5381 PITT_Cov1 (Page 1) - Pitt Med - University of Pittsburgh

OW TO CUT5.3 BILLIONNCOSTSROP PATIENTORTALITY BY9% MAKERIENDS ANDNFLUENCEUNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE | MAY 2003PITTMEDA CHEAPER, BETTER ICU

SECOND OPINIONM A YJUST RESTINGI thoroughly enjoyed the mostrecent edition of Pitt Med, butwas just thrilled when I sawthe photo on the next to thelast page of the sleepers inScaife Hall (“Last Call,” Jan.2003). In the bottom rightcorner is the man who, next tomy dad, had more influenceon me than any other man I have come toknow: Dr. Ameene Makdad (MD ’53).Ameene entered my life when he served as achaperone for the marching band at GreensburgSalem High School. He went on just about everytrip that we made over a three-year period. Then,when my mother became ill with cancer, he actuallyhired me to do odd jobs around his home—not because he had odd jobs that he needed to getdone, but because it allowed me (a kid who livedabout 12 miles away from the hospital) a way tobe near my mother on a daily basis, right up untilher death.I could go on and on about the things he didfor me and my family, ranging from makinghouse calls, to saving the life of my father, bothmy grandmothers, and our youngest son. Hebelieved in giving back to the community, and hedid so through the fire department, communitynursing association, and by taking in kids whowere in tough family situations and nurturingthem through difficult times. He was a trulyamazing man. He died a few years ago, leaving agreat void in the Greensburg community, but I,for one, will never forget him.Thank you for publishing that photo. He wasproud to be a graduate of the School of Medicine.I know he was resting up on that day in 1953. Hehad to save all of his energy for all of the projectshe needed to complete, for all of the patients thatwould call on him, and for the community thathe was compelled to serve over the rest of his life.Albert J. Novak Jr.Interim Vice Chancellor forInstitutional AdvancementUniversity of PittsburghKEEP THECUSTOMERSATISFIEDI look forward to receiving eachnew issue of Pitt Med. You havedone an excellent job of highlightingthe school’s past achievements;detailing its current rapidprogress; and providing a glimpseof an even brighter future.This information builds solidarity and prideamong alumni, faculty, and staff and informsthe academic and hospital worlds of the school’sdistinguished position in American medicine.Thomas J. Gill IIIDuxbury, Mass.Thomas Gill is the Maud L. Menten Professor ofExperimental Pathology Emeritus and an emeritusprofessor of human genetics at the University ofPittsburgh.THANK YOU,DR. BAHNSONOnce upon a time, there was a baby girl born inFlorida with a hole in her heart. As she grew tobe a 2-year-old, her skin was blue; her tonguewas blue. She could take a few steps on the livingroom floor, but then she would fall downand fall asleep.During a visit to Pittsburgh, the little girl’s parentsand grandparents met with Dr. HankBahnson (“The House That Hank Built,” Oct.2002). A doctor in Florida had thought that openheartsurgery would be too risky. Thankfully,Dr. Bahnson tried the surgery anyway.I was that baby girl. Now, I am 38 years old.My husband and I have been married for 20 years.God has blessed us with four happy, healthy children.I would like to thank Dr. Hank Bahnsonfor trying to save a “too risky” case like me.Pam DornburgSprings, Pa.Henry T. Bahnson died Jan. 10, after a stroke.A remembrance may be found on page 38.With this issue, we’ve shifted Pitt Med’s schedule.The magazine now comes out in February, May,August, and November. (Our old schedule wasJanuary, April, July, and October.) You’ll receivePitt Med just a couple of weeks later than usual.We welcome photos and letters (which wemay edit for length, style, and clarity).Pitt Med400 Craig HallUniversity of PittsburghPittsburgh, PA 15260Phone: 412-624-4147Fax: 412-624-1021E-mail: medmag@pitt.eduwww.health.pitt.edu/pittmedPlease send address corrections to thealumni office:Pitt Med Address CorrectionATTN: Crystal KubicM-200k Scaife HallUniversity of PittsburghPittsburgh, PA 15261Phone: 412-648-9090Fax: 412-648-9500E-mail: medalum@medschool.pitt.eduHenry Bahnson (left) and Thomas Starzl2003 MAGAZINE HONORSGold Medal, General Interest MagazinesCouncil for Advancement andSupport of Education (CASE)District II Accolades

PITTMEDUNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE MAGAZINE | MAY 2003, VOL. 5, ISSUE 2DEPARTMENTSOF NOTE 3Diabetes research at the South Pole.Meet the mentors’ mentors.Expecting teens, unexpected pals.INVESTIGATIONS 8Stroke and cellular suicide.How to cut a tumor’s lifeline.A meeting of minds.98.6 DEGREES 31A mall of science: Pitt breaksground for what’s probablyits most complex building ever.C ONTRIBUTORSATTENDING 32Ross Musgrave can cut the ties,but not the cord.What 50 years in medicine hath wrought.ALUMNI NEWS 36Mary Williams Clark was“a guy like that.”Remembering Tim Oliverand Hank Bahnson.LAST CALL 40Whistle while you dissect.TRINA WOOD—[“Cleaning up Blood” and “Crossing the Barrier”] When she was in graduate schoolstudying journalism, Trina Wood often took her daughter, Brittany, who was not yet 8, along with herto videotape news segments. Brittany always wore a fishing vest, stuffed with extra batteries andtapes, video cables, and notepads. “She was a great icebreaker,” says Wood, adding that finishing herundergraduate and graduate degrees as a single parent were two of the biggest accomplishments ofher life. A California-based freelance science writer, Wood is a frequent contributor to this magazine.HIEN NGUYEN—[“ICU: The Episode You Won’t Want to Miss” and Follow-Ups] As a teenager inVietnam, Hien Nguyen loved art, but his parents warned him that he couldn’t make a living at it. Hespent several unhappy years taking engineering and computer classes until someone showed him agraphic design magazine. There, to his surprise, he saw folks who made their living as artists. Sincethen, the award-winning Nguyen has followed his heart (and his art). In addition to doing illustrationsand design for clients like the National Institutes of Health and Inova Health System, he teaches graphicdesign at Gibbs College in Tyson’s Corner, Va. EDWIN KIESTER JR.—[“A Hospital Is Born”]The board of directors of Sigma Xi, the scientific research society, recently elected to invite EdwinKiester to become an honorary member. This November, he’ll be initiated into that society. With thishonor, he joins the likes of science writers from The New York Times, Al Gore, and others who’ve takenleadership roles in raising awareness about scientific issues. They say you can never go home again.We’ll see: After 48 years in New York, Northern California, and abroad, Kiester will return to hishometown, Pittsburgh, with his wife, Sally Valente Kiester.COVERSaving lives, saving money, and reducing complications: Pitt researchers say that having intensivistsrun ICUs could do all three.FEATURESModern-Day Schweitzers 12Like the good Dr. Schweitzer, these med students felt an impulse to serve.BY DOTTIE HORNA Hospital Is Born 17Thanks heavens it was hard to say “no” to Louise Lyle, founder of UPMC Presbyterian.BY EDWIN KIESTER JR.A Big Bang 20Barry Brenner’s work won’t shut down dialysis centers, but it will slowthem down.BY ERICA LLOYDICU: The Episode You Won’tWant to Miss 24Many believe critical care medicine can cost fewer dollars and fewer lives.COVER STORY BY JASON TOGYERCleaning up Blood 29The Sum of Its Parts 30New tools for critical care.FOLLOW-UPS BY TRINA WOOD AND KRISTIN OHLSON12

DEAN’S MESSAGEPITTMEDPUBLISHERArthur S. Levine, MDEDITOR IN CHIEFErica LloydART DIRECTORElena Gialamas CerriSENIOR EDITORJason TogyerA SSOCIATE EDITORDottie HornPRODUCTION COORDINATORChuck DinsmoreSTAFF CONTRIBUTORSMeghan Holohan, Megan E. Sofilka,Star ZagofskyOBITUARIES CONTRIBUTORMacy Levine, MD ’43CIRCULATION MANAGERCrystal KubicCHIEF EDITORIAL ADVISORKenneth S. McCarty Jr., MD, PhDEDITORIAL ADVISORSSteve N. Caritis, MD, Res ’73Cameron Carter, MDLestina Clay, Class of ’04Jonathon Erlen, PhDRobert Ferrell, PhDJennifer Rubin Grandis, MD ’87Joan Harvey, MDRonald B. Herberman, MDAlana Iglewicz, Class of ’05Steven Kanter, MDMargaret C. McDonald, PhDGeorge Michalopoulos, MD, PhDRoss Musgrave, MD ’43Paul Paris, MD ’76David Perlmutter, MDGabriel Silverman, Class of ’05Peter Strick, PhDSimon Watkins, PhDMarshall Webster, MD, Res ’70Mark Zeidel, MDOFFICE OF PUBLIC AFFAIRSRobert HillJohn D. Harvith, JDPitt Med is published by the Office of the Dean and Senior ViceChancellor for the Health Sciences in cooperation with the alumniand public affairs offices. It is produced quarterly for alumni, students,staff, faculty, and friends of the School of Medicine. PR 3978The University of Pittsburgh is an affirmative action, equalopportunity institution. Copyright 2003, University of PittsburghIn September 1999, 18-year-old JessieGelsinger died while taking part in agene-therapy trial at the University ofPennsylvania. On March 28 this year, largely as aresponse to his death, the Bush Administrationproposed guidelines that would let research institutesdecide whether to restrict scientists’ financialinterests in studies involving human subjects andwhether such interests should be reported to theresearch volunteers. (The director of the Gelsingerclinical trial owned stock in the company thatfinanced the trial.) This guidance represents the next step, short of a mandated and specificnationwide standard, in the response being made by many academic organizations, and nowthe government, to this and other such trials. The concern: Where outcomes of certain trialsactually had the potential to pad researchers’ bank accounts—might that factor have cloudedobjectivity? And might it have influenced the well-being of patients and normal volunteers?The potential for reward influencing the way research is pursued has always been with us—the historic reward being promotion, tenure, or honors. However, it is science itself that hasadded to the potential for wealth in this milieu. The possibility of very substantial financialgain from human subjects research is rather recent, emerging as biology has evolved from apurely descriptive to an experimental science, with a yield of drugs that have made manyresearchers wealthy. Furthermore, the Bayh-Dole Act of 1980 encouraged commercializationof academic discoveries and, in fact, mandated the transfer of these technologies to the commercialsector if federal dollars supported the discovery. Thus both science and the law haveset the stage for this “duality of interests.” It’s important to note that not only may an investigatorbe conflicted, perhaps unconsciously, but an institution may be conflicted—especially ineconomic times when institutions are grateful for the royalties accruing to them as researchleads to marketable discoveries.St. Augustine once uttered, “O Lord, help me to be pure, but not yet.” About 25 percentof all biomedical scientists now have financial affiliations with industry, and 70 percent of academicinstitutions have equity in start-up companies arising from intellectual property.Entrepreneurship has become the “fourth mission” of many academic medical centers, giventhe extraordinary financial constraints under which most such centers now labor. Nonetheless,economic partnerships between the academy, government, and industry have time and againaccelerated research and promoted medical advances. Thus the challenge is to manage conflictwhen it cannot be avoided. How? Institutions can separate responsibility for financial andresearch decisions; establish committees to verify the absence of financial interest; verify thatIRB members have no conflicts of interest regarding the protocols they consider; assure thatan independent third party explains clinical research studies to subjects and obtains consent;provide subjects with information on the source of research funding; and make the sameinformation available in every relevant research grant application and publication.Biomedical research is sustained by public support and trust, and we must never permitconflict of interest to threaten scientific integrity and the safety of human subjects.Transparency is necessary but not sufficient. Good judgment and rigorous oversight are critical.Entrepreneurship needn’t be at the expense of trust, and we certainly do not want its managementto become a witch-hunt. If forced to choose between riches and integrity, however, thereis no choice.Arthur S. Levine, MDSenior Vice Chancellor for the Health SciencesDean, School of MedicineJULIA MAROUS STRAUT2 PITTMED

OF NOTEDevoted to noteworthyhappenings at themedical school...To stay abreast ofschool news day by day,see www.health.pitt.eduExtreme ResearchWith a sun that never set and temperatures as low as minus 27 degrees Fahrenheit,Bret Goodpaster, assistant professor of medicine, knew he wasn’t in Pittsburgh anymore.He recently skied 120 miles to the South Pole as a researcher and participantin the NovoLog Ultimate Walk to Cure Diabetes. His research compared how thephysiology of two men changed as they skied 700 Antarctic miles in two months.One man was Will Cross, the expedition leader and a Type 1 diabetic. The other wasnot diabetic. “Will had doctors tell him he was crazy for doing this,” saysGoodpaster, a PhD exercise physiologist at the School of Medicine. The descriptivestudy—along with Cross’ successful completion of the trip—suggests that a Type 1diabetic, with proper training and preparation, can accomplish astonishing physicalfeats in demanding conditions. His forthcoming paper,Goodpaster jokes, is best suited for the Journal ofAntarctica Research. —Star ZagofskyFOOTNOTEIt’s fine to have a song in your heart. Butresearchers at the University of Cincinnatisay 98 percent of test subjects frequentlygot songs stuck in their heads for severalhours. “Who Let the Dogs Out?” by theBaha Men was a frequent offender,Reuters reported. Researchers identifieda common quality of the self-replicatingtunes: “Stupid lyrics.”Why does someone with Type 1 diabetes ski tothe South Pole? Because it’s there.PITT DUO TO RECEIVE MOTT PRIZEThe General Motors Cancer Research Foundation will award a husband-andwifePitt team the Charles S. Mott Prize in recognition of their contributionsto cancer research.Patrick Moore and Yuan Chang are best known for their 1994 discoveryof KSHV, the herpes virus that causes Kaposi’s sarcoma, now one of themost common cancers worldwide. KSHV is an excellent study model,because it is a complete cancer-causing package in and of itself. “Thevirus carries all the genes that are required to cause a tumor in previouslyhealthy cells,” says Chang, a professor of pathology. By dissectinghow KSHV works, the scientists hope to shed light on the pathwaysinvolved in the development of all types of cancer, notes Moore, a professorof molecular genetics and biochemistry.“The Mott Prize may be the most prestigious award given worldwidefor cancer research, short of the Nobel,” says Arthur Levine, dean andsenior vice chancellor for health sciences. —Dottie HornMAY 2003 3

OF NOTEA&Qwith Beth Fischer and Michael ZigmondMichael Zigmond, a professor of neurology and psychiatry, is known not only forhis work in Parkinson’s disease, but for his role as a “mentor’s mentor.” The PhDrejects a mind-set he has encountered among too many academics, a way of thinking,he says, that amounts to: “The way you train graduate students is you putthem in a lab, you close the door, and five years later, you open the door, and therethey are.” Zigmond and Beth Fischer, an instructor in education, codirect theUniversity’s Program in Survival Skills and Ethics. They reach 500 Pitt graduatestudents each year—as well as academicians all over the world—with theirworkshops on skills essential to success in academia.On the most crucial skill they teachFischer: “Oral communication. It’s important because you need to be able to goout and give a seminar, but it’s also how you present yourself, how you’re going tonetwork at meetings.“Michael and I were at a meeting where we heard someone who had won the NobelPrize give a lecture. ... We went up to him [a day or so later] and said, ‘That was awonderful talk.’ I will never forget how he said, ‘That was the most exciting momentof my scientific career. You can’t believe what it was like to feel that you were connectingwith 5,000 people.’”On how much mentoring is valued in academiaZigmond: “Faculty get together and talk about science reasonably often, but exceptin those cases where Beth and I have initiated it, I’ve never heard faculty membersget together and talk about different mentoring strategies the way you might talkabout different parenting strategies. ... A lot of faculty members don’t realize thatyou can get, I would say, every bit as much satisfaction from having an impact onpeople through your mentoring as you can from making an important discovery.”A question for the worldZigmond: “I would be interested to know, from those people who have left their formaltraining [at Pitt] and gone out into the ‘real world,’ what training do they wishwe had provided so that they could do better?” —Interview by Dottie HornFOR MORE INFORMATION: www.pitt.edu/~survivalFaculty SnapshotsPitt scientists have used gene therapy to reducecancer-related pain in mice with tumors. Thetherapy reduced guarding (the avoidance ofusing a limb) and limping in mice with a bone tumor inone leg. David Fink, professor of neurology and an MD,along with Joseph Glorioso, chair of the Department ofMolecular Genetics and Biochemistry and a PhD, hope tobegin testing the experimental treatment in humans withina year. The researchers created a vector, or gene-transportvehicle, by crippling the herpes virus that causescold sores—a project under way for 10 years, notes Fink,who’s chief of neurology at the VA Pittsburgh HealthcareSystem. The herpes virus has a unique quality that makesit useful for treating pain: When injected under the skin,it travels to nearby sensory neurons in the skin. The genecarried by the vector stimulates the nerve cells to produceproenkephalin, a pain-killing protein.Children exposed to alcohol while in the uterus showeffects of that exposure at age 14, according to a newpaper by Nancy Day, professor of psychiatry, pediatrics,and epidemiology. “The most important finding was that thereare effects of prenatal exposure to alcohol at such lowdoses—less than two drinks a week,” says Day, a PhD whoseongoing $20 million study follows 500 mothers and children.Her results showed that children of women who drank duringpregnancy were shorter, weighed less, and had smaller headsthan children of mothers who did not drink whilepregnant. (Head circumference is a measure ofbrain development.) The bottom line, accordingto Day: “Women should not drink during pregnancy,not any amount. They should stop drinkingas soon as they know they’re pregnant. BetterDayyet, if they’re planning on being pregnant, theyshould stop drinking then. Women aren’t hearingthat message loud and clear ... and they need to be.”On November 19, Peter Safar, Distinguished Service Professorof Resuscitation Medicine, got a surprise. The next day, his colleaguestold him, the First Annual Safar Symposium would beheld at Pitt in his honor. At the day-long event, he saw manyfamiliar faces—including Max Harry Weil, who initiated thespecialty of critical care medicine with Safar. Tore Laerdalwas there as well; his father created the first mannequinsnow widely used in resuscitation education.The annual event pays homage to Safar,who helped develop CPR. This spring, hereceived an honorary doctorate from theUniversity during its honors convocation. —DHSafarCRAIG THOMPSON4 PITTMED

RIGHT: ELENA CERRI. ABOVE: MICHAEL LOTENEROTHE HUMAN FIGURE,R EVISITEDAshish Mahajan (Class of ’05) had a question: Is there a difference between ornamentationand cosmetic surgery? When Seattle-based sculptor Akio Takamori includes big hairstyles,flowing skirts, and traditional Japanese costumes in his work, is that different from whenplastic surgery resident Sean Bidic sculpts a nose or tucks a tummy?Bidic pointed out that many plastic surgery procedures are reversible. This made the lineeven fuzzier for Mahajan. There were few easy answers during this recent panel discussion, featuringBidic; Takamori; Margaret Ragni, a professor of medicine; and Elisabeth Agro, an assistantcurator at the Carnegie Museumof Art. Pitt med students attended thediscussion on influencing the humanfigure as part of a pilot program.Modeled after classes offered at Yaleand Cornell, the pilot aims to teach studentsabout art while making themaware of how they observe and describe.According to a study published in theJournal of the American MedicalAssociation in 2001, such efforts canhelp train medical students to observepatients more thoroughly. JenniferHarris (Class of ’05), Mahajan’s partnerin creating the program, believes theprogram also helps refine descriptiveabilities. Last year, groups of med studentsdelineated still-life paintings aspart of a discussion on nature led by arthistorian Charles Pearo. —SZBREATHING SPACEChildren’s Hospital of Pittsburgh hasannounced a change in plans for constructionof its new $420 million hospital, ambulatorycare center, and pediatric research facility.The structures were to be located on the alreadydensely packed Oakland campus; now, theywill occupy the site of the former St. FrancisMedical Center in Lawrenceville. Less than a10-minute drive from Oakland, the Lawrencevillecampus includes an additional 9.5 acres, whichmeans Children’s can build a larger hospitalnow and expand in the future. Another advantage:A 230,000 square-foot facility on the newsite will allow all of the hospital’s pediatricresearchers to be housed under one roof. Thehospital, which should be completed by 2007,will be one of the first environmentally “green”hospitals in the United States. —SZSafariPittsburghImagine it’s July, and a soon-to-bePitt med student is about to move toPittsburgh from Idaho. She’s nervous,wondering what to expect fromthe next four years. Helparrives in the mail:The Official Pitt MedSurvival Guide. It’s a108-page powerhouse. There’sa detailed guide to Pittsburgh—includingcommentary on places to eat, drink, andhave fun. There are practical tips for thrivingduring each step of med school—includinghow to prepare for the United States MedicalLicensing Exam (a.k.a. the “Unsavory Sado-Masochistic Loathsome Experience”). Don’tmiss the 10 Laws of Remaining Happy andFruitful at Pitt Med. (One pointer: “You’ll gobananas if you study every minute of yourfree time.”)Funded by the Medical Alumni Association,the guide is mailed to incoming students eachsummer. “Before you come to Pittsburgh, theguide helps generate a lot of excitement,”says second-year student Elena Balestreire,who edited the Class of ’06 edition withclassmate Sarah Harper. —SZMAY 2003 5

A Painterly LifeThough he has sold dozens of his paintings,82-year-old Ralph Kniseley (MD ’43) laughs atthe notion that he’s a professional artist. And heknows a good source for cheap canvasses: “I’m paintingover stuff I did 20 years ago rather than store it.”The retired associate chair of the medical division ofOak Ridge Associated Universities, Kniseley lives inTennessee. His vibrant paintings often depict placeshe has visited—crumbling Mayan ruins, an Idahomountain, a Peruvian river. Forty-five of his paintings—most donated by the artist—are on permanent displayin Falk Library and Scaife Hall. —SZKNISELEY: TOM ALTANYAppointmentsSome things are better left alone.Our DNA is damaged every day by normal living—that’s in addition to anyharm that hazardous radiation levels or chemicals might inflict. This isn’t usuallya cause for alarm, however, since our bodies employ tactics like base excisionrepaired properly ends up causing a very,very severe problem,” says Sobol. He seeksto understand how interruptions in BER canlead to tumors and cell death.repair (BER), one of several wayscells repair DNA. BER takes placeWhen neuralthrough a minimum of five steps: In THEY’RE INactivity in one partthe first step, for example, anPitt now boasts 15 faculty members elected to theof the brainenzyme removes the damaged base, Institute of Medicine. James Roberts and Karenincreases, bloodMatthews are the latest on the school’s faculty to beleaving a hole in the genome. Yet, ifflow to that regionso honored.the repair process is not completed—afterany of the five known steps reproductive sciences and director of Magee-Womens Functional MRIsalso increases.Roberts, a professor of obstetrics, gynecology, andDo fMRIs tell us what we thinkthey do?along the way—the outcome for the Research Institute, is changing the way physicians view measure changescell can be worse than if the damagedpreeclampsia, which claims the lives of 50,000 expect-in blood flow, so scientists use them to studyDNA had been left untouched. ing women in developing countries each year. Roberts which parts of the brain are active when a personhelped show that the disease involves a profound abnormalityof endothelial cells lining blood vessels. HeThat’s according to studies by Robertperforms a particular task. But how accurate anSobol, a PhD assistant professor ofheads a new clinical trial that will treat 10,000 womenindicator of neuronal activity is the technology?pharmacology who came to Pittrecently from the National Institute ofwith vitamins C and E to see if the therapy is preventive.Matthews, a professor of psychiatry, studies behavioralThe relationship between activation of neuronsand increased blood flow is not well-defined, notesfactors that put adolescents and postmenopausal Seong-Gi Kim. The professor of neurobiology cameEnvironmentalwomen at risk for cardiovascular disease. She hasHealth Sciences.to Pitt last June from the University of Minnesota.shown that in teens higher physiologic responses to“What we haveA PhD chemist, he would like to improve currentstress predict higher blood pressure later in life.discovered isthat damageMatthews tries to unravel which groups of adolescentsare most physiologically reactive to everyday stressors.fMRI technology, develop new imaging methods,and better define the relationship between bloodthat’s notOne finding: Children who grow up in families that are flow and neuronal activation. —DHSobolcohesive and warm (where family members care abouteach other overtly) are less reactive to stress than kidswhose families are less so. —DH6 PITTMED

EXPECTINGTEENS,UNEXPECTEDPALSBY MEGAN E. SOFILKAMARTHA RIALFourteen-year-old MarlanaJernigan was going to herprenatal appointmentsalone last year. Then she wasasked if she would like a medicalstudent to accompany her.Sure, whatever. She wasn’t veryinterested in a stranger comingalong. That’s before she knewSandy Fernando (Class of ’05),a volunteer with the Pregnant AdolescentsLearning with Students (PALS) programoffered by the School of Medicine.Fernando was paired with Jernigan and mether less than two months before the teenwas due to give birth.“At first I didn’t care if I had a PAL ornot,” says Jernigan, who turns 15 in May, atall girl whose hair is pulled back in elaboratetwists. “But then I was really happywhen I met Sandy.”For the next several weeks, the two wentto prenatal classes andFLASHBACKIn his 1927 book Pioneer Medicinein Western Pennsylvania, TheodoreDiller wrote that late-18th-century doctorscommonly had their apprentices care forthe horses and stables, clean offices, shineshoes, chop wood, catch leeches, and, it wasrumored, help “the doctor’s good wife withthe family washing.” They also were expectedto pull teeth and assist in surgery. Thepatients, who didn’t have the benefit ofanesthetics, probably weren’t theonly ones biting bullets.When Marlana Jernigan (left) delivered Khaliya, med student Sandy Fernando was there.doctor’s appointments together. Fernandowas there for support, but, if needed, couldalso serve as a bridge between physiciansand the teen, explaining medical optionsand language. As the due date grew near,Fernando made sure Jernigan had her cellphonenumber, so that she could hurry toMagee-Womens Hospital as her PAL wentinto labor.Fernando is one of the approximately 20Pitt med students each year who volunteerwith PALS. The program is designed to helppregnant teens lacking a strong support network.Sometimes, teens’ families are too busyto accompany the girls to their doctor’s visits,or they simply don’t see the need to go.Often, the babies’ fathers are uninvolved.When it was time to deliver, Jernigan washappy to have Fernando by her side. The11-hour birth included seven hours ofcramping before the girl received painrelief. Fernando wheeled a television setup to the room so that the two couldreview birthing videos to help putJernigan at ease. She also made a tripto the gift shop for hard candy, atreat for the mom-to-be.After the birth of Khaliya inOctober, the two women kept incontact. Jernigan talked to the medstudent about her weight concerns.Fernando helped the teen understand differentoptions for birth control, including sideeffects to expect. Meeting again for the firsttime in a few months, they hug and telleach other how great they look.“Did you cut your hair?”“Yeah! Do you like it?” replies the petiteFernando, whose short dark hair accents herlarge brown eyes.“Yeah it looks nice! I just did mine theother day, too. All my friends have beenasking me to style theirs, too!”They speak as if they’ve known eachother for years, as though most of their timetogether hasn’t been while one was wearinga paper gown.For Fernando, the program was a chanceto help someone in a meaningful way andgain clinical exposure during her first year.“Delivery was the most interesting part,” shesays. “Besides the doctor, I was the only personwho could actually see the progress ofthe birth. I could give Marlana feedback onwhat was helping in the process, such aswhat kinds of pushes helped.”And PALS has a new ambassador:“I try to get all my friends to come hereso they can have the same thing I had,” saysJernigan.■MAY 2003 7

INVESTIGATIONSExplorations and revelations taking place at the medical schoolJun Chen figured out how totake an intact and functionalprotein across the bloodbrainbarrier. This imageshows neurons that haveabsorbed a brain-protectingprotein (green).CROSSING THE BARRIERA NEW STRATEGY FOR STROKE | BY TRINA WOODJun Chen sat near the man’s bedside, struggling to find a wayto tell him there was no more the doctors could do. Paralyzeddown the right side of his body by a stroke, the patient couldnever hope to regain an active life. And though his mindremained sharp, the 50-year-old could no more communicate histhoughts than could a young child.As a neurosurgery resident at Beijing Neurosurgery Institute, Chenfelt helpless each time a stroke patient was brought to the hospital. Atthe time, during the late ’80s, there were no methods to prevent or8 PITTMED

interfere with the development of symptomsfollowing cerebral ischemia or stroke.Eventually, his frustration led Chen to giveup the bedside for the lab bench.Now Chen, an associate professor of neurologyat the University of Pittsburgh, studieshow cells die in cerebral ischemia. In thistype of stroke, the blood supply to majorbrain vessels is blocked. Without sufficientblood, brain cells die a messy death, necrosis,caused by a lack of oxygen and glucose.Scientists once believed that necrosis was theonly way cells died during and after a stroke.But Chen is among the first to accumulateevidence that cerebral ischemia also activatesapoptosis—in other words, some cells dienot from lack of blood, but because theycommit suicide.The only drugs currently available totreat stroke aim to open the blood vesselsand re-establish normal blood flow. If cellsare dying from apoptosis, reasoned Chen,there might be other ways of treating thedisease.Chen’s lab has recently focused on Bcl-xL,an anti-apoptotic protein normally expressedat high levels in the brain. Previous studiesshowed that following ischemic stroke,Bcl-xL levels in the brain were much lowerthan normal. Administering the protein,Chen thought, might help prevent braindamage from stroke. But since a proteincannot be injected directly into the brain,the researchers needed to find a way tocross the blood-brain barrier. Protein molecules,in general, cannot cross this barrierbecause they are too large or are otherwiseill equipped.So Chen and his colleague, Guodong Cao,research assistant professor of neurology, constructeda fusion protein. They took theBcl-xL molecule and latched onto it asequence of 11 amino acids from HIV, a virusknown to cross the blood-brain barrier. (Thesmall HIV sequence does not contain a pathogenicdomain of the virus.)Once Chen and his colleagues had createdthe fusion protein, they tested it in amouse model.In the first part of the study, mice wereinjected with the Bcl-xL fusion protein beforebeing induced with ischemic stroke. In thesecond part, mice were first induced withischemic stroke and then treated with thefusion protein. The protein provided protectionto neurons in both cases, even whenadministered 45 minutes after the onset ofischemia. That’s very promising in terms of afuture clinical application, Chen says. Theresults were published in the July 2002 issue ofthe Journal of Neuroscience.Chen’s research is the first to show that itis possible to take an intact and biologicallyfunctional protein across the blood-brainbarrier. The new type of therapy is calledpeptide-mediated protein transduction.Stroke is one of the top three causes ofdeath in the United States, with medical costsof $20 billion each year. The NationalInstitutes of Health and the American HeartAssociation have awarded Chen and his colleagues$4.6 million to study stroke andParkinson’s disease.“This technology potentially can be usednot only for ischemic stroke,” Chen says, “butfor other types of stroke and neurological disorderssuch as traumatic brain injury andepileptic seizures.”■INTERCEPTING CANCER’SHIT MENOLIVER NORTH HAS NOTHING ONTHESE SHREDDERS | BY DOTTIE HORNLEFT: COURTESY CHEN. RIGHT: COURTESY WANProtein-shredding proteosomesget involved inimportant cellular eventslike chromosomes beingpulled toward oppositepoles (shown here).Understanding how theseshredders work could leadto new cancer therapies.No protein lasts forever. Eachhas its own life span. Whenit’s time, each is degradedand replaced.The agent of destruction is the proteosome.Its octopus-like tentacles wave andgrasp and beckon—pulling proteins into oneend of a cylinder. The proteins enter wholeand come out the other end chopped intobits and pieces. Think of the cylinders, theproteosomes, as a bunch of shreddingmachines inside the cell.MAY 2003 9

In cancer cells, some proteins have a drasticallyshortened life span. Normally, tumorsuppressorproteins would help stop theout-of-control growth of the cell. But in thecase of cancer, the cell degrades the tumorsuppressorprotein almost as fast as it isproduced. It’s as though the cancer cell hasput out a contract on all the good guys.One novel cancer treatment strategy preventsthe proteosome from functioning.This is like taking the gun away from the hitman. Without the proteosome, the tumorsuppressorproteins cannot be destroyed.They keep trying to stop the cancer cellfrom dividing, while the cancer cell’s owndeviant proteins try to speed division. Thenthe cancer cell becomes confused from theconflicting messages it receives—Divide!Don’t divide! In response, it self-destructs.But drugs that inhibit the proteosomeaffect both cancerous and healthy cells.Imagine a more sophisticated approach—onethat would have less impact on the functionof normal cells. Instead of knocking out theproteosome altogether, what if you could preventjust the tumor-suppressor proteins frombeing destroyed?This is where a sophisticated understandingof the steps that lead to a protein’s beingdegraded could prove handy. Yong Wan, anassistant professor of cell biology and physiology,is helping the cancer community betterunderstand those predegradation events.He joined the faculty this spring after completinghis postdoc at the Harvard School ofMedicine.Wan explains that the cell has a system forletting the proteosome know which proteinsto destroy—it tags them with a marker (theprotein ubiquitin). Marker molecules form achain on the ill-fated protein. One enzyme,E3, plays the critical role of linking this markerto proteins. There are some 250 differenttypes of E3—each one specialized, attachingthe marker only to certain types of proteins.Say you could inhibit a type of E3 that worksonly on tumor-suppressor proteins. Youwould stop the destruction of those proteins,but otherwise proteosome degradation wouldcontinue as normal.Wan has identified four activators and oneinhibitor of a type of E3 called anaphase-promotingcomplex, which is a master regulatorfor cell division.“Future therapeutic drug design could befocused on E3,” says Wan.“This field is very hot.”■A mutant mouse (right)was unable to develop thelarger blood vesselsfound in the normalmouse on the left. Theability to interfere withthe development of bloodvessels that feed tumorsmay be relevant to newcancer therapies.COURTESY KWONHOW TO CUTA TUMOR’S LIFELINECut off a cancer’s lifeline and the tumor will die.That lifeline sprouts up as cancer cells trick the body into growingnew blood vessels to feed their incessant division. Controlling thedevelopment of those blood vessels has been a focus of new cancertreatment strategies.Normally, blood vessels form in two steps. In the first stage, a spiderweb-like network of microscopic capillaries forms. In the second stage,the network is remodeled to include large blood vessels. Yong TaeKwon, an assistant professor in the School of Pharmacy who recentlycame to Pitt from the California Institute of Technology, has managedto stop the network’s development in its tracks. He has createdmutant mice that form the initial network of capillaries but are unableto accomplish the remodeling—they can’t form mature blood vessels.The mice, who also have deformed hearts, die as embryos.Kwon’s work could put a gash in cancer’s lifeline. His mice lackwhat’s considered an E3 enzyme (called ATE1). If researchers couldinhibit this enzyme in human adults, he explains, they might be ableto prevent tumor-feeding new blood vessels from developing—withoutaffecting existing circulatory structures. Kwon’s insight was reportedin Science last July 5.His findings came about from his investigation of proteosomes—cell structures that do away with proteins by chopping them into bits.In Kwon’s knockout mice, the proteosome isn’t able to shred certainproteins, leading to deformed hearts and blood vessels. —DH10 PITTMED

A MEETINGOF MINDSAS GOES SCIENCE, SO GOES THEPHD PROGRAM | BY MIKE RANSDELLHolly Scott didn’t know what todo. Her research had hit a wall.A few years ago, the graduatestudent was studying how immune cells move tothe lungs to fight tuberculosis infection. To continueher project, however, she needed to dissecta small cluster of inflammatory cells, called agranuloma, from a diseased lung using a lasercapturemicroscope. Just one problem: The highpoweredmicroscope was in New York City.Then, at an annual symposium for Universityof Pittsburgh School of Medicine PhD students,Scott stood next to her poster board in the lobbyof the Biomedical Science Towers explaining herresearch—and dilemma—to Sergio Onate, anassistant professor of cell biology and physiology.“No problem,” Onate said. “You can use ourlab.” The machine that Scott thought was hundredsof miles away was within walking distance.Stunned, she accepted his offer. Since then, thetwo labs have formed a strong collaboration.The graduate program is set up to spur suchhappy happenstances. There was a time, however,when the multidisciplinary symposiumdid not exist. Back then, the many PhD programsin the medical school were compartmentalized.Students went straight into their departmentsof choice; nothing existed to bring studentsfrom different departments together.That changed in 1997 with the creation ofthe school’s Interdisciplinary BiomedicalGraduate Program. Now, before studentschoose a specialty, they spend their first yearsoaking up a broad cross section of disciplinesthrough course work and three research rotations—eachin a different field. Only in theirsecond year do students specialize—choosingfrom one of nine PhD-granting programs likemolecular genetics and neuroscience.The format requires a little patience for newstudents champing at the bit to apply themselvesto one specialty, but most appreciate thebreadth, and program organizers say it helpsstudents make informed decisions.“Now students whothink they want to do biochemistrycan apply to ourinterdisciplinary program andtest that interest—haveresearch experiences in cellbiology or pharmacology orimmunology,” says StephenPhillips, associate dean of graduate studies.Phillips and others decided to reshape theprogram because biomedical research wasevolving, requiring more cross-disciplinaryskills and techniques. For example, geneticengineering was becoming (and is now) a toolcommon to many biomedical fields. Also, bycreating a shared entry pointinto the program—repletewith symposia, seminars, andteam-taught courses—studentsand faculty from differentdepartments could moreeasily establish bonds thatmight lead to ongoing scientificconversations and long-lastingresearch collaborations.As part of the program’soverhaul, the school alsotightened its admission standards,requiring a more extensiveundergraduate researchexperience.The results? In the pasttwo years, the applicant poolhas more than doubled,boosted primarily by a largernumber of out-of-state andinternational applicants. The2002-03 pool numbered arecord-high 586.In addition, applicants’GRE scores are up substantiallysince 1997.VEERScott says she looked at a lot of schoolsbefore choosing Pitt. The interdisciplinarynature of the program helped her make upher mind.“There were a lot of good collaborationsgoing on here,” she says, “which is always asign of a good program.”■KNEE-KNOCKINGPRESENTATIONSThe first poster exhibit we see in the lobby of the BiomedicalScience Tower is “Prolongation of Cardiac Allograft Survival inCCL19/CCL21–Deficient Mice.” Recognizing only three words—“cardiac,” “survival,” and “mice”—we read the abstract untilour knees start wobbling. Luckily, Bridget Colvin, an immunologyPhD student, takes pity on us. She’s one of 170 PhD candidatesshowcasing work during the annual BiomedicalGraduate Student Research symposium.Colvin explains that she tried to determine whether mice lackingtwo proteins that regulate immune-system response wereless likely to reject transplants. She had a microsurgeon graft tissuefrom normal mice into mutant mice and found that the graftslasted much longer than those implanted into normal mice.We walk away, feeling sure of our bearings again, untilDavid Werner’s presentation has us leaning toward the refreshmenttable. Then Werner, like Colvin, makes his work soundsimple. The pharmacology PhD student has been investigatingwhether a certain amino acid influences how mammals respondto anesthesia. Using mice that lacked the receptor for thatamino acid, he tested their responses to four chemicals, buttheir reactions weren’t consistent with his hypotheses.“Disappointed?” we ask.“Just because you don’t get what you expect to see, doesn’tmean it isn’t good data,” he replies. “There’s always somethingyou can see from the experimental process. It can open up wholenew doors, new pathways, new procedures.” —JTMAY 2003 11

MODERSCH12 PITTMEDThe spirit that inspired Albert Schweitzer is alive and well in Melisha Krejci and Julian Escobar.

FEATUREN-DAYWEITZERSTO CHANGE A CORNER OF THE WORLDBY DOTTIE HORNJulian Escobar (Class of ’04) was 15 when his mother discovereda lump in her breast. His family, originally fromColombia, had moved to Dallas from Costa Rica a fewmonths before. At the time, Escobar knew only a littleEnglish; his mother knew even less. She asked her son tocome with her to the doctor.At the clinic, the staff handed his mother a 10-page medicalquestionnaire. She gave it to Escobar so he could translate and fillin the answers for her. Some of the words were easy, like name andaddress. Some of the questions he thought he could decipher butwasn’t sure. He worried that if his translation wasn’t right, hismother might get the wrong treatment. And then the teen sawPHOTOGRAPHY | MARTHA RIALMAY 2003 13

other questions to ask his mom: How manysexual partners have you had? Have you hadsexually transmitted diseases? What contraceptiondo you use?“It was absolutely horrendous,” saysEscobar. “My mother reminded me of it theother day. She was incredibly bothered by it,but she had no choice.”When he came to medical school, Escobarwanted to help address healthcare needsamong Pittsburgh Latinos, who numberabout 11,000.“I know what it is to be in a new place andnot speak the language, not know the culture,not know how the system works,” he says.His first week at Pitt, he met MelishaKrejci (Class of ’04). As a college student inTacoma, Wash., Krejci had volunteered at alocal emergency room, where she met patientswho spoke a variety of first languages.Escobar (left) knows how frustrating it can be toaccess the healthcare system when you’re new toa country.“I realized [knowing only one] languagewas definitely going to limit my ability to be akind, caring physician who’s open to all peopleand who doesn’t turn her back on anyone,”says Krejci.By the time she started med school, Krejcihad decided to spend the summer after herfirst year taking Spanish-language courses inSpain. Learning a new language would be afirst step, she thought, toward expanding thepopulation of patients she could serve.In time, Escobar and Krejci teamed up toform Students and Latinos United AgainstDisparities (“SALUD”), to help local Latinosaccess medical services and health information.A plan took shape for one SALUD project:Every Saturday from 10 a.m. to 1 p.m.,the Birmingham Free Clinic on the SouthSide, run by the Program for Health Care toUnderserved Populations and the SalvationArmy, offers free medical care to walk-inpatients. The students would place volunteerswho speak Spanish at the clinic to translate.Then they would promote the clinic amongthe Latino population as a place where aSpanish interpreter was available.They began work on the project in January2002; in April that year they received a U.S.Schweitzer Fellowship to help bring it about.Nearly 90 years before Escobar and Krejcistarted their clinic program, the Alsatianphysician Albert Schweitzeropened a hospital inLambaréné, in what istoday the West Africancountry of Gabon. Hewas 37 at the time anddevoted his life to tendingto the healthcare needs ofthat region. In 1953,Schweitzer won the NobelPeace Prize for his humanitarianefforts. The fellowshipprogram named forhim helps graduate studentsin health-relatedfields launch projects thataddress unmet healthneeds by working withexisting community organizations.As fellows, Escobarand Krejci are expected toput in at least 200 hours ontheir project (it has beenmore like 700 hours); they share a $2,000stipend; and they attend monthly meetingsto discuss the progress of their projects. SevenUniversity of Pittsburgh med students wereSchweitzer fellows this academic year. Theirprojects included developing support oreducational programs for teens, womenover 50 with alcohol or substance abuseproblems, and womenwith HIV or AIDSwho miss many oftheir doctor’s appointments.A total of 40Pitt med students havereceived fellowships since the PittsburghSchweitzer program started in 1997. (U.S.Schweitzer Fellowships support student initiativesin seven American cities.)Kerry Sutherland and Jessie Smith (Classof ’05) had a plan. In downtownPittsburgh were former homeless shelters,no longer in use. They would persuade localbusinesses to donate money. They would deckout one of the unused shelters with nice furniture—creatinga club for the homeless that wouldbe a point of contact about services, a place theywould take care of together. The students wantedto encourage homeless people to get medical care,so only those who were going to all their doctor’sappointments would have access to the club.They enlisted the help of Jim Withers (MD’84) as a project mentor, hoping to work throughOperation Safety Net, a Mercy Hospital outreachprogram founded by Withers, whichprovides free healthcare on the streets toPittsburgh’s homeless.Talking to Withers, they realized—they weresetting up another barrier for the homelessperson. They were saying, “Unless you meetour requirements, you’re not even allowed intothis place that’s supposed to be created for yourcommunity.”They vastly revised their plan, developing onethat seemed more manageable, more likely toreap benefits: They would create a buddy programfor the homeless. Sutherland and Smithwould first spend the summer doing research—talking to the homeless, learning about the population.In the fall, they would recruit and trainmed student volunteers. In the spring, each volunteerwould be paired with a homeless personand act as his or her advocate. The studentsreceived a Schweitzer Fellowship to help implementthe project.By the summer of 2002, the research leg ofSutherland and Smith’s project was in full swing.Their Schweitzer stipend, with funding fromBridging the Gaps and the Medical AlumniAssociation, allowed them to spend every weekdayimmersed in homeless culture. They wentout with Operation Safety Net night after night,canvassing Pittsburgh’s streets and alleyways. Onediabetic man they met had a huge sore on his leg.“You need to have that looked at,” they said. “ButOne diabetic man they met had a huge soreon his leg. “You need to have that looked at,”they said. “But it doesn’t hurt,” he replied.14 PITTMED

it doesn’t hurt,” he replied, not realizing thatbecause of nerve damage, diabetic wounds oftendon’t hurt, yet they still need medical attention.The young women spent one or two dayseach week at clinics for the homeless, wheremany patients would get prescriptions for theirconditions. The patients could get prescriptionsfilled at a discount but still had to pay part of thecost. Worries about money led many to deviseways to make medications last longer or to get byon less. If I take a pill once a day instead oftwice a day as prescribed, it might be just asgood. Or maybe I’ll take it every other day, theyreasoned. They didn’t realize how essential it is tocomplete a full drug regimen.Why do so many homeless people live on thestreets when there are shelters available? the studentswondered. Then they visited a shelter andfound out. No privacy, no security for personalbelongings, little comfort, and lots of rules, requiring,for example, that those who stay must showerand may not use drugs or alcohol.On a snowy February day, in a desertedScaife Hall classroom, Smith andSutherland talk animatedly abouttheir project. Both are in their 20s; both areearnest and confident; they sometimes finisheach other’s sentences. Before medschool, Sutherland volunteered at a SanFrancisco emergency room that treatedmany homeless patients. How are these peoplegetting help? she asked herself. Someoneshould do something. Once she enrolled atPitt, she met Smith, who’s from Apollo, Pa.The two spent a night on the streets withOperation Safety Net and eventually decidedto get involved.As they came to know individuals amongthe homeless, they became more and moremotivated to help. “We saw people we connectedwith. We saw a shining light inthem,” says Smith. “One guy came close toour hearts.” They met him last summer.Let’s call him Ron. Night after night, thetwo women would approach him, trying toengage him in a conversation. He was alwaysquiet and would say very little. They continuedtrying to talk to him. By the end of thesummer, Ron had changed—he laughed andchatted and walked up to them when he sawthem coming. “It’s amazing how much aA program started by Jessie Smith (left) andKerry Sutherland (right) offers street peoplea human connection.person can change just by having a little bitof constancy and a relationship,” says Smith.Sutherland and Smith realized they’dachieved something significant. Yes, Ron isstill homeless, but he has become a littlemore trusting, a little more engaged in theworld. And he has taught them somethingimportant: “The homeless need more than ahome, than medical care, than food,” saysSutherland. “They need help on a morehuman level.” To think that they boostedRon’s self-esteem and helped him break outof his shell, that was worthwhile.Their buddy program, they hoped, wouldoffer a human connection. After completingthe fall training, program volunteers would bewell versed in available community resourcesand in illnesses common among street people,like diabetes and mental disorders. Theywould be prepared to go with clients to doctor’sappointments, helping patients understandillnesses or treatments. Each volunteerMAY 2003 15

would be paired with one homeless client,meeting once a week.“The program provides an incentive totake interest in your own health and life bysomebody else taking an interest in you,”says Sutherland.She notes that one of those summer nightson the streets was particularly memorable.The young women were with two other outreachworkers when they got caught in a windand dust storm. Ron invited them into his“home,” a patch of concrete under a bridge.The wind blew the dust so hard that for 20minutes, the group sat together with theireyes closed, crouching on sloping cement,faces buried in their shirts. Their new friendhad freely offered what he had to give—amakeshift shelter open to the wind and a littlecompanionship.Smith and Sutherland spent night after night on the streets getting toknow Pittsburgh’s homeless.At this story’s deadline, Sutherland andSmith were about to pair med student volunteerswith their clients—and they were holdingtheir breath, waiting to see the results oftheir efforts.It was Escobar’s turn to talk. At thisFebruary meeting, the group alreadyknew from previous Schweitzer fellowgatherings that the Spanish-language clinichad been up and running since September.The publicity for the clinic had paid off: Ona typical Saturday, from three to five Spanishspeakingpatients would visit the clinic duringthe few hours it was open.“I’m very, very happy that the project’sgoing so well,” Escobar told the group. “But atthe same time, it’s overwhelming, because it’sgetting very large. How am I going to deal withthis?” When he and Krejci had planned theproject, they’d been naïve; they’d never consideredthe time follow-up care would require.Phone calls were consuming a lot of histime, Escobar explained. Sometimes, theclinic might arrange for a patient to see aspecialist. Escobar or Krejci would call volunteers,trying to find someone who couldgo with the patient—on a given date andtime—to translate.Other times, the Birmingham clinic wouldrefer a patient to have lab work done. The clinicwould get the test results back and hold themuntil Escobar could call the patient. He mighthave to call repeatedly, at night or on weekends,until he reached the person.When he finally gotthrough, he was oftenseen as an ally, an advocate,a friend. Peoplewould tell him personalstories about their families.They would invitehim over for coffee ordinner. The phone conversationsoften tookhalf an hour or more—and sometimes he hadto be up at 5 a.m. thenext morning for hisclinical rotation.And there was the situationwith his cellphone. At a meeting ofcommunity leaders wherehe and Krejci had spokenabout their project,he’d given one person hiscell number. Now it wascirculating throughout the Latino community.One day, Escobar had a call from a man whowasn’t sure, but thought he might have had aheart attack that morning. The man had nohealth insurance and couldn’t afford an emergencyroom visit. “What should I do?” hewanted to know. Escobar never knew what toexpect when he answered the phone.“It’s draining,” he told the other fellows.“How do you draw the line when you have somuch personal investment in something?”Talking about his frustrations with theother Schweitzer fellows helped him to assessthe project and redefine his role in it. He andKrejci decided to recruit and train newSpanish-speaking volunteers, most of whomwill make follow-up calls.“That takes a lot of weight off my shoulders,”Escobar says. “I have better focus now.”Escobar pulls up outside the BirminghamFree Clinic one Saturday inFebruary. The car in front of hissports a bumper sticker proclaiming,“Managed Care Is Neither.” He walksinside, into a room where five patients, onewith two children, wait to be seen. “Julian,we’re so glad to see you,” says a nurse. Whena woman arrives who speaks Spanish, hetakes her to a partitioned-off cubicle. Heholds a clipboard, a yellow folder, and a longlist of questions.All morning, in the adjoining cubicle,other medical students interview the clinic’sEnglish-speaking patients. The studentsare businesslike as they read off theform and jot down answers.The 42-year-old woman in Escobar’scubicle has long reddish hair. Her arms arecrossed in front of her; one hand touches herface. Tall and lithe, Escobar leans toward herover his clipboard. The two speak inSpanish. The woman’s eyes are often on theform; they seem to be reviewing it together.Escobar marks down information, but stopsseveral times as he and the patient burst outin laughter. Once, he laughs and holds hisyellow folder up in front of his face, in mockor real embarrassment.He interviews other Spanish-speakingpatients. Each time there is the same conversationalatmosphere with outbreaks of laughter.Soon SALUD’s clinic hours are over. Thered-haired woman has received a bottle ofeye drops after being evaluated for dry eyes.A woman from Argentina has had herinjured heel examined and wrapped. Awoman from Mexico was referred for prenatalcare. Escobar leaves the clinic with a messagefrom another patient who called thatmorning: She doesn’t know how she will getto her specialist appointment on Monday.“I just know that I have something thatI can give to these people,” he says. “OnceI know that someone has a need and noone else is providing it, how can I just notdo it?”■Our August issue will feature alumnus JimWithers and his work with the homeless.FOR MORE INFORMATION ON SALUD:www.pitt.edu/~mgk5/salud/salud_main.htm16 PITTMED

FEATUREA HOSPITALIS BORNSHE DIDN’T WAITFOR PERMISSIONBY EDWIN KIESTER JR.Amazing what a woman can do with $5 and a lotof gumption. Visit UPMC Presbyterian and seethe evidence. In 1893, Louise Wotring Lylecame to Pittsburgh as a newly minted MD whenfemale physicians were about as common as female shot-putters.Appalled by the health problems of the city’s burgeoningimmigrant population, she decided that a new, charitable hospitalwas needed, and that she was the one to organize it.PHOTOS COURTESY UPMC PRESBYTERIANMAY 2003 17

The fact that shewas a widow withonly a year’s professionalexperience, anda mere $5 in herpurse, didn’t stop her.She persuaded aNorth Side landlordto lease her an oldthree-story house andforego a security deposit,then boughtfurnishings on aninstallment plan. SheLouise Wotring Lyle spent one of her preciousdollars gettingthe place cleaned; soon after, she pronouncedthe six-bed hospital ready for patients.She called it the Louise J. Lyle Hospital, butthat name was only a placeholder. Lyle hadgrown up in a strong Presbyterian family, marrieda minister, and from childhood had beenfilled with missionary zeal. She was flabbergastedthat Pittsburgh, then the stronghold ofPresbyterianism, did not have a sectarian hospitalwhen Presbyterian hospitals were beingfounded in Chicago, New York, Philadelphia,and elsewhere. She went to the localPresbyterian ministers and asked for support.But, she was to recall decades later, “I was told,‘No money in sight.’” She asked the presbytery,the local church governing body, forpermission to name the place “PresbyterianHospital.” They waffled. Lyle acted, referringto her hospital as Presbyterian Hospital beforethey could reach a verdict.Within a year, the hospital was in the black.The unstoppable Lyle had successfully proselytizedlocal congregations and persuadedPittsburgh’s most prominent Presbyterianwomen to constitute the first Ladies Board ofManagers, which would be responsible forthe hospital’s daily operations. In 1895, thehospital’s trustees, at Lyle’sstrenuous urging, officiallyadopted the namePresbyterian Hospital.Lyle’s hospital movedthree times on the North Side (then AlleghenyCity) before it came to Oakland. The founderherself never saw the 12-story structure that isnow the jewel of UPMC. But, at 90 and in awheelchair, she visited the site and gave it herblessing. According to the PresbyterianHospital Bulletin, she turned to her companionsand smiled, declaring that “her heart wasfilled to overflowing with gratitude andthanksgiving because of the result of her workin helping to found the hospital so many yearsago.” In 1938, six years after her death,Presbyterian began welcoming patients as aUniversity of Pittsburgh teaching hospital.Founding what grew into one of thenation’s leading teaching hospitals was onlyone achievement of this remarkable woman.She was the youngest of 11 children of aprominent Washington County family. Herfather, Abraham Wotring, was a judge so benton education for his children that he set up aneighborhood academy in his home, whereLouise was educated before attending theWashington Female Seminary. At 20, shewent off with a clergyman brother-in-law tonurse Civil War wounded, roll bandages, andmake hospital supplies. In her travels, she meta young ministerial student, Joseph Lyle, andafter the war she married him.The Rev. and Mrs. Lyle did missionarywork in Indiana and Illinois, then served congregationsin Homestead and Wheeling.(Lyle plunged into the role of the minister’swife with such energy that she rates her ownmention in the history of the presbytery.)Then in 1884 Joseph Lyle died—somereports say he never recovered from warwounds. Louise Lyle was widowed at 41.PAGE 17: Presbyterian Hospital on RIdge Avenue, 1900. LEFT: Graduatingclass of hospital nurses in 1915. ABOVE: Surgery in progress, c. 1914.Their Wheeling church had been heavily damagedby a devastating flood. After the reverend’sdeath, Louise stayed on and raised the money torebuild it. Then she took up temperance work andprison reform. Next she moved to Cincinnati,where she established a free dispensary for womenand children and helped found what eventuallybecame the Presbyterian Hospital and Women’sMedical College of Cincinnati. Along the way, shefounded a hospital in Newark, Ohio, as well as theCincinnati Visiting Nurse Association. That wasnot enough; the restless Lyle decided to become aphysician. But after studies in Chicago andCleveland medical colleges, she was called back toCincinnati to raise funds for the medical collegeshe’d helped to establish. (Reports conflict aboutwhy she left Cleveland; one claims grades were anissue.) While fund-raising, she enrolled as a studentand earned her MD in April 1892. Shereturned home to Washington County, passed herstate board examinations, and hung out her shingle.Within a year she was in Pittsburgh, setting upher shoestring hospital.According to the late Ruth Maszkiewicz in herhistory, The Presbyterian Hospital of Pittsburgh1893–1927, Lyle’s favorite leisure pastime washunting. “She was an expert with a rifle,”Maszkiewicz wrote. You might think this sharpshooterwould exude a steely determination andtoughness. A photo of Lyle shows a woman in adark, buttoned-to-the-throat Victorian dress. Shewears her hair closely cropped, no jewelry, and ano-nonsense expression. Still, you can discern afaint smile and twinkle in the eye. MarthaSwearingen, who was in Presby’s first nursing classin 1897, saw her as anything but stiff. When shereturned for a class reunion decades later,Swearingen described Lyle: “The doctor had a18 PITTMED

FROM LEFT: Rounds in the men’s ward, a private room, the nursery (all c. 1915).wonderful personality. She had a quick tongue, aready wit, and a great many friends.”She was also a persuasive talker. Every hospitalroom required a gas stove, Swearingen remembered,but in the early hand-to-mouth days,money wasn’t always available. “Dr. Lyle would goout and beg, and usually she came back with thestove, many times with the donor having supplieda boy to carry it to the hospital.” She asked fordonations of food, too, and used them to build aculinary reputation. She planned all the menus,supervised the cooking, and even arranged thepatients’ trays.She certainly needed all those skills andattributes in the early days. Her first patient—referred by Jane Vincent, Pittsburgh’s first womanphysician—signed in at $15 a week, but not manyfollowed. It looked like Lyle’s dream might die ininfancy. Then—godsend!—three nurses fromanother hospital (seeking “more congenial quarters,”Lyle said in 1922) asked to be accepted astemporary lodgers. Their payments kept the hospitalafloat until patients came.And come they did; 385 were treated in thefirst year. “From that time,” Lyle said in 1922,“the hospital was full, and many were turnedaway.” Women came from West Virginia,Virginia, Ohio, Maryland, and elsewhere, survivingarduous horse-and-buggy journeys, to betreated for kidney sarcomas, pleurisy, typhoid,abdominal tuberculosis. By 1895, Lyle said in the1922 interviews, all debts were paid, and the hospitalhad a nest egg in the bank.Soon Presbyterian expanded to the buildingnext door, becoming a 24-bed hospital. But thenew hospital was less than convenient: Therewas no connection between the two structures.To transfer patients between the surgical suiteand wards, staff had to wheel patients outdoorsto get to the adjacent building. (This led tothe wisecrack that “patients never knewwhether they were coming or going.”) In1899 the hospital moved again, to the 90-bed former “Doctor Sutton’s Hospital” onRidge Avenue. Those quarters eventually alsoproved too small. In 1911, Presbyterian builta new home: a six-story hospital (now part ofMercy Providence Hospital) on Arch Street.By then Lyle was back in private practicein Washington County. From the first, shehad been the hospital superintendent; afterthe incorporation, she was also named to theboard of managers. Then a bizarre incidentin 1899 ended her appointment.One night, a critically ill woman wasTen of 13 trustees voted to accept the resignation, and senther off with two months of salary and what the board minutesdescribe as a “kindly” letter in light of the scandal.brought to the hospital door. Lyle admittedher. There was no available space in thewomen’s ward, so she placed the dyingwoman in the men’s. According to a storyLyle later told the trustees, she went to thehome of a comanager, Anna Shields, andasked for consent in this emergency to lodgethe woman with the male patients. Shields,however, maintained that Lyle had not askedher consent, but merely informed her thatthe woman had been put to bed in the men’sward for the night. The board agreed thatsince it was a life-or-death situation, Lyle wasright to admit her. However, they noted, sheshould have moved the male patients elsewhereto maintain segregation of the sexes.The board accepted Shields’ explanation, andLyle offered to resign. Ten of 13 trusteesvoted to accept the resignation, and sent heroff with two months of salary and what theboard minutes describe as a “kindly” letter inlight of the scandal.But she did not cut her ties to Presbyterian.As a private practitioner, she continued tosend patients there, and, in 1911, at 69, tookan active role in planning the new hospital.She helped it through a financial crisis in theearly 1920s, when the state cut off funds toreligiously affiliated hospitals, and accordingto a later superintendent, Mary Miller, maintaineda continuing interest in the hospitalthroughout her last days.Lyle died October 16, 1932, in Buffalo,Washington County, in the home where shewas born. The record says she was “active”(probably meaning that she did not retire)until a few weeks before her death.There is no memorial plaque to itsfounder in the current Presby, but clearly theindomitable woman with $5 and a visionwas the hospital’s cornerstone. ■Megan E. Sofilka contributed to this story.TO A DEGREENot much was easy about establishing Presbyterian Hospital, but Louise Lyle would have foundit even less so without her groundbreaking foremothers. Elizabeth Blackwell was the firstwoman known to graduate from a medical college. In 1847, the faculty of Geneva MedicalCollege, in Geneva, N.Y., not wanting to deny a qualified candidate, asked the students to decideon Blackwell’s admission—whoops! The students thought it was a joke and unanimouslyapproved it. But Blackwell wasn’t the first woman doc. Five-foot, pale, high cheek-boned JamesBarry with small hands and feet passed for a man in the British Army until her death in 1865.Though it had been suggested to her, Blackwell shirked the idea of cross-dressing in order topursue medicine. Barry, however, did so for more than 40 years, treating royalty and performingthe first cesarean section in Africa. By the 1880s, when Lyle was widowed, these women hadpaved the way for about 470 female certified physicians in the United States. —SZMAY 2003 19

“There are 500 differentthings that can kill thekidney. And they wereapproached, when I started,as 500 different things thatkill the kidney. There wasno unified field theory.”20 PITTMED

FEATUREBARRY BRENNER CHANGED THE WAYKIDNEY DISEASE IS TREATED AND UNDERSTOODBY ERICA LLOYDA BIG BANGIt was bound to happen. A renal fellow at Boston’s Brighamand Women’s Hospital—in all likelihood, someone new tothe division—would give a presentation at the weeklyresearch conference.Let’s say the analysis was not well thought through or the datawere questionable. At the end of the presentation, Barry Brenner(MD ’62), the Brigham’s formidable renal division director, wouldrise and crumple the fellow’s handout into a ball, saying,“You’ve just wasted 40 man-hours on this dreck.”Worse was when he didn’t say anything—juststood, balled up the paper, and slam-dunked it intothe wastebasket on his way out.PHOTOGRAPH | JIM HARRISONBrenner showed thatglomerular failure liesat the root of nearlyevery renal disease.COURTESY BRENNERMAY 2003 21

Tough audience. Brenner also required hisfellows to rehearse their papers for upcomingconferences in front of the division. If you didokay at that high-voltage session, the “real”conference presentation was cake, recallsMark Zeidel, who trained under Brenner andis now the chair of medicine at the Universityof Pittsburgh: “Barry was a much harsher criticthan anyone you’d run into at the meeting,and some of them could be pretty harsh.”Brenner, the Samuel A. Levine Professor ofMedicine at Harvard Medical School, isknown for his uncanny ability to synthesizeinformation and determine what’s important.He gets impatient with mediocrity and sloth,whether he sees it in fellows, waiters, taxi drivers,or the Red Sox. Still, even traineeswho’ve made his ears turn red with fury willtell you Brenner is a generous—and theyalways speak of him as generous—teacher andmentor. The word around Boston:Once you’reBarry Brenner’s fellow, you’re always BarryBrenner’s fellow. He’s interested in makingopportunities for people, helping them intheir careers, notes more than one trainee andcolleague. He didn’t build what is consideredto be the finishing school for nephrologistsmerely by being impatient or tough. Andunder Brenner, Brigham’s division grew to bethe largest in the world.He trained “some of the really great renalphysiologists,” says Julian Seifter, associateprofessor of medicineat Harvard. Amongthe 200 or so formerBrenner fellows: TomHostetter of the National Institutes ofHealth, Bryan Myers at Stanford University,Iekuni Ichikawa at Vanderbilt University,Zeidel at Pitt, and dozens of other heads orformer heads of medicine and of renal centersaround the world. Now, Brenner notes, sincehe stepped down as division director twoyears ago, he has one fellow: “Me. And I don’tget any trouble,” he says with a wry smile.At renal conferences, it’s not unusual to seepeople seeking out Brenner to ask him toautograph his textbook The Kidney, which heoriginally coedited with Floyd Rector.(Brenner is working on the seventh edition.)There are reports of fans having autographedpages laminated and of hanging framed photosof the renal celebrity in their offices.Besides The Kidney, Brenner has edited severalother well-received books, journals, andserved on almost 30 editorial boards. He’s anauthor on 600 papers.“Many of ... the commandments of renalphysiology started with him,” says DavidMount, assistant professor of medicine atHarvard and an investigator at Brigham.“Barry Brenner is probably the world’s topnephrologist,” notes longtime friend JohnDirks, president of the Gairdner Foundation,chair of the International Society ofNephrology’s commission for global advancement,and a professor emeritus at theUniversity of Toronto.“What he’s done won’t shut down dialysiscenters but will slow them down.”The Brenners of Brooklyn were takenaback when their son said he wantedto go into medicine. No one in thefamily had ever gone to a four-year college.Now their boy, who’d graduated early from acommuter college, Long Island University,was being invited around the country formed school interviews. Brenner remembershis first time on a plane, a puddle jumper thattook him to an interview in South Carolina.It was the same day Sputnik was launched; hepeered out the window, wondering if hemight catch a glimpse.Eventually he landed at Pitt’s School ofMedicine. Shortly after his arrival, he spotteda “super genius” from his high school. Panicwashed over him: My God, how am I going tocompete if everyone is at this level? (Thegenius from home eventually dropped out ofthe program.) Brenner moved into a room inSalk Hall. Other medical students stayedthere, as did the football team. Day and nightthe teammates called out plays to each other.More interesting was listening to Brenner’snext-door neighbor, classmate AlbertBraverman (MD ’62)—“a really superiorintellect. Whatever he said, you learned something.Albert would be in his room listeningto all this great music and smoking Frenchcigarettes and not being able to put down hisThomas Mann or Immanuel Kant. All I likedto do was memorize Gray’s Anatomy.”That’s an odd thing to hear from a manknown today as an aficionado of fine wine,gourmet cuisine, Schubert, and Klee, who“What he’s done won’t shut down dialysis centers but will slow them down.”delights in sharing such pleasures with friends andfamily. But Brenner the freshman had promisedhis parents he would get a scholarship; and afterall he was there to learn medicine. So despite thedistractions of the Panther playbook and greatphilosophy, Brenner stayed the course. He endedup doing so well on his first two anatomy exams,Professor Rosenthal thought he might be cheating.What is it, son, that you’re trying to do?Brenner realized he could ease up a bit. Butletting-up Brenner style translated to volunteeringin Harold Segal’s and Abraham Braude’s labs;starting a program for a group of sophomores towork in the pathology lab of Joseph Feldman(where they duplicated famous Frank Dixonexperiments); moonlighting at small local hospitals;and signing up for the most rigorous rotations,which meant having Jack Myers andThaddeus Danowski in medicine as attendings.“Myers was scary. In those days, when youpresented to the attending, everybody stood atthe bedside. And you didn’t use notes; youstayed up all night until you were ready,” saysBrenner, adding that Myers taught him “a standard”—“Hewas precise in a way that I’d neverencountered before.”Likewise, Brenner must have impressed hisattendings. When he graduated, he was handedthe George Heard Memorial Prize in Medicine.As an intern at the Albert Einstein Collegeof Medicine, he became engrossed with Straussand Welt’s Diseases of the Kidney. Anyone hopingto really understand this organ needed totackle ion transport, biophysics, biochemistry,thermodynamics, and then some. DuringEinstein’s famous daily conferences (known as“morning prayers”), where residents wereexpected to give presentations on scholarly subjectsrather than on cases they saw the nightbefore, Brenner talked about the kidney. Onemorning when Brenner was presenting, someonehad invited Robert Berliner, of theNational Institutes of Health’s famed renal andelectrolyte lab, to sit in. Afterward, the distinguishedguest asked Brenner: “What are youdoing with the rest of your career?”After his ascension at morning prayers,Brenner ended up spending a few fruitfulyears with Berliner at NIH. In1969, he was recruited by the University of22 PITTMED

COURTESY BRENNERCalifornia, San Francisco, where he started arenal program for the VA hospital. That’s wherehe heard about a curious strain of rats in theMunich lab of Klaus Thurau. For some reason,these animals had cherry red spots on their kidneys.Thurau was stumped. He couldn’t figureout what the spots meant. Brenner asked if hecould have a look.Thurau sent a dozen rats to San Francisco.(Only 11 arrived, leading Brenner to wonderwhat essential 747 cables the escapee might havegnawed away.) It didn’t take long for Brenner torealize that the mysterious spots were glomeruli,popping up on the cortical surface of the kidney.Here was a terrific opportunity: Each kidney isfilled with a million microscopic nephrons thatfilter blood. Each nephron is made up of a narrowtubule, on one end of which is a roughly cauliflower-shapedpack of capillaries, the glomerulus.“The wisdom of the kidney,” as Brenner puts it, isin how it interprets signals from your body to figureout, no matter what you have for lunch,which ions, toxins, and the like should end up inyour urine and which your body needs to reclaim.In the nephron, this process begins in theglomerulus. And until Brenner came across thesepeculiar rats, most investigators focused on therole of the tubule, paying little attention to thenephron’s other end. Scientists didn’t know muchabout the glomerulus because they couldn’t get atit; in mammals, glomeruli are usually buried inthe kidney. They don’t appear on the surface.So now Brenner had these bizarre animalmodels plus a novel micropuncture instrumenthe’d brought with him from NIH that heplanned to use to measure pressures in tubules.He changed his plans. Time to concentrate onthe glomerulus. No one knew, for instance, atwhat pressures the arterial tree pumped fluidacross the walls of the glomerulus. Brenner’s team(including physician Terrance Daugharty andchief technician Julia Troy, who retired from hislab only recently) found the pressures were muchlower than everyone thought.There was one thing Jane Brenner had toresign herself to: Usually around 3 a.m., herhusband would wake up with a revelation,maybe a better title to his latest paper, maybe anew way of looking at physiology. Trustingnothing to memory, he would write it all downon a stack of index cards he kept on his nightstand.Those index cards broughtforth a storm of breakthroughs—from mathematical models ofglomerular pressure to definingthe exact process of urine formation.They also helped crystallizefor Brenner an understanding thatwould change the way kidney diseasewas approached, promising tobetter the lives of millions.“There are 500 different thingsthat can kill the kidney. And theywere approached, when I started,as 500 different things that kill thekidney. There was no unified fieldtheory,” says Brenner.As it turned out, problems with tubuleswere not the primary cause of kidney disease,glomerular failure was. Brenner’s team foundthat when the kidney is injured, someglomeruli are damaged, and the others take upthe slack. Their pressure level goes up, so theyform more filtrate. That higher pressure damagesthe glomeruli that are helping out. “Itleads to a vicious circle of progressive injury,”notes Brenner. “This second wave of injury isnot caused by the original disease; it’s causedby the adaptation—which is common to everykidney disease.” It became clear: To allow thekidney to survive longer, one needed to lowerglomerular pressures. The best way to do that,Brenner found, was with antihypertensiveUsually around 3 a.m., her husband would wake up with a revelation.drugs like angiotensin-converting enzymeinhibitors (ACE inhibitors). Low protein dietsalso helped slow renal deterioration. (Severalscientists, including Brenner, suspected proteininjured tubules.)He recently completed definitive clinicaltrials on antihypertensive therapies: “Now Ican close my lab,” he says, satisfied.Today this eye-opening explanation of thevicious cycle inherent to chronic renal diseasesis widely known as the glomerular hypertensiontheory, or Brenner’s theory. Brennerrefers to it as his “big bang.”“What he has done eventually will helpmillions,” says Dirks. “If you just take diabetes,200 million people have it worldwide.Probably one-third of them will getkidney disease.”“There certainly are people who did a lotABOVE: China, 1998. Brenner traveled extensively on behalf ofthe International Society of Nephrology.of work in the glomeruli,” says Zeidel. “ButBarry basically defined how the glomerulusworks, how it is destroyed, how it is damagedin various kinds of disease, and developedthe only effective means we have toslow the damage that happens in theglomeruli. The scope of his contribution isalmost unheard of in physiology.”One Brenner family joke (there seemto be a lot of them) goes like this: Anold man falls from the curb onto thestreet, hitting his head. Onlookers rush overto help; one asks: “Mister, are you comfortable?”The man says, shrugging and raising hishands, “I make a living.”Robert Brenner and his sister, JenniferAsh, have heard their dad tell that oneumpteen times. There was a time, abouta decade ago, when they didn’t feel somuch like joking: Barry Brenner was in postopfrom bypass surgery. The family was concerned.Dad had made it through the operation,but bypass patients sometimes experienceddecreased mental acuity. RobertBrenner, who’s also a nephrologist, wondered,would his dad have the same razor-sharp wit?Would he be the man he’d always known?When the family went to visit him afterthe procedure, they saw their patriarch on aventilator with tubes pumping fluid into himand draining it out. A nurse was in his room,attending to him. As she wiped his brow witha cloth, she asked, “Dr. Brenner, are youcomfortable?”The perfect setup line.The patient slowly shrugged his shoulders,then raised his hands.He was fine.■MAY 2003 23

N THE MEND NOW,HE PEERS ATOUJOUKOS BLEARILY.HOW’S YOUR BREATH-NG TODAY?” HE ASKS.DO YOU FEEL SHORTF BREATH?” LEANING CLOSEO HEAR HER ANSWER,OUJOUKOS NODS. “SQUEEZEHIS HAND TIGHT,” HE SAYS.TIGHT! TIGHT! TIGHTER!

COVER STORYNEW LIFE FOR CRITICALCAREBY JASON TOGYERICU:THE EPISODE YOUWON’T WANT TO MISSThe beeping of a cardiac monitor and whoosh of aventilator greet Arthur Boujoukos as he approachesthe woman in Bed 15 of the cardiothoracic intensivecare unit at UPMC Presbyterian. Resting one palmgently on her forehead, Boujoukos’ other hand grasps one of hers.She stirs, almost imperceptibly. “Good morning, dear,” he says.“How are you? It’s Dr. Boujoukos. Open your eyes.”The woman, who had a coronary bypass a few days earlier,developed colitis in the hospital and was transferred to the cardiothoracic(CT) ICU. On the mend now, she peers atBoujoukos blearily. “How’s your breathing today?” he asks. “Doyou feel short of breath?”MAY 2003 25

Leaning close to hear her answer,Boujoukos nods. “Squeeze this hand tight,”he says.“Tight! Tight! Tighter! There you go!”Making some notes, Boujoukos, whooversees the CT ICU, steps away from thebed and consults with fellows Paula Gordonand Indra Singh. They move to the computerterminal near the bedside and check thewoman’s charts. “No matter what, we shouldget her out of bed today,” Boujoukos tellsSingh and Gordon.This is one of the most hectic places inPresbyterian; patients come and go quickly,and the 22 beds are rarely empty for long.This morning, Boujoukos, an associate professorof critical care medicine at Pitt, has afull house.Compared to ICUs nationwide, the CTICU at Presbyterian is something of ananomaly. It’s overseen by an intensivist—aphysician specializing in critical care medicine.Only intensivists or attending surgeonscan write orders here; Boujoukas often doesso in consultation with other specialists.More than 4 million Americans are admittedto ICUs each year. But according to theLeapfrog Group, a national consortium oforganizations that purchase health insurance,only 10 percent of those ICUs are “closed”—that is, directed and staffed byintensivists. In the bulk of therest, patients are treated by thedoctors who admitted them. Thismodel, called the “open ICU,” iscommon in the United States,but it severely tests the ability ofphysicians to manage patientcare, says Derek Angus, an associate professorand vice chair of research at Pitt’s Departmentof Critical Care Medicine, the first suchdepartment in a U.S. medical school.Physicians whose patients are in an openICU usually have other responsibilities in thehospital or at their practice, he says. “If youround on the patient in the morning, write abunch of orders, and go to your office or clinic,you’re relying on juggling things by telephone,or relying on the quality of the nursesor the resident in the ICU,” Angus says.Leapfrog, the Society for Critical CareMedicine, and other groups now recommendthat intensivists be put in charge of ICUs.“They are at the bedside, continuouslychanging the care plan, evaluating theresults,” says Mitchell Fink, who chairs Pitt’snew Department of Critical Care Medicine.Until recently, policy makers and healthcareadministrators paid less attention to theICU than to other areas of hospitals. Butrecent studies indicate that intensivist-runICUs would save a lot of money—and a lotof lives.The concept of dedicated units forthe critically ill grew out of thepoliomyelitis epidemics of the 1950s.Before development of the whole body ventilator—the“iron lung”—polio was frequentlyfatal, because patients were unable to breathe.Though the early ventilators saved lives, theywere also expensive to operate, and cumbersome.The first “acute care” units opened inScandinavia in the 1950s to provide an efficientcentral location for iron lungs.Other lifesaving medical techniques—some developed during World War II and theKorean War—were also advancing rapidly. Sowere complications. “The need becameapparent to provide life support for long periodsfor comatose or otherwise unstablepatients from any service—medicine, surgery,gynecology, obstetrics, or pediatrics,” PeterSafar wrote years later of his work as an anesthesiologistat Baltimore City Hospital. “Ithought, why not have such a unit next to theBCH polio ward, using the same nurses.”The first physician-staffed intensive care unitin the United States was opened at BCH in1958. ICUs soon sprung up at hospitalsacross the country. Safar opened the first ICUat Presbyterian shortly after coming to Pitt in1961 to chair the new Department ofAnesthesiology.American ICUs developed along a differentpath than European units, because care inthe United States is less centralized, saysAngus, a Scot who trained in Glasgow. InEurope, where closed ICUs are universal,anesthesiology residents do much of theirtraining in critical care, and most intensivistsare anesthesiologists. In the United States,according to Peter Pronovost, an associateprofessor of anesthesiology and critical caremedicine at Johns Hopkins University,finances drove anesthesia departments to beAlready, according to Angus, $180 billion is spent annually on criticalcare—almost 2 percent of the gross domestic product. ICUs now consume,on average, 25 percent of hospital budgets.oriented toward ORs, where insurance reimbursementswere greater.“There was no ‘owner’ of the ICU systemhere,” Pronovost says. Instead, most Americanhospitals adopted open ICUs, where anyphysician with rights to practice could writeorders. Open ICUs—which represent nearly70 percent of the United States’ 6,000 criticalcare units—provide continuity of care butdon’t have the patients’ attending physiciansavailable to manage emergencies. (Some U.S.ICUs are semi-closed, meaning intensivistsmanage problems as they arise and primarycare physicians and specialists also writeorders.) But ICU patients are prone to ailments,like sepsis and respiratory distress,that few office-based physicians treat regularly,Angus says.Pronovost, of Hopkins, collaborated withpeers at Pitt on a study of ICU staffing. Using35 years of data, the researchers found thatwhere intensivists manned the units—the“closed ICU” model—patient mortalitydropped 29 percent. Hospital stays werereduced in about 75 percent of the cases. Theresulting article, by Angus and Pronovost, waspublished in the November 6, 2002 Journalof the American Medical Association.A 2000 review funded by the Departmentof Veterans Affairs also found that intensiviststaffedICUs reduced mortality at significant,and perhaps astonishing, rates. The authorsreviewed nine studies that reported dropsranging from 15 to 60 percent. Full implementationof intensivists in American ICUswould save at least 53,850 lives per year, thestudy concluded.Experts believe that as the median age inthe United States rises, the nation will near acrisis in critical care. Already, according toAngus, $180 billion is spent annually on criticalcare—almost 2 percent of the grossdomestic product. As early as 1987, a study inthe Journal of Critical Care Medicine indicatedthat ICU patients consumed 20 percent ofhospital budgets—a cost, per bed, three tofour times higher than in regular wards.Michael Breslow, former director of the surgicalICU at Johns Hopkins Hospital, estimates26 PITTMED

that, on average, ICUs now consume 25 percentof hospital budgets.“This is really an area that hospitalsshould be paying more attention to, becausethis is where patients are dying, and [hospitalsare] spending a huge amount of money,”Breslow told Modern Healthcare.Suzanne Delbanco, executive director ofLeapfrog, cites a Dartmouth study that foundstaffing large ICUs solely with intensivistswould cut annual costs by $5.3 billion. Thesavings would come from reduced ICUadmissions, fewer unnecessary tests, andmore efficient use of physician time, she says.The premise—that doctors trained inICU practices should be in charge of ICUs—sounds simple. In fact, patients usuallyassume that’s the case and are “startled” tolearn otherwise, says Delbanco. “Most peopledon’t think about it until they’re there.”Though the School of Medicine’s CCMdepartment may be the first in the UnitedStates, the interest in reforming ICUs suggestsit won’t be the last. The academicdepartment, which celebrated its firstanniversary in January, could be a model forother schools of medicine to follow.Pronovost sees Pitt, Hopkins, Harvard,and the University of California, SanFrancisco as the U.S. leaders in critical caretraining. Pitt’s new academic department “isquite visionary,” he says. Granting criticalcare its own academic home, on an equalfooting with primary specialties such assurgery and medicine, can help direct neededICU reforms, notes Pronovost.Despite the increased interest, proponentsof closed ICUs—standard in Canadaand Australia as well as Europe—say thiscountry has a long way to go. Medical centersare large organizations, and large organizationsare, by their nature, reluctant tochange, Fink says. Even with Pitt’s proud historyof critical care research, featuring thelikes of Safar and Ake Grenvik, the creationof a stand-alone academic CCM departmentmet with some resistance. A lot of specialtieshave a “vested interest” in critical care, saysFink. He notes that critical care and emergencymedicine are the only two specialtiesdefined by areas of the hospital.A survey last year of 831 practicing physicians,conducted by the Harvard School ofPublic Health and the Kaiser FamilyFoundation, found only 34 percent thoughtthat having ICUs staffed by intensivists would“very effectively” cut down on medical errors.Pitt’s CCM department may be the first in the United States, but it’s not likely to be the last.Angus calls this “the natural history of anevolving specialty.” Reluctance by physiciansto adopt closed ICUs will wane as betterstudies become available, he says. Publicpressure may help break down that reluctance;the same 2002 Harvard survey foundthat 73 percent of the public was in favor ofstaffing ICUs with intensivists.Financial pressures will mount as well.Leapfrog is encouraging the employers it representsto ask insurance companies if theirhospital coverage complies with its “ICUPhysician Staffing” standard. The standarddiscourages the use of open ICUs.“It’s about making sure the right care isdelivered at the right time to the right person,”Delbanco says.At 10:30 a.m., Boujoukos, the intensivistin the Presbyterian CT ICU,stops to consult with Ken McCurry,assistant professor of surgery at Pitt anddirector of lung and heart-lung transplantationfor the Thomas E. Starzl TransplantationInstitute. One of McCurry’s patients, whoawaits a heart-lung transplant, was admittedto the ICU in respiratory distress a few daysago. Now her condition is stable, and she’sHIEN NGUYENMAY 2003 27

eady to be transferred.The transplant patient’s progress satisfiesBoujoukos. More vexing is the patient inBed 7 with pneumonia, endocarditis, andrenal failure. Two weeks ago, he underwentopen-heart surgery to repair a damagedvalve. Since then, Boujoukos has been at hisbedside daily. (He spends about 2,500 hoursin the CT ICU each year.)Patients like the man in Bed 7, who suffersfrom multiple-organ failure, benefitfrom the “cross-training” that critical caredocs can provide. “In a predominantlyclosed unit, the intensivist has to knowabout the management of problems thatoccur in the ICU setting—regardless of theorgan system—and needs to be able to managethose problems on a subspecialty level,”Boujoukos says.Good intensivists don’t monopolize care.Because ICU cases involve multiple specialties—accidentvictims might require anorthopaedist, a neurologist, and a generalsurgeon—one of the jobs of intensivists is tokeep all of the doctors well-informed and toseek out their expertise. They also ensurethat one specialist’s recommendations aren’tjeopardizing another’s treatment.When Boujoukos started his career ininternal medicine, he found he didn’t wantto narrow his scope to any particular organsystem or patient population. Nor did hewant an office practice. Becoming an intensivistgave him “an opportunity to stay inmultiple fields,” he says.Yet intensive care is still considered a subspecialtyin this country. Intensivists startout in a residency in anesthesia, emergencymedicine, internal medicine, pediatrics, orsurgery. When their residency ends, theircritical care training begins. Those whocomplete surgical or internal medicine residenciesdo two more years in critical care,for instance. Pediatric intensivists completea three-year fellowship.At any given time, Pitt has 25 trainees inadult critical care medicine and 10 in pediatrics.Since 1963, when Safar created a criticalcare fellowship program within the anesthesiologydepartment, 550 physicians have beentrained in critical care at Pitt.Most trainees take a more direct route thanpediatric critical care fellow Mary Hartman.“I was going to work for the EPA,” she says.Hartman was a junior geology major atMount Holyoke College in Massachusettswhen she attended a seminar on environmentalissues and healthcare policy.“It dawned on me that the reason I wasinterested was because I’m interested in howthe environment impacts people,” she says.“But I was headed for a career that wouldhave me working alone, riding around in apickup truck, checking soil samples. I said,‘Oh, my God, I don’t want this.’”Hartman will get her wish. Her chosenfield is filled with human interaction andthen some. In her routine workday, theimmediacy of life and death and disabilitywill be laid bare from moment to moment.“Critical care is unique,” she says. “Youhave a very intense connection with apatient and their family, and then they’reLeapfrog is encouraging the employers it represents to ask insurancecompanies if their hospital coverage complies with its “ICU PhysicianStaffing” standard. The standard discourages the use of open ICUs.gone. The best intensivists really connectwith the family very quickly, and learnabout them very quickly.”Fink says the relationship between anintensivist and a patient can become as deepas that of a family practice physician—thedifference, besides the severity of illness, isthat relationships are measured in days orweeks, not lifetimes. Intensivists are “shortfeedback loop kind of people,” Fink says.“And they like dealing with an excess of datarather than a paucity of data. To them, it’snot daunting—it’s stimulating.”The variety and severity of ICU casesappeal to intensivists, he says.“It’s an enormous palette of problems,ranging from routine post-operative monitoringto multiple organ system failure andmultiple trauma,” says Fink, who came toPitt in 1999 from Harvard Medical School,where he was the Johnson & JohnsonProfessor of Surgery and chief surgeon atBeth Israel Deaconess Medical Center.Now, Hartman, who recently completedher pediatrics residency at the University ofRochester Medical Center, is beginning apediatric critical care fellowship at Pitt.Many pediatric CCM fellows complete theirclinical fellowship then spend a fourth yearworking on research. Hartman is first earninga master’s degree from Pitt’s Graduate Schoolof Public Health—to learn the statisticalmethods she’ll need for her future research.She begins her clinical work this July.At Pitt, investigation of new therapies ismoving at a rapid pace, notes Fink. (See“Follow-ups” on pp. 29 and 30.) Thedepartment was launched with $5 millionin federal research funding; the amount hassince risen 80 percent.“We’re starting to get to the point wherewe can treat the reasons for organ failures,rather than just the organ failures,” he says.“This is the best time to be doing criticalcare medicine. The level of understandingof the biology of critical illness is goodenough that we can really make a differencefor these patients.”Another priority for training programslike Pitt’s is to address theshortage of intensive carespecialists.In 2000, Angus wrotethat if current trends continued,the United States in 20years would need four timesas many intensivists.“I’m not necessarily proposing that we goout and hire another 20,000 intensivists,”he says. “For one thing, there aren’t 20,000intensivists to hire; the existing programs arefull. But U.S. hospitals, especially in smallerareas, have to consider combining theirICUs to conserve resources.”There may also be room to simplify thetraining. In Spain, physicians serve a sixyearresidency in intensive care, which hasbeen a primary specialty for 20 years, Angussays. As the importance of intensive carebecomes more evident to insurers, hospitals,and policy makers, Fink predicts, that daywill come in the United States.For now, he jokes, what the field reallyneeds to raise its profile is a TV show:“Instead of ER, it would be called ICU.” ■Some details in this story were changed toobscure patient identities.FOR MORE INFORMATION:http://jama.ama-assn.org/Search Vol. 288, No. 17.28 PITTMED

follow-upCLEANING UPBLOODA NEW DEVICE GETS NASTY STUFF OUTBY TRINA WOODBOTTOM: © 2003 RENALTECH INTERNATIONAL. TOP: HIEN NGUYENMedics struggle to lift the inertbody of the young soldier onto astretcher, then pause to take apulse and measure other vital signs—he isstill alive, yet unconscious, with no externalsign of injury. Quickly, they set up a bloodpump and begin running his blood througha baton-sized filter. Until the medics canreach a hospital and figure out what chemicalor biological agent was used in theattack, this small device may keep enoughtoxins out of the soldier’s bloodstream tokeep him alive.While this scenario may seem straightout of a science-fiction novel, John Kellum,associate professor of critical care medicinein the School of Medicine, says the realityof being able to use such technology mayonly be a few years distant.His team of basic scientists and clinicalresearchers, including Mingchen Song andRamesh Venkataraman, is developing adevice that shows promise in clearing noxioussubstances from blood, includingthose brought on by biological weapons.Specifically, this device reduces the concentrationof inflammatory mediatorsknown as cytokines, produced primarilyby white blood cells as a response to illnessor trauma. Normally present insmall quantities, these proteinscause damage to cells and tissuewhen present in high levels.John Kellum and colleagues’ CytoSorb isdesigned to remove harmful levels of cytokinesfrom blood. It will soon be tested in clinical trials.What looks like a Wiffle ball (right) is actuallya 500-micron-size bead. CytoSorb is filled withsuch beads, which absorb only small and midsizemolecules, notably cytokines.Throughout the past decade, researchershave tried to find ways to either stop theoverproduction of these mediators or removethem from the blood. None of their effortsworked very well—until now.Nearly two years ago, Kellum was workinglate in his office when an e-mail came throughat 2 a.m. Thinking it might be a colleaguefrom the other side of the planet, Kellum readit immediately. To his surprise, the e-mailcame from a company called RenalTech inNew York. Scientists at RenalTech had read apaper of his describing how inflammatorymediators may be best removed from theblood by absorption. Their chemists hadrecently developed BetaSorb, a cartridgeshapeddevice undergoing testing in clinicaltrials for hemodialysis patients. BetaSorb wasdesigned to remove a class of toxic moleculesfrom the blood (molecules similar in size tocytokines) not efficiently removed by standarddialysis. (These molecules jeopardize thehealth and quality of life for chronic renalfailurepatients.) With a few bioengineeringmodifications, they felt Kellum could use thisexisting technology to remove large volumesof cytokines from acutely ill patients.Joined by collaborators at RenalTech,Kellum’s team set to work on a new evolutionof BetaSorb specially designed to absorbcytokines. The end result is CytoSorb, a cartridgeabout 12-inches long by 3-incheswide, packed with a column of tiny beads(each about 500 microns) covered with poreslike a Wiffle ball. Kellum notes this device isnovel because each bead is made from ahighly absorbent polymer and coated with abiocompatible surface, so that white bloodcells don’t react to the beads. As blood flowsthrough the device, small to mid-size moleculescan get inside the beads where all theabsorption occurs, but larger molecules andcells can’t.Within the next several months, CytoSorbwill be used in clinical trials for patientsundergoing cardiopulmonary bypass. Thesepatients typically experience an inflammatoryresponse owing to stresses of surgery and thebypass machine. Though inflammation isoften a normal response to infection, theresponse in these cases only causes harmbecause it triggers a massive release ofcytokines. Reducing these harmful levels ofcytokines may result in better patient outcomes,says Kellum.CytoSorb could also be used in treatingsevere sepsis. Transplant recipients whosenew organs are suffering from reperfusioninjury could also benefit. And victims ofbioterrorism or biological weapons arepotential target patients, because the lowtech,portable device can be used to purifythe blood during evacuation, even beforedoctors identify the harmful agent.“This device is potentially cheaper andmore effective than drug therapy with a muchbroader applicability,” Kellum says. ■MAY 2003 29

follow-upGREATER THANTHE SUM OF ITS PARTSPATIENTS WITH THE SAME CONDITION MAY REQUIREDIFFERENT TREATMENTS | BY KRISTIN OHLSONImagine that two people have survived acar crash and are rushed to the same emergencyroom. They present the same mix ofphysiological red flags: Both have sufferedtrauma to the body and blood loss. Both havesimilarly abnormal readings for blood pressure,respiration, heart rate, and other factors.The ER team rushes to set their bones, closetheir wounds, give them blood, and offerother standard treatments. Both patients seemto be stable after 24 hours. Yet days later, onedies in the ICU of multiple organ failure andthe other survives.When faced with trauma or severe infection,the body unleashes a fusillade of cellularand molecular events to reduce blood loss,fight pathogens, and eliminate damaged tissue.Sometimes, though, the response is sooverwhelming that it destroys the body it istrying to protect. Why does one patient’sinflammatory response save him, while thatof another leads to systemic shock or multiorganfailure?“The inflammatory response is like a gameof chess,” says Gilles Clermont, assistant professorof critical care medicine at theUniversity of Pittsburgh and an attendingphysician at UPMC Presbyterian. “We’re verygood at knowing exactly how the pawn movesand how the queen moves, but we are still notgood at knowing how the whole game works.”In other words, critical care specialists mayknow what a certain enzyme is doing butdon’t understand overall how individualpatients will fare in this high-stakes game. “Itall has to do with one genetic makeup comparedto another,” Clermont adds.HIEN NGUYENBefore Clermont joined what’s now Pitt’sDepartment of Critical Care Medicine in1994, he had done graduate work in physicsand never lost his interest in that subject,especially in the study of complex systems.This field of study examines how dozens ofprocesses create a global system that is dauntinglymore complex and mysterious than thesum of its parts; in particular, researchers inthis field look at the indirect effects resultingfrom the interdependence of many seeminglyunrelated or distantly related processes. Thestudy of complex systems has been applied todiverse areas—from environmental woes toeconomic cycles. Clermont’s own graduatethesis discussed complex systems in languageformation. At some point in the ICU, helooked at a patient in the throes of inflammationand realized that here, too, was a complexsystem. He began to imagine a diagnostic toolthat could assess the integrated effect of all theinflammatory processes at work in an individualpatient and offer custom therapies.With the help of a National Institutes ofHealth grant, Clermont and Pitt specialists inmathematics, immunology, surgery, and statisticsbegan developing software that usesmathematical modeling to simulate the interactionof more than 20 key processes involvedin the inflammatory response. When this toolreceives its final tweaks, emergency and ICUphysicians will prepare data for it by takingblood samples from a patient at several timedintervals, even as they begin treatment, andmeasuring the patient’s changing levels ofimmune cells and cytokines. As they feed thisdata into the computer model, it will gaugethe action and energy of patients’ inflammatoryresponses over time and reactions totreatments.“The model ‘learns’ you as it gathersinformation,” explains Clermont. “When wetake your last blood sample, it will havezeroed in on who you are as an individual andwhat will drive your outcome many daysdown the road.” He believes the model willnot only be able to determine what kind ofdrug or combination of drugs a particularpatient needs, but it also will be able to determinethe best time to administer the dose.Clermont and his team are still developingthe model with animal and human data; aworking clinical version probably won’t beready for another three years. However, a partnershipbetween the Pitt team andLaunchCyte, a company that commercializesbiotechnology breakthroughs, may deliveranother promising application sooner. Thepartners have founded Immunetrics, a companythat markets a version of the softwaredesigned to reduce the cost of drug developmentas well as speed the development ofdrugs for inflammation-related diseases likesepsis, a frequently fatal response to infectionthat afflicts 750,000 Americans every year.Using this tool, pharmaceutical and biotechcompanies could test the action of promisingcompounds before they ever reach the stage ofcostly animal trials. In addition, they may beable to run virtual clinical studies that accountfor the millions of combinations of criteria—the type of patient enrolled, the timing of thedrug administration, the dose, etc.—to designmore productive human trials.“This method will replace a lot of trialand error,” says Tom Petzinger Jr., CEO andchair of LaunchCyte. “And with the computer,you can do a lot of marginal experiments,too—the ones no one wants to try becausethey’re such long shots.”■30 PITTMED

98.6 DEGREESPeople and programsthat keep the schoolhealthy and vibrantA MALL OF SCIENCETOWERING IDEASBY JASON TOGYER ANDMIKE RANSDELLWhen the Greek-colonnaded MellonInstitute opened in 1937, prominentPittsburghers lauded it as “atemple of science.” The impressive buildingon Fifth Avenue in Oakland was designed asa place for research into the emerging technologiesof the day—man-made chemicalcompounds and atomic energy, for instance.From the Mellon Institute portico, visitorswill soon see another “temple of science”rising a few blocks to the west. Rather than aplace for solving the problems of the chemical,steel, and energy industries, this additionto the Oakland skyline will provide a homefor research into tissue engineering, therational design of drugs, nanoscience, andneurological diseases—pursuits that wouldhave seemed far-fetched to the people at theMellon Institute in the 1930s.The BiomedicalScience Tower 3 maybe the most complexstructure Pitt hasever built, accordingto University officials.Constructionof BST3—so namedto distinguish itfrom the two currentBiomedical ScienceTowers—should beN EOSCAPEcomplete in 2005. Rising 10stories above Fifth Avenue, thetower will eventually house500 people in 50 groups, rangingfrom basic research toapplied technology.Maybe instead of a “templeof science,” we’ll call this graniteand limestone tower a“mall of science.” It’s designedfor an easy flow of people (andideas) from place to place. Andthe University hopes its laboratorieswill spur commerce—not shopping, but Pittsburgh’sfecund biotech community.Pitt will be the primary user of the labs, yet thefacilities also will be available for use by otheruniversities and local biotechnology firms.Beginning at the top and working down,BST3 will provide floors for research into newdrug therapies and pharmaceuticals; neuroscience;stem cell and tissue engineering;nanotechnology; proteomics; and computationalbiology. (That’s the high-performancenumber-crunching that helps map genomes,among lots of other dazzling applications.)A major tenant of BST3 will be thePittsburgh Institute for NeurodegenerativeDiseases, a cross-disciplinary group establishedby neurology professors MichaelZigmond and Robert Moore and now headedby Steven DeKosky. The institute is a magnetfor scientists intent on curing degenerativediseases like Alzheimer’s, Parkinson’s, andamyotrophic lateral sclerosis. PIND has beenpraised by the National Institutes of Healthfor creating a new model for the study of thediseases that kill nerve and brain cells: Ratherthan having separate groups tackle individualdisorders, PIND brings researchers togetherto work on a variety of diseases. The institute’swork has already attracted two of the largestgifts in the University’s history—$10.8 millionfrom the Scaife Family Foundation andthe DSF Charitable Foundation; that gift wasmatched by UPMC.In addition to these grants, the $188 millioncost of BST3 will be paid with University andstate funds, debt financing, and philanthropicgifts. Pitt still must raise substantial funds ingifts for construction.Besides providing a home for PIND,BST3 fills a strong need for additional spacefor all of the health sciences, says MichelleBroido, associate vice chancellor for basic biomedicalresearch. Since 1997, NIH-fundedresearch at the University has nearly doubled,but space for such research has increased moreslowly. (BST1 was completed in 1990; BST2opened in 1996.)“Any time a new investigator moves in, oran existing investigator develops a new technique,you have to move walls, move benches,move fume hoods—very expensive and timeconsumingprocesses,” Broido says. BST3’sinnovative design will permit more flexibilityand economy when such moves are required.The tower will house unique technologies,like very large, very strong superconductingmagnets necessary for research into areas suchas structural biology. Such technologies willhelp Pitt recruit top-notch scientists; they’ll alsopose tricky design challenges for the tower’s architects(e.g., those big magnets can’t be placed nextto elevators)—challenges that are slightly moreheady than, say, designing a food court. ■BOOSTER SHOTSGilbert Meyers Jr. (MD ’47) carries the “physiciangene.” His late father, Gilbert Meyers Sr.(MD ’17) attended Pitt, and four of his ninechildren are MDs. Meyers’ own years in medical schoolwere shaped by World War II. He says his classmates inthe army were confined to barracks in the Cathedral ofLearning while he and other naval officer trainees gotthe royal treatment, relatively speaking: As long as theyattended classes, the midshipmen could do as theypleased. Recipients of the Class of ’47 scholarship areunder no obligation to join the navy, but they mightthink of Meyers. His recent class reunion rekindled hisinterest in his alma mater—and inspired him to donatethousands to the scholarship fund.Last August, New York City lost a dedicated member ofits medical community: Benjamin F. Bryer (MD ’37).Steven Zaretsky, chair of the New York CountyMedical Society Special Committee on Workers’Compensation, says Bryer, who was the vice chair,attended every meeting—even after 20 years on thecommittee. Bryer, Zaretsky remembers, sympathizedwith the injured workers as he strived to improve thestate’s compensation laws. In the fall, a scholarshipfunded by Bryer’s $100,000 endowment will be awardedto a needy medical student of high ethical standardswho plans to conduct research. —SZPerhaps the most complex building Pitt has ever builtMAY 2003 31

His has been a voice over the shoulder, gently guiding generations of Pitt med students.LINDA WALLEN32 PITTMED

ATTENDINGRuminations on the medical lifeA PHYSICIAN SECOND,A PERSON FIRSTROSS MUSGRAVE’S EXAMPLE | BY SALLY ANN FLECKERYears after he trained with RossMusgrave (MD ’43), plastic surgeonRobert Chase (Fel ’59)could still hear Musgrave’s voice over hisshoulder as he taught his own residents thevery procedures Musgrave had so meticulouslyimpressed upon him: the care withwhich tissue is handled, the way wounds areclosed, the precise time at which stitches areremoved. By the time he trained withMusgrave, Chase already had logged countlesshours in the operating room, first trainingas a thoracic surgeon and later, during theKorean War, as a reconstructive hand surgeon.He recognized skill and finesse when hesaw it. Musgrave was precise and exacting. Hetook pains to pass that discipline along toChase and the other 124 surgeons he trainedthroughout his long career.“I considered him a wound-geometry wizard,”Chase, a Stanford University School ofMedicine professor emeritus of surgery, says.“Turning flaps of tissue from one place toanother required some mathematical study.And Ross was very, very good at that—andvery good at teaching that. He seemed like hewas interested in anatomical mathematics, likeLeonardo da Vinci was.”Chase calls Musgrave “the Leonardo of plasticsurgery.” It’s a grand and generous remark—and one that’s fitting. Ross Musgrave has livedhis life as surgeon, actor, artist, and teacher—each facet informing the others. For 62 years(minus the few when he was in the army andgraduate training), the University of PittsburghSchool of Medicine has been at the center of hisprofessional universe—first as a student; later,after World War II dropped him back into hisown life, as a resident; and finally as aDistinguished Clinical Professor of Surgery. Helast wielded a surgical knife in 1990. Thispast December, after 12 years, he retired asexecutive director of the Medical AlumniAssociation. Among friends and family, however,this much is clear: He may cut the tiesbut not the cord.Musgrave’s reputation extends well beyondthe Pitt community. Says Chase, “I’m surethere’s not a plastic surgeon alive who doesn’tknow who Ross Musgrave is.” Over the courseof his career, he has held every top nationalpost in his field: president of the AmericanSociety of Plastic Surgeons, president of theAmerican Cleft Palate–Craniofacial Association, governorof the American College ofSurgeons. (“I felt that I had theability to lead,” Musgrave says,“and I took the time to do it.”)Many’s the award he has receivedfrom regional and national medicalsocieties. Pitt honored himwith the Bicentennial Medallionof Distinction and both the University’s andthe School of Medicine’s distinguished alumniawards. Most recently, he was handed thefirst Donald Fraley Award for his work mentoringmed students. And each year at thesenior luncheon, one of the awards given tooutstanding students is named for him—theRoss H. Musgrave Award in Plastic Surgery.He has served as a trustee for both UPMCand the University of Pittsburgh.Not bad for a boy who started out in aone-room schoolhouse.Musgrave was born in 1921 in Economy, arural town 18 miles west of Pittsburgh. Hisparents owned an evergreen nursery. The rootsof his interest in acting and art harken back tohis early days. He learned flower-arrangingworking beside his mother and father andfound opportunities to act in school.Artistic inclinations were put on hold in1940 when Musgrave began the wartimewhirlwind of a condensed medical schoolschedule. By the time he was 22, he had hisMD. The call to service came in July 1945:first Camp Polk, La., which, he says, was in“wild, wild, wild country.” Musgrave arrivedat camp to find there were two openings—onein general surgery, the other in orthopaedics.He had nine months of surgical training underhis belt; the other inductee had 12. “I gotThey take all afternoon, he’d complain ofthe plastic surgeons he watched. Theyput the stitches in. They don’t like them.They take the stitches out.orthopaedics,” Musgrave says. He was sent toan army hospital in Sendai, Japan. The 11thAirborne, with its jump school, kept him busy.He treated 1,300 fractures in 13 months.In July 1947, he mustered out of the armyand was married the next month. This summer,he and Norma Jane (his “fabulous” wife)will celebrate their 56th anniversary.Never did he think he would be so takenwith plastic surgery. They take all afternoon,he’d complain of the plastic surgeons hewatched. They put the stitches in. They don’tlike them. They take the stitches out. When hefound, after a year of training at theUniversity of Pennsylvania and six months ofa general surgical residency at the Universityof Pittsburgh Medical Center, that he wasMAY 2003 33

eing assigned to thespecialty services, whichincluded orthopaedic,thoracic, and plasticsurgery, he went to seeSo easily identifiable by thethe head of his department.“I thought youconfident flower in his lapelliked me,” he said, confessing that plasticsurgery was too slow-moving for him to bear.Instead of getting the assignment that he’dhoped for, he was told, “Go on, kid. It’ll doyou good.” And it did. It wasn’t love at firstsight—truth is, it took a few weeks of scrubbingin before he appreciated the intricaciesof the discipline. But it was true love. Plasticsappealed to the perfectionist and the artistwithin him. God was in the details. Musgravewas hooked.Through the years he became known forhis technical brilliance, especially when itcame to cleft lip and cleft palate repair. “Hewas a superb surgeon for the repair of thatkind of congenital abnormality,” says BettyJane McWilliams, emeritus director of theUniversity of Pittsburgh’s Cleft Palate–Craniofacial Center and emeritus professorof communication disorders. Musgrave wasparticularly deft in creating the dynamicmechanism, called the velopharyngeal valvingmechanism, that separates the oral andnasal cavities during speech and helps onespeak normally.McWilliams remembers giving a presentationat the University of Michigan. She hadbeen monitoring a group of 29 youngpatients who’d had palate repairs at the center.All 29 spoke clearly, without the nasalityor poor articulation of consonants oftenassociated with cleft palate. A colleaguestood up and said that he’d not come acrossthat many normal cleft speakers in the courseof his entire 40-year career. Musgrave hadthem all the time; and others on the center’ssurgical staff achieved similar results.No detail was too small for Musgrave’sattention. He applied dressings rather thanhanding off the task to a resident. (“I insistedmy dressings were a work of art where possible—accurateand neat and sparkling,” hesays. “That’s your badge of honor.”) Thenight before surgery, he would stop in to seehis patients, meet family members, andanswer any last questions. On the day ofsurgery, he would drop by again. He knew hecould cushion anxiety by letting patientsknow he was in the building in plenty of timeto prepare for the procedure, by letting themsee for themselves that he was in great physicaland mental shape, all set.A balanced life is not easy to achieve in ahigh-pressure profession. More than onemedical student at Pitt will recall Musgrave’sthoughts on this matter—a point drivenhome by the very way that he has approachedhis own life. In his mid-30s with his career infull stride, Musgrave re-engaged himself inthe world of theater. (Several years later herediscovered his latent talent as an artist whenhe took his first oil painting class. InFebruary, he mounted a one-man show of hisfabric collage work in his winter home ofLongboat Key, Fla.)In regional summer stock and other venues,he found himself often cast in leading roles, costarringin The Odd Couple and On GoldenPond. He even managed to get his colleagues inon the fun. Some of Pittsburgh’s most distinguishedsurgeons could be found dressed indrag, twirling and singing for colleagues. ThePittsburgh Academy of Medicine’s annualmusical, of course, was Musgrave’s doing.Crouching Patient, Hidden Finger. SavingRyan’s Privates. Productionsthat gave recent Pitt meders andfriends a chuckle might neverhave come to be withoutMusgrave. He hasn’t been activewith Scope and Scalpel indecades, but he served as thestudent show’s first facultyadviser and is credited withkeeping the idea of a seniorproduction alive after the firstshow in 1955. The good dochas interviewed admission candidatesfor 43 years and set thetone for incoming students atthe White Coat ceremony forthe past eight. So well known afigure is he to med students—and so easily identifiable withhis elegant suits, the confidentflower in the lapel, and hisunfailing courtesy—a RossMusgrave character continuesto be lampooned in Scope andScalpel most every year.Although his work as asurgeon, and even as an actor,gave him a high profile in hisprofession, Musgrave would like to be remembered,he says, as a role model and mentor. It’slikely he’ll get his wish.Gregory Jesteadt (MD ’00), now finishinghis residency in family practice at the Universityof Virginia, remembers first meeting Musgravewhen he came to Pitt for his admission interviews.His meeting with Musgrave was the lastfor the day. Afterward, he was free to go.Instead, Jesteadt found himself chatting withMusgrave into the late afternoon.The ease of the conversation surprises himeven now. Despite the world of difference intheir personal interests—Jesteadt is an outdoorsmanwhile Musgrave favors the arts—the two hit it off. The rapport was not an accident.As he did with so many others,Musgrave reached out during the next fouryears to get to know the student, to understandwhat makes him the person he is.Jesteadt now carries with him pieces of wisdomshared during those interactions. It’s wisdomhe’ll continue to grow into—aboutthoughtfulness toward patients, about rememberingto be a human being first, a physiciansecond. It’s the voice over the shoulder thatevery young doctor needs.■34 PITTMED

AS TIME GOES BYWHAT 50 YEARS HATH WROUGHT | BY LOIS M. BARONIn 1952, Martha Dixon Nelson satacross a desk from a member of theUniversity of Pittsburgh School ofMedicine faculty. If she were accepted, hesaid, she would be taking the place of a man.What did she plan to do with her education—get married and quit practicing to stay homeand have children? Would their efforts totrain her be wasted?“It was disconcerting,” Nelson (MD ’56)admits. Once accepted though, she wasn’t treatedany differently from her male counterparts.The pressure was indiscriminate.“They put all kinds of stress on us as wewent through,” Bernard Miklos, fellow ’56er,says, recalling two huge anatomy exams thatmade up most of the class grade. “They purposelydidn’t give us our grades for a month.”Then, while the students were in the midst of afour-hour class, Davenport Hooker would walkaround handing out grades on two-by-twoslips of paper, folded twice.“He’d look you over and put it down.How could you concentrate with that?“A blank paper meant you passed,” continuesMiklos. “If you didn’t, there was a U for‘Unsatisfactory.’ They were very, very strict,and they put you through the wringer.”The men wore white shirts and ties.Classes met every weekday and half a day onSaturday. Anatomy lasted all year. Studentsbegan seeing patients at the end of their secondyear. Electives? There were none. RobertE. Lee remembers sneaking away to attendpathology conferences: “The surgeon I wassupposed to cover for could never find me.”Half a century later, first-year students areasked to at least look respectable when wearinga white coat. They have six weeks ofanatomy in their schedule, are exposed topatients early on, meet in smallgroups for problem-basedlearning, and will, eventually,choose electives.Mapping genomes anddubious claims of cloninghumans make headlines today.Nelson, Lee, et al. also gavewitness to remarkable times.As they studied, or took breaksat Cantor’s (to get a Coke for anickel and a sandwich for aquarter), F. John Lewis performedthe first open-heartsurgery (1952) and Watsonand Crick described DNA’sstructure (1953). ProfessorBenjamin Spock was starting achild-development programand, around the corner, JonasSalk was getting lots of attention.Iron lungs lined hospitalhallways; complete bloodcounts were done manually,taking 20 minutes each. Halfthe nation’s hospital beds werefilled with mentally ill patients.“There were whole wards ofcatatonic patients,” says Edwin J.Whitman (MD ’56).He remembers watching someonedie of renal failure in the daysbefore dialysis, “a cruel death.”The first kidney transplant wasperformed the year he graduated.Many of Whitman’s friendswere from his end of the alphabet,because class was always seated alphabetically.Row-mate Cyril Wecht doesn’t rememberwhat problems medicine faced when he was inschool, but he knows what his class didn’t haveto deal with: managed care, third-party payers,decreasing fees from Medicare and Medicaid,access to care issues. Current first-year JoeMadia isn’t sure he’s ready for a world wheredocs stop seeing patients because they can’tafford malpractice insurance premiums: “Ican’t imagine.”Alicia Saunders (Class of ’06) is 30, one ofmany enrolled today who fit in a so-called“nontraditional” age group at Pitt. (The GIBill meant the Class of ’56 had several studentswith more life experience as well.)Saunders is a single parent who cobblestogether care for her 6-year-old son with thehelp of family. A study group makes life easierby meeting at her place. Now and then, shegoes out for an evening with other classmates(no 25-cent sandwiches). She includes her sonin most extracurricular activities, like servingdinner at a men’s shelter. (It’s not unusual forPitt med students to spend some of theirsparse free time volunteering.)Fifty-sixers came mostly from Pennsylvania.Saunders’ classmates come from all over thecountry. Nearly half are women; 21 of the148-member class are from minority groups.Many tried their hand at another career beforebeing accepted. Undergraduate degrees rangefrom the biologic basis of behavior to theater.Wecht recalls quotas that excluded many.He was one of 10 Jews allowed in his 100-member class. “It’s obscene that only fourwomen were admitted in our year,” he says.Two of the women and 13 men disappearedafter the first year.“Nobody flunks out anymore,” grumblesMiklos in good humor. (He prefers the currentsystem.)Arturo Torres, of the Class of ’06, agrees,sans grumble, noting that the school willeven pay for tutoring if a student happens tofalter.“It’s very competitive to get in,” he says,“but once you’re in, you’re in.”■MAY 2003 35

ALUMNI NEWSCLASS NOTES’50s Edward Berman (MD ’56) has beenin private practice in Los Angeles for 40 years and hasno plans to retire. It’s not surprising the cardiologisthas so much energy; he has been running since the’40s. Berman has participated in 100 marathons, thelast of which was the 2000 Boston Marathon. For years,he ran 12 miles a day to keep in shape for distanceevents; now he runs about seven miles a day. Many ofhis running buddies are from the Pittsburgh area.Joseph Marasco Jr. (MD ’57) was the recipient ofthe Beclere Medal from the International Society ofRadiology. The emeritus chair of radiology at St. FrancisMedical Center, Forbes Health System, and Ohio ValleyGeneral Hospital, all in Allegheny County, Marascospent much of his career promoting the education andtraining of radiologists worldwide. He chaired a meetingat the World Health Organization to improve thetraining of radiologists and other physicians in underdevelopednations.’60s William Furrer Jr. (MD ’65)practiced as an orthopaedic surgeon for 17 years inPullman, Wash., where he was also orthopaedic consultantand team physician for Washington StateUniversity. He now works as a medical consultant toinsurance companies, evaluating injuries. The new paceis nothing compared to the four hectic years he spentcrisscrossing the country when his son was a startingquarterback for Virginia Polytechnic Institute andState University. The son of friend and fellow alumDan Kanell (MD ’65) was a quarterback for FloridaState University at the same time; both young menlater played in the National Football League.’70s Gary Quick (MD ’72) is an emergencyphysician at Midwest Regional Medical Center inMidwest City, Okla., and Oklahoma Heart Hospital inOklahoma City. He also recently became emergencyultrasound coordinator at both institutions. Quick hasserved as secretary and newsletter editor for theAmerican College of Emergency Physicians Section ofEmergency Ultrasound for the past three years.Richard Hauger (MD ’74) says evidence is mountingthat anxiety and mood disorders are connected tostress. A professor and director of the neuroendocrineresearch program at the University of California, SanDiego, he is investigating the connection by studyingthe molecular structure of two corticotropin-releasingfactor receptors that play critical roles in brain andpituitary response to stress. The CRF receptor systemis overactive in patients suffering from depression,bipolar illness, and anxiety disorders. Hauger hopes toidentify how stress interacts with these mood disorderson the molecular level so that he can create a treatmentspecifically tailored to each disorder.Mary Ann Wolak Michelis (MD ’75) is president ofthe medical board at the 683-bed HackensackUniversity Medical Center in New Jersey and the firstwoman to serve in that capacity in the center’s 115-yearhistory. Michelis also serves as chief of the hospital’sclinical diagnostic immunology lab as well as the chiefof allergy/immunology for the pediatrics and internalmedicine departments. Pitt’s Bruce Rabin first piquedher interest in immunology. Then, working with Pitt’sPhilip Fireman, she says, made her feel like her favoritechildhood literary character, teen detective Nancy Drew.Steven Shapiro (MD ’75, Pediatric Neurology Fellow’78–’81, Auditory Neurophysiology Research Associate’81–’82) has been interested in brain damage in newbornssince his days working in Aage Møller’s lab atPitt. Shapiro, an associate professor in the departmentsof neurology and pediatrics at Virginia CommonwealthUniversity in Richmond, studies bilirubin toxicity, whichcan occur when an infant suffers from jaundice.Although jaundice is common in newborns, excessivelyhigh levels of bilirubin in the bloodstream can causekernicterus. Children with kernicterus have difficultycontrolling their motor functions and often have hearingproblems. Shapiro hopes to study the benefits of deepbrain stimulation—among other therapies—for childrenwith the disorder.A. Robert Morelli (MD ’76, Pediatric Resident’77–’79) retired after 20 years in private practice withthe intent that he and his wife would travel. After onlythree months, Morelli was bored and started makingcalls to see if his hometown of Clearwater, Fla., had apediatric hospice. When he discovered that, nationwide,WE KNEW YOU WHEN | MARY WILLIAMS CLARKBY MEGAN E. SOFILKAIt was December, and Mary WilliamsClark, a resident at UPMC Presbyterian,was making roundswhen her pager began to beep. Shecalled the number, which was answeredby a nervous secretary from a localorthopaedic office. “Um, Dr. Williams,we usually send the residents subscriptionsto Playboy for the holidays ...would you prefer, um, Ladies’ HomeJournal?” Laughing, Clark replied, “Oh,c’mon, I’m not gonna be any differentfrom the guys—send me Playboy!” She liked the articles.Even as a Yale med student, Clark knew orthopaedics would bea field in which she met few other women. Her mentors during herABOVE: Mary Williams Clarkin a 1975 faculty photo.RIGHT: Williams Clark morerecently, boating with herdaughter.36 PITTMED

very few of the approximately 53,000 children whoneed palliative care actually receive it, he helpedexpand the children’s program of the Hospice of theFlorida Suncoast. He and his wife are starting to takemedical missions to Honduras. His wife hopes to organizea medical library; Morelli plans to help establish aburn unit.Susan Sprau (MD ’78) is determined to improveMedicaid funding in California, which has one of thelowest levels of reimbursements in the nation. Unlessthe reimbursements increase, she says, fewer hospitals,clinics, and physicians will be able to treatMedicaid patients. Sprau became a legislative advocatewith the American College of Physicians– AmericanSociety of Internal Medicine after being frustrated bythe “bureaucratization” of medicine. As the chief liaisonbetween the ACP–ASIM and the California MedicalAssociation, she has been a consultant on Californialegislation capping the amount for which patients cansue, in hopes that malpractice insurance costs willdecrease. Last year, the ACP–ASIM recognized herservice to patients and physicians with the JeremiahTilles Award.’80s Janice Anderson (MD ’84) is workingpart-time at Wilkinsburg’s Metro Family Practice, anonprofit service. (So that Wilkinsburg residents wouldcontinue to have access to their services, her colleagueswere determined to keep a practice there whenthe local hospital moved out.) Anderson focuses onimproving maternity care in underserved populations.She recently obtained a grant from the United Way ofAllegheny County for prenatal care and education. Afterinterviewing groups of women in low-income neighborhoods,Anderson and her colleagues at East LibertyFamily Healthcare concluded that they needed to disseminatemore information about issues like breastfeedingand the importance of folic acid. She becameinterested in obstetrics during a rural rotation in NorthCarolina, when she helped a physician deliver a baby atthe mother’s home. Anderson was “amazed” that adoctor could have that kind of impact on a family.Keith Kanel (MD ’83, General Medicine Intern’83–’84, Resident ’84–’86) just returned to UPMC toopen a practice in general medicine. Kanel used to be ateam physician for Pitt athletics. With his partners, hehopes to develop a new model of primary care thatfocuses on preventive medicine. He says Michael Karpf,a former Pitt professor, inspired him to pursue internalmedicine.RESIDENTS AND FELLOWSDonald Marion (General Surgery Intern ’83,Neurosurgery Resident ’83–’89) was a professor ofneurological surgery at the University of Pittsburghuntil last year. He left to chair the neurological surgerydepartment at Boston University. Marion spent about15 years studying brain ischemia. When the brain sufferstrauma, the blood flow to its tissues is restricted,causing damage. He and others found that cooling thebody can prevent such damage.’90s Shawn Fultz (MD ’97, InternalMedicine Intern ’97–’98, Internal Medicine Resident’99–’01, Internal Medicine Fellow ’01–present) wasappointed to the national board of directors of theresidency at Pitt from 1967 to 1972 were all men, including Albert Ferguson, whoarranged for her to spend three months of her residency at Rancho Los AmigosHospital in California. There she learned about rehabilitation while treating patientsin the stroke and amputee/complex-fracture units.In 1976, Robert D’Ambrosia (MD ’64), whose residency at Pitt overlapped withClark’s, was chairing the orthopaedics department at Louisiana State University. Thenew medical director of Children’s Hospital of New Orleans was recruiting staff forthe facility and approached D’Ambrosia, telling him, “I need a guy who is anorthopaedist who understands rehabilitation.” D’Ambrosia replied, “I know a guylike that, and I’ll call her up.” Clark got the job.These days, she teaches at Michigan State University and practices at SparrowRegional Children’s Center. Her most lasting legacy, however, mayturn out to be Who Is Amelia?, which she cowrote. Amelia is aboutcaring for children born with congenital limb defects. The AmericanAcademy of Orthopaedic Surgeons sends it, free of charge, to anyorthopaedic resident who requests it. Clark’s reputation has alsotaken her to Mister Rogers’ Neighborhood, where she applied acast to the host’s arm to ease the fears of children who may oneday have to visit the hospital.Gay and Lesbian Medical Association.Fultz, who will serve a three-year term,hopes to improve healthcare for thegay, lesbian, bisexual, and transgendercommunities by educating patients andthe doctors who treat them. At the VAPittsburgh Healthcare System, Fultzcoordinates a study—based at theCincinnati VA Medical Center—thatexamines how spirituality affects thequality of life of veterans sufferingfrom HIV and AIDS.The Hippocratean, 1995William Davenport (MD ’98) wasrecently appointed director of the University MedEvacprogram at Hahnemann University Hospital. He’s alsothe faculty adviser to a student-run clinic associatedwith Prevention Point Philadelphia, which offers a needle-exchangeprogram. Davenport is a clinical assistantprofessor at Drexel University and an attending physicianin the Hahnemann emergency department. He“loves every minute” he works in the ER. At the sametime, he has found a great stress reliever: motorcycleroad racing. Davenport is former president of theNational Motorcycle Patrol (a group providing first aidto motorcycle racers). He celebrated his graduationfrom medical school by riding his bike all the way toHonduras. — MH, MES, & SZTHE WAY WE ARE: CLASS OF ’92BY STAR ZAGOFSKYDrew Feranchak (MD ’92, Pedatric Resident’92-’95) made his singing debut in the Scopeand Scalpel production Operation ThyroidStorm. He missed every note, confessesFeranchak, now a pediatric gastroenterologistat Children’s Hospital of Denver and anassistant professor of pediatrics at theUniversity of Colorado.At least country-western singer Naomi Judddoesn’t see Feranchak as a potential threat. Onbehalf of the American Liver Foundation, shepresented him with a grant so that he couldcontinue his research into the liver’s release ofadenosine triphosphate, or ATP, a small moleculethat all cells use for energy. His work suggeststhat ATP can leave cells and attach toMembers of theClass of ’92 at theirreunion in OctoberMAY 2003 37

ALUMNI NEWSreceptors on neighboring cells, triggering variousprocesses. Because most childhood liverdisorders are associated with poor bile flow,Feranchak is studying ATP’s role in stimulatingbile secretion. (Judd suspended hersinging career because of chronic liver disease.)It wasn’t singing that temporarily stymiedEvan Baker (MD ’92). Baker rememberswhen his class operated on pigs during surgicalrotation. His group summoned HankBahnson when they noticed the pig havingproblems. The world-renowned cardiothoracicsurgeon took one look at the team’swork and said, “There’s not much we can dohere.” Baker decided that he wasn’t going tobecome a surgeon. These days, Baker, an assistantprofessor of pathology at Pitt, is helpingto resuscitate Homestead, Pa., where residentselected him to borough council in 2000.When he entered office, the community wasreeling from decades of neglect and unemployment.There hadn’t been any new homes builtfor more than 20 years. Baker promised hewould focus on community redevelopment,and last year five new houses were constructed.Had she attended last year’s class reunion,Kathryn Gaydos Clark (MD ’92) couldhave told Baker about her own governmentconnections—well, a little. She really can’tdiscuss many of her assignments at theArmed Forces Medical Intelligence Center(AFMIC) in Frederick, Md., except withthose with the proper security clearance.Clark’s team studies infectious diseasesaround the world like Crimean-Congo hemorrhagicfever, Q fever, and Rift Valley fever.She recently traveled to South Africa andthe Democratic Republic of the Congo tovisit hospitals, water treatment facilities, andother health organizations. The data shegathered helps AFMIC estimate the impactof disease on Defense Department personnel.Though she hasn’t practiced clinicalmedicine in more than a year, Clark is contentwith a job that allows her to travel, freesher from pressure to publish, and even helpsher balance career and family. After all, it’snot her kids who ask her to leave work at theoffice; it’s the federal government.The Class of ’92 gathered for an Octoberreunion in Pittsburgh. They attended theSyracuse-Pitt game—the Panthers won with alast-minute field goal. Then 30 alumni andguests went to dinner at Asiago. ClassmatesEvan Baker, Carolyn Ellis, Christopher O’Hara,and Timothy Klatt planned the get-together.HENRY T. BAHNSONNOV. 15, 1920–JAN. 10, 2003Henry T. Bahnson set two goals when he moved to Pittsburgh to chair theDepartment of Surgery—take the program to national prominence and findBahnsona home with a ski hill. He was successful on both counts, though the ski hillcame first. Bahnson rigged an automobile engine in the backyard to pull a rope, towingskiers to the top of the hill.His five children enjoyed it immensely, as did their friend, Bartley Griffith. “He waslarger than life,” recalls Griffith, now chief of the division of cardiac surgery at theUniversity of Maryland. “He was a great skier and outdoorsman. People just wanted tobe led by him.” Griffith, who went on to scrub with Bahnson, never forgot the last advicehe gave him—be brave and trust in your training.Achieving a stellar surgical program took a few years longer, but Bahnson pulled thatone off, too. Thomas Starzl says it’s hard to conceive of the School of Medicine’s currentstatus without the man who trained “generation after generation of outstanding surgeons”and set an example of “fundamental, implacable integrity.” “A lot of people are great surgeons,”Starzl says of his friend, Bahnson, who died Jan. 10 at age 82 after suffering astroke, “but not very many are great men.” —Chuck StaresinicOliverTHOMAS K. OLIVER JR.DEC. 21, 1925–JAN. 6, 2003Thomas K. “Tim” Oliver Jr. had his own version of the golden rule.While chairing the Department of Pediatrics at both Children’sHospital of Pittsburgh and the School of Medicine from 1970 to1987, he didn’task others to doanything hewouldn’t have done. He deliberatelychose a small office—8 by 10feet—so faculty wouldn’t complainabout lacking space. And Olivertaught an extra clinic that no oneelse wanted, on Friday afternoons.“Nobody on the faculty couldsay they wouldn’t do it if the chairmanwas doing it,” says his wife,Lois Pounds Oliver (MD ’65).Oliver loved teaching so muchthat, at his insistence, the School ofMedicine’s executive committeerearranged its meeting schedule sohe could spend his mornings(including Saturdays) teaching. In17 years at Pitt, Tim Oliver trainedmore than 250 residents. Since herhusband’s death on Jan. 6 at thecouple’s home in Chapel Hill,N.C., Lois Oliver has received hundredsof letters from his former studentsand patients who rememberhis dedication. —SZIN MEMORIAM’30sHUMBERT L. RIVA(MD ’39)JAN. 21, 2003’40sCHARLES W. GABOS(MD ’44)DEC. 2, 2002WILLIAM C. HULLEY JR.(MD ’44)NOV. 30, 2002MATTHEW MARSHALL JR.(MD ’44)DEC. 20, 2002’50sIRVING S. GOLDMAN(MD ’50)FEB. 4, 2003W. LINDSAY JACOB(MD ’51)FEB. 10, 2003CHARLES H. TYSON(MD ’54)NOV. 19, 2002’70sLEE A. TRACHTENBERG(MD ’71)JAN. 10, 2003NANCY CAROLINE(FEL ’73–’76)DEC. 12, 2002FACULTYA. JULIO MARTINEZDEC. 27, 2002THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, ONCE APRIMARY SOURCE FOR DEATH NOTICES OF OUR ALUMNI, NO LONGERPRINTS AN OBITUARY LIST. WE ENCOURAGE YOU, MORE THAN EVERNOW, TO LET US KNOW ABOUT ALUMNI WHO DIED RECENTLY. (ONTHE INSIDE FRONT COVER, YOU’LL FIND CONTACT INFORMATION FORTHE MAGAZINE.)38 PITTMED

SCOTT HARRISON:A MISSION OF HOPEBY MEGHAN HOLOHANMEDICALThe lesion slowly eating away at his vertebraeis immobilizing Louis Andanke(not his real name). From his hospitalbed in Malawi, the 30-year-old man, sufferingfrom tuberculosis of the spine, looks atorthopaedic surgeon Scott Harrison hopefully.“So you’re the American doctor who isgoing to cure me.”Surgery could straighten and stabilize thespine, but Harrison (MD ’63) isn’t sure heshould operate. At Hershey Medical Center incentral Pennsylvania, Harrison operates onchildren, in rooms equipped with the latesttechnology. This southeast African hospitaldoesn’t even have chest tubes for intubation;Harrison brought his own. It can’t afford toreplace surgical gloves, so old gloves arereused. Some of them are full of holes.The chief of surgery at the hospital pullsHarrison aside. “I can’t forbid you from doingthe surgery,” he says, “but we don’t have anICU.” Harrison knows the chief is afraid theoperation will be botched. But as he thinksabout Andanke’s excitement at the possibilityof a cure, Harrison knows he must operate.Without his help, Andanke will be paralyzed.The operation goes smoothly. In the backof his mind, Harrison thinks he proved thechief of surgery wrong, and he’s happy thatAndanke will walk again. But when the patientawakes, he can’t move his fingers or toes.Harrison is devastated. Between operating onother Malawians, he serves as Andanke’s nurse.ALUMNI ASSOCIATION OFFICERSPAUL M. PARIS (MD ’76)PresidentFREDDIE H. FU (MD ’77)President-electSTANLEY M. MARKS (MD ’73)Vice PresidentGRAHAM JOHNSTONE (MD ’70)SecretaryPETER FERSON (MD ’73)TreasurerROBERT E. LEE (MD ’56)HistorianJOHN F. DELANEY (MD ’64)RICHARD RAIZMAN (MD ’71)JOANN VIRGINIA NARDUZZI (MD ’62)CHARLES M. HEFFLIN (MD ’74)Members at LargeSUSAN DUNMIRE (MD ’85)Interim DirectorM-2OOK Scaife HallUniversity of PittsburghPittsburgh, PA 15261tel 412-648-9090; fax 412-648-9500medalum@medschool.pitt.eduCOURTESY HARRISONHarrison’s organization is building a hospital in Afghanistan.After a few weeks, Andanke starts moving.That was 17 years ago. At another doctor’ssuggestion, Harrison had agreed to go toAfrica on a medical mission—but with somereluctance, because he didn’t know the otherphysician very well. After Andanke—Harrison’s first patient—made a full recovery,any trepidation the physician had about travelingto Africa quickly faded. In the next severalyears, Harrison made more than 50 tripsto African hospitals, often performing operationsall day and into the night.For relaxation, Harrison, an avid huntersince high school, went on several safaris. Butthis combination of sport and surgery “didn’tsit right,” he says. “You have to get mentallyprepared in different ways, and it was toomuch to do both.” And all around the impoverishedcountryside, Harrison could see thattrained physicians and modern hospitals weredesperately needed.In 1996, he and his wife, Sally Harrison,made a decision: They would stay in Africaand open a hospital inKenya. Within a year,a rehabilitated buildingin Kijabe, northof Nairobi, becamethe first hospital inHarrison’s new nonprofitorganization,CURE International.CURE now hasthree operational hospitalsin Africa, withtwo more about toopen in Afghanistanand the Dominican Republic. Each facility istailored to the specific needs of an area: In aregion with a high percentage of limb deformities,for instance, the hospital will focus onorthopaedic surgery. Besides much-neededhealthcare, the hospitals offer among the fewlearning opportunities available to youngdoctors and nurses in developing nations.“Scott’s a world-class physician, and he’salso a very good businessman, with a quickmind, confidence, and stability,” says RexLysinger, who grew up with Harrison inMcKeesport, Pa., and later attended theUniversity of Pittsburgh with him. Now aretired CEO of a diversified energy company,Lysinger sits on CURE’s board of directors.“Idon’t have too many heroes—very few ofthem—but Scott is one.”Lysinger tells a story of when CURE wastrying to start a hospital in Uganda.Government red tape delayed the organizationat every turn: No land, no visas for doctors, nohealth permits. Finally, CURE representativesmet with the wife of President YoweriMuseveni. “If you need land, we’ll find it,” thefirst lady said. “If you need permits, we’ll getthem.” The Americans were stunned. Whywas she so eager to help them?“We have been praying for years for someoneto build a hospital and take care of ourchildren,” she said.Patients like Andanke inspire Harrison topersevere. Andanke still writes to Harrison;he told the doctor how scared he was back in1986. He didn’t want to show it at the time,because he thought Harrison wouldn’t operateon someone who was so afraid. ■MAY 2003 39

LASTCALLAll of 5 feet tall, Davenport Hooker was animposing figure in the School of Medicine.As the chair of the Department of Anatomyfrom 1919 to 1956, Hooker was often the barrierbetween the first and second year for Pittmed students. Macy Levine (MD ’43) won’t soonforget him: “He had a loud booming voice, and hecommanded attention. When he said something,you listened.” On the off chance students weren’t listening,they’d be dealt a piercing blow from a whistle(shown here), which the professor carried primarily toherd students into lecture. (Please send your Hookermemories to medmag@pitt.edu or the editorial officeaddress on the inside front cover.)WHISTLE, TOM ALTANY. PORTRAITS OF HOOKER,THE HIPPOCRATEAN40 PITTMED

C A L E N D A ROF SPECIAL INTEREST TO ALUMNI AND FRIENDSINAUGURAL ALUMNIW EEKENDMAY 15–18CLASSES CELEBRATING:1938 19731943a 19781943b 19831953 19881958 19931963 19981968For informationMedical Alumni Association412-648-9090 or 1-877-MED-ALUMmedalum@medschool.pitt.eduSENIOR CLASS LUNCHEONMAY 16The Twentieth Century Club11:30 a.m.For informationMedical Alumni Association412-648-9090 or 1-877-MED-ALUMmedalum@medschool.pitt.eduSCHOOL OF MEDICINESCHOLARSHIP TEAMAY 16University Club3:30 p.m.For informationMedical Alumni Association412-648-9090 or 1-877-MED-ALUMmedalum@medschool.pitt.eduRECEPTION HONORINGRALPH KNISELEY (MD ’43)MAY 16Falk Library for the Health Sciences3:30 p.m.For informationMedical Alumni Association412-648-9090 or 1-877-MED-ALUMmedalum@medschool.pitt.eduANNUAL ALUMNIDINNER DANCEMAY 16Pittsburgh Athletic Association6 p.m.For informationMedical Alumni Association412-648-9090 or 1-877-MED-ALUMmedalum@medschool.pitt.eduSCOPE AND SCALPELMAY 16 AND 17The SopranololsCarlow College Auditorium7 p.m.For informationSing Tsai (Class of ’03)info@scopeandscalpel.orgALUMNI BREAKFASTMAY 17“Celebrating Excellence”University Club8:30 a.m.For informationMedical Alumni Association412-648-9090 or 1-877-MED-ALUMmedalum@medschool.pitt.eduESTATE PLANNINGBREAKFASTMAY 18“Take a Bite Out of Estate Taxes”Holiday Inn Select—University Center9 a.m.For informationMedical Alumni Association412-648-9090 or 1-877-MED-ALUMmedalum@medschool.pitt.eduGRADUATION CEREMONYMAY 19Carnegie Music Hall10 a.m.For informationStudent Affairs Office412-648-9040student_affairs@medschool.pitt.eduCLASS OF 2007W HITE COAT CEREMONYAUG. 10Lecture Rooms 5 and 6, Scaife HallFor informationStudent Affairs Office412-648-9040student_affairs@medschool.pitt.eduCLASS OF ’48 REUNIONSEPT. 19–21Hidden Valley ResortSomerset, Pa.For informationMedical Alumni Association412-648-9090 or 1-877-MED-ALUMmedalum@medschool.pitt.eduTO FIND OUT WHAT ELSE IS HAPPENING AT THE MEDICAL SCHOOL, GO TO www.health.pitt.edu

THE FUTURE’S SO BRIGHTPitt med graduates have a bright future ahead of them.But many also carry hundreds of thousands of dollars instudent loan debt. In some cases, financial concernseclipse their desire to teach, conduct research, or pursueless lucrative specialties, like primary care. Gifts to theSchool of Medicine’s scholarship funds are like rays ofsunshine to new physicians. To find out how you can lightup a career (it will warm your heart as well) call the Officeof Alumni and Development at 1-877-MED-ALUM.HULTON ARCHIVEUNIVERSITY OF PITTSBURGHSCHOOL OF MEDICINESUITE 401 SCAIFE HALLPITTSBURGH, PA 15261CHANGE SERVICE REQUESTED

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