A student’s warm heart and “amazing” smile

Mila Rainof’s embrace of others has inspired an enduring memorial at the medical school.

As the 96 members of the Class of 2008 processed to Old Campus for Commencement on May 26, they paused at the corner of York Street and South Frontage Road. One by one, each graduate placed a carnation in memory of Mila Rainof, a classmate who was not with them in the procession.

On April 19 Rainof was struck by a car as she crossed the intersection. She died the next day of her injuries. At a medical school town meeting called by Dean Robert J. Alpern, M.D., on the Monday after Rainof died, Alpern said, “The medical school family has lost a member way too young in age.”

In the wake of her death, Rainof’s friends and classmates have found many ways to honor her. Her close friends stood by Rainof’s parents and sister when they came to New Haven and organized a memorial service in the medical school’s Rose Garden. Others began collecting photos and remembrances for a book to be given to her family. Students have organized efforts to improve safety at intersections near the medical school. (See sidebar.) A memorial scholarship and award fund is being established at the School of Medicine to honor and perpetuate Rainof’s memory, in particular her compassionate spirit and humanistic approach to medicine. Students also planted a cherry tree in her honor on Harkness Lawn.

Rainof’s parents have shared with Merle Waxman, director of the Office for Women in Medicine and a mentor to Rainof, that their daughter loved Yale and was happy here. Her phone calls, they told Waxman, were always filled with her enthusiasm for her classmates, teachers and patients.

What friends remember best about Rainof is her warm and welcoming smile. “Like everyone else,” her boyfriend and classmate James Troy said at the Rose Garden memorial, “I was instantly won over by her amazing smile.” A friend and classmate, Ellen House, recalled sharing clinical rotations with Rainof and all the patients asking for “the smiley one.”

Margaret A. Drickamer, M.D., associate professor of medicine, recounted a trip to Seattle with Rainof to attend a conference. They walked all over the city, she said, talking and telling stories. “We laughed, we cried—and we did go to some poster sessions.” Beyond Rainof’s warm and friendly demeanor, Drickamer said, was a determination to help people. “Mila really cared about people, especially when she felt a responsibility for their welfare, and she steadfastly refused to let anything get in the way of that caring,” Drickamer said.

Karen J. Jubanyik, M.D., assistant professor of surgery (emergency medicine), described a difficult shift at Yale-New Haven Hospital the day after Rainof died. “I just thought, ‘What would Mila do?’ ” Jubanyik said. “She would contribute any way she could. She would go to the patient’s side, hold their hand and genuinely listen to them.” Friend and classmate Maggie Samuels-Kalow said, “Mila was the person that you wanted at your side when the patient was getting sicker and you didn’t know what to do.”

Kristina Zdanys, one of the class co-presidents, said that the students in the Class of 2008 are a close-knit group and would have felt the loss of any of their members, but that Rainof was special. “Whenever she walked into a class or Marigolds, she was always smiling or had something nice to say,” Zdanys said.

“If you asked people to think of a person in the class who always made people feel good … she would be the first person,” said Rachel Wattier, who has been leading a committee that has met with city and university officials to improve traffic safety.

A few days before Commencement, students, faculty and others gathered at the intersection where the accident occurred. Bearing signs that read “Yield 4 Walkers,” and “No Turn on Red,” the group asked drivers to slow down and respect the traffic lights.

“There was really no one to blame,” Gregory L. Larkin, M.D., professor of surgery (emergency medicine), said at a meeting in The Anlyan Center the day after Rainof died. Larkin had been the attending in the emergency room when an ambulance delivered Rainof. The day before the accident, Larkin had been her teacher, instructing her in the use of ultrasound. Rainof was scheduled to begin a residency in emergency medicine in Oakland, Calif., after graduation.

On the morning of April 19 Rainof was on her way back to her York Street apartment after working out in the gym in Harkness Dormitory. A truck was leaving the loading dock of Yale-New Haven Hospital against a red light. As Rainof crossed South Frontage Road, also against the red light, the truck cleared the intersection and cars in the three oncoming lanes moved forward. Two swerved to avoid her, but a third struck her when she was just a yard away from the curb and safety. She died the next day of severe head injuries.

—John Curtis

After a tragedy, the medical school community mobilizes around traffic safety

On the afternoon of May 22, about two dozen students, faculty and staff from the School of Medicine marched from Cedar Street to the corner of York Street and South Frontage Road, where Mila Rainof, a fourth-year medical student, died after being struck by a car a month earlier.

Pedestrians have long dreaded this and other intersections near the medical school. Drivers in a hurry to reach the Route 34 Connector feeding into Interstate 91 and Interstate 95 routinely run red lights and ignore pedestrian crossing signals.

Students have organized a Traffic Safety Group since Rainof’s death—their goal is to make the streets safer for pedestrians.

“It is important that we honor Mila and keep the traffic safety effort in the spirit of what she would have done,” said Rachel Wattier, a fifth-year medical student who is leading the traffic group. “A lot of people have deep-seated concerns about traffic that they were never able to act on. People see an opportunity to have their concerns addressed.”

Plans are already under way to improve four intersections adjacent to the medical school area. They are part of a larger plan for street improvements as part of a deal struck between Yale-New Haven Hospital and the city for the construction of the Smilow Cancer Hospital. The model will be the intersection at Cedar Street and Congress Avenue, which has pedestrian crossing lights that flash and count down the seconds remaining for a safe crossing.

The hospital will also relocate a truck loading dock at South Frontage Road and York Street under the adjacent Air Rights Garage. Traffic that now leaves the garage onto South Frontage Road will leave through a roundabout to be built where the Route 34 Connector meets the garage.

In light of the planned improvements, the safety group is developing materials to promote pedestrian and cycling safety, petitioning the city government to enforce the city’s 25 mile-per-hour speed limit, and calling for strict enforcement of traffic regulations governing stop lights and signs, cell phone use, bicycle lanes and crosswalks.

—J.C.

School of Medicine goes green as it aims for lower carbon emissions by 2020

The Yale School of Medicine’s sustainability campaign is ambitious and costs a little extra, but it’s perfectly willing to accept hand-me-down jeans—in fact, that’s part of the point.

Denim discarded in the jean manufacturing process, which now helps insulate the Sterling Hall of Medicine’s C wing, is one of many recycled materials that are lightening the university’s carbon footprint. The building’s recently renovated lab casework, ceiling tiles and wall insulation also come from such recycled materials as wheat straw board and soy-based spray foam. In total, the sustainability campaign squeezes more light from the sun, diverts trash from landfills and conserves water and heat.

Adding such features to previously planned renovations costs more—between 1 and 2 percent of the $8.2 million price tag of the Sterling renovations that were completed in 2006—but Yale can’t afford not to do it, said Virginia Chapman, director of construction and renovation for the School of Medicine’s facilities office. “We’re saving the university money as a by-product of reducing carbon emissions,” she said. Still to come, Chapman added, are renovations to the second and third floors of Sterling’s I wing, the Brady Memorial Laboratory, the Hunter Building, the sixth and seventh floors of the Laboratory for Epidemiology and Public Health and the Laboratory for Surgery, Obstetrics and Gynecology, all of which will incorporate green features.

Yale’s overall sustainability strategy began with the student-initiated “Yale Green Plan” in 1998. In 2002, the university’s Advisory Committee on Environmental Management proposed a set of environmental principles, and in 2005 President Richard C. Levin committed the university to reducing greenhouse gases to 10 percent below 1990 levels by the year 2020.

Implementing a sustainable laboratory renovation that could be benchmarked and measured by a national standard would not come easily. Success is measured by the U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED), but the organization had not set standards for lab renovations. “LEED was designed for new buildings or full-building renovations but not laboratories nor smaller-scale renovations of the kind we do here at the medical school,” Chapman said.

The work on the third floor of the C wing created a yardstick in 2006 when it became the first laboratory renovation project in the United States to gain LEED gold certification for its sustainable features. Among those features, said Robert Skolozdra, an associate at the architectural firm Svigals & Partners, which designed the renovations, are sensors that switch lights on only when a person is in the room. “Daylight harvesting”—adding windows—maximizes available light. The project eased the strain on landfills by recycling 85 percent of construction and demolition debris. Lab faucets have reduced their output from 2 to 1.5 gallons per minute, and low-flush toilets and urinals have been installed. Water use is now down 35 percent overall.

As green renovations continue at the medical school, officials know that the older buildings will pose a challenge, but The Anlyan Center, which opened in 2003, is also “a big energy user,” Chapman said. When it was designed, “other concerns outweighed concerns for the environment.” The building is undergoing an energy audit to determine how to address the high energy use, she said.

—John Dillon

New financial aid policy geared toward middle-income families and students

Some students opening acceptance letters from the School of Medicine this spring had another reason to celebrate. While their colleagues in the Class of 2008 graduated with an average debt of $115,000, a new financial aid formula should ease that burden for middle-income families.

Dean Robert J. Alpern, M.D., Ensign Professor of Medicine, announced the new policy in April. Formerly, parents with a combined income over $45,000 were expected to help pay the costs of their child’s medical education. Beginning this academic year, that threshold has been raised to $100,000. The “base loan” (the amount students are expected to borrow before receiving scholarship funds) has been raised from $17,000 to $18,000, keeping it among the lowest in the country. The new formula applies to all current students.

“What we were expecting was not realistic,” said Richard Belitsky, M.D., the Harold W. Jockers Associate Professor of Medical Education and deputy dean for education.

The change was made possible after Yale’s endowment income added $1.1 million to the medical school’s financial aid budget. The school’s financial aid committee then decided that students from middle-income families needed the extra funds most. Especially needy families did not need to borrow more than the base loan, as School of Medicine scholarships make up the difference, while affluent families were less burdened by tuition costs. The resources of students from middle-income families, though, consistently fell short of the old financial aid formula’s estimate, and these students were forced to borrow above the base loan to pay what the school required.

“They should have been borrowing $68,000—four times the unit loan—but the average debt was $115,000,” said Alpern.

Another reason for the change, said Belitsky, was that high debt often influences specialty choice. For example, primary care physicians are in critically short supply nationwide, perhaps in part because they are less well reimbursed than their colleagues in some specialties. Of the 97 Yale students who matched this year, only four entered primary care, and another three entered family medicine. The American Medical Student Association has stated that the current American model of financing medical education harms efforts to improve physician diversity and patients’ access to care.

Richard Silverman, director of admissions, speculates that the change may also affect the diversity of the applicant pool. “If another school is widely perceived to be generous or liberal in its financial aid policy, it might get more applications from candidates who assume that Yale, because of the name, is only for the wealthy,” he said. Tuition, fees and expenses at the School of Medicine this year are expected to range from $62,000 to $69,000.

Other medical schools are also changing their financial aid policies. In March, citing concerns about debt and specialty choice, Harvard Medical School raised its parental-income threshold to $120,000.

“If a student wants to be a neurosurgeon instead of going into primary care,” said Alpern, “I’d hate for them to do it just because of the loans they had.”

—Jenny Blair

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Provost leaves for Oxford

Provost Andrew Hamilton, Ph.D., is leaving Yale after 11 years to become the next vice chancellor of the University of Oxford in England.

“As a noted scientist, a successful department chair, university citizen and provost these past four years, Andy has had a remarkable impact on Yale since joining our faculty in 1997,” said President Richard C. Levin.

Hamilton helped create the Yale Center for Genomics and Proteomics and the Yale Institute for Nanoscience and Quantum Engineering. He has been instrumental in developing plans for research programs and core facilities for Yale’s new West Campus. Hamilton also helped to create the new interdisciplinary Humanities Program and has supported Yale’s investments in the arts.

After joining Yale, Hamilton became chair of the chemistry department in 1999. He became deputy provost for science and technology in 2003 and provost in 2004 after then-Provost Susan Hockfield, Ph.D., was appointed president of MIT.

In September, Peter Salovey, Ph.D., dean of Yale College was named provost.

—John Curtis

62 YMG members in top docs list

New York Magazine’s 2008 list of the region’s top physicians includes 62 physicians from Yale Medical Group (YMG). Yale’s “top docs” are in 40 specialties and serve patients of all ages.

The list, which appeared in the magazine’s June 16 issue, is based on the Top Doctors New York Metro Area guidebook, published annually by Castle Connolly Medical Ltd. The publishers ask doctors throughout the region which of their colleagues they would recommend to a friend or relative. The guidebook includes the top 10 percent of the metro area’s physicians. New York Magazine publishes a shorter list—the top quarter of the top 10 percent.

“Our strong representation in the New York metro area highlights the fact that YMG is a regional and, in some cases, national practice,” said David J. Leffell, M.D., CEO of YMG. “Patients throughout New York and New England are coming to see YMG as a medical destination of choice.”

—J.C.


			Originally published in Yale Medicine, Autumn 2008. Copyright © 2008 Yale University School of Medicine. All rights reserved.