Starting point

SECOND OPINION
BY SIDNEY HARRIS

“Who among us would share?”

Please pass on my thanks to Ariane Kirtley for her article “Water is Life” [Yale Medicine, Winter 2007].

I was especially moved by her account of being invited to share a meal by two women in one of the villages she visited. Despite having had to scavenge for wild zucchini and wild grains during a time of famine, they were eager to share what they had with someone who to them must have seemed unimaginably prosperous.

Who among us would share what we had if we had so little? And who among us will share what we have, since we have so much?

Michelle Sanders, M.D. ’99
West Westford, Mass.


I wanted to congratulate the photographer Ariane Kirtley on the amazing cover photographs she took for the most recent edition of Yale Medicine. Simply amazing.

Kevin M. Johnson, M.D. ’03
St. Louis, Mo.

Beeson article brings back memories

I read with more than passing interest the piece by Richard Rapport, M.D., on Paul Beeson, who was one of my real-life heroes [“Fever, Internal Medicine and Paul Beeson,” Yale Medicine, Winter 2007]. In it, he mentions the tragic case of the young woman who died from an overdose of intrathecal penicillin. I am certain that from that incident came the study that led to the paper by Elihu Schimmel, M.D.’54, HS ’61, FW ’64, titled “The Hazards of Hospitalization,” which appeared in the Annals of Internal Medicine in January 1964.

Each of Beeson ’s chief residents had a yearlong project that usually became the subject of medical grand rounds toward the end of the academic year. Schimmel’s project was titled “The DOMP Syndrome,” the acronym referring to diseases of medical progress, perhaps the precursor of the Institute of Medicine’s volume To Err is Human. In-hospital complications of all sorts, including iatrogenic deaths, are front-burner items today. I hesitate to think of the reams of regulations that have been generated hoping to prevent, or at least minimize, these untoward occurrences.

As medicine becomes more technology-driven, the pace of hospital practice quickens and the severity of illness of those patients who are hospitalized increases, the health care professionals who battle to reduce in-hospital complications will be working against a considerable gradient. I wish them good luck in this difficult and worthwhile endeavor.

I enjoy Yale Medicine and read it regularly. Keep up the good work!

James B.D. Mark, M.D., HS ’60
Stanford, Calif.


The obituary for Paul Beeson brought back many memories for me, and one of the anecdotes certainly rang a bell. When I started my internship in 1963, I learned that there were more interns than slots for residents and one intern would not be kept on.

One of my patients, who had alcoholic hypoglycemia, was chosen to be the subject of grand rounds that summer. Tom Ferris, my chief resident, told me to write the history and physical examination and then to come to his office to rehearse. The next day, the auditorium was packed. In the first sentence I extemporaneously described the patient as “an alcoholic bum.” There was an audible gasp from the audience and I knew I had done something wrong. On Monday, Tom told me that Beeson wanted me to know that there may have been bums at Bellevue but there were no bums in New Haven. I imagined then that my fate was sealed—I would be the intern who was cut because I was not enough of a New England gentleman. Fortunately that did not happen. Before the year was out, however, I received a draft notice and went to see Beeson. He was able to get me reassigned to the Public Health Service at the Communicable Disease Center (which later became the Centers for Disease Control and Prevention), and he apologized to me for not being able to keep me out of the service altogether!

His advice was to make an opportunity out of what appeared to be adversity. I did, and that began my career in infectious diseases. I subsequently went to visit him in Oxford to ask his advice about where to do a fellowship. We had lunch at a pub; he was generous with his time and advice. He was so happy at Oxford, working on the immunology of eosinophilia in rats with trichinosis. He said he had left Yale so that he would have time to do research, rather than doing only administration for a department that had grown too large for his taste. I only regret not having had more time directly under his tutelage. He was a great teacher and a terrific role model.

Joshua Fierer, M.D., HS ’68
San Diego, Calif.


Thank you very much for the magnificent article about Paul Beeson ’s tenure at the School of Medicine. The author, Richard Rapport, M.D., could not possibly express the awe that Dr. Beeson inspired in our entire class. It is no accident that a majority of my classmates chose internal medicine as their career choice—inspired, of course by the great physicians and teachers that surrounded Dr. Beeson.

We were thunderstruck by the fact that one of our classmates actually died as a complication of an infectious disease while a patient of Dr. Beeson ’s at the Grace-New Haven Medical Center! We could not imagine that Dr. Beeson could permit such a tragedy to occur!

Fred M. Palace, M.D. ’60, HS ’64
Basking Ridge, N.J.

Starting point:

Simulation, Chinese herbs and a career studying killers

For our cover story this issue we asked writer Jennifer Kaylin to explore the ways in which simulation is used to train physicians. Simulation techniques range from mannequins that talk, breathe and even “die,” to sophisticated computer simulators that let residents and students test their skills at intubation and colonoscopy, to actors who take on the characters—and ailments—of patients in order to teach interview skills. These techniques have become standard training tools in medicine and, as medical education increasingly emphasizes clinical skills, a new way of evaluating students and residents.

We also focus on the meeting of mainstream medicine and traditional Chinese medicine. Since ancient times and all around the world, humans have found remedies in herbs and plants. As writer John Dillon reports, Yung-Chi Cheng, Ph.D., the Henry Bronson Professor of Pharmacology, has taken the lead at Yale in seeking out Chinese herbal medicines that can enhance the effects of chemotherapy while mitigating toxic side effects.

Finally, writer Colleen Shaddox takes us into the world of Dorothy O. Lewis, M.D. ’63, HS ’70, who has spent her career studying killers. Since her childhood Lewis has been driven by a desire to know what makes society’s outcasts tick. Although her initial theories fell outside what was then the psychiatric mainstream, her ideas have become accepted and even cited in Supreme Court decisions. Among those she has studied are serial killer Ted Bundy, John Lennon’s assassin Mark David Chapman and Washington sniper John Muhammad. In all violent offenders she has found three elements that add up to a recipe for violence.

John Curtis
Managing Editor
john.curtis@yale.edu