatric
disturbances are well documented. Moreover, psychiatric
medications have been used in the treatment of dermatosis
resistant to conventional treatment. Often, an inciting event
leads to repetitive scratching and, later, excoriations and infection.
These pruritic areas are generally located on accessible
areas such as forearms, face, and back.
Although Marat was regarded as insane, few attempts have
been made to diagnose the psychiatric disturbance of a man
who loved “carnage like a vulture.” 14 Marat’s grandiosity and
sleep disturbance suggest a manic state and there appears to
be an element of psychomotor agitation:
In speaking in society he always appeared much agitated,
and almost invariably ended the expression of a sentiment
by a movement of his foot, which he thrust rapidly forward,
stamping with it at the same time on the ground, and then
rising on tiptoe. 7p4
Though Marat was known to spend much time confined
to his house, no specific periods of depression are recorded.
Ironically, he was among the first proponents of electroconvulsive
therapy for treatment of a host of conditions ranging
from edema to eczema, and lead poisoning to paralysis. His
preference for solitude also typifies the diagnosis of schizophrenia,
most likely paranoid type. Supporting such a conclusion
is Marat’s well- documented disheveled appearance. One
historian considered the man “a Caesar draped in rags.” 15 We
have, however, no clear evidence of hallucinations or severe
thought disturbance. A diagnosis of delusional disorder best
accounts for his supposed persecution, as Marat’s thoughts
reflect a fixed false belief in the absence of frank psychosis.
Marat also displays several traits of the cluster A personality
disorders, and a diagnosis of paranoid personality disorder is
most appropriate.
Hated by many, a set up for
assassination—Charlotte Corday,
come forth!
20 The Pharos/Spring 2009

The name of Marat dishonors your race. He was a ferocious
beast, who was about to devour the remains of France by
the fire of civil war.
—Charlotte Corday at trial 16p198
As his skin condition worsened, Marat continued writing at
a furious pace. He published a second journal, Junius François,
in addition to numerous pamphlets. In 1792 he was elected as
the people’s representative to the National Convention, the
first legislative body of the newly formed Republic of France.
He quickly learned that his friends were few as he addressed
the Convention after his election: “ ‘In this Assembly I have a
large number of Personal Enemies.’ ” The assembly cried back
“ ‘All of us, all of us!’ ” 5pxxiv
As his status increased, so too did his denunciations. They
seemed almost random, and his most consistent position was
hypervigilance. Though Marat seemed to hate any man in a
position of prominence, his ire was most consistently aimed
at those in the Girondin party, the ruling majority in the
National Convention. They had initially enjoyed the backing
of the people, but in the mood of the times, today’s radicals
were tomorrow’s moderates. The Girondins had exhausted
their support on a failed war against Prussia and the party’s
reluctance to bring Louis XVI to trial. Inspired by Marat, the
commoners of Paris had no such reservations, and their voices
would not be denied—Louis was guillotined in 1793. In an effort
to silence Marat, the Girondin-led Tribunal arrested him
on the charge of inciting to rebellion. After his acquittal, he
led the Convention to overthrow the Girondin leadership, in
favor of the more radical Jacobin rule. It was a period of soaring
rhetoric and rule by an iron fist, but the Jacobins held the
promise of economic stability. The Girondins fled death, and
many sought refuge in the northern city of Caen.
Marat’s medical condition kept him confined to his baths
but did not prevent him from working on a small table improvised
from an upturned wooden box. On the twelfth of July,
1793, the painter Jacques-Louis David visited Marat beside his
tub to wish him a rapid recovery. He admired Marat, even if
he did not fully understand him, and he held that the only true
martyrs were revolutionary ones. Unknowingly, he was about
to get his most famous subject.
The next day a young woman claiming to be from Caen
appeared at 30 Rue des Cordeliers and sought an audience
with Marat. He refused her on two occasions but relented
when she returned a few hours later, claiming to be in possession
of the names of Girondin sympathizers. The woman was
Charlotte Corday, a passionate admirer of the Girondin party
and, though she had traveled from Caen, she had not come to
betray her fellow patriots. When she began to recount to him
the names of the traitors, Marat replied, “ ‘Good, in a few days
I will have them all guillotined.’ ” 2p736 In an instant she leaned
over the man, pulled a knife out from the top of her dress, and
plunged it down hard into the Marat’s right chest. The knife
By and about Jesse Woodard
I am a member of the class of 2009
at the University of South Carolina
School of Medicine. I currently reside
in Greenville, South Carolina, where I
am completing my fourth and final year
preparing for a career in radiology. In
the few moments of my day that are not
currently consumed with the residency
matching process, I reminisce about how much happier
I would potentially have been had I not abandoned my
first love—cooking. I enjoy listening to folk music, eating
fruit roll-ups in a single bite, and doing the crossword
puzzle with my wife over a cup of coffee.
pierced “between the first and second rib, traversing the upper
part of the right lung as well as the aorta, and going into the
left clavicle.” 3p258 He called for help but any aid was in vain.
Corday did not attempt escape. Expecting her arrest, she
carried her certificate of baptism and a letter to the nation of
France explaining her actions. At trial she calmly defended
her actions, “I knew he was perverting France. I killed one
man to save a hundred thousand.” 16p198 Four days later she was
guillotined. Immediately upon decapitation, one of the executioner’s
assistants—a man hired for the day named Legros—is
said to have lifted her head from the basket and slapped it on
the cheek.
David—a great painter with
strong political views
The responsibility of vengence fell to Jacques-Louis David,
rightly regarded as the greatest neoclassical painter in France.
A Jacobin member of the National Convention, David had
voted for the death of the king, an odd career move since
Louis XVI had commissioned his most famous work to date
The Oath of the Horatii. The work had earned him a reputation
for capturing the revolutionary spirit, and his depiction of
The Death of Marat is a lesson in propaganda.
David sought to portray Marat as a revolutionary martyr,
painting him in a pose much like that of Christ in
Michelangelo’s Pieta and Caravaggio’s Deposition of the Cross.
So striking was this similarity that the work would later be
known as “David’s Pieta.” The wound in Marat’s side and the
linen clothes are clear references to Christ, as is the simple
wooden desk which recollects the cross.
Marat himself is idealized in the painting. His skin is fair.
He appears peaceful, perhaps even smiling. The instrument of
The Pharos/Spring 2009 21

Marat’s terror
22 The Pharos/Spring 2009

death lies harmlessly on the floor. The simple composition
and subtle color forces the viewer to pity the man. The neutral
space above the scene is too conspicuous to be incidental.
Occupying nearly half the canvas, the space leaves the viewer
feeling somber and oppressed. In his left hand, Marat holds
the treasonous letter with which Corday gained her meeting;
in his right, the pen with which he was to record the names of
the traitors. On his desk lies an assignat, a banknote issued by
the revolutionary government and Marat’s instructions for it
to be given to a widow with five children whose husband had
died for the revolutionary cause.
Napoleon: “Vanity made the
French Revolution”
Marat has largely been overshadowed by other infamous
names of the French Revolution, among them Marie
Antoinette, Danton, and Robespierre. The man who brought
an end to the Revolution, Napoleon Bonaparte, captured the
period best: “Vanity made the French Revolution; liberty was
only the pretext.” 17p505
Jean-Paul Marat was no exception. Violent, unstable, and
loud, his life typified the times. He was insane, and all of France
with him. His uncompromising opposition to the throne made
him both a hero and a villain. Perhaps what endeared Marat to
ordinary men and women of France was that he truly wrote as
a friend of the people, elevating Parisian concerns above the
rancor of public debate and power plays. Marat summarized
his own legacy in an address to the National Convention:
My ideas, however revolting they might appear, tended only
to the public good, for no person was ever more fond than
myself of order, and the reign of just laws. If your ideas are
not sufficiently elevated to enable you to understand me, the
worse for you. 18p39
In April 1941 Adolf Hitler issued a declaration that he
intended to celebrate the New Year in the palace of the tsar
in Leningrad, Russia. Thus began a bloody 900-day siege
on the city, which ended with the death of more than one
and a half million Soviet citizens. The port of Leningrad was
defended by the Russian battleship Marat. Originally named
the Petropavlovsk, the ship was renamed during the Russian
revolution. In the battle, German Stutka pilots sank Marat.
The vessel lay wounded in shallow water while retaining many
of her guns. In the years that followed, the ship sustained
the most brutal siege in the war but continued to serve as an
Paul Baudry (1828–1886): Charlotte Corday. Oil on canvas. Inv.
802.
Location: Musée des Beaux-Arts, Nantes, France. Photo credit: Gérard Blot, Réunion des
Musées Nationaux/Art Resource, NY.
all- important Russian battery to withstand the German assault.
Mortally wounded, the Marat refused to be silenced and
defended the homes of those left in Leningrad from the fear of
Nazi oppression. Like its namesake, the battleship continued
to spew venom from a tub.
Acknowledgment
This paper would not have been possible without the guidance of
Dr. J. David Woodard, professor of Modern and Classical Political
Thought and the Strom Thurmond Chair of Political Science at
Clemson University. Dr. Woodard’s insight into the French Revolution
was as invaluable as his assistance in editing this paper.
References
1. Loomis S. Paris in the Terror. New York: Avon Books; 1964.
2. Schama S. Citizens: A Chronicle of the French Revolution.
New York: Alfred A. Knopf; 1989.
3. Burr CW. Jean Paul Marat, Physician, Revolutionist, Paranoiac.
In: Packard FR, editor. Annals of Medical History. New York:
Paul B. Hoeber; 1920: 248–61.
4. Marat JP. An Essay on Gleets: Wherein the defects of the actual
method of treating those complaints of the urethra are pointed
out, and an effectual way of curing them indicated. London: W.
Nicoll and J. Williams; 1891.
5. Warren RF. Dr. Marat of Paris. Am J Psychiatry 1964; 121:
xx–xxv.
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I, Davies H, Kalman J, editors. French History and Civilization:
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(Australia): The George Rudé Society; 2005. www.h-france.net/
rude/2005conference/Zizek2.pdf.
7. Bax EB. Jean Paul Marat; The People’s Friend: A Biographical
Sketch. London: Charing Cross Publishing; 1879.
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of His Life and Writings. Volume III. Edinburgh: Stirling and Slade;
1820.
9. Hugo V. Les Miserables. Volume V. New York: Carleton
Publishing; 1884.
10. Marat JP. Letter to the Jacobins by Jean-Paul Marat 1793.
http://www.marxists.org/history/france/revolution/marat/1793/letter-jacobins.htm.
11. Cohen JHL, Cohen EL. Doctor Marat and his skin. Med Hist
1958; 2: 281–86.
12. Møller-Christensen V, Jopling WH. An examination of the
skulls in the catacombs of Paris. Med Hist 1964; 8: 187–88.
13. Jelinek JE. Jean-Paul Marat: The differential diagnosis of his
skin disease. Am J Dermatopathol 1979; 1: 251–52.
14. Moore J. A Journal During a Residence in France, from the
Beginning of August to the Middle of December 1792. Volume 1.
London: G. G. J. and J. Robinson; 1793: 338. (Available on-line at
books.google.com.)
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The Pharos/Spring 2009 23

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Charlotte Corday being led to the guillotine. © Bettmann/CORBIS.
Putnam’s Sons; 1916: 337. (Available on-line at books.google.com.)
16. Besant A. History of the Great French Revolution: A Second
Course of Lectures (Delivered at the Hall of Science, London,) Continuing
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London: Freethought Publishing; 1883.
17. Perry RB. The Present Conflict of Ideals: A Study of the
Philosophical Background of the World War. New York: Longmans,
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Volume II. London: T. Cadell, Jun. and W. Davies; 1799.
The author’s address is:
639 Bear Drive
Greenville, South Carolina 29605
E-mail: jwoodard@gw.med.sc.edu
24 The Pharos/Spring 2009

� ���������
You take me back
To The Sound of Music,
To the yodeling Von Trapps
Orchestrating “The Lonely Goatherd” from above—
marionette in my mind for the first time—
But nothing compared to you,
The C6 quad
Who opens a jar of peanut butter
Between two, once functionless, hands,
Who brushes her golden hair
One deliberate stroke at a time
And lifts the steaming aroma
Of Columbian coffee
Toward eager lips
With arms and hands
That have found a voice again—
Functional electrical stimulation—
A fractured, incomplete language
Of electrical words
Running in subcutaneous wires
From the implanted chest stimulator
To the forearm motor,
Brio to the listless,
Like the strings of the velvet marionette
Who dances the dance of the manipulator—
Watching you move,
I can’t help but twirl around,
Looking for my invisible strings.
Jason David Eubanks, MD
The author (AΩA, Case Western Reserve University, 2003) is a
Spine Fellow in the Department of Orthopaedics at the University of
Pittsburgh. His address is: 36901 Beech Hills Drive, Willoughby Hills,
Ohio 44094. E-mail: jdeubanks2002@yahoo.com.
The Pharos/Spring 2009 25
Illustration by Laura Aitken

Baloney Below knee
Bed time kamood Bedside comode
Buccal fracture Buckle fracture
Cashews Cast shoes
Café olé spots Café au lait spots
Clot through Claw toe
Crampy todactyly Camptodactyly
Destruction osteogenesis Distraction osteogenesis
Free jerks ataxia Friedreich’s ataxia
Gate analysis Gait analysis
Grandma seizures Grand mal seizures
Hell fracture Heel fracture
Herb palsy Erb’s palsy
Insight to fusion In situ fusion
Knot knees Knock knees
Kind box syndrome Keinbock syndrome
Kay ciel KCl (potassium chloride)
Loose frank fracture Lisfanc fracture
Mass of swelling Massive swelling
Psychoceramic Psychosomatic
Piggin toes Pigeon toes
Plastic dysplagia Spastic dysplasia
Partial phallectomy Partial patellectomy
Pillow fracture, to low fracture Tillaux fracture
Public harness, pubic harness Pavlik harness
Range of emotion Range of motion
Rotator cough Rotator cuff
Screwliosis Scoliosis
Tarsal collision, torso coalition Tarsal coalition
Trigenital nerve Trigeminal nerve
Thibula Fibula
Tibua Tibia
Unicranial cyst Unicameral cyst
Waffle type chew Wassel Type 2
Illustrations by Jim M’Guinness
Cashews
Cast shoes
Screwliosis
Scoliosis
26 The Pharos/Spring 2009

New medical
TERMS
James G. Gamble, MD, PhD, Theresa Pena, RN,
and Lawrence A. Rinsky, MD
The authors are members of the Packard Children’s Hospital at
Stanford. Dr. Gamble (AΩA, University of Maryland, 1974) is professor
in the Department of Orthopaedic Surgery. Ms. Pena is a
nurse in the Pediatric Orthopaedic Clinic. Dr. Rinsky (AΩA, University of
Cincinnati, 1970) is a professor in the Department of Orthopaedic Surgery.
As part of the electronic medical record in teaching hospitals, residents and attending
physicians use telephones to dictate notes of their clinical encounters
with patients. These dictations are transcribed by voice recognition programs
or by transcription services on the Internet. Before application of an electronic signature,
physicians have an opportunity to review and correct their notes. However, with
the hectic schedule of most residents and attending physicians, it can be difficult to
review, in detail, each note before application of an electronic
signature. Transcription errors thus enter
the permanent medical record. Many of these
terms occur repeatedly.
The following list, with the original intent,
relates mostly to the musculoskeletal
system as the terms were discovered in
pediatric orthopaedic clinical notes. The
list is certainly incomplete and should be
considered a work in progress.
Editor’s note
A paper I once dictated contained the
phrase “Cell-free translation,” which came back
as “Self retranslation.” I admit that the latter
might have been more interesting to discuss.
Send correspondence to:
James G. Gamble, MD, PhD
800 Welch Road, Suite 212
Department of Pediatric
Orthopaedics
Stanford, California 94304-5709
E-mail: jgamblemd@gmail.com
Gate analysis
Gait analysis
Waffle type chew
Wassel Type 2
The Pharos/Spring 2009 27

New medical terms
Grandma seizures
Grand mal seizures
Hell fracture
Heel fracture
Knot knees
Knock knees
Piggin toes
Pigeon toes
28 The Pharos/Spring 2009

Four Season Haiku
S
wirling snow tempest!
Coating the crooked fingers
Of dormant trees.
Cherry blossom youth,
Circle memorial to
Young nation’s founder.
Coneflower cafes—
Serving royal pollen to
Monarch butterflies.
Aspen leaves scatter;
Wind-surfing autumnal zephyrs
Above mountain streams.
Steven F. Isenberg, MD
Dr. Isenberg (AΩA, Indiana University, 1975)
is assistant professor of Otolaryngology—Head
and Neck Surgery at Indiana University School of
Medicine. His address is: 1400 North Ritter Avenue,
Suite 221, Indianapolis, Indiana 46219. E-mail: sisenberg@good4docs.com.
The Pharos/Spring 2009 29

Erica Aitken
Larry Zaroff, MD, PhD
Completing
the
circle
The author (AΩA, George Washington
University, 1956) is a consulting professor
at Stanford University School
of Medicine & Program in Human
Biology and a senior research scholar
at the Center for Biomedical Ethics.
He has been a writer for the New York
Times science section, and now works
one day a week as a volunteer family
doctor. In 2006 he was honored as
Stanford’s Teacher of the Year.
He had inoperable lung cancer,
which had spread to the
lymph nodes in the neck, as
well as his liver and brain, and was in
the city hospital for terminal care.
No hospice was available in the 1950s.
I was on the general medical ward, my
initial rotation and exposure to clinical
medicine. In costume: short white
coat, a necklace of stethoscope, jewels
of percussion hammer, tuning fork,
otoscope protruding from pockets. The
Merck Manual for support, making me
ready, but with false credentials. Not
a real doctor. Yet a thrill, intoxicated
by the idea of the act. The days when
I knew little but was asked to know
everything about everything. As students,
we expected to learn from our
teachers, obtain the clinical clues that
would allow a correct diagnosis and
treatment. I thought patients were for
30 The Pharos/Spring 2009

learning on, not learning from. What
could they know? I was wrong. Who
understands a disease better than the
patient?
A first patient. A dying patient.
With generosity and tolerance, he answered
the many questions medical
students were required to ask. When I
put my cold stethoscope on his chest,
he smiled and murmured, “Doc, you
may want to warm that up next time.”
The first of the lessons he taught me.
He led my hand to the hard nodes
above his clavicle, guided me to his
swollen liver, and demonstrated the
weakness in his left hand.
It is easy to remember the details of
that first patient. But after moving to
cardiac surgery for twenty-nine years,
then dropping out of medicine for ten
years to climb mountains, and finally
returning to Stanford in 1995 to study
humanities and staying to teach medical
humanities, I recalled little of general
medicine.
It seemed like a full life. I did not
miss the operating room but missed
the patient contact, the real doctoring
that connected with my teaching—
the literature that embraces illness.
This year when a clinic opened for the
low-income and minimally insured
population of our town, I volunteered
to help the two family doctors who
took time from their busy private practices
to work there. It was a tsunami of
surprises, worse than I expected. I was
as lost and confused as King Lear in
the forest. I knew little of modern general
practice. Fortunately the two doctors
in our clinic were willing to teach.
The first patient I saw was a man in
his late seventies who was in the clinic
for a routine visit and to renew his
prescriptions. He was complicated. Not
the single problem of a stenosed aortic
valve or blocked coronary arteries I had
encountered as a surgeon. Back pain,
high blood pressure, asthma, elevated
cholesterol. And then I noticed he was
sitting in a wheelchair. “My leg, Doctor,
I had polio.” I had not seen a patient
with polio in fifty years. He explained,
“Just missed the vaccine.”
My first medical patient in twentytwo
years had more diseases than I
could imagine. I retreated humbly to
the conference room and consulted the
family doctor working that day. “How
do you deal with so many diseases
in one patient? How can you know
enough? In my first go-around as a
student we had few medications for
high blood pressure, high cholesterol,
asthma.” He smiled and suggested I take
my time, go over each problem, then
ask what was really bothering him. My
patient sat quietly in his wheelchair, did
not complain at my tardiness, allowed
me to ask the dozens of questions he
had answered many times. His blood
pressure was slightly elevated, but his
lungs were clear. He remarked, “Another
cold stethoscope.” I was embarrassed.
Twice in one medical life. I reassured
him that his problems were well controlled.
His last question was a surprise.
“Doctor, could I have—I would appreciate
some samples of Viagra. Might I
have a few tablets?” Another shock. In
my era not only did few doctors talk
about sexuality, but rarely did a patient
bring up the subject. My first patient,
once again: enlightenment. That has
not changed. Given the opportunity and
the time most patients will reveal their
complexity, their charm, and will teach
us. He deserved samples of Viagra.
The author’s address is:
433 Bridgeway
Sausalito, California 94965
E-mail: larryz.zaroff@gmail.com
The Pharos/Spring 2009 31

The half-tico, half-gringo robot
Lindsey Finklea
The author is a member of the Class of 2009 at Eastern
Virginia Medical School.
It was our sixth week teaching English in rural Costa Rica
when my husband Patrick was bitten on the leg by a ferde-lance,
a deadly pit viper. Alone in the jungle, I said a
quick prayer before leaving him behind to search for help.
Months before, back in the United States, we had dreamt of
a journey that would allow us to give of ourselves to others
less fortunate—the beginning of a vocation in social justice.
Within a split second, our world turned over, and we became
the recipients in need.
Patrick, who spoke no Spanish, stood out for his overtly
gringo appearance. Still, the elementary school children we
taught flocked to him for his lively animations and notable
ability to lift seven to eight children at a time. Now, six
hours after the snakebite, he lay in the San José Emergency
Department almost lifeless from shock, unable to communicate,
and at the mercy of the hospital staff.
The hospital was surrounded by armed guards. They kept
order in the long lines that trailed around the corner of the
building. Inside, where the humidity crept into the open-air
hospital, doctors in their long-sleeved coats wiped the sweat
from their foreheads.
Filleting the dreadful compartment
syndrome
“They will cut the fascia to treat the compartment syndrome,”
the doctor stated, nodding as if to indicate agreement.
I did not nod back.
“The what?” I replied. He sketched a swollen leg with a
scalpel making incisions on either side. I nodded.
I kissed Patrick on the forehead as he was taken to surgery.
Afterwards he was placed in the intensive care unit.
During the first of several blood transfusions, the surgeon
informed me Patrick had a fifty percent chance of survival.
The next morning I watched with joy tinged with embarrassment
as the nurses struggled to bathe him and administer an
asthma treatment. He was more than alive—he was yelling
about Snickers bars and Coca-Cola. I began to laugh and to
cry at the same time, and even though his eyes were swollen
32 The Pharos/Spring 2009

shut he recognized my voice and began to cry too.
Relieved that I spoke Spanish, one of the nurses lamented
briefly over Patrick’s obstinance and then left us for a moment.
“Coca-Cola” is the same in English as it is in Spanish.
Five minutes later she returned with a small glass.
Over the course of two weeks Patrick became proficient
at certain Spanish expressions. “I have pain in my leg” and
“Can I have Coca-Cola, amigo?” were his favorites. But most
important was the language the hospital staff learned to use
with him. A reciprocal thumbs up or down meant everything
was going well or poorly. Arms stretched out wide with
eyes closed followed by adios meant it was time for another
operation, seven in all. And tico, the word Costa Ricans use
to refer to themselves, was notification that another blood
transfusion was coming. The doctors often joked that he was
half-tico, half-gringo. But as Patrick suddenly declined into
hallucinations and a lung infection, this primitive system of
words and gestures crumbled.
Dr. Izaguirre, the head attending, was a thin man and his
white coat was stiff with starch. As he grew more frustrated
the creases deprived of a home on his coat burrowed thick
and ominous into his forehead.
Patrick’s most vivid hallucination cast him as the leg
segment of a robot. We were merely props in his play, the
setting and plot changing by the moment. Like a stagehand
laboring to keep the lights on and the curtain from falling,
Dr. Izaguirre swooped in and out of the room almost undetected.
The rest of us struggled to keep Patrick calm and
in bed. The infection was improving, but the hallucinations
were not. The doctor was stumped.
Two days went by—no change.
Robotic mimicking and iatrogenic
hallucinations
On day three, Dr. Izaguirre entered and stood over
Patrick’s bed. Like a mannequin from a display window, the
doctor remained motionless in thought. Patrick lay watchful
from below. After five minutes the doctor raised his hand deliberately,
careful not to wrinkle his coat, and scratched the
The Pharos/Spring 2009 33

The half-tico, half-gringo robot
top of his head. Patrick did the same. The doctor’s forehead
creases grew deep as he lifted his eyebrows in surprise. In
the same rigid, mechanical way, Dr. Izaguirre put both arms
straight ahead. Patrick did the same. The creases moved into
the corners of the doctor’s mouth as he began to smile. They
mimicked each other’s robotic movements for some time and
then began adding machine-like sounds to the narrative. I
will never know what they communicated in this intermission,
but Act Two had begun.
With the same mechanical gestures and kindness, I
watched the staff administer lung treatments, change bandages,
and maintain a sterile environment for Patrick’s open
wounds. In these moments humanity transcended language
and the art of medicine rose above critique.
Dr. Izaguirre ultimately discovered the source of the hallucinations:
one of the medications used for pain. Patrick
recovered in time for his birthday, which was spent in the
hospital dining on cake and Coca-Cola. Two days later we
flew home.
We settled back into the comfort of our lives, but
remained unsettled by the experience. We were changed.
With an appreciative eye, I realized that medicine knows no
gender, no age, and no language. I knew this was my calling.
I am a fourth-year medical student. I am the shadow of
my intern, the gatherer of lab data, the student baffled, humbled,
and challenged by her attending’s knowledge. Tempered
by the daily grind of medicine, my naïveté has been tested.
Still, I see glimpses of humanity all around.
I have not yet met another half-tico, half-gringo patient
who thinks he is a robot—I probably never will. Instead, I
see remarkable patients each with their own idiosyncrasies
and challenges. The physicians who manage these patients
preserve their stories in an imaginary toolbox equipped for
the unexpected and extraordinary. For anyone unfamiliar
with its therapeutic use, I recommend storing a few cans of
Coca-Cola.
The author’s address is:
4 Windy Knoll
Grapevine, TX 76051
E-mail: finlelb@evms.edu
34 The Pharos/Spring 2009

I learned from Dr. Lynn Carmichael that when you
make a house call, you excuse yourself to go to the
bathroom and peek into the medicine cabinet to check
on the pills you’ve prescribed. And there they all were,
in chronological order, unopened.
From Seeing Patients: The Sketchiest Details by
Alan Blum, M.D.
From his earliest days as a medical student, Dr. Alan
Blum (AΩA, Emory University, 1985), Gerald Leon Wallace MD
Endowed Chair in Family Medicine at the University of Alabama,
has captured thousands of patients’ stories in notes and drawings.
The sketches and jottings bring back the essence of a
conversation, a detail of personality, and the fragmentary clues
patients give their doctor about the experience of illness. Dr.
Blum’s address is: 26 Pinehurst Drive, Tuscaloosa, Alabama 35401-
1148. E-mail: ablum@cchs.ua.edu
The Pharos/Spring 2009 35

Empty memory album
discarded by the curb
These poems are the winners of the Winter 2008
contest to write a poem to accompany a photograph of
a empty photo album on the curb. Congratulations to
contest winners Ben K. Azman, MD, Babette B. Caraccio,
MD, James L. Foy, MD, Helene Hubbard, PhD, MD, and
Christopher Papa, MD.
Gutted, abandoned
the book with amnesia
lost memories . . . lost lives
James Foy, MD
Dr. Foy was elected to AΩA at Loyola
University Stritch School of Medicine in
1977. His address is: 3940 Washington Street,
Kensington, Maryland 20895.
He loved her more than life
His warm, attractive wife
With her soft, angelic smile
Destined to beguile
The years they spent together
Pledging their love to one another
But then the joy, the laughter
Would not last forever after
One day her lips grew cold
Her words became more bold
And they would fight and fight
Into the emptiness of the night
Give up he would never
Till he found she had a lover
Broken by the hurt, the pain
He felt he lived his life in vain
So he tossed the photos into the fire
Why cling to the memory of a liar?
The empty album went out the window
Lying by the curb, his love a forgotten shadow
Ben K. Azman, MD
Dr. Azman was elected to AΩA at the University of Alberta
in 1967. His address is: 2435 Kaanapali Parkway, Suite H-7,
Lahaina, Hawaii 96761-1980. E-mail: benazman@hawaii.rr.com.
36 The Pharos/Date

Discarded and but not forgotten
No place for photos or mementos,
His heart is dead to mine.
Icy and unforgiving
Wind will chill the empty pages
No soft breeze will comfort me.
There is not cleansing for my soul
Trapped in love and by love
I live my days and nights alone.
The sight of him pains me,
The thought of him burns
I cast away his image but not his memory.
Who will trample these pages?
Like worthless refuse
As he has done to my heart
Is there healing?
Will the memories fade into peace?
I hope but fear not.
This album is cast away
No more to haunt me
Yet, he haunts me still.
I, too, am a castaway
Adrift in despair and loneliness
Awaiting my end.
Babette B. Caraccio, MD
Dr. Caraccio was elected to AΩA at New York University
School of Medicine in 1982. Her address is: 23 Mianus View
Terrace, Cos Cob, Connecticut 06807. E-mail: babettecmd@
optonline.net.
Empty memory album, discarded by the curb,
Evokes an image dark, intended to disturb,
But faded and lost photos, we knew would never last,
Have now become the remnants of the techniques of the past.
The albums of today, stored in many bytes and bits,
Are in a fast computer that on a desktop sits,
They’re all stuffed there within, a large and neat selection
Of digital results, to forms just near perfection.
They make their rounds with lightening speed, o’er electronic
space,
And unite the far flung family at very distant place,
But there’s that special image which is quite hard to find,
It’s stuck there in the neurons that pass for what’s my mind.
My Dearest
We shared so much so long
Life bulged with unborn dreams
Unexpected joy grew from gentle sweetness
into hearty robust love
Then you left
And took me with you
Except the plastic cover
That hides my empty space keeping everyone
from seeing I have gone
Helene Hubbard, PhD, MD
Dr. Hubbard was elected to AΩA at East Tennessee State
University in 1986. Her address is 408 Manatee Avenue, East,
Bradenton, Florida 34208. E-mail: hhub@kidsdoingbetter.com.
Christopher M. Papa, MD
Dr. Papa was elected to AΩA at UMDNJ—New Jersey Medical School in 1986. His
address is: 17 Clover Hill Lane, Colts Neck, New Jersey 07722-1004. E-mail: doxite@verizon.net.
The Pharos/Date 37

The physician at the movies
Peter E. Dans, MD
Man on Wire
Starring Philippe Petit/Paul McGill, Jean-Louis Blondeau/
David Damato, Annie Alix/Ardis Campbell.
Directed by James Marsh. Rated PG-13. Running time 90
minutes.
On August 7, 1974, while the United States was preoccupied
by the Watergate controversy that culminated
in the resignation of President Richard Nixon the following
day, Philippe Petit, a Paris street performer and magician,
fulfilled a long-held dream. In 1968, while sitting in a dentist’s
office, he had read about the construction of the World Trade
Center (WTC) and became obsessed with walking on a wire
suspended between the Twin Towers. Based on his book, To
Reach the Clouds, this fascinating, fictionalized documentary
©2008 Jean-Louis Blondeau / Polaris Images.
or docudrama recounts the meticulous planning underlying
this remarkable (and illegal) feat. Director James Marsh goes
back and forth in time, intercutting interviews with Petit and
the other principals. Petit comes across as child-like and selfcentered,
but also filled with a courageous (or “foolhardy”)
passion and radiating a charisma that enables him to get
people to help him fulfill his dreams. A climber as a child and
blessed with an extraordinary sense of balance and concentration,
he was fascinated by wire walkers, not circus performers
but those who did daredevil stunts as performance art. The
perfect illustration of the French concept of sangfroid, he relates
how one to two millimeters of error in placement of his
foot or a quarter of a second of inattention can result in losing
one’s life. He adds, “If I die, what a beautiful death! To die in
the exercise of one’s passion.”
38 The Pharos/Spring 2009

Philippe, who was brought up strictly in a privileged environment,
had a “bad boy” side. He enjoyed the aspect of
illegality and the feeling that comes with attempting forbidden
and “impossible” things. He likened himself to a spy as he
reconnoitered entry to the WTC through various subterfuges
and kept in character by watching bank- robber movies. He
sought out co- conspirators who were not only supportive but
had a little larceny in their hearts.
Having walked on wire across the cathedral of Notre Dame
de Paris and the Sydney Harbour Bridge in Australia, he was
ready to tackle the highest manmade structure. Petit and his
co- conspirators made numerous visits to the WTC to determine
how to gain entry and to ascend the 110 floors to the top,
over 450 meters (1476 feet) from the ground. They enlisted
an insider with a top floor office where they could store their
equipment. The film takes us back to a time when
Americans were more trusting. He gained access
to the top floors from the manager of the complex
by posing as journalist for a French magazine seeking
to interview the construction crew to learn
about wind conditions and other potential hazards.
While doing so, his two “magazine photographers”
took pictures of the site to determine placement
of the guy wire; in so doing they learned that the
two corners to serve as anchors for the wire did
not face one another, but were askew. At one point
during his stay, he injured his ankle and had to use
crutches, which paradoxically allowed him greater
entrée as people were more concerned with holding
the door for him than checking his identification.
One of the most ingenious things was how the
team got the guy wire or cable across to the conspirators
in the other tower, 200 feet away. Petit’s friend
Jean Louis Blondeau, who is the most sympathetic
character in the film, learned to use a crossbow, and
they adapted the wire so that it could be shot the
required distance. As they got closer to the event,
Jean Louis and the others began to think of being
potentially responsible for a friend’s death and of
being caught in a litigious America and charged
with assisted suicide or involuntary manslaughter.
How wrong they were!
The day before the walk, they infiltrated the
WTC and got the equipment in place. This, the
most exciting part of the film, involved close encounters
with the guards and a race against the
clock to be able to do the stunt before the WTC
came alive. Beginning at 7:45 am, Petit made an
estimated eight crossings which he prolonged to forty-five
minutes of theater as he knelt and lay down on the wire while
eluding the policemen who were trying to capture him. Finally,
as the wind began to pick up and a misty rain began to fall, he
was warned that a helicopter was getting ready to scoop him
up. He terminated the stunt and was arrested and ordered to
be examined by a psychiatrist who pronounced him sane. The
initial charges of illegal trespassing and disorderly conduct
were dropped in exchange for him giving a show for New York
City children.
The most interesting thing was how the event affected Petit
and his friends. The celebrity was immediate as he hooked up
with a groupie on being discharged from jail, even before he
returned to see his girlfriend Annie, Jean-Louis, and the others
who had helped make it all possible. They and he admit
that it closed a chapter in their lives as they became alienated
from his now famous life. He is shown reflecting on how he
has done sixty more performances including one on the Eiffel
Tower. Vowing never to repeat himself, he follows his “passions,”
living life “on the edge,” although admitting that his “life
©2008 Jean-Louis Blondeau / Polaris Images.
is a mess.” The other beneficiary of the stunt was the WTC,
which had been vilified, but now became part of the public
imagination and began to fill up with tenants. One wonders
how much all of this attention influenced the terrorist plotters
in 1993 and September 11.
The Pharos/Spring 2009 39

The physician at the movies
Glenn Ford and Van Heflin in 3:10 to Yuma (1957).
Columbia Pictures/Photofest © Columbia Pictures.
Remaking a forgotten classic Western
While channel- surfing one evening, I got drawn in by the
acting in the original 3:10 to Yuma and I thought it might be
fun to contrast it with the 2007 re-make to see what it says
about filmmakers and audiences separated by half a century.
3:10 to Yuma (1957)
Starring Van Heflin, Glenn Ford, Leora Dana, and Felicia Farr.
Directed by Delmer Daves. Not rated. Run time 92 minutes.
Based on a short story by Elmore Leonard, the film opens
with a stirring rendition of the title song by Frankie Laine,
known for his recordings of “Mule Train,” “Cry of the Wild
Goose,” and the theme from the television show “Rawhide.”
Like High Noon, the movie focuses on a man’s willingness to
do his duty and keep his word, no matter the cost and no matter
the enticements to turn his back on it. The protagonist is
rancher Dan Evans (Van Heflin), a Civil War veteran who went
West with his wife Alice (Leora Dana) and their two children.
After four years of hardscrabble existence and six months of
drought that threatens the loss of his cattle and his ranch, he is
a failure in the eyes of his family. While rounding up his cattle
that had been dispersed by outlaw Ben Wade (Glenn Ford)
and his gang, Evans and his sons come upon the gang robbing
Russell Crowe and Christian Bale in 3:10 to Yuma (2007). Lionsgate/Photofest © Lionsgate.
a stagecoach loaded with gold. After shooting a gang member
being used as a shield, as well as the guard, Wade takes the
Evans family’s horses and their canteens of water and heads
with his gang to Bisbee.
Passing themselves off as hired hands heading for Mexico,
they report the robbery to mislead the sheriff and line up at
the bar for a celebratory drink. Meanwhile, Evans and his
sons get their horses, which Wade left two miles away, and
herd the cattle back to the ranch. Evans decides to go to town
to talk the banker into not foreclosing on his ranch, which
is now worth more to the bank because of the railroad coming
through. Coming upon the marshal (Ford Rainey) and
Butterfield the stagecoach owner (Robert Emhardt), he tells
them that Wade and his gang were headed to Bisbee. Realizing
that they were duped, they return to Bisbee to find that the
gang has cleared out, all except for Wade, who has dallied
with the barmaid Emmy (Felicia Farr). Although captured and
handcuffed, Wade is unperturbed because he knows that his
gang will rescue him. The decision is made to pay two volunteers
$200 dollars to take Wade to the town of Contention to
catch the 3:10 to Yuma where the federal prison is located.
Evans, desperately in need of the money, volunteers to do so,
as does the town drunk Alex Potter (Henry Jones).
The stagecoach drops Wade, Evans, and Potter at Evans’s
40 The Pharos/Spring 2009

homestead, and the sheriff and the rest head off as a decoy
as if transporting Wade themselves. There are some excellent
scenes around supper, the saying of grace, and Evans cutting
the handcuffed Wade’s meat (no fat, please). Wade becomes
acquainted with Alice and begins to get some insight into their
family. The rest of the film involves their arrival in Contention
and the interplay between Evans and Wade in the hotel’s bridal
suite as they wait for the train. Two significant events, the saving
of Wade by Evans and the arrival of Alice, set the scene for
the well- choreographed and dramatic ending in which Evans
must get Wade to the train as the gang positions itself to rescue
Wade and kill Evans.
3:10 to Yuma (2007)
Starring Russell Crowe, Christian Bale, Peter Fonda, and Ben
Foster.
Directed by James Mangold. Rated R. Running time 122 minutes.
The re-make, which is a half-hour longer than the original
(and feels it) differs significantly. It opens with the Evans
barn being burned by the banker’s hooligan. The elder Evans
son William (Logan Lerman) expresses disdain for his father
Dan Evans (Christian Bale) because he won’t do anything but
simply grovel for more time before foreclosure. While they
go to round up the cattle, they come upon the robbery of the
stagecoach, this time loaded with paper currency, not gold,
and with a lot more shooting and killing. The stage is carrying
Pinkerton detectives, one of whom, Byron McElroy (Peter
Fonda), is Ben Wade’s (Russell Crowe) nemesis. Wade shoots
McElroy in the abdomen at point-blank range. As in the original,
Wade spares the Evans family and heads for Bisbee where
he is captured after dallying with the barmaid Emma Nelson
(Vanessa Shaw). The filmmakers felt compelled to sprinkle in
some profanity, which adds nothing to the dialogue, as well as
partial nudity. The liaison between Wade and the barmaid was
handled off-screen in 1957. There is a medical sidebar when
McElroy is operated on without anesthesia by veterinarian
Doc Potter (Alan Tudyk). Simply removing the bullet leads to
a remarkable recovery and McElroy joins Evans, Doc Potter,
and Butterfield the stagecoach owner (Dallas Roberts) in
transporting Wade to Contention.
The supper at the Evans homestead is more crowded and
not as much a family event. Evans still cuts the handcuffed
Wade’s meat but this time he’s asked to cut off the gristle. We
also learn more about Evans’s Civil War record and that he
lost a leg (not so in the original). Nonetheless, he is able to
run like a deer in some key scenes. From here, the re-make
diverges widely from the original as the film covers the trip
to Contention, which the original did not. There’s a lot more
violence, special effects, and issue- oriented dialogue that the
director acknowledges in the DVD commentary was intentional.
This includes vilifying the Pinkertons for presumably
slaughtering Apache women and children, as well as the railroad’s
exploitation of Chinese and Negroes. In contrast to the
low-key performance by Richard Jaeckel as Charlie Prince,
Wade’s second-in- command, in the original, Ben Foster gives
a riveting performance as a vicious psychopath who is dedicated
to Wade, although the feeling is not mutual. While I’m
not a fan of psychopaths, Foster’s portrayal, which is reminiscent
of Richard Widmark’s performance in The Killers, was,
for me, the highlight of the movie.
Evans’s wife is no longer involved in the ending, which
is much different from the original although the last line is
virtually the same. Director Mangold decided to drop her
(whose role I much preferred) and made the elder son a main
character. Both play the same role in humanizing Wade as he
builds an appreciation of Evans and the importance of trying
to preserve him for his family’s sake. In this version, Wade
quotes the Bible, as many movie villains do these days. He
confesses that his mother left him in a hotel room with a Bible
and promised to return. He read it in three days, but she never
came back for him. His favorite quotations are from Proverbs
13:3 and 21:2. Crowe appears at times to be sleepwalking
through the picture, but to give him his due, he does convey
menace in ways that Glenn Ford did not in the earlier version.
As Wade says to Matthew, who is enamored of Dime Novel
western desperadoes like himself, “Kid, I couldn’t last five
minutes leading an outfit like that if I wasn’t rotten as hell.”
Yet he’s an artist and a philosopher, the prototypical post-’60s
anti-hero. His exchange with Evans as to why he doesn’t do
good deeds is particularly noteworthy.
As one might expect of someone who came of age in the
1950s, I much preferred the original, which features straightahead
storytelling with a powerful performance by Van
Heflin, who specialized as the solid second male co-star, most
especially in Shane. Leora Dana’s role, though smaller, is essential
in conveying the importance of character and family.
Still, as noted, there are some excellent scenes and standout
performances in the re-make, especially by Ben Foster, as well
as Peter Fonda. I was also grateful for the re-make in that it
led me to watch the older version. There are some interesting
features on the DVD, especially the one that shows how the
picture was made. Another, an altogether too brief survey
of the Western outlaws gangs like the James Brothers, the
Youngers, the Daltons, and the Earps, discusses how many of
them walked the fine line between being lawmen and outlaws,
periodically falling to one side or the other.
Dr. Dans (AΩA, Columbia University College of Physicians and
Surgeons, 1960) is a member of The Pharos’s editorial board and
has been its film critic since 1990. His address is:
11 Hickory Hill Road
Cockeysville, Maryland 21030
E-mail: pdans@comcast.net
The Pharos/Spring 2009 41

Reviews and reflections
David A. Bennahum, MD, and Jack Coulehan, MD, Book Review Editors
Geriatric Bioscience: The Link
Between Aging and Disease
David Hamerman
The Johns Hopkins University Press,
Baltimore, Maryland, 2007, 279 pages
Reviewed by Denise Zwahlen-
Minton, MD
Get ready to clear out the cobwebs
everyone! Geriatric Bioscience
will take you back to the days of biochemistry
and pathophysiology lectures
and add in a couple more details. Dr.
Hamerman describes the molecular
process of multiple diseases associated
with aging, including osteoarthritis, diabetes,
osteoporosis, and more. The
depth of knowledge presented
is astounding. I found myself
reading in small sections so
I could fully process the
information covered
and I realized just
how much our
knowledge of aging and diseases has
exploded due to research.
This book is not meant to tell you
how to treat your patient, but how to understand
your patient’s illness and why
certain treatments are recommended
and, further, how to avoid the disease in
the first place if at all possible.
In the preface, Dr. Hamerman expresses
his desire to pass on his vast
knowledge and theories on aging by
presenting a new term he calls “geriatric
bioscience.” Dr. Hamerman defines geriatric
bioscience as “the interrelations
of the biology of aging and disease.” px
His goal with this book is to “promote
greater awareness of the biological basis
of aging and related diseases; introduce
the relevance of early origins of disease
as part of overall development; and
encourage geriatricians to be aware of
assessing risk factors to permit timely
interventions.” pxiii
As a young geriatrician, I especially
enjoyed the chapter covering the
evolution of geriatrics, and that Dr.
Hamerman calls on future geriatricians
to continue the quest for knowledge in
aging and prevention of disease. I have
recommended that our geriatric fellows
read Geriatric Bioscience to develop an
appreciation of the history and future
of geriatrics, as well as to increase their
knowledge of aging, the chronic disease
process, and how closely related these
entities are.
In the body of the book, Dr.
Hamerman conveys the knowledge
he has gained in the science of aging,
spanning his half-century career in
medicine and geriatrics. He covers the
basic science of many common geriatric
syndromes, and discusses how the normal
aging process contributes to the
development of disease and how common
pathways lead to different disease
processes.
The covered geriatric syndromes
were described individually, which
made it easy to go back to find a disease
process; but the discussion of common
pathways between diseases could be
better referenced to other chapters. It
would be interesting to try fitting a patient
with multiple co-morbidities into
the pathways Dr. Hamerman presents
and then discuss how the patient got to
be in the shape he or she is in, as well as
the key points for intervention that were
missed by the patient or the physician.
Overall, I enjoyed reading Geriatric
Bioscience. I feel it is a must-read for
young and in-training geriatricians. It
will help to build knowledge on the
molecular basis of the aging process
and how aging affects chronic disease
and its management and prevention.
Geriatric Bioscience also inspires one to
pursue knowledge in aging and chronic
disease management through research.
Dr. Hamerman has truly fulfilled his
goal of conveying his knowledge, as well
as inspiring future geriatricians to keep
the torch of understanding of the aging
process burning.
Dr. Zwahlen-Minton is an assistant professor
in the Division of Geriatrics at the University
of New Mexico School of Medicine.
Her address is:
MSC10 5550
1 University of New Mexico
Albuquerque, New Mexico 87131
E-mail: dminton@salud.unm.edu
42 The Pharos/Spring 2009

Life in the Balance: A
Physician’s Memoir of
Life, Love, and Loss with
Parkinson’s Disease and
Dementia
Thomas Graboys, MD, with Peter
Zheutlin
Union Square Press, New York, 2008,
224 pages
The Light Within: The
Extraordinary Story of a Doctor
and Patient Brought Together
by Cancer
Lois S. Ramondetta, MD, and Deborah
Rose Sills
William Morrow, New York, 2008, 272
pages
Reviewed by Jack Coulehan, MD
(AΩA, University of Pittsburgh, 1969)
Once upon a time, pathographies
(i.e., illness narratives) and physician
memoirs were few and far between.
Undoubtedly, the experience of illness
raised existential questions for sufferers
then as now, but the only people
moved to communicate their encounters
with illness for public consumption
were those whose business it was to
do so; clergymen and creative writers,
for example. Likewise, while the occasional
doctor published his memoirs,
the public in general wasn’t consumed
by a passion for reading about medical
exploits. This state of affairs is difficult
for us to imagine today because for
several decades now pathographies and
medical memoirs have been hot items in
the publishing world. In the 1970s and
’80s, many such books concentrated on
anger, exposé, and condemnation, with
physicians telling the terrible truth about
medical training and patients documenting
the inhumanity of American medical
care. More recently, many doctor- and
patient-writers have shifted their attention
to the existential and spiritual
dimensions of medical experience.
Life in the Balance and The Light
Within are interesting, and in some
ways surprising, examples of this recent
“greening” of medical nonfiction.
In both, health care professionals and
medical institutions come across as
good guys rather than villains. And in
both books the major theme is interior
growth. Life in the Balance is the story
of a cardiologist who develops progressive,
disabling illness while at the peak
of his profession. Speaking from the
perspective of patient and doctor, Dr.
Thomas Graboys struggles not only
with the meaning of illness in his own
life, but also with its impact on his patients
and colleagues, and the difficult
decision of when to retire from practice.
The Light Within is co-authored by a
gynecologic oncologist and an ovarian
cancer patient with whom she established
a close personal relationship. This
“extraordinary friendship,” as described
in the book’s subtitle, leads both women
to discover deeper meaning in their
lives and work.
Life in the Balance
An eminent Boston cardiologist,
Harvard professor, and protégé of
Bernard Lown, Dr. Thomas Graboys
developed Parkinson’s disease while
still in his late 50s. Shortly after his
wife died of cancer in 1998, Graboys
noticed unusual fatigue and physical
and mental sluggishness. He naturally
attributed these symptoms to grief.
But they continued, and a couple of
years later he experienced episodes of
stumbling, falling, and syncope. Despite
receiving a permanent cardiac pacemaker,
these symptoms recurred in
2002 around the time of his marriage
to Vicki, a woman he had met a year
or so after his first wife’s death. During
2003 Graboys confided to his diary that
it was “increasingly difficult to express
concepts.” p30 He also noticed tremor,
problems with dictation, and frequent
loss of his train of thought, symptoms
“typical of Parkinson’s.” p24
While Graboys recorded these concerns
in his diary, outwardly he denied
that anything was wrong, even to
family and close friends. He courted
and married Vicki without revealing his
symptoms or explaining their implications.
When a long-time nurse colleague
questioned him about his health, he
replied, “I’m just tired.” p26 In fact, his
denial remained intact until the day in
2003 when the chair of Neurology at
Harvard accosted him in the parking lot
and pointedly asked, “Tom, who is taking
care of your Parkinson’s?” p27
Despite some improvement with
treatment, Dr. Graboys faced an even
more difficult challenge in 2004 when
he developed the vivid, violent dreams
and memory lapses that led to a diagnosis
of Lewy body dementia, a form
of progressive dementia sometimes associated
with Parkinson’s disease. With
the cat out of the bag at last, the author
finally began to confront the issue of
professional impairment. But initially
the confrontation was indecisive. He
wrote a letter telling his patients about
his illness, cut back on his practice, and
even had his neurologist certify that he
The Pharos/Spring 2009 43

Reviews and reflections
“will be able to continue as an effective
physician” p34 Finally, in mid-2005
Graboys’s colleagues had to seize the
initiative themselves. “I was told, gently
but firmly, that it was the unanimous
opinion of my colleagues that I was no
longer fit to practice medicine.” p36
Writing now with the assistance
of journalist Peter Zheutlin, Graboys
reviews these events with unblinking
honesty. He acknowledges his betrayal
of Vicki and the subsequent tension and
distrust in their relationship. He confronts
his anger over being ill and the
prolonged denial that led to personal
and professional isolation. At the same
time, however, the author reveals the
thoughtful, generous, and passionate
side of his character: good friend, loving
husband and father, a man determined
not to give up. At one level he
approaches the challenges of declining
physical and mental ability with Stoiclike
equanimity, while at another level
he maintains fierce determination to
fight as long as he can.
“What will become of me?” This is
the question that now lies at the center
Dr. Graboys’ personal world. He knows
that his loss of mental and physical
control will worsen. With almost superhuman
effort and his family’s strong
support, he has been able to adapt to
his limitations and maintain a sense
of meaning in his life. Will that continue?
In a chapter entitled “End Game,”
he addresses the question of suicide.
Reflecting on his condition, especially
the dementia, Graboys asks, “Will I
lose myself, my very essence, to this
disease?” p161 Yet what end-of-life instructions
should he give to his surrogate
decision makers? “Who is to say
how much dementia is too much to live
with? Who will know what really goes
on in my head when I lose the ability to
communicate?” p166
In the last chapter, Graboys acknowledges
that he has no “simple prescription
that will help you or someone you love
live a life beyond illness, or tell you how
to tap the hope that lives within.” p181
Unfortunately, he then goes on to make
several suggestions of the superficial
advice-manual variety: “Use your family
and friends as motivation to live life
with as much grace as you can muster.”
“Find a safe place . . . to unburden
yourself of anger.” “Acceptance is key
to defusing anger, stress, and self-pity.”
“Use your faith in God, if you believe in
God.” pp181–82
I found the last comment dispiriting.
Up until that point (six pages from the
end of the book), Graboys says nothing
explicit about the role of spirituality in
coping with progressive illness. I use
the term “explicit” here because in my
opinion the kind of existential work the
author describes qualifies as implied
spirituality. So I don’t mind the absence
of transcendent language or revelatory
experience. No, I found the bland Godcomment
disappointing because with it
the author introduces a new character
(God) who plays no role in his plot.
Why toss belief into your recommendations,
if you immediately dispose of
it with such a truism? As noted in the
previous paragraph, perhaps my major
complaint about Life in the Balance is
the disconnect between the engaging
personal story that occupies most of
the book and the advice manual last
chapter. I guess Dr. Graboys felt that he
owed his readers a summary take-home
message. However, he didn’t. Trust me,
his story speaks eloquently for itself.
The Light Within
The same is true, although in a much
different way, for The Light Within. Dr.
Lois Ramondetta was a fellow in gynecologic
oncology at the M. D. Anderson
Hospital in 1998 when she was called one
night to the bedside of Deborah Rose
Sills. Sills, a professor of comparative religion,
had undergone surgery for ovarian
cancer the year before and was now
admitted for small bowel obstruction.
Scheduled for surgery the next morning,
she had refused to drink her laxative
on the basis of being “already empty.” p3
Dr. Ramondetta’s verbal intervention
was successful. So, too, was the surgery,
during which no recurrent cancer was
found. Ramondetta and Sills hit it off
well from that moment on. Their relationship
developed over the next seven
or eight years from doctor-and-patient
to close friendship and eventually coauthorship
of this intriguing memoir.
In the early part of the book, the
women’s stories remain largely independent,
except for medical contacts.
Dr. Lois writes about her early marriage
to a medical classmate, its rapid
unraveling under the stresses of residency,
their infant daughter Jessica,
and subsequently the complexities of
her life as a single mother. (The women
almost immediately begin referring to
one another as “Dr. Lois” and “Deb,”
a practice I’ll adopt here.) Deb’s sections,
printed in italics, tell of a highly
regarded university professor adopting
a strange new life as an cancer patient.
She struggles against reinterpreting
herself as sick. As Dr. Lois writes, “One
of the first things I learned . . . was how
much she disliked to be defined by
her illness.” p31 The women also reflect
on their developing relationship. Deb
writes, “the two of us [are] still dancing
our way around each other.” p79 In
a companion section, Dr. Lois observes
that Deb considers friendship “an ongoing
conversation.” p80
The stories converge as the two become
close friends. Some of their interactions
take place at M. D. Anderson, as
Deb first returns for a phase II clinical
trial that requires a seven-month treatment
protocol, highlighted by a bone
marrow transplant, and later for management
of recurrences and complications.
Their friendship also blossoms in
nonmedical settings, both in Houston
and at Deb’s home in Santa Barbara.
Among the stories they share is that
of Dr. Lois’s courtship and marriage to
Nuri, a local disc jockey. Another is the
rock-solid support of Deb’s family. In
addition, the friends begin to collaborate,
first on a lecture and then on an
academic paper about spirituality and
ovarian cancer. This dialogue eventually
leads to the book itself, completed only
after Deb’s death in 2006.
44 The Pharos/Spring 2009

Dr. Lois relates one sobering incident
in the realm of medical ethics.
Toward the end of her life, when cancer
had obstructed her ureters, Deb
decides against having nephrostomy
tubes inserted to prevent renal failure.
“I’m not going to be medicalized,” she
explains. p168 Deb’s choice comes as a
surprise to Dr. Lois, who by that time
had already been practicing medicine at
least six years: “That conversation was
a real eye-opener for me. With most
patients, I had never thought of this as
a choice.” p168 Not a choice? Hadn’t she
ever discussed forgoing life-extending
therapy with one of her cancer patients?
I would hope that Dr. Lois had
done so before Deb’s case, which occurred
after she had completed several
years of gynecologic oncology practice.
Fortunately, Deb is then offered a stent
rather than an external tube, an option
she accepts, thus making her earlier
decision moot.
Although I found The Light Within
interesting and competently written, I
was disappointed because through most
of the book the spiritual dimension—so
often referred to by its protagonists—
doesn’t come alive. Early in the text
Deb introduces Dr. Lois to Buddhism
and Ram Dass’s teaching, “Be here
now.” Much later, Nuri, her fiancé, is
helping her learn the same lesson: “to
enjoy the present—to be in the now,
as Deb had put it.” p156 In the chapter
entitled “Spirituality and Cancer,” Deb’s
ovarian cancer recurs and the question
“How long do you think I have?” arises.
Dr. Lois observes, with regard to their
friendship, “I began to notice that some
of my fellow oncologists were also being
drawn—sometimes against their
will—into similarly deep and spiritual
relationships.” p167 Yet the narrative contains
few reflections on human dignity,
suffering, or the meaning of illness, and
no attempt to evoke in words the spiritual
experiences the authors refer to.
Thus, I was taken by surprise when
on page 197 I came to the episode where
Deb reads a passage from the biblical
book of Isaiah to Dr. Lois: “The voice
said, Cry. And he said, What shall I cry?
All flesh is grass, and all the goodliness
thereof is as the flower of the field.” My
reaction to this passage was immediate
and visceral. I burst into tears. Not just a
single sob or two, not just a crinkling of
my eyes. No, I literally burst into tears,
feeling a sense of loss and a deep yearning
seemingly unattached to any specific
object. As I read on, a quieter version of
the same reaction occurred at page 218
where Abby, Deb’s adolescent daughter,
thanks her dying mother for being her
mother and for fighting so hard to stay
alive. I’m not sure how to interpret these
reactions, and it is probably unprofessional
for a reviewer to cite tears as data
in a book review. Nonetheless, I acknowledge
them because the spirituality
I was looking for all along seemed to
“click” for me in the last chapter of The
Light Within. The authors’ stories may
appear for most of the book to promise
more than they deliver, but in the end
they come together powerfully and, at
least for me, they triggered a revelatory
experience.
Life in the Balance and
The Light Within are
two very different, but
complementary, memoirs.
Neither is stale or
routine. Each is fresh
and surprising in
its own way. Both
are tales that deserve
our attention.
Dr. Coulehan is a published
poet and author.
He is the book review
editor for The Pharos
and a member of its editorial
board. His address is:
Department of Preventive
Medicine, HSC L3-086
State University of New York at Stony
Brook
Stony Brook, New York 11794-8036
E-mail: jcoulehan@notes.cc.sunysb.edu
Office Hours
A search for disease
Amidst innocent chatter.
Anxious eyes.
Hidden fears.
Disease selects a stranger,
And merges our lives.
Adding me to the broth,
That sustains a life.
Each subsequent visit;
A sip of sustenance,
Cratered in a bowl
Of hope.
Cupped by trembling hands,
The bowl touches lips.
Eyes speak,
“OK to drink?”
Eyes that occupy
My pensive moments.
My morning drive.
My sleepless nights.
Steven F. Isenberg, MD
Dr. Isenberg (AΩA, Indiana University, 1975)
is assistant professor of Otolaryngology—Head
and Neck Surgery at Indiana University School
of Medicine. His address is: 1400 North Ritter
Avenue, Suite 221, Indianapolis, Indiana 46219.
E-mail: sisenberg@good4docs.com.
The Pharos/Spring 2009 45

The World Is Sleeping
3:03 AM. The world is sleeping.
Skin stretched over bones,
her weight pretends to depress the hospital mattress.
These waking hours are unbearable pain.
Writhing and worming in bed,
she digs her own grave.
An exhaust fan sounds like tiny hands clapping.
It makes a wind to kiss the sweat of her hairless skull.
Tumors devour her.
Mitotic spindles dance wildly
a choreographed mayhem.
Her body is indifferent to a half-empty syringe.
Blood vessels protrude from her arms,
calling Morpheus to ease her through—
memories of 96 years need more than minutes to pass.
Neon lights buzz to reveal her.
A steady pulse barks out to the stethoscope.
A needle prick, a rose blooms—
a red flash hardens to crimson.
Her heart is now a blood-soaked sponge.
Each contraction rattles and cracks her crusted ribs.
Minutes pass. Time slows.
3:17 AM. The world is sleeping.
Michael R. Bykowski
Mr. Bykowski is a member of the Class of 2011 at The University of Pittsburgh
School of Medicine. His address is: 2158 Fairland Street, Pittsburgh, Pennsylvania
15210. E-mail: bykowski.michael@medstudent.pitt.edu.
46 The Pharos/Spring 2009

Announcing the 2009 Alpha Omega Alpha
Robert J. Glaser Distinguished Teacher Awards
These awards are based on a national competition conducted
annually through the offices of the deans of U.S.
and Canadian medical schools, and are designed to recognize
distinction in medical student teaching. Each school
may submit one application. Recipients are selected by a
committee jointly appointed by ΑΩΑ and the Association
of American Medical Colleges (AAMC).
Up to four faculty awards of $10,000 each are made.
In addition, each award winner’s nominating institution
receives $2,500 for teaching activities. If that school has
an ΑΩΑ chapter, a $1,000 stipend is awarded toward its
activities.
Nomination materials for 2009 have been sent to every
medical school by the AAMC, which administers all aspects
of the competition. The deadline for nominations is
May 1, 2009. Information and nomination forms are available
at www.aamc.org/about/awards/aoa.htm. Queries
regarding nominations should be addressed to Henry
M. Sondheimer, MD, at the AAMC, 2450 N Street, NW,
Washington, DC 20037-1127; telephone (202) 828-0680;
e-mail: hsondheimer@aamc.org.
The awards will be presented during the annual meeting
of the AAMC in Boston, November 6–11, 2009.
Minutes of the 2008 meeting of the board of
directors of Alpha Omega Alpha
The meeting in Menlo Park, California, was convened at
8:30 am by President Rae-Ellen Kavey, MD.
Present were: Secretary-Treasurer C. Bruce Alexander,
MD; member at large N. Joseph Espat, MD; President Rae-
Ellen Kavey, MD, MPH; member at large Douglas S. Paauw,
MD; councilor member Robert G. Atnip, MD; medical organization
member John Tooker, MD; Executive Secretary
Edward D. Harris, Jr., MD; Assistant Treasurer William F.
Nichols; and national office members Mara Celebi, Ann
Hill, Debbie Lancaster, and Carol Wong. Participating by
conference call were Vice President Donald Wilson, MD,
and student member Natalia Berry.
Absent and excused were: members at large Michael V.
Drake, MD, Ruth-Marie Fincher, MD, Don W. Powell, MD,
and Joseph W. Stubbs, MD; councilor members Eric P. Gall,
MD, and Amy Goldberg, MD; student members Smeeta
Sinha and Kara Cavuoto.
The minutes of the 2008 meeting of the board of directors
were reviewed and approved.
New board and honorary members
Nominations for the 2008/2009 board of directors slate
were reviewed and voted upon. Elected to a three-year
term as member at large: Robert Atnip, MD, Pennsylvania
State University. Re-elected to three-year member-at-large
terms: C. Bruce Alexander, MD, University of Alabama at
Birmingham; Donald B. Wilson, MD, Director, Minority
Health & Health Disparities, Owings Mills, Maryland. Elected
to a three-year term as councilor member: Anne Mancino,
MD, University of Arkansas School of Medicine. Elected to a
three-year term as student member: Cason Pierce, University
of Texas Southwestern Medical School at Dallas.
Honorary member nominations were reviewed and
voted upon. Elected to honorary membership were: Lihadh
Al-Ghazali, MBChB, MRCP, FRCP, FRCPCH, United
Arab Emirates University, Al Ain, United Arab Emirates;
Rodolfo A. Armas-Merino, MD, MACP, University of Chile,
Santiago, Chile; Kai-Ming Chan, MBBS, FRCS (Edin.),
FRCPS (Glas.), FHKCOS, FACS, The Chinese University
of Hong Kong, Hong Kong Special Administrative Region,
People’s Republic of China; Ronald Dorfman, MBBCh,
FRCPath, emeritus professor of Pathology, Stanford
University School of Medicine, Stanford, California;
Ogabara K. Doumbo, MD, PhD, University of Mali, Bamako,
Republic of Mali; Torello Lotti, MD, University of Florence,
Florence, Italy; Prof. Dr. med. Dr. H. C. Thomas Ruzicka,
Ludwig-Maximilian University, Munich, Germany; K. V.
Thiruvengadam, BSc, MD, FRCP, FAMS, DSc, FCCP (US),
FCAI, Madras Medical College, Chennai, India; Nuria M.
Greenfield Tortosa, MD, University of Panama School of
Medicine, Panama City, Panama.
Reports of officers and programs
Reports of the president, executive secretary, and managing
editor were presented, followed by reports on the
programs the national office administers.
Ms. Celebi and Ms. Wong presented the report on online
registration of new members. The board decided in
2006 to require registration of new members on-line:
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dues to support AΩA programs.
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The Pharos/Spring 2009 47

National and chapter news
may only be inducted into the Society after the membership
fees to the local chapter [if any] and to the national
AΩA office have been paid.”
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AΩA web site, which the national office will use increasingly
for communication with members.
The new registration procedures resulted in 96 percent
of all nominees having paid dues as of August 2008, compared
with 38 percent at the same point in 2007, before the
new registration procedures took effect.
The board unanimously approved the following statement
regarding nonpayment of dues by students elected
to AΩA:
As established in the AΩA Constitution (Article IV,
Section 2f), a student chosen for membership in AΩA
“. . . may only be inducted into the Society after the
membership fees to the local chapter and to the national
AΩA office have been paid.”
The AΩA Board of Directors established at its annual
meeting in October 2007 that all new member dues
must be paid through a process of online registration
using the AΩA website, effective with all subsequent
chapter elections. This process has been successful at
enrolling 97% of new members over the past 12 months.
Students who do not initially pay their dues receive
reminders from the National Office, both in person and
through their AΩA Councilor.
By unanimous vote, the AΩA Board now reaffirms
that AΩA membership will not be granted to any student,
who after a reasonable process of notification, has
failed to satisfy the dues requirement prior to September
1 of the year of graduation. After that date, a final letter
of non-election will be sent to the Councilor and to
the Dean of the medical school. It is expected that the
Councilor will then make appropriate efforts to notify
the candidate of his/her status.
This action of non-election as a student will not
preclude any candidate from future election to AΩA in
other defined membership categories.
Dr. Alexander and Mr. Nichols presented the financial
review. AΩA’s financial health continues strong in spite of
the problems in the stock market. The change in registration
procedure resulted in a small improvement in dues
income. National programs accounted for $1.27 million in
actual expenses for the 2007/2008 fiscal year.
New initiatives
The proposal for the Professionalism Fellowship was
discussed and approved. Announcement of the fellowship
was sent to all chapter councilors and deans of schools of
medicine having active AΩA chapters.
A survey of medical students was completed. The survey
sought to determine:
1. Student awareness of AΩA as an organization: Is the
student familiar with AΩA? Does the student understand
its function as a medical honor society?
2. Student understanding of AΩA: Does the student
know about AΩA opportunities within chapters and nationally?
3. Student perception of AΩA: Is the student associated
with AΩA? Is AΩA a negative or a positive influence?
Should honor societies exist in medical training?
4. Visibility of AΩA on campus.
The survey was designed and conducted by student
member Natalia Berry of Dartmouth Medical School with
the input of marketing professor Jackie Luan at the Tuck
School of Busines at Dartmouth. Two groups of students
were surveyed: junior AΩA students and a broader group
of AΩA and non-AΩA students.
Almost 200 third-year students, elected as juniors,
completed the survey, as did an additional fifty senior
students. Names and medical schools remain anonymous.
Most reported first hearing about AΩA from elected students.
Those reporting recognized scholarly achievement
(95%) and professionalism/leadership/service (82%) as the
primary functions of AΩA. Forty-seven percent listed help
in obtaining a residency as a primary function. Of these
elected students, 41% believed that AΩA was active and
visible at their school. Of the small number of elected students
(2% of those responding to the survey) who felt that
there was no appropriate role for a honor medical society,
the principal reasons were that it increased stress and pressure
and competition. The attributes of membership most
important to recently elected junior students were help
with residency match (77%) followed by prestige. A number
of written comments indicated that the lack of visibility of
AΩA on campus resulted in the organization appearing as
if it were a secret society.
Presentation by Stanford Alumni Consulting Team
AΩA’s board of directors decided at its 2007 board
meeting to investigate ways to increase AΩA’s visibility,
both in medical schools and generally, to enhance existing
programs, and to generate revenue for additional
important programs. A group of alumni from the Stanford
University Graduate School of Business, the Stanford
Alumni Consulting Team (ACT), provides pro bono management
consulting services to nonprofit agencies. The
group presented its report to the AΩA board of directors
at this meeting. The board has taken ACT’s proposals under
advisement and will implement selected recommendations
over the next several years.
48 The Pharos/Spring 2009

I Am the Patient
I give my name,
Take a seat.
It feels odd from this vantage.
They call me Ms., ask me in.
This is my turf, but I’m not in charge.
Today I am the patient.
My vitals taken,
I sit, ill at ease not being in charge.
There’s a reason I sought that degree.
The doctor comes in,
Asks my complaint.
I try to be helpful, descriptive,
Though I don’t enjoy being vulnerable,
Or asking for my needs to be met.
I need to be the patient.
My visit almost complete,
I recheck—did I miss anything?
“I hope you feel better,” my physician offers
And I thank him for seeing me as a walk-in.
God, I just hope the cough will ease tonight
And I can get some rest.
I pay my copay,
Get my prescriptions and note for work.
“Oh, you’re a doctor,” the receptionist notes.
I smile.
Not today.
Suzanne Minor, MD
The Pharos/Spring 2009 49
Dr. Minor (AΩA, University of Miami, 2001) lives in Florida. Her address is
16555 NW 25 Avenue, Opalocka, Florida 33054. E-mail: suzieminor@aol.com.

Letters to the editor
Locked-in syndrome
I enjoyed the review of The Diving
Bell and the Butterfly by my friend and
classmate Peter Dans in the Autumn
2008 issue of The Pharos. I would
agree with his characterization of the
film as outstanding and, as a neurologist,
I found the depiction of a patient
with the locked-in syndrome quite
accurate. The protagonist showed
remarkable inner strength and intelligence
despite his desperate condition,
being unable to move or speak and
only able to communicate with eye
blinks. Bauby, the patient, had a contract
to write a feminine counterpart
of The Count of Monte Cristo, presenting
a powerfully ironic situation,
as its author, Alexandre Dumas, père,
penned the first literary depiction of a
person with the locked-in syndrome in
this novel. Whether or not the screen
writer knew this is not clear.
The description of “the paralytic,”
who was in this state for six years, is as
follows:
M. Noirtier, although almost as immovable
and helpless as a corpse,
looked at the new-comers with a
quick and intelligent expression . . .
Sight and hearing were the only
senses remaining, and appeared
left, like two solitary sparks, to
animate the miserable body which
seemed fit for nothing but the
grave. The speaking eye sufficed
for all. He commanded with it; it
was the medium through which his
thanks were conveyed. 1
As in the movie, there were
several people who learned to
communicate with Noirtier by
attempting to interpret his
eye blinks. His granddaughter
Valentine,
however, worked
out a system much like that used by the
speech pathologist in the film. She first
recited the letters of the alphabet until
Noirtier indicated that the first letter of
the word he wanted was reached. The
second letter of the word was than determined
the same way. Valentine then
held up a dictionary and ran her fingers
down the columns until her grandfather
signaled that she was at the word
he wanted.
Although rare, the locked-in syndrome
occurs often enough that it
needs to be considered in the differential
diagnosis of any patient who has
no voluntary movements but seems to
have some level of wakefulness. These
patients are individuals with whom reliable
communication can be achieved,
unlike patients with coma, the chronic
vegetative state, or conditions associated
with minimal consciousness.
The same careful assessment needs
to be applied to children, as the syndrome
has been reported in pediatric
patients. 2 Patients with amyotrophic
lateral sclerosis and some other neuromuscular
conditions can eventually
become locked-in, but this does not
occur calamitously as in the case of a
stroke or traumatic brain injury.
References
1. Dumas A. The Count of Monte Cristo.
Chapter 39, M. Noirtier de Villefort.
2. Golden GS, Leeds N, Kremenitzer
MW, Russman BS. The “locked-in” syndrome
in children. J Pediatrics 1976; 89:
596–98.
Gerald S. Golden, MD
(AΩA, Columbia University College of
Physicians & Surgeons, 1961)
Anatomy—with or without a
cadaver
It was a pleasure to read the
Autumn 2008 issue of The Pharos.
I read with great interest the article,
“Bring out your dead?” by W. Roy
Smythe (pp. 10–15). In Nepal, dissection
is a necessary component of the
gross anatomy curriculum for medical
students. Students dissect certain
regions of the body and are shown
prosected specimens of other regions.
During the practical examinations, students
do not have to dissect the human
body but are shown prosected specimens
and identification of individual
structures followed by a viva voce with
the examiner.
In Nepal, the basic science subjects
of anatomy, physiology, biochemistry,
pathology, microbiology, and pharmacology
are taught in an integrated
organ system-based manner during
the first two years of the undergraduate
medical (MBBS) course. A survey
was carried out in a medical school in
western Nepal to study the emotional
impact of cadaver dissection using the
appraisal of life events (ALE) scale. 1
The loss, challenge, and threat scores
were compared initially on first exposure
to dissection and at the time of
the study. The loss and threat scores
declined over the course of study. The
loss and threat scores were lower than
that reported previously. The challenge
scores were higher. Majority of students
considered anatomy dissection as
a significant positive life experience.
The December 2004 issue of the
magazine The Clinical Teacher had
an interesting article about how a new
medical school in the United Kingdom
teaches anatomy without cadavers. 2
The department decided that they
would rely on living anatomy and
medical imaging. Peer examination, life
models, body projection, body painting,
digital surface anatomy atlases,
computer models, and simulations are
among the various methods used. A
major disadvantage of dissection ac-
50 The Pharos/Spring 2009

cording to the authors is that the color,
texture, and smell of a cadaver is not
like real life and cadavers cannot be
auscultated, palpated, or usefully asked
to change position. 2
I am a medical educator and the
medicine program coordinator in my
medical school, and am interested in
strategies to deal with the knowledge
explosion in medicine. These days
knowing “what not to teach” according
to me is as important as knowing what
to teach. A possible problem is that
anatomists and anatomy teaching have
concentrated on the requirements of
surgeons and surgical specialties. The
majority of medical graduates will not
be surgeons and the anatomical knowledge
they need and the way they approach
the body may be quite different.
During my undergraduate days I
was taught the detailed relations of
various nerves and blood vessels. I do
not remember any of that now and
also did not find it useful in practice.
I personally feel that the procedures
like peer examination, body projection,
and other methods adopted in the U.K.
school 2 will equip students with a more
relevant knowledge of anatomy. A doctor
while doing a physical examination
(palpation) should be able to visualize
what structures lie underneath the
examining hand and should also know
about the surface anatomy of different
organs. With the widespread availability
of CT scans and MRIs cross-sectional
anatomy is becoming more important.
In my undergraduate days, anatomy
was taught in a traditional manner and
was not clinically oriented. Dissection
may be useful in that it is a group activity
and learning takes place in consonance
with adult learning principles.
Students can also be introduced to
death in a sensitive manner. However,
this objective was not fulfilled during
my undergraduate days. Most medical
schools in South Asia do dissections
as a mechanical activity which is mandatory
as it has been included in the
curriculum. I feel medical educators
and doctors other than anatomists and
surgeons should also be engaged in the
important issue of curriculum design.
This may also be required for other
basic science subjects. Their broader
and more holistic viewpoint can have
a significant impact on the narrower
viewpoint of subject experts resulting
in a more relevant curriculum.
Anatomy describes the setting of
events, as rightly pointed out by the
author. The questions are what methods
to use to teach and learn about the
body and to what depth to teach and
which details are necessary and which
are irrelevant and may be omitted.
The guiding principle I feel is that the
undergraduate course in most parts of
the world prepares the student for a
career as a primary care physician. The
teaching of all subjects should keep
in mind this important fact. Facts and
details needed for various postgraduate
courses can be better taught during the
particular course and not during the
undergraduate days!
References
1. Vijayabhaskar P, Shankar PR, Dubey
AK. Emotional impact of cadaver dissection:
a survey in a medical college in western
Nepal. Kathmandu Univ Med J 2005;
3: 143–48.
2. McLachlan JC, De Bere SR. How we
teach anatomy without cadavers. The Clinical
Teacher 2004; 1: 49–52.
Dr. P. Ravi Shankar
Department of Medical Education
KIST Medical College
Lalitpur, Nepal
AΩA membership—more than
high GPA
In recent years, the Gamma AΩA
chapter at UT Southwestern had been
making student nominations based
strictly on GPA, and individuals were
only nominated during their senior
year of medical school. Last year, the
chapter leadership made two important
changes in its selection process.
First, selection criteria were changed
to incorporate leadership, research,
and service activities as outlined in the
AΩA Constitution. Second, for the first
time in over a decade, members were
nominated from the junior class.
The benefits of making these two
minor changes in the selection process
have been tremendous. Weighing
leadership, research, and community
service in the selection process better
insures that student members have the
skill set and commitment necessary
to foster a dynamic organization. By
selecting a small group of members
and student officers prior to the fourth
year, the organization’s leadership has
had more time to identify and organize
projects that serve the community and
that boost the visibility of the organization
and its ideals on campus.
After their selection last spring, the
student officers met with the chapter
councilor, executive committee, and
outgoing student officers. Following
this meeting, the new officers together
came up with ideas for several new
programs designed to improve the
university community, serve the community
at large, and strengthen the ties
of its faculty and former student members.
The officers then organized a
meeting with the newly-selected junior
AΩA members to discuss these project
ideas, identify those ideas with the
most member support, and delegate
responsibilities for development and
implementation.
The AΩA student leadership and
members identified several opportunities
to provide service to the university
community. The organization made
one of its goals to encourage a collegial
atmosphere among medical students.
To achieve this goal, AΩA worked with
the university administration to create
a program where each of the forty
AΩA members serves as a mentor to
the small groups of first- and secondyear
students within the newly created
UTSW Colleges. These mentors
provide support by assisting with instruction
in performing different components
of the physical exam, working
with students to improve their patient
The Pharos/Spring 2009 51

Letters
write-ups, providing encouragement
and advice regarding Step 1 preparation
and the residency application process,
and by hosting their small groups of
students for dinner. AΩA plans to
make this partnership a cornerstone of
its service activities and is working to
improve the overall experience for all
of the involved parties.
In addition, the chapter leadership
felt that, given the academic success of
its members, the group was in a unique
position to offer advice on study
habits and exam preparation to first-
and second-year medical students.
Several AΩA members developed a
survey instrument and polled their
fellow members to determine those
study methods and resources most
consistently utilized. They then incorporated
this information into several
Powerpoint presentations and shared
it with first- and second-year medical
students during a series of lunch workshops.
Several other members are still
working to create a similar resource for
second-year students related to Step 1
and wards preparation.
The chapter community service
project involved partnering with a local
nonprofit organization to provide free
sports physicals for the school-aged
children of north Dallas. AΩA student
members advertised the event, helped
with patient intake and discharge,
and conducted physicals with appropriate
faculty supervision. Physician
volunteers were recruited from the
local AΩA faculty. In total, the group
saw sixty-nine patients during a single
Saturday morning in early September.
AΩA plans to make this community
service activity an annual event.
Moreover, the officers felt it important
to strengthen the relationship
between AΩA faculty, former student
members, and current members. They
contacted all current AΩA faculty
members and asked for responses from
those willing to serve as mentors to
student members. They then compiled
this list of mentors, organized it by
area of medical specialty, and made it
available for all of its student members.
The organization is also working to
acquire contact information for alumni
members so they can be made aware of
the various chapter activities.
To further improve visibility and
communication within the organization,
the student leadership has made
a significant effort to update and improve
its chapter website. The new
website features information about
the various AΩA activities, a list of all
current faculty AΩA members, those
faculty members willing to serve as
mentors for AΩA members, and all
recent student members. It also contains
downloadable copies of the “study
tips” documents, the current selection
process, and the AΩA Constitution.
The chapter has also produced the first
edition of what it hopes will become a
biannual chapter newsletter for distribution
to faculty, student, and alumni
members.
Several forces are responsible for
this rapid and significant revitalization
of the UT Southwestern Gamma
Chapter. Strong faculty and administration
support has been crucial.
However, the main driving force for
these recent changes has been greater
opportunity for student leadership and
greater student member involvement.
This enhanced student involvement
stems directly from the recent changes
in member selection. We encourage
other chapters to re-examine their selection
processes and the organization
of their student leadership so that they
may better contribute to their local institutions,
better serve their local community,
and better promote the ideals
of the national organization
Cason Pierce, Chapter President,
Gamma Texas
(AΩA, University of Texas
Southwestern Medical School, 2008)
Dallas, Texas
Editor’s note
Prior to receiving Mr. Pierce’s letter,
we sent out a reminder of AΩA selec-
tion principles to each chapter councilor,
and requested responses from
each about his or her own chapter
processes:
Most chapters do indeed follow
the guidelines in the constitution
(Article IV, section 2) that stipulate
that from the upper 25% of the class
expected to graduate, one sixth of
the total number may be nominated
for membership. Up to one
half of the total may be nominated
in the spring of the junior year.
Those chosen for nomination from
the upper quartile by the following
guideline (IV.2.c): “Scholastic
achievement should be the primary
but not sole basis for nomination
of a student. Leadership capabilities,
ethical standards, fairness in
dealing with colleagues, potential
for achievement in medicine, and
a record of service to the school
and community at large should be
criteria in addition to the academic
record.”
There are several important
points to stress: One is that
“nomination/nominated” replaces
“election/elected” because students
(or faculty, residents, alums) nominated
are not full members until
they have registered online and
paid first-year dues or lifetime dues.
Another is that within the context
of the constitution, each chapter is
free to weight these less objective
criteria (perhaps best summarized
by the term “professionalism”) as it
chooses.
The message is a simple one:
Those chapters that choose nominees
for membership using only
the Grade Point Average are in
violation of the constitution, and
must change. The evaluation of
the subjective criteria does not sit
squarely on the the shoulders of
the councilor. Fellow students (e.g.,
when elected juniors are considering
seniors) and, most important,
faculty member assessments, are
very important to gather. Members
52 The Pharos/Spring 2009

of numerous chapters have noted
that the selection meetings have
been very rewarding interactive
experiences when input from many
voices is heard.
Edward D. Harris, Jr., MD
Editor
Poetry—perhaps best read
aloud
I enjoyed reading your editorial, “It’s
not a word I can put into feelings,” in
the Spring 2008 issue of The Pharos.
My older brother, Professor John
Pick (born September 18, 1912), graduated
maxima cum laude from the
University of Notre Dame in 1933. He
Significant Other,
Late in Life
we came together
late in life
two rivers mingling
where each had been
apart and unaware
now flowing
as one
our bond
holier than holy
impossible to rend
bound for
a common sea
Eric Pfeiffer, MD
then earned his PhD at the University
of Wisconsin under tutelage of Helen
C. White, PhD. He was editor of
Renaissance, the Catholic Literature
Critique, for at least twenty years.
He taught graduate students various
branches of English, but always insisted
on teaching one undergraduate course
in grammar, rhetoric, etc., so that he
might keep up with any changes in
punctuation, rules of paragraphing,
etc., which helped him as an “editor.”
He enjoyed teaching poetry, but his
specialty was the Victorian novel.
My reason for writing was to point
out that John always insisted his students
read poetry aloud, as a recitation,
and I note your various editors have
Dr. Pfeiffer (AΩA, Washington University in St. Louis, 1960) is a member of the editorial
board of The Pharos. His address is: 3120 W. Hawthorne Road, Tampa, Florida 33611. E-mail:
epfeiffe@health.usf.edu.
also emphasized this. It makes sense,
and emphasizes the real fundamentals
of poetry by the auditory sense of the
rhymes and rhythms of any language.
All readers need to be reminded of this
essential, because it leads to a greater
appreciation of poetry as a means of
communication.
I have been leafing through my collections
of The Pharos from over the
many years, and have been surprised at
the variety and frequency with which
you have promoted poetry. Thanks.
James W. Pick, MD, MS
(AΩA, Northwestern University, 1938)
Shorewood, Wisconsin
Erica Aitken
The Pharos/Spring 2009 53

Alpha Omega Alpha elects
honorary members
Individuals who have contributed sub-
stantially to medicine and fields related
to medicine, but who are not eligible
for membership in A!A as graduates of
a medical school with an A!A chapter or
as a faculty member of a medical school
maintaining an active A!A chapter, may be
nominated for honorary membership by any
active member of the society. In 2008 Alpha
Omega Alpha’s board of directors extended
invitations to the following distinguished
physicians and scientists.
Edward D. Harris, Jr., MD
Executive Secretary
Lihadh Al-Gazali, MBChB, MRCP, FRCP, FRCPCH
United Arab Emirates University, Al Ain, UAE
Dr. Al-Gazali, a British citizen born in Baghdad, Iraq, is
Professor in Clinical Genetics and Paediatrics in the Faculty
of Medicine and Health Sciences at Al Ain, United Arab
Emirates. She graduated from Baghdad Medical College
and went on to receive pediatric and genetics credentials in
England and Scotland. Her goal in research is to identify and
delineate genetic disorders that are prevalent in the UAE and
Arab populations. Her group and collaborators internationally
have identified more than a dozen recessive genes and has
mapped four of these. Crucial for her research has been her
establishment of a Registry for Birth Defects in the UAE. Her
teaching expertise benefits both
pediatric clerks and sub-interns,
and she was honored with the
Distinguished Performance Award
at UAE University. She is a Fellow
of the Royal College of Physicians
of Ireland and the Royal College
of Pediatrics and Child Health,
United Kingdom. She is the winner
of the 2008 L’Oréal-UNESCO
award for women in science for
Africa and Arab States.
Rodolfo A. Armas-Merino, MD, MACP
University of Chile, Santiago, Chile
Dr. Armas-Merino is a Professor of Medicine at the
University of Chile, and a gastroenterologist at the Hospital
San Juan de Dios in Santiago. He served as the Chairman of
the Department of Medicine at the University of Chile from
1984 to 1994, and has been a Member of the Council of the
Faculty at the University of Chile. In addition, he has been a
member of the Editorial Board of the Revista médica de Chile
and of Gastroenterologia y Hepatologia (Barcelona, Spain).
Professor Armas-Merino has held many other academic
and administrative positions in his career, including the
Presidency (1986 to 1996) and Vice Presidency (1982 to
1987) of the Superior Council of the Chilean Corporation
for Certification of Medical Specialties; membership in the
Council for the Technological Development of the Chilean
Commission for Research in Science and Technology; a member
of the Chilean Council for Research in Health since its
foundation in 2003, and Vice President since 2007.
He has served on a number of International Committees
and belongs to many professional societies, including the
Sociedad Médica de Santiago (President from 1983 to 1985);
Colegio Médico de Chile serving as a Member of the Santiago
Regional Council from 1969 until 1973, and the National
Council from 1973 until 1975. In 1982 he became a Fellow
of the American College of Physicians and served as the
Governor of the ACP Chile Chapter from 1996 until 2000, and
has been a member of the Chapter Council from 1994 until
2008. He was made a Master of the ACP in 2001. He joined
the Chilean Society of Gastroenterology in 1968 and was the
Director from 1975 until 1990, he has been a member of the
Chilean Academy of Medicine since 1989, was Treasurer from
54 The Pharos/Spring 2009

2001 to 2008, and became the Academy Secretary in 2008.
He was President of the Chilean Society of Medical Societies
since its foundation in 2000 until 2007. Professor Armas-
Merino is held in the highest professional esteem in Chile and
internationally.
Kai-Ming Chan, MBBS, FRCS (Edin), FRCPS (Glas),
FHKCOS, FACS
The Chinese University of Hong Kong
Hong Kong
Dr. Chan is Professor and Chair of the Department of
Orthopaedics and Traumatology at the Chinese University of
Hong Kong, and director of both the Hong Kong Centre of
Sports Medicine & Sports Science and the WHO Collaborating
Centre for Sports Medicine at his university. As a mentor/
teacher he has overseen thirty graduate students, and his
funded grants during his career have, to date, totaled almost
$14 million. He has written 196 papers published in peerreviewed
journals, been an editor or co-editor of twenty-five
books, written fifty-two book chapters and assembled 570
conference proceedings. International recognitions of his
energy and accomplishments have included membership on
the International Steering Committee of the WHO-endorsed
Bone and Joint Decade, and being elected president of the
International Federation of Sports Medicine (2002 to 2006).
He is a Fellow of the American College of Surgeons and a
member of the American Academy of Orthopaedic Surgeons
and the American College of Sports Medicine. In 1995 he
was honored by being named an OBE, Officer of the Most
Excellent Order of the British Empire.
Ronald F. Dorfman, MBBch,
FRCPath
Emeritus Professor of
Pathology, Stanford University
Ronald Frederick Dorfman
is an Emeritus Professor of
Pathology at Stanford University
School of Medicine and one of
the most noted hematopathologists
in the world. He is a South
African graduate of the University
of the Witwatersrand and
Medical School in Johannesburg.
His pathology training was at the
South African Institute for Medical Research in Johannesburg.
His major interest for nearly fifty years has been in diseases
of the lymphoid system, making early major contributions
to the role of enzyme histochemistry in the understanding
of Kaposi’s sarcoma and, after moving from South Africa to
Washington University in St. Louis in 1963, reporting the first
case of Burkitt’s lymphoma outside of Africa. During the
same period, he and his colleague Juan Rosai described what
has become the well-recognized entity of sinus histiocytosis
with massive lymphadenopathy commonly referred to as
“Rosai-Dorfman Disease.”
He was recruited to Stanford University in 1968 and,
for thirty-five years co-directed the Laboratory of Surgical
Pathology. During this time, he was a major participant in
seminal clinicopathologic studies of Hodgkin’s disease and
other lymphomas carried out at the University. He was, as
well, one of six expert pathologists involved in a worldwide
study that eventuated in “The Working Formulation of non-
Hodgkin Lymphomas for Clinical Usage.” He is the author of
over 170 peer-reviewed publications and many book chapters
and has trained more than a generation of hematopathologists
including Dr. Roger Warnke who is the current Ronald F.
Dorfman, MBBCh, FRCPath, Professor of Hematopathology
at Stanford University.
Ogabara K. Doumbo, MD, PhD
University of Mali
Dr. Ogobara Doumbo has been the Director of the Malaria
Research and Training Center in Bamako, Mali, since its inception.
He is also Chair of the Department of Epidemiology
of Parasitic Diseases at the University of Mali. Awarding him
honorary membership in AΩA recognizes his excellence in
service through the Malaria Research and Training Center
(MRTC).
The MRTC is a collaborative effort between the staff of
the Faculty of Medicine, Pharmacy and Odonto-stomatology
(FMPOS) and the National Institutes of Health (NIH) in the
United States. This program has also received significant support
from a number of USAID programs including the USAID
Mission in Bamako. This is a uniquely African operation in
which the work is planned, directed, and executed by the local
staff.
In March 1998, President Clinton recognized the MRTC
and made a promise for continued support. A site visit in
October of 2007 clearly demonstrated that the MRTC presence
and its protocols in the treatment of malaria have upgraded
the health of the region under the leadership of Dr.
Doumbo. Dr. Doumbo has contributed hgreatly to the health
of the citizens of Mali and the success of the MRTC. The basic
tenet of AΩA is to be “Worthy to serve the suffering,” and Dr.
Doumbo certainly fulfills this mission.
Torello Lotti, MD
University of Florence, Florence, Italy
Torello Lotti graduated from the Universita di Firenze and
specializes in Dermatology. He is a Professor in the Faculty of
Medicine at the University of Florence. He embodies the spirit
of AΩA. In addition, Torello is a force in organized dermatology
in America and worldwide. He is acknowledged internationally
as an expert clinician. He has the titles of Visiting
Professor at three American medical schools (Bowman Gray,
The Pharos/Spring 2009 55

Honorary members
Medical University of South Carolina, and the University of
Louisville), and is an honorary member of eight international
dermatology societies. He is the founding editor of Journal of
the European Academy of Dermatology.
Prof. Dr. med. Dr. H.C.
Thomas Ruzicka
Ludwig-Maximilian
University, Munich,
Germany
Prof. Dr. med. Dr. H.C.
Thomas Ruzicka, Professor
and Head of Dermatology at
Ludwig-Maximilian University
in Munich, exemplifies the attributes
we expect of AΩA
honorary members, being a
respected leader in academic
medicine who cements with
towering leadership the academic excellence of what may be
the finest dermatology department in the world. Professor
Ruzicka is an internationally renowned authority on atopic
dermatitis with more than 500 full articles and a number of
highly regarded books. He has led world dermatology with
aplomb, beginning a new Munich tradition that has attracted
English speakers in the same way that the Fortbildungswoche
für praktische Dermatologie und Venerologie has been a magnet
for German-language physicians to update their medical
knowledge. His life exemplifies academic excellence, clinical
acumen, and inspirational teaching at all levels with a warmth
and graciousness that marks him in the first order of wonderful
human beings.
K. V. Thiruvengadam, BSc, MD, FRCP, FAMS, DSc,
FCCP (USA), FCAI
Madras Medical College, Chennai, India
KVT, as he is popularly known, is in his eighty-second year,
having enjoyed an outstanding academic record as Professor
and Head of the Department of Medicine at Madras Medical
College in Chennai. Earlier he had a distinguished academic
career at the Stanley Medical College, Chennai, India, as the
best outgoing student of the college and also of the University
of Madras in 1950.
KVT’s primary areas of expertise have been clinical allergy,
infectious diseases, and occupational medicine.
For the past nearly fifty-three years he has focused his
attention on teaching undergraduates and postgraduates—
for nearly thirty-one years in the State Medical Service and
later in private medical institutions for nearly twenty years
to date. Indeed, KVT is a legendary teacher at the bedside,
in small groups, and the lecture hall, and was recognized by
the Medical Council of India with the Dr. B.C. Roy award
for eminent medical teacher. His medical school alma mater,
Stanley Medical College, honored
him with the Star of
Stanley Medal. Many of his
former students have distinguished
themselves in India,
the United States, the United
Kingdom, and elsewhere.
A prize in his name was
established at Stanley for
the senior student graduating
with the highest GPA in
both physiology and medicine.
Lectureships in his name
were instituted at Madras
University and Madras Medical College. An award in his name
was established by the Rotary Club of Chennai.
Along with his teaching efforts, KVT has published more
than 100 peer-reviewed papers. He has given a number of
prestigious lectures on chest diseases, allergy, and internal
medicine. He served as Regent of the College of Chest
Physicians of India, and is a Fellow of the Royal College of
Physicians, Edinburgh.
KVT has been Honorary Physician to the President of
India. The government of India bestowed on him the honorific
“Padma Sri” in 1981.
Nuria M. Greenfield
Tortosa, MD
University of Panama School
of Medicine, Panama City,
Panama
Nuria M. Greenfield
Tortosa just completed
four years as Governor of
the American College of
Physicians for Panama and
has done a remarkable job as
advocate for outstanding patient
care and raising the level
in quality of care in her country. She went to medical school
at the Faculty of Medicine at the University of Panama, graduating
in 1969. She did her internship at the Hospital Santo
Tomas in Panama and then a rural internship at Area Sanitaria
de David, Panama, followed by her residency in Internal
Medicine and a residency in Nephrology. She has served as a
Clinical Professor at the University of Panama since 1993 and
an Adjunct Professor in Internal Medicine at the University of
Guadalajara. She served as the president of the Panamanian
Society of Internal Medicine from 1995 to 1997, and as governor
for the American College of Physicians, Panama Chapter,
from 2004 to 2008. It is hard to convey the importance of this
person to her country’s medical establishment. Dr. Tortosa has
an energy that lifts everyone around her.
56 The Pharos/Spring 2009

Full Nelson
Under the state tournament banner
He wears a wrestler’s
String bikini helmet
And a singlet whose leg holes
Reveal two stumps
Emerging like wary prairie dogs
From their underground dens
As he balances his torso
On truncated arms
That lost necrotizing hands
Twelve years ago.
To me he seems half a man
Until I see him in his circle
Where he escapes my limiting hold—
Reversal—
Just as he did the nights of tears
And the endless days of “stumpy” and “freak”
To place me beneath him
Like the struggling wrestler
Wrapped in his twitching elbows,
Twisting on the mat
Whose painted circle
Belies the geometry of this man,
Complete in his abridgement,
A four limb amputee
Who is both beast and being
In his victorious, gymnasium roar,
A mouth stained red
In the invigorating blood
Of a long-awaited kill.
Jason David Eubanks, MD
The author (AΩA, Case Western Reserve
University, 2003) is a Spine Fellow in the
Department of Orthopaedics at the University
of Pittsburgh. His address is: 36901 Beech Hills
Drive, Willoughby Hills, Ohio 44094. E-mail:
jdeubanks2002@yahoo.com.

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