A down-to-earth leader who gets things done

Texas dean Robert Alpern, a distinguished nephrologist, takes the reins at Yale.

When Donald W. Seldin, M.D. ’43D, HS ’46, was recruiting a chief nephrologist to the University of Texas (UT) Southwestern Medical Center in 1987, one of the names on his list was Robert J. Alpern, M.D., a junior faculty member at the University of California, San Francisco (UCSF) and a rising star in the field of kidney research. “He had just barely finished his own training,” recalled Seldin, a Yale alumnus who served as Southwestern’s chair of medicine for 38 years and helped build the Dallas school into an academic powerhouse. “In surveying the country, I thought he was one of two people who had what I was looking for, despite his young age.”

A dozen years later, Alpern was named dean of UT Southwestern’s medical school, and in late April of this year he was introduced to Yale faculty members as the School of Medicine’s 16th dean. He began work a month later, on June 1.

Alpern’s reputation as an affable colleague and a leader who gets things done preceded him. “Bob is an extraordinary catch for us,” Yale President Richard C. Levin told the faculty gathering on April 30, “He is a person who not only has a record of accomplishment [as a dean and section chief], but also one who has all the human qualities that make an outstanding leader. He is a highly accomplished scientist, a fabulous teacher … and a person who inspires confidence and has the support of virtually everyone with whom he works.”

A native of Brooklyn, N.Y., who grew up on Long Island, Alpern attended Northwestern University and the University of Chicago’s medical school before training in internal medicine at Columbia and nephrology at UCSF. At UCSF he was a solidly well-rounded academician, excelling as a teacher and clinician and launching a research career focused on the underlying mechanisms of acid-base balance in the kidney. He traces his interest in medicine to an early love of science and a desire to help others and fondly recalls the month he spent at Yale as a visiting fourth-year medical student in 1975.

It was in the lab that he met his wife and research collaborator, Patricia A. Preisig, Ph.D. They began working together when he was a postdoctoral fellow and she was a graduate student in the lab of Floyd C. Rector Jr., M.D., at UCSF; since then they have focused their studies on better understanding the role of the kidney’s proximal tubule in acid-base regulation. Their work has shown how two molecules, the Na/H antiporter known as NHE3 and the citrate transporter NaDC-1, mediate the kidney’s ability to excrete acid and defend against a metabolic acidosis.

Preisig will be moving her lab to New Haven as a faculty member in the Department of Internal Medicine in 2005; for the coming academic year, she will remain in Dallas, where their daughter, Rachelle, will be a high school senior. Their son, Kyle, is starting ninth grade.

Gerhard H. Giebisch, M.D., remembers meeting Alpern in the early 1980s when Alpern interviewed at Yale to spend time in the Giebisch lab. They have remained friends and colleagues ever since. According to Giebisch, Alpern has become a world leader in the field of acid-base regulation in the kidney. “His work has really been fundamental and pushed the field forward,” said Giebisch, Sterling Professor of Cellular and Molecular Physiology, citing Alpern’s development of sophisticated fluorescence techniques for measuring acid inside living kidney cells, which previously had not been possible. Alpern also worked out key details that explain how nephrons compensate to handle an increased acid load, as might occur during kidney failure.

Search committee members said they were impressed by Alpern when he visited New Haven in February and March. “He listened effectively, he was thoughtful and he was down-to-earth,” said committee member David L. Coleman, M.D., HS ’80, the interim chair of medicine. (According to Seldin, Alpern was successful in Dallas because he cared a great deal about quality and is “thoughtful, composed and balanced.”) In checking Alpern’s references, “one of the striking things about him was that there wasn’t a single call that wasn’t positive,” another search committee member said. “The consensus was that he is absolutely fabulous. He comes across as youthful, energetic and very, very bright.” And despite his easygoing personality, he apparently has the ability to make tough decisions. “The story we heard more than once is that you go into his office to make a request, he says no—and you feel good about it. That’s a rare talent.”

Alpern said he is coming to Yale with major goals that he began formulating during the interview and negotiation process. “I sensed that at every level, from President Levin and Provost [Susan] Hockfield all the way down, everyone wants to make Yale School of Medicine better.” He said he asked Levin for significant resources to do just that and that “we were in total agreement on the vision for the school” regarding programs, space and faculty. “Without going into details,” he said, “the university was generous in its support.” Levin confirmed this when he introduced Alpern in April, noting that the economics of medical schools “are not what they were 20 years ago.”

“Medical margins are tight, recoveries on grants are not fully compensatory, and we recognize that until the school develops the kind of philanthropic base that it must develop over the coming years,” Levin said, “the university is going to have to step in and provide the resources that will stop it from treading water.”

Alpern said his vision for the school is “to have outstanding programs in education, research and clinical care. These programs should be as good as they can be, among the best in the world. Yale already has many outstanding programs in these three arenas that are likely among the best, but no medical school is perfect in all aspects. We will identify our priorities for program improvement and then move forward.”

As Alpern prepared to move to New Haven, UT Southwestern named an acting dean to see it through its coming search process for a new leader. For this post, UT chose a Yale alumnus, pharmacologist Alfred G. Gilman, M.D., Ph.D., a winner of the 1994 Nobel Prize in physiology or medicine for the discovery of G-proteins.

Levin praised neurosurgery Chair Dennis D. Spencer, M.D., HS ’77, who served as interim dean for the past year, for “an absolutely spectacular job” shepherding the school and building bridges among its diverse constituencies. “He brought this faculty together in a way it hadn’t been for some time and worked very hard to collaborate, not only within the medical school but also with the university and hospital, in ways that were welcomed by all of us.”

—Michael Fitzsousa

For doctors, scientists, workshop series is an initiative in translation

Catalin S. Buhimschi, M.D., is just starting out on his research career studying high-risk pregnancies in the obstetrics, gynecology and reproductive sciences department. Cardiologist Albert J. Sinusas, M.D., an associate professor in the departments of medicine and diagnostic radiology, investigates diseases that typically occur at the other end of life. He looks for ways to image and model the beating heart, especially after an infarction, to improve diagnosis and treatment. Under normal circumstances, their paths might never cross, but they discovered they had much to talk about when they finally met.

The meeting of the two investigators was just one of the unlikely, and potentially productive, encounters among faculty who attended the Dean’s Workshop on May 7 in the Anlyan Center Auditorium. The meeting was the first in a series of events designed to bring together basic scientists, clinical researchers and clinicians from across the School of Medicine to explore ways to move basic science advances more swiftly to patient care. The workshops are part of a larger initiative launched last academic year by Interim Dean Dennis D. Spencer, M.D., HS ’77, who told the overflow audience, “This is an attempt to further focus our efforts on why we are here: patients and patients’ health.”

As part of that initiative, Spencer also announced a commitment by the School of Medicine of up to $1 million in funding for pilot projects that bring basic and clinical scientists from different departments together. The two-year grants will provide up to $150,000 with the aim of generating data that will attract additional outside funding. Said Spencer, “I visualize a research continuum where human investigators and basic researchers will focus together on a single problem.”

The translational research program comes partly in response to the Roadmap initiative announced by the National Institutes of Health (NIH) last September. NIH Director Elias A. Zerhouni, M.D., had identified major opportunities and gaps in biomedical research that no single institute at NIH could tackle alone, but that the agency as a whole could address to make the biggest impact. The Roadmap also established new funding for research across institutes.

The first Dean’s Workshop focused on Yale’s magnetic resonance imaging core research facility and some of its applications for structural and functional studies. Three faculty members from the Magnetic Resonance Research Center, James S. Duncan, Ph.D., R. Todd Constable, Ph.D., and Douglas L. Rothman, Ph.D., spoke about their efforts to develop new contrast mechanisms and algorithms to improve both imaging methods and understanding of the results. Much of that work results from helping basic and clinical investigators carry out their research. “We all work in a collaborative matrix,” Duncan said.

Three clinical researchers—Sinusas, neuroscientist Marcia K. Johnson, Ph.D., and diabetes investigator Gerald I. Shulman, M.D., Ph.D., gave overviews of their studies using imaging technologies. Sinusas said findings from his 15-year effort with Duncan to model and analyze the changing shape and structure of the beating heart may help predict heart wall damage and patient prognosis following an infarct.

After the workshop, Buhimschi, an instructor in obstetrics and gynecology, spoke with Sinusas about his efforts to model the changing uterus. “I was aware of Yale’s interest in new imaging techniques, but I wasn’t aware of Dr. Sinusas’ work,” he explained later. “I hope to identify ways to pursue our idea, maybe even together with him. Ultimately, I will apply for a grant.”

—Marc Wortman

An author and physician helps residents become better doctors through writing

Physicians who listen to their patients’ stories—who listen as writers would—strengthen their relationships with those patients, according to physician and author Abraham Verghese, M.D., M.F.A. And doctors who forge these connections to their patients are likely to take better emotional care of themselves as well, said Verghese, speaking recently at medical grand rounds.

“To be aware of stories is to be empathetic. … What we’re talking about is imagining the patient’s life,” said Verghese, director of the Center for Medical Humanities and Ethics at the University of Texas Health Science Center at San Antonio. Verghese wrote My Own Country: A Doctor’s Story, a memoir of caring for AIDS patients in Tennessee in the early days of the epidemic, which Time magazine called one of the five best books of 1994.

Verghese’s talk, “What the Pen Teaches the Stethoscope,” was linked to a writer’s workshop for residents that he’d run last fall. The workshop was part of efforts by the Department of Internal Medicine to strengthen the doctor-patient relationship, said Asghar Rastegar, M.D., the department’s associate chair for medical education and academic affairs.

“Our goal is to provide a counterweight to the increasing use of medical technology, which requires less direct contact between physician and patient,” said Rastegar, who developed the writing program in partnership with former Chair Ralph I. Horwitz, M.D. (Surgeon and medical writer Atul Gawande, M.D., M.P.H., this year’s Commencement speaker, spent time with the residents in May.)

Fourteen medical residents, chosen on the basis of writing samples, spent two and a half days with Verghese critiquing one another’s work. In teaching the residents, Verghese used techniques he’d learned at the Iowa Writers’ Workshop at the University of Iowa in 1990-91. The residents compiled their stories about patients, both fictional and real, in a booklet called Capsules. They read from their work when Verghese returned in January as part of the program financed by a fund in memory of Fredrick L. Sachs, M.D.

Workshop participant Amy M. Nuernberg, M.D. ’00, chief resident in medicine, said she experienced a catharsis while writing about a college student in her care who had died in a matter of weeks. “It made me realize how strongly it had affected me,” said Nuernberg. “She wasn’t just another patient. … It helped me sort out on paper all these conflicted emotions.”

In his talk, Verghese described what he’d recommended to the residents: that they try to delineate in their patients’ predicaments elements of drama—danger, desire and a crucial insight, or epiphany. For patients, a simple doctor’s visit can contain all these elements, said Verghese: “When they come to see you, your patient is engaged in a story. … There is danger lurking. There is danger and a great desire to walk away with a clean bill of health and a blessing to go on.” Good news or bad, the diagnosis can be a kind of epiphany.

Verghese acknowledged that it’s easy to reduce patients to labels: a ROMI becomes a MIRO who may nonetheless need a CABG (that is to say: a “rule out myocardial infarction” becomes a “myocardial infarction ruled out,” possibly needing a “coronary artery bypass graft”). When doctors use “the voice of medicine,” said Verghese, “they begin to lose sight of the person, and people become almost disease labels. … Even though it’s the language of medicine you record in the chart, let the voice of the patient stay alive in your imagination.”

By writing, and thus bringing to the surface the feelings that patients’ stories engender, physicians stay in touch with their own humanity. “It’s very difficult to walk through a life in medicine and see the carnage you and I see and not to experience intense emotions,” said Verghese. But the “macho culture” of medicine encourages doctors to suppress their pain. “We’re in a very secret and lonely business.”

Gastroenterologist Michael C. Bennick, M.D., concurred with Verghese, saying that writing about a painful experience provides “an opportunity to listen all over again. You needn’t shut out that pain; once the blinding light passes, it’s often illuminating,” said Bennick, an assistant clinical professor and the associate chief of medicine, who attended the residents’ reading.

Verghese argued that doctors who repress their feelings not only distance themselves from their patients but also “begin to do that to themselves.” Verghese noted that doctors often guard against pain in dysfunctional ways. “I think of it [medicine] as a romantic pursuit, but I have seen its seamy underbelly,” said Verghese, whose 1998 memoir, The Tennis Partner: A Doctor’s Story of Friendship and Loss, tells the story of a medical resident, a close friend, struggling with a powerful addiction to drugs.

Verghese said that reading fiction could help doctors reconnect with deep feelings. As can writing.

“I would encourage everybody to keep a journal. It keeps you healthy,” said Verghese.

—Cathy Shufro

EPH receives grant for mapping Lyme disease risk

Durland Fish, Ph.D., professor of epidemiology, has received a $2.9 million, four-year grant from the Centers for Disease Control and Prevention to map the risk of Lyme disease infection in the eastern United States. Fish and his colleagues will focus on the prevalence and genetics of Lyme disease bacteria carried by ticks in the largest field study of tick-borne diseases conducted in the United States. Satellite imagery and geographic information systems will be applied to the project.

—John Curtis

Et Cetera

New institute to explore cortex

The Kavli Foundation of Oxnard, Calif., has endowed the Kavli Institute for Neuroscience at Yale University to pursue multidisciplinary studies of the cerebral cortex. Pasko Rakic, M.D., Ph.D., the Dorys McConnell Duberg Professor of Neuroscience and professor and chair of neurobiology, will direct the new institute.

“The cerebral cortex is universally recognized as the instrument of human intelligence,” Rakic said. “The goal of the institute is to understand how arrangement of the nerve cells and their synaptic circuits in the cortex embody knowledge of the outside world. We will study how molecular changes in these circuits imprint learning of something new and retain what we already know. We will also explore how our genome constructs the microarchitecture of the cerebral cortex, which is able to carry out high cognitive functions such as language and thought.”

—John Curtis

Hospital imaging goes digital

Film and paper will become things of the past as the Department of Diagnostic Radiology begins implementing a digital archive of radiological images. The new Picture Archiving and Communication System is a filmless information system for acquiring, sorting, transporting, storing and displaying medical images.

“Imagine how much easier it will be to log on and view images and reports rather than shuffle through all that X-ray film and paper,” said James A. Brink, M.D., interim chair of diagnostic radiology. According to Steve Bencivengo, director of diagnostic imaging at Yale-New Haven Hospital, the move to a digital system allows physicians to access images and radiology reports through a secure hospital network. This new system also creates a permanent, nondegradable archive. Implementation of the new system began last fall and should be complete by December of this year. The system will archive all diagnostic images.

—J.C.


			Originally published in Yale Medicine, Summer 2004. Copyright © 2004 Yale University School of Medicine. All rights reserved.