4 - Alpha Omega Alpha

THE 

PHAROS 

OF ALPHA OMEGA ALPHA SPRING 2009 

HONOR MEDICAL SOCIETY

THE 

PHAROS 

of Alpha Omega Alpha honor medical society Spring 2009 

Alpha Omega Alpha Honor Medical Society 

Founded by William W. Root in 1902 

Editor: Edward D. Harris, Jr., MD 

Editor Emeritus: Robert J. Glaser, MD 

Associate Editor and Managing Editor 

(in memoriam) 

Helen H. Glaser, MD 

Managing Editor Art Director and Illustrator 

Debra M. Lancaster Jim M!Guinness 

Administrator Designer 

Ann Hill Erica Aitken 

Jeremiah A. Barondess, MD 

New York, New York 

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Stanford, California, and 

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Henry M. Claman, MD 

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Fredric L. Coe, MD 

Chicago, Illinois 

Jack Coulehan, MD 

Stony Brook, New York 

Ralph Crawshaw, MD 

Portland, Oregon 

Peter E. Dans, MD 


Scott K. Epstein, MD 

Boston, Massachussetts 

Editorial Board 

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Sleepy Hollow, New York 

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Nashville, Tennessee 

Abraham Verghese, MD, DSc 

(Hon.) 


Steven A. Wartman, MD, PhD 

Washington, DC 

Gerald Weissmann, MD 


David Watts, MD 

Mill Valley, California 

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“Worthy to Serve the Suffering” 

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David P. Hill 

Editorial 

Marat and Harvey, revolutionaries 


Revolution is defined in several ways. One is the forcible 

overthrow of a government or social order in favor 

of a new system. This type of revolution invariably 

occurs over a short period of time. “Marat’s Terror” by Jesse 

Woodard (pp. 17–24) describes the troubled but powerful life 

of physician/ polemicist Jean-Paul Marat and his role in the 

French Revolution. His fiery doctrines were quenched suddenly 

when Charlotte Corday stabbed him while he bathed. 

Revolutions in medicine and the medical sciences 

are less radical and follow a second definition: a dramatic 

and wide- reaching change in the way something 

works or is organized and in people’s ideas 

about it, a transition from one paradigm to another. 

Today’s physicians and scientists are familiar with 

this type of revolution. We have experienced the 

discovery of penicillin, streptomycin, and cortisone; 

the development of vaccines against poliomyelitis 

and other infectious scourges; the definition of the 

structure of DNA, the translation of the genetic 

code, and the establishment of methods to synthesize 

DNA; the initiation and growth of transplant 

surgery; the technical advances informing CT, MRI, 

microarrays, and stem cell biology; and the slower 

but no less important revolutions in public health. 

We relish the exploration of the unknown. 

Why did it take more than 1500 years, from 

the first to the seventeenth century, for empiric 

observations to enable understanding of the circulation? 

Galen, in the first century AD, adopted the 

Hippocratic theory of the four humours: blood, phlegm, and 

yellow and black bile, and the importance of having balance 

among them to ensure good health. Although reported to be 

conceited, cruel, and vindictive, he cannot be blamed for the 

blind allegiance to his teachings that persisted for centuries. 

Those who followed Galen failed to use the tools they had— 

eyes, brain, and hands—for at least two reasons: first, human 

dissection was prohibited, and second, it was philosophers 

and the clergy who for many centuries determined the truths 

of life for the people. Most significant among those who led 

thought was Aristotle. Bertrand Russell writes that ”it was two 

thousand years before the world produced any philosopher 

who could be regarded as approximately his equal.” 1 It was 

Aristotle who gave science to mankind. He observed, and 

deduced logical conclusions. Consider his realization that 

no drop of water has been added to nor taken from the earth 

and its atmosphere since creation: “This is a cyclic world, says 

our philosopher: the sun forever evaporates the sea, dries up 

rivers and springs, and transforms at last the boundless ocean 

into the barest rock; while conversely the uplifted moisture, 

gathered into clouds, falls and renews the rivers and the seas,” 

writes Will Durant. 2 Aristotle observed that life was growing 

steadily in complexity and power, with increasingly specialized 

function. Indeed, he was on the verge of deducing the theory 

of evolution. Why then was Aristotle not the one to define the 

physiology of the circulation, that the heart (not the brain) 

pumped blood through arteries, and that blood flowed back 

to the pump through thinner vessels, the veins? He certainly 

had each of the tools—eyes, a brain, and hands—needed to 

do this. 

William Harvey based his 

theory of the circulation of the 

blood on a series of simple experiments 

in which he studied 

venous blood flow using 

a tourniquet and digital compression. 

His famous book, 

“Ecercitatio anatomica de motu 

cordis,” published in 1628, illustrates 

these experiments and 

elucidates the observations he 

made and deductive reasoning 

he used to arrive at this theory. 

Traditionalists following in the 

footsteps of Galen attempted 

to reject Harvey’s conclusions, 

but uniformly failed to find 

weaknesses in either his experiments 

or deductions because 

to deny a single part of 

Harvey’s theory would be to reject the whole, and this was 

impossible. Nevertheless, many tried! 

The revolution sparked by Harvey’s new paradigm brought 

much new knowledge from diverse sources. For example, 

Antoine van Leeuwenhoek built an instrument, the microscope, 

that would be a revolution in itself. Leeuwenhoek’s 

microscope revealed the presence of red blood cells and, more 

importantly, the hair-thin anastomoses between the blood 

vessels that he named “capillaries,” a discovery that linked the 

veins and arteries to complete the elements of the circulation 

that Harvey had outlined. 

Scientific revolutions continue to evolve in both intensity 

and sophistication, combining the resources of eyes, brains, 

and hands to bring biological science to the heights it has 

reached today, with more to be ascended tomorrow. 

Courtesy of the National Library of Medicine 

References 

1. Russell B. History of Western Philosophy. London: George 

Allen & Unwin; 1974: 173. 

2. Durant W. The story of philosophy. New York: Simon and 

Schuster; 1953: 53. 

The Pharos/Spring 2009 1

The Pharos • Volume 72 

Number 2 • Spring 2009 

1 Editorial 

Marat and Harvey, 

revolutionaries 


38 

42 

DEPARTMENTS 

The physician at the 

movies 


Man on Wire 

3:10 to Yuma (1957) 

3:10 to Yuma (2007) 

Reviews and reflections 

Geriatric Bioscience: The Link 

Between Aging and Disease 

Reviewed by Denise Zwahlen- 

Minton, MD 

Life in the Balance: A 

Physician’s Memoir of 

Life, Love, and Loss with 

Parkinson’s Disease and 

Dementia 

Reviewed by Jack Coulehan, 

MD 

The Light Within: The 

Extraordinary Story of a 

Doctor and Patient Brought 

Together by Cancer 

Reviewed by Jack Couelhan, 

MD 

50 Letters 

Page 4 

In This 

Drinking in earnest 

Alcoholic paradigms in Hemingway’s 

For Whom the Bell Tolls 

A little drink now and then . . . often leads to more 

Gregory H. Miday, MD 

Remembering to forget 

A student’s mind dashing back and forth in time 

Page 12 

ARTICLES 

4 

Gabriel Thompson Cade 

12 

Marat’s terror 

A physician-assisted revolution 

Jesse D. Woodard 

17 

Page 17

Issue 

New medical terms 

The plague of medical transcription services 

James G. Gamble, MD, PhD, Theresa Pena, RN, 

and Lawrence A. Rinsky, MD 

26 

Completing the circle 

Retreading an otherwise fine tire 

Larry Zaroff, MD, PhD 

30 

The half-tico, half-gringorobot 

What a difference a snake meant 

Lindsey Finklea 

32 

Page 26 

Page 30 

Page 32 

Please insert small 

version of cover 

47 

54 

POETRY 

16 

On the cover 

See page 26 

National and chapter news 

Announcing the 2009 Alpha 

Omega Alpha Robert J. Glaser 

Distinguished Teacher Awards 

Minutes of the 2008 meeting of the 

board of directors 

Alpha Omega Alpha elects 

honorary members 

Burning Books 

Manuel Martinez-Maldonado, MD, 

MACP 

25 Marionette 

Jason David Eubanks, MD 

29 

35 

36 

45 

46 

49 

Four Season Haiku 

Steven F. Isenberg, MD 

Seeing Patients 

Alan Blum, MD 

Empty memory album 

discarded by the curb 

Ben K. Azman, MD 

Babette B. Caraccio, MD 

James Foy, MD 

Helene Hubbard, PhD, MD 

Christopher M. Papa, MD 

Office Hours 


The World Is Sleeping 

Michael R. Bykowski 

I Am the Patient 

Suzanne Minor, MD 

Significant Other, Late in 

53 Life 


INSIDE 

BACK 24 COVER 

AΩA NEWS 

Full Nelson 

Jason David Eubanks, MD

Drinking 

in 

earnest 

Gregory H. Miday, MD 

Alcoholic paradigms in Hemingway’s 


The author is an intern in Internal Medicine at Washington 

University in St. Louis. This essay won third prize in the 

2008 Alpha Omega Alpha Helen H. Glaser Student Essay 

Competition. 

A 

cold crisp glass of Cava while watching the bullfights. 

Absinthe, emerald green poured over sugar, shared 

between young lovers. And cocktails—before reading, 

before dining, before dancing, before everything. Scenes 

from Hemingway are inexorably bound to drinking, so it is no 

surprise that his work may inform us on the topic of alcoholism. 

The pages of his fiction are figuratively soaked in booze 

and, in many cases, probably literally as well. The descriptions 

of distinct and complex alcohol- related behaviors range from 

abstention to healthy social imbibing to pathologic, chronic, 

and relapsing alcoholism. Hemingway describes the disease 

with such vividness and clarity that medical professionals 

might benefit from studying the models presented in his novels. 

The author once remarked, “I’m trying in all my stories to 

get the feeling of the actual life across—not just to depict life— 

or to criticize it—but to actually make it alive. So that when 

you have read something by me you actually experience the 

thing.” 1p153 He succeeds, and his pen strokes illustrate both the 

full-blown end-stage alcoholic and early alcoholism, as well 

as the many gradations between the alcohol abusive problem 

drinker and the alcohol dependent. His works capture the 

diverse symptoms and complications of pathologic drinking, 

going beyond the pathology well known to medical students: 

neuropathy, cirrhosis, encephalopathy, delirium tremens, etc. 

These organic consequences of alcoholism, while medically 

important, are dangerously late manifestations of the disease. 

Hemingway conveys the subtle and sometimes not so subtle 

nuances of the alcoholic, including but not limited to comorbid 

psychopathology, personality changes, “craving,” isolation, 

obsessive thinking, and compulsive behavior. 

Another compelling reason to regard Hemingway’s fiction 

as a potent source for understanding alcoholism is the concept 

of “autopathography” put forth by Dr. Stephen Moran, which 

describes “a type of literature in which the author’s illness 

is the primary lens through which the narrative is filtered.” 2 

Papa pours a shot… 

Photo by Tore Johnson/Pix Inc./Time Life Pictures/Getty Images. 

4 The Pharos/Spring 2009



For Whom the Bell Tolls (1943). 

Paramount Pictures/Photofest. 

Because Hemingway was himself an alcoholic who never 

conquered denial, his writings are all the more convincing on 

the subject. If his purpose in For Whom the Bell Tolls was to 

give the reader, in Aristotlean terms, a poetic understanding 

of the human condition, he was uniquely well equipped to do 

so with regard to addiction. 3 In dramatic irony, the disease 

about which Hemingway so adeptly wrote was not recognized 

by his own alcoholic mind, and ultimately played a role in his 

suicide. 4p75 

For Whom the Bell Tolls focuses on three characters— 

Robert Jordan, Pablo, and Pablo’s wife Pilar—who are avatars 

of the three common types of alcohol user: abusive, dependent, 

and healthy. In addition to providing a tripartite model 

for ethanol- related behavior, For Whom the Bell Tolls marks 

a literary departure of the author: “Instead of omission, of 

suggestiveness by implication, Hemingway adds and becomes 

explicit, pausing to develop the many facets of a situation or a 

personality. . . . He has devoted nearly five hundred pages to 

seventy hours of action.” 3p151 The wealth of detail is ideal for 

examining character pathology. 

Pablo: Drinking his way through 


The year is 1937 and the Spanish Civil War is raging. Robert 

Jordan, rugged, handsome, and equipped with two packs 

of explosives, finds himself in the picturesque mountains 

of central Spain behind enemy lines, charged with assisting 

the International Brigade in its fight against Franco and the 

Fascists. An American college professor turned anti- fascist 

dynamiter, his primary task is to destroy a bridge near Segovia. 

We are introduced to Robert as he surveys the target bridge. 

During his reconnaissance, Robert meets Pablo, the leader of 

a guerilla unit harbored in the same mountains. 

Pablo, played by 

Akim Tamiroff. 


Pablo cuts a formidable figure, rough and tough talking, 

perched on his stolen steed with a carbine rifle over his shoulder. 

He is proud and authoritative, and from the remarks of 

his compatriots it appears that his braggadocio was earned 

through bravery and valiant if violent deeds—“ ‘Pablo . . . 

has killed more people than cholera . . . more than the bubonic 

plague.’ ” 5p26 It also seems, however, that something 

has changed in the past several months. Pablo has become 

muy flojo—very flaccid—according to Anselmo, an older 


gentleman who has agreed to help Robert explode the bridge. 

Anselmo explicitly remarks that Pablo drinks too much. In his 

drinking Pablo has become sad and desperate, preferring the 

company of his horses to humans. Living in a fantasy world, 

he seems fixated on finding an escape from the seeming dead 

end of war and life as a fugitive. Robert can see Pablo’s sadness, 

and thinks, “That sadness is bad. That’s the sadness they 

get before they quit or before they betray. That is the sadness 

that comes before the sell-out.” 5p12 

Pablo’s condition reeks of late-stage alcoholism. Throughout 

the rest of the novel we will see him display six of the seven 

DSM-IV criteria for substance dependence: tolerance, withdrawal, 

increased intake, excessive time devoted to the substance, 

major activities given up because of substance use, 

continued use despite consequences, and failed attempts to 

abstain. Three of these are required for diagnosis; Pablo never 

tries to abstain. 6 In chapter 14, when Robert returns in the 

afternoon to the guerrillo camp, he finds Pablo thoroughly 

intoxicated. 

“I have been drinking all day waiting for the snow.” 5p179 

. . . . 

“I am drunk,” Pablo said with dignity. “To drink is 

nothing. It is to be drunk that is important. Estoy muy 

borracho.” 5p211 

Here Pablo displays knowledge of his increased tolerance 

and obsession with drinking, a self diagnosis. In this chapter 

he also displays the Jekyll-and-Hyde personality changes not 

mentioned in the DSM-IV but common in alcoholics. When 

drunk the alcoholic is prone to drastic mood swings. Pablo, 

for instance, is combative with Robert, accusing him of being 

Scottish and wearing kilts. He proposes a snowball fight 

and eventually provokes the gypsy Agustín, who strikes him 

repeatedly in the face. Unconvinced his drinking is the cause 

of any of his problems, Pablo simply remarks, “ ‘An intelligent 

man is sometimes forced to be drunk to spend his time with 

fools.’ ” 5p215 

The dipsomaniac is a genuine monomaniac, with alcohol 

being a powerful object of desire, hatred, and many of the 

alcoholic’s thoughts. Pablo’s monomania is especially evident 

during one encounter with Robert. Each man has a cup of 

wine, but Pablo’s eyes 

were looking at the wine bowl as though he had never seen 

one before. . . . 

Pablo looked from the wine bowl to Anselmo’s face as he 

drank and then he looked back at the wine bowl. 5p331 

“Listen, Inglés,” Pablo spoke directly to the wine bowl. 

. . . . “I have admired thy judgment much today, Inglés,” 

Pablo told the wine bowl.” 5p332 

Alcohol has become the center of his life. 

By and about Gregory Miday 

Raised in beautiful Cincinnati 

by a brilliant psychiatrist and an 

astute epidemiologist—my mother 

and father—I have always had an 

interest in understanding mental illness 

and the societal impact of psychiatric disorders. 

While my primary passion is for internal medicine, I 

have not wanted to neglect my other passions: art, history, 

literature, and music. My bachelor’s degree from 

Northwestern University is in Art History. 

Throughout medical school I made a point to continue 

reading nonmedical literature for both pleasure 

and intellectual fulfillment. I have known people who 

struggled with substance disorders, and the idea for 

this essay struck suddenly while reading Hemingway’s 

oeuvre. 

I am an intern at Washington University in St. Louis 

in Internal Medicine. I plan to continue to explore the 

connections between the humanities and medicine. 

The key will be finding the time to do so! 

The alcoholic can be a 

powerful leader 

Pablo’s position as group leader is no contradiction. Early 

ethanol abusers may possess an “alcoholic charm” that makes 

them attractive members of society. This has been viewed as 

a true compensatory reaction by the ill person to mask the 

disease. For example early-stage alcoholics are on average 

better dressed and groomed than nonalcoholics. 4p36 Also, in 

another type of subconscious autoregulation, the alcoholic 

may display a high degree of egoism. It is hypothesized that 

this develops as the alcoholic realizes he no longer has control 

over his drinking. This powerlessness over alcohol manifests 

itself as a desire to have control in other arenas. The combination 

of charisma and drive for ego satisfaction (derived 

from the acquisition of sex, money, power, respect, etc.) often 

places alcoholics in “egocentric” positions and occupations. 

Thus alcoholics are often writers, actors, politicians (with an 

estimated prevalence of thirty percent compared to ten percent 

in the general U.S. population), and, in this case, de facto 

commanders of guerrilla factions. 4p9 

The deceptive compensation can sometimes last decades, 



but will eventually fall apart assuming the drinker does not 

quit drinking or go into spontaneous remission. As the disease 

progresses, the alcoholic neglects his health and appearance, 

develops bizarre personality traits, and is frequently inebriated 

at inappropriate times. As with Pablo, the untreated 

severe alcoholic tends to become antisocial, losing his own 

self- respect and the esteem of his peers. The late-stage exhausted, 

or “bottom,” alcoholic demonstrates intense emotional 

reactions to alcohol, including, according to Dr. Jorge 

Valles: moodiness, irritability, impatience, excessive sensitivity, 

intolerance, compulsiveness, procrastination, suspiciousness, 

jealousy, remorsefulness, irresponsibility, hostility, loneliness, 

deceitfulness, and confusion. 7 Watch as Pablo pathetically 

caresses a horse in a drunken stupor, whispering sweet nothings, 

“ ‘Thou lovely white-faced big beauty. . . . Thou dost 

not insult nor lie nor not understand. Thou, oh, thee, oh my 

good big little pony.’ ” 5p63–64 Listen as Pablo’s wife reprimands, 

“ ‘Borracho!’ ” 5p32 the colorfully loaded term for “drunkard” in 

Spanish, then verbally castrates him in front of his new guest 

and declares herself the true leader. Feel what Pilar means 

when she describes her husband awaking in sobs, “ ‘as though 

there is an animal inside that is shaking him,’ ” 5p90 and finally 

states, “ ‘But now he is finished. The plug has been drawn and 

the wine has all run out of the skin.’ ” 5p89 

Gary Cooper plays Robert Jordan. 


Let us now focus on protagonist Robert Jordan. Upon 

first meeting Pablo’s troops and accompanying them to their 

cave hideaway, a large wineskin is produced and drink offered: 

“Robert Jordan drank it slowly, feeling it spread warmly 

through his tiredness.” 5p20 He then drinks another cup of wine 

with dinner. After dinner, he dips for a third cup. There is an 

attractive young woman in the cave, Maria, recently orphaned 

and brutalized by the facissimos and saved by Pablo’s group. 

Robert has felt a “thickness” in his throat since laying eyes on 

her, and it is noted that this feeling remains despite the third 

cup of wine. While some healthy alcohol users will have a 

drink to boost confidence and lower inhibitions, the deliberate 

and mindful attempt to self- medicate by using alcohol as 

an anxiolytic is a characteristic of problem drinking. Robert 

later drinks a fourth cup of wine. When he asks about a fifth 

cup Pablo denies him, claiming the wine is near finished (we 

later find this is not true but another instance of alcoholic 

mendacity to keep more for oneself). In response Robert asks 

for a cup of water instead. But not to worry, Robert has no 

intention of quitting so early. He empties half the water and 

then withdraws a flask from his belt, from which he slowly 

pours absinthe, mixing it with the water. A gypsy queries, 

“ ‘What drink is that?’ ” Replies Robert, “ ‘A medicine . . . It 

cures everything. If you have anything wrong this will cure 

it.’ ” 5p50 As he drinks he experiences a pleasant feeling of 

euphoric recall, picturing a beautiful Parisian evening as “he 

tasted that opaque, bitter, tongue- numbing, brain- warming, 

stomach- warming, idea- changing liquid alchemy.” 5p51 After 

he finishes his second absinthe, “making a warm, small, fumerising, 

wet, chemical- change- producing heat in him,” 5p57 he 

passes his cup for more vino. That makes six drinks, not that 

anybody’s counting. 

A drinking problem? Or just a man 

who likes drinking? 

The rate and quantity of consumption in this scene are 

characteristic of someone who may have a drinking problem. 

In addition, when Robert steps outside the cave, he notes that 

he is surprisingly clear despite the alcohol. Increased tolerance 

and adaptive changes such that one may not feel or appear 

intoxicated after six quick drinks are also signs of a possible 

alcohol problem. It is important to distinguish the person 

with alcohol abuse from the alcoholic. While addiction runs 

on a continuum and should be considered on an individual 

basis, science has shown that alcohol abusers and alcoholics 

are usually distinct entities. The first will have some problems 

due to drinking. He will have guilt and will have suffered adverse 

consequences from alcohol use but will not demonstrate 

physiologic withdrawal upon abstaining. Nor will he have the 

same degree of cravings and obsessive thinking and compulsive 

behavior that the alcoholic experiences. While his life is 

not centered about procuring and ingesting alcohol, and he 

may be normal in all other facets of life, he has a pathologic 

relationship to alcohol. Even if he continues to drink heavily, 

however, he probably will not become an alcoholic. The 


est evidence for the differentiation comes from adoption 

studies. One sibling of alcoholic parentage adopted by a nonalcoholic 

family has the same risk of becoming alcoholic as a 

sibling (about twenty percent) reared in the alcoholic home. 

Children of nonalcoholics adopted by alcoholic families have 

a significantly higher chance of being abusive drinkers, but not 

of becoming alcoholic. The implication is that alcoholism is a 

disease with strong genetic origins, while problem drinking 

may be mostly determined by environmental factors. 8 

The likely ethanol- abusive Robert Jordan drinks more or 

less continuously throughout the rest of the novel. On day 

two, when he visits El Sordo, another guerilla leader nearby, 

the two talk over several whiskeys. It is not yet noon. Morning 

drinking, especially after a previous night of drinking, can 

be repugnant to healthy drinkers, but welcomed by problem 

drinkers and alcoholics as the best cure for a hangover and 

morning jitters. Later, as Pilar is getting to know Robert and 

inquiring about his interests, she states, “ ‘You like to drink, I 

know. I have seen.’ ” He responds, “ ‘Yes. Very much. But not 

to interfere with my work.’ ” 5p91 A problem drinker’s problem 

is almost invariably evident to others before it is self- evident. 

A moment of clarity for Robert, when he surely realizes his 

reliance on alcohol, comes towards the end of the novel as he 

lies on the ground wounded, anticipating what will likely be 

his own death. 

Then he remembered that he had the small flask in his 

hip pocket and he thought, I’ll take a good spot of the giant 

killer . . . But the flask was not there when he felt for it. 

Then he felt that much more alone because he knew there 

was not going to be even that. I guess I’d counted on that, 

he said. 5p467 

In contradistinction to Robert and Pablo, Pilar exemplifies 

the normal, healthy drinker. In the initial scene at the cave, 

when Robert offers her a cup of wine, she declines, “ ‘Not until 

dinner,’ she said. ‘It gives me heartburn.’ ” 5p32 The next morning, 

when offered whiskey: “ ‘I don’t want any,’ Pilar said and 

covered her glass with her hand.” 5p142 Then, offered wine instead, 

she answers, “ ‘No. Water.’ ” 5p142 Pilar does enjoy a glass 

of wine with food, and in her stories she reminisces on the 

delight of a cold beer in the afternoon, but during the novel 

she never has more than two drinks at a time and possesses 

the ability to take it or leave it without much thought or worry, 

the hallmark of the normal drinker. 

Alcoholism—Genetic pathways 

in the brain 

The “Big Book” of Alcoholics Anonymous describes alcohol 

as “cunning, baffling, powerful!” 9p58–59 and from both a 

Ingrid Bergman plays Pilar. 


medical and lay perspective it is. One of the most fascinating 

aspects of the drug—the crux of the reason why Pablo, Pilar, 

and Robert are so different—is that alcohol is selectively addicting. 

In the United States, about nine percent of people who 

drink will become problem drinkers, with a smaller subset of 

those becoming alcoholic. The alcoholic who never takes a 

first drink will never suffer from the disease! 10 Ethanol affects 

almost all people similarly in its initial stages. It is first a stimulant—people 

become talkative and carefree. People drink for 

this initial favorable response. These universal reactions are 

not limited to humans, and as Anselmo points out in chapter 

3: “The gypsies believe the bear to be a brother to man because 

he has the same body beneath his hide, because he drinks 

beer.” 5p40 Alcohol is later a sedative, but subsequent reactions 

vary greatly, and are different among different types of alcohol 

users. Normal, healthy drinkers will experience adverse affects 

after several drinks, including sedation and sometimes nausea 

and unease. They will naturally slow down or stop ingesting, 

hence Pilar’s heartburn. Alcoholics also metabolize alcohol 

differently, and their central nervous system responses, especially 

processes in the deep, primitive brain structures, are 

also different, though this is still not well understood. With 

ingestion of one-half to an ounce of alcohol, both alcoholics 

and nonalcoholics experience not only “euphoria, relaxation, 

and [a sense of] well being,” but also improved “concentration, 

memory, attention span, [and] creative thinking.” 11p52 These 

improvements quickly disappear in the nonalcoholic as blood 



alcohol levels rise, but they are persistent in the alcoholic up to 

much higher levels of ethanol intake. 11 Most importantly, alcoholics, 

despite signals indicating they should cease drinking, 

lack the ability to do so. It is this lack of control, and the inherent 

unpredictability of whether they will drink to intoxication, 

that most specialists believe to be the sine qua non of alcoholism. 

10 The abusive drinker reacts similarly to the alcoholic in 

many ways, and will binge drink, but will never experience 

total loss of control over drinking. It is impossible to separate 

the abusive drinker from the early alcoholic. In For Whom the 

Bell Tolls, Robert Jordan is a problem drinker, but one cannot 

say whether or not he will develop alcoholism. 

The purging of the fascists from Avila, a story within a 

story told by Pilar, provides the most poignant and deeply 

affecting passage in the novel. Alcohol plays a prominent 

role in the drama and deserves special attention. The narrative 

describes the storming of Avila by Pablo’s guerilla force. 

After executing the fascist soldiers, the fascist civilians are 

collected from around the city and packed into the town hall, 

the Ayuntamiento. A line of townspeople forms, making an 

aisle from the building to the edge of a high cliff. One by one 

the fascists are forced to walk the line, where they are brutally 

clubbed and finally flung over the precipice. The killing 

of each fascist is described in detail, and in the lines of the 

townspeople we see anger, fear, guilt, pride, and, not to be ignored, 

a lot of drunkenness. As the scene unfolds, Hemingway 

uses a musical, sonatesque composition of melody, harmony, 

and counterpoint. Resounding through the drama is the major 

key of death and reprisal, the vertically melodic crescendo of 

each killing, and the harmonic minor key composed of the 

quotidian aspects of the scene strung together compositionally 

by the alcohol that saturates the crowd. 12 Pilar says at first only 

a few townspeople are drunk, the “ ‘useless characters who 

would have been drunk at any time.’ ” 5p104 As tension builds, 

they begin 

“. . . handing around bottles of anis and cognac that they 

had looted from the bar of the club of the fascists, drinking 

them down like wine. . . . Those who did not drink from the 

bottles of liquor were drinking from leather wineskins that 

were passed about.” 5p115 

After the first fascist is flung to his death by a hesitant crowd 

the alcohol and strong emotions begin to affect the people in 

the lines. When Don Guillermo is brought out pleading for 

mercy he is struck on the head and rolls about 

“. . . while the drunkards beat him and one drunkard jumped 

on top of him, astride his shoulders, and beat him with a 

bottle.” 5p118 

Pilar observes, 

“Two men had fallen down and lay on their backs in the 

middle of the square and were passing a bottle back and 

forth between them. One would take a drink and then 

shout, ‘Viva la Anarquia!’ lying on his back and shouting 

as though he were a madman. . . . 

“A peasant who had left the lines and now stood in the 

shade of the arcade looked at them in disgust and said, ‘They 

should shout, “Long live drunkenness.” That’s all they believe 

in.’ ” 5p120 

Pilar, having dealt with an alcoholic husband, is bitter but 

also wise. She recognizes the ability of alcohol to foment mob 

behavior and to cause normally sane and sensitive people to 

commit heinous acts. While watching the commotion a man 

presses against her, 

“His breath on my neck smelled like the smell of the 

mob, sour, like vomit on paving stones and the smell of 

drunkenness . . . 

“As I watched, this man turned away from the crowd 

and went and sat down and drank from a bottle and then, 

while he was sitting down, he saw Don Anastasio, who was 

still lying face down on the stones, but much trampled now, 

and the drunkard got up and went over to Don Anastasio 

and leaned over and poured out of the bottle onto the head 

of Don Anastasio and onto his clothes, and then he took a 

matchbox out of his pocket and lit several matches, trying to 

make a fire with Don Anastasio. But the wind was blowing 

hard now and it blew the matches out and after a little the 

big drunkard sat there by Don Anastasio, shaking his head 

and drinking out of the bottle and every once in a while, 

leaning over and patting Don Anastasio on the shoulders of 

his dead body.” 5p122–23 

Pilar has at once illustrated both “alcoholic insanity” and the 

existential futility that seems to plague the alcoholic. As her 

story draws to an end and the last of the fascists are killed, 

Pilar concludes, “ ‘It would have been better for the town if 

they had thrown over twenty or thirty of the drunkards . . . 

and if we ever have another revolution I believe they should 

be destroyed at the start.’ ” 5p127 

There is much disagreement regarding diagnosis and treatment 

of alcoholism (and addiction in general), and science has 

yet to elucidate many aspects of this complicated condition. 

In Great Britain, the concept of alcoholism as a disease is less 

widely accepted. 13 But Ernest Hemingway, a highly intelligent 

drinker given to solipsistic reverie in his writing, unwittingly 

unravels some of the mysteries of alcohol use and abuse in 

this novel. By separating out the three most common types of 

drinkers, who comprise the majority of the adult U.S. population, 

he provides us with entertaining and informational 

guides to recognizing and characterizing ethanol behavior. 

Alcoholism is a unique disease with broad consequences not 


just for the alcoholic, but for family, friends, and society at 

large. The indirect victims of this disease are often hurt and 

angry, and rightly so. The most powerful condemnation of 

alcoholism in this novel comes from the afflicted wife Pilar, 

who acidly exclaims: 

“Of all men the drunkard is the foulest. The thief when 

he is not stealing is like another. The extortioner does not 

practice in the home. The murderer when he is at home can 

wash his hands. But the drunkard stinks and vomits in his 

own bed and dissolves his organs in alcohol.” 5p208 

Alcoholics: Often not recognized 

and inadquately managed 

But the real outrage of alcoholism, and a heavy burden 

on the medical profession, is that it is under- recognized, 

under- researched, and under- treated. Statistics tell the story: 

A recent study of over 40,000 subjects representative of the 

U.S. population demonstrated a lifetime prevalence of alcohol 

abuse of 17.8 percent and alcohol dependence of 3.8 percent. 

Less than a quarter of those with alcohol dependence received 

any treatment at all. 14 Unlike in the days of the Spanish Civil 

War, there now exist FDA- approved drugs for the treatment 

of alcoholism. Other pharmaceuticals are in the pipeline, 

and successful rehabilitation therapies ranging from psychotherapy 

to twelve-step programs abound. Hopefully, by taking 

a multidisciplinary approach that may even include looking to 

American literature, the problem may be investigated more 

thoroughly and better addressed. The next time you read a 

novel, or examine a new patient, keep a vigilant eye for the 

alcoholic, because his disease is deadly but treatable, and he 

needs your help. 

References 

1. Hemingway E. Ernest Hemingway: Selected Letters, 1917– 

1961. Baker C, editor. New York: Charles Scribner’s Sons; 1981. 

2. Moran ST. Autopathography and depression: Describing the 

“Despair Beyond Despair.” J Med Humanit 2006; 27: 79–91. 

3. Hovey RB. Hemingway: The Inward Terrain. Seattle (WA): 

University of Washington Press; 1968. 

4. Graham J. The Secret History of Alcoholism: The Story of 

Famous Alcoholics and Their Destructive Behavior. Shaftesbury, 

Dorset (UK): Element; 1996. 

5. Hemingway E. For Whom the Bell Tolls. New York: Scribner; 

2003. 

6. Substance Use Disorders: Substance Dependence. In: First 

MB, editor. Diagnostic and Statistical Manual of Mental Disorders. 

Fourth Edition, Text Revision (DSM-IV-TR, 2000). Washington 

(DC): American Psychiatric Association; 2000. 

7. Valles J. From Social Drinking to Alcoholism. Dallas (TX): 

Tane Press; 1969. 

8. Goodwin DW, Schulsinger F, Møller N, et al. Drinking 

problems in adopted and nonadopted sons of alcoholics. Arch Gen 

Psychiatry 1974; 31: 164–69. 

9. Alcoholics Anonymous World Services, Inc. Alcoholics 

Anonymous: The Story of How Many Thousands of Men and 

Women Have Recovered from Alcoholism. Fourth edition. New 

York: Alcoholics Anonymous World Services; 2001. 

10. Goodwin DW. Alcoholism: The Facts. Third edition. Oxford 

(UK): Oxford University Press; 2000. 

11. Milam JR, Ketcham K. Under the Influence: A Guide to the 

Myths and Realities of Alcoholism. Seattle (WA): Madrona Publishers; 

1981. 

12. Williams W. The Tragic Art of Ernest Hemingway. 

Baton Rouge (LA): Louisiana State University 

Press; 1981. 

13. Heather N, Robertson I. Problem Drinking. 

Third edition. Oxford (UK): Oxford University Press; 

1997. 

14. Hasin DS, Stinson FS, Ogburn E, Grant BF. 

Prevalence, Correlates, Disability, and Comorbidity 

of DSM-IV Alcohol Abuse and Dependence in 

the United States. Arch Gen Psychiatry 2007; 64: 

830–42. 

The author’s address is: 

4961 Lacleded Avenue, Apartment 111 

St. Louis, Missouri 63108 

E-mail: miday01@aol.com 

The cat drinks water… 

Photo by Tore Johnson/Pix Inc./Time Life Pictures/Getty Images. 


Gabriel Thompson Cade 

The author (AΩA, University of South Carolina, 2008) is 

a candidate for an MD/MPH in the Class of 2011 at the 

University of North Carolina at Chapel Hill. This essay won 

second place in the 2008 Alpha Omega Alpha Helen H. 

Glaser Stu dent Essay Competition. 

I 

have always loved the quiet intensity of the operating 

room, the concerned focus of the operating team. The 

room was bright and busy. There were beeps and there 

were flashes. I held my arms up and stood where they told me 

to, and someone helped me with my gloves and apron. We 

were all anonymous in our green drapes, but committed to a 

common cause. The room smelled clean through my mask, 

smelled like alcohol, antiseptic, and conditioned air. It was a 

little cold, but comfortable in the layers of aprons. The fetal 

heart monitor chirped enthusiastically, a strong, regular rate. 

I kept standing where they told me to, I held the clamp where 

they pointed. I talked like a second-year medical student to 

my preceptor and the assisting physician who was, coincidentally, 

the assisting physician on the C- section of my own 

birth. It felt very safe, like everything had been thought of. 

The operation went smoothly and I didn’t faint, or screw 

anything up. There was more blood than I had expected but 

it was so incredible to dive into the mesenteric maze of the 

human abdomen, to push aside this organ, that organ. Hidden 

in the folds of this gastric mess was this incredible treasure, 

this pearl. And once located, it was a very short time before 

you were holding a brand new baby. And there I was, holding 

a new person, with so much life ahead of him. 

The baby already looked beautiful. He looked curious. He 

looked strong. I could hear his dad laughing when we came 

out of the room. I could hear his mom, also laughing, behind 

us—her enthusiasm boosted by anesthesia. Their baby had 

entered into the world with love and attention all around him. 

When I handed him on to the nurse I thought of all the possibilities 

in store for this child. 

There was another feeling at the edge of my consciousness, 

a single tenterhook from something forgotten, but that 

notion was overrun by this fresh awe. This was not the first 

Rememberi 

baby I’d held but it felt like it was. I felt so elated I was going 

to be a doctor. I was going to help take care of babies. I was 

going to help take care of pregnant women. I was going to 

have a front-row seat to the biological wonders of human existence. 

This was awesome. This was why I sought out medicine. 

Of course, this excitement was only possible because I 

had remembered to forget about Africa. 

Trying to make a difference in a 

hopeless world 

I’m watching the baby today. I watch the baby clench his 

shriveled hands. I watch his wrinkled pink claws wave blindly 

through the space around him and inevitably into his mouth. 

I watch him turn his tiny head away while I’m washing him. 

He doesn’t say anything, he just clenches his eyes even tighter 

and turns away. He doesn’t even like the warm water I’m using 

today. Often we don’t even have any water. 

I watch him drink tepid formula. He spits it up or, slightly 

worse, he immediately passes the wet payload through to his 

diaper. I have to cut the diapers in half to fit him. He weighs 

four pounds, and when I hold him he almost fits between my 

wrist and my elbow. He makes sounds but he doesn’t really 


ng to forget 

cry. I listen to his heart but it doesn’t make any more sense 

to me than his occasional verbal sputters. I’ve only seen him 

open his eyes once in the week since his birth. He has thick 

and dark hair for his size, and it mats in tangled patches when 

he’s sweating. He sweats all the time. I sweat all the time. 

Zambia feels so hot lately. The baby smells like milk and baby 

powder and he attracts flies. I’m watching him die, so I try to 

pay attention to everything, I try to remember everything. I 

also try to forget everything. 

Sarah says he should have a name. I don’t want to give him 

a name. 

The baby sleeps with us some nights. He doesn’t move 

much at night, and his breathing is so quiet it sounds like 

two pieces of paper rubbing together. It is almost completely 

lost in the awful whine of the mosquitoes, so if he is sleeping 

we have to listen closely to be sure he is breathing. When he 

doesn’t sleep I sing to him. Sometimes I ask him not to die. 

Sometimes I ask him to stop suffering and die. We didn’t really 

adopt him, but his mother died at the clinic. She was the 

outside party in an extramarital affair. The teenage children 

of that family beat her to death when she showed up seven 

months pregnant. She lived long enough only to deliver her 

premature son. It probably doesn’t even make things any 

Illustration by Erica Aitken. Photo credit: Left, Flying Colours Ltd. Center, Roadsworth. Right, AFP/Getty Images. 

worse that he was born with her HIV infection, but I think 

about it because of the father, and the rest of his family. 

In the last week, when I see pregnant women or babies, I 

want to cry. Sometimes I do. I’m sad, of course, and also I feel 

very angry. I feel angry because I feel very helpless. I don’t 

know what I’m doing with these patients. I don’t know what 

I’m doing with this baby. I don’t know how to make a difference. 

I especially don’t know how to make a difference when 

the world around me looks so hopeless. And I don’t know 

how, once I leave here, I will ever close my eyes and not see 

the images of this world around me. 

Lesson for a student: There is healing 

strength in understanding death 

We left the clinic a little earlier than usual and drove together 

to the hospital where we would meet one of my mentor’s 

oldest patients, moving from hospital care to hospice 

care. Although my preceptor worked with pregnant mothers 

and pediatrics, the bulk of his practice was in the wider world 

of family medicine. He took great pride in treating as many 

as four generations of a family. He had pictures in his office 

of patients he has delivered and is now still treating in their 

twenties. With a patient population spanning such a spectrum 

of age, he was in a position to witness those great beginnings 

as well as to counsel those coming towards the great 

endings of their lives. 

The patient we were going to see had had a lifetime of reasonably 

good health and activity, now culminating in a week 

of shallow breaths and the feeling of pressure on her heart. 

To me this was one of the great hallmarks of the medical profession: 

the role of the physician at the end of life. What can 

you do to ease the frightening transition into noncorporeal 

existence? What tools of sympathy and empathy can you conjure 

up to achieve an effect of soothing compassion? What do 

you say to the family? What do you say to yourself about your 

abilities to preserve life? 

I wanted to save most of my questions until after our 

meeting with this patient and her family, but I talked a little 


Remembering to forget 

to my preceptor during the ride over. 

“How often do you have to do this?” 

“Not that often, but a few times a year.” 

“Do you talk about religion or faith?” 

“Sometimes, if the family brings it up.” 

“Does it get easier or does it get harder the more you do 

it?” 

“It feels like the first time every time, which is neither easy 

nor hard.” 

I stopped after the third question because the answer 

surprised me. How did you forget a patient’s death on your 

watch? Aren’t you thinking about the last patient you had to 

coach into biological collapse? Aren’t you thinking about the 

first patient you saw run out of breath, run out of road, run 

out of time? Can you really just internalize those moments 

and move on? When you participate in this, perhaps the most 

intimate of patient interactions, how do you bottle up the 

necessary emotional context and go forward? 

The patient’s room was filled. Filled with the cards and 

flowers from church and community friends. Filled with the 

bodies of family members and closer friends. They perched 

on chair armrests looking at our patient. They sat on the 

other, empty bed, looking out the window, trying to avoid 

the nature of the room and what it meant, what our presence 

there meant. Everyone spoke quietly to each other and 

loudly to the woman lying in the bed. She looked pale, a sort 

of ashen gray hue hung off of every exposed bit of flesh. Her 

breathing was wet and labored, but she looked very calm, she 

looked very happy even, surrounded as she was by life, by the 

products of her own life. She raised an old hand to the doctor, 

and the skin sagged indifferently below the thin arm bones. 

She smiled at him and they held hands for a minute as they 

talked. 

We asked everyone but the woman’s husband and their 

two children to step outside. The room felt bigger but it was 

still fragrant and full with the warmth and affection of the 

other visitors. I stood in a quiet corner near the door and 

tried not to invade the personal nature of the atmosphere. 

The conversation was not unexpected and before we even 

began there were quiet tears from the husband and daughter. 

The son didn’t cry. He seemed almost indifferent to the proceedings, 

but I recognized that as its own form of angry remorse, 

covered extensively in medical school psychology and 

interview- training books. 

My doctor spoke calmly and confidently to the patient 

and her family. He lamented the limitations of medical care 

but stressed the generous magnitude of his patient’s life. He 

pointed to all the love he had seen coming into the room and 

what a reflection it was of a fulfilling existence. He told the 

patient he was sorry. He told the family he was sorry, and 

that he couldn’t adequately understand what they were going 

through, and he was sorry for that, too. He answered all of 

their clinical questions. He deflected most of their spiritual 

questions but encouraged them to seek those answers with 

someone more capable. He said he could put them in touch 

with support groups and that he, himself, would be available 

to them for questions they had and assistance they needed 

until she passed on. 

The family seemed moved by the sincerity of the doctor’s 

words. I was moved, too. The daughter hugged him. The husband 

hugged him. The woman put up her gray arm again, and 

the doctor held her hand and smiled warmly at her. Despite 

their tears, the family looked calm. She still looked calm. She 

smiled at him, she even smiled at me, the intruder in her last 

sanctum of hope. I smiled back, meek but as warm as I could 

muster. 

I thought to myself, I won’t ever forget this, what it looked 

like to face death with serenity. I won’t forget the importance 

of these moments for a doctor. I won’t forget the healing 

strength in understanding the role of death in life, and in 

sharing that understanding with patients. 

Memories of deaths, deaths in a faraway 

world 

It’s really the hardest when the death piles up. It even 

sounds funny to me when I say it, but I mean it quite literally. 

We usually only lose one patient per day. There’s usually only 

one night of crying and wailing from wives and daughters and 

mothers. There are only three shelves in the stagnant cold of 

our morgue, three steel cots slide out of the metal bunk bed. 

We usually only need to keep bodies in the morgue for one 

day before the families come and relocate the remains. You 

don’t see death when it slips quickly in and out. But when 

death hangs around, when it lounges in the corner of the 

ward, casting its eye over thirty beds of potential escorts, you 

can’t avoid it. 

Those three drawers represent our ability to distance the 

patients, and ourselves, from death. One hundred feet of 

separation from life to death. Those drawers represent the 

comfortable capacity of the morgue, but occasionally we are 

forced to exceed this expected occupancy limit. 

We move the bodies quietly at night, trying not to awaken 

other patients, who already cling with such fragility to rest 

and peace. We even try not to wake up the families. The 

women always scream or sing or wail out loud in any of the 

seventy-two dialects used near the clinic. We move the bodies 

and then we move the families. They can wail outside. 

Tonight I am already awake when the night nurse comes 

and raps on my window just after midnight. Three women 

have been howling and sobbing outside of the morgue since 

that afternoon. My bed is also one hundred feet from the 

clinic. One hundred feet from the clinic, one hundred feet 

from the morgue; I feel like I don’t ever leave. When she raps 

on my window I am sure Philipo is dead. I have spent weeks 

watching him die. 


HIV- positive, like everyone, paralyzed from the waist 

down from a tuberculosis infection in his spine. By the time 

Philipo came to us he had already spent months immobilized 

in bed, and the sore across his lower back was as large as a 

compact disc, and exposed the lower rungs of his spinal column 

and his pelvic bones. Every day I clean the dead tissue 

away. I almost fainted the first time I did it. I felt the temperature 

rise in the room. A bead of sweat gathered on my 

forehead and I watched it run down over my eye and gather 

again at the end of my nose. I leaned forward, and when that 

didn’t feel right I leaned backwards, collapsing onto the bed 

behind me where I was able to grab my breath and regain my 

composure. Since then I have been able to work quickly and 

confidently in tending his wounds—more sores on each hip 

also expose the heads and insertion of his femurs. 

In the last week, Philipo has begun to regain feeling in his 

back. I hoped he would die before it fully returned. His wife 

stopped visiting him, his children never came. He looks at 

pictures in my National Geographic while I work on him and 

he points at things he’s never seen before, places he would 

like to go. I like Philipo and I care about him, but we are unable 

to speak to each other. Even with his little English, and 

my little Nyanja, we are never really connecting with each 

other. Even with perfect communication I think I would not 

know what to say. 

Rearranging bodies in the morgue 

I am already dressed so it is easy to slip out of bed and 

away from Sarah to head back to the clinic. Philipo doesn’t 

weigh anything but he is tall, and even with both of us it is a 

little difficult. The nurse helps me move him out of his bed, 

across the dirt courtyard, and onto the floor of the morgue. 

The women there wail even louder as we walk by with Philipo 

wrapped in his own bed sheet. The nurse leaves me and 

heads back to the clinic, closing the door behind her, muting 

the shrill shrieking from outside and leaving me instead with 

the deafening silence of the cooler and its inhabitants. 

When I open the bottom drawer I am not surprised to see 

the top of a dark head facing me out of the void. The second 

drawer is also taken. The third drawer is full. I hate when this 

happens. Now I have to reach in and rearrange the bodies. 

I have to push one of the bodies up against the side of the 

drawer and then I will have to shove in Philipo, a little bit at 

a time. 

His legs dangle and drag on the floor. Alone with me in the 

dim light he feels heavier than he did crossing those hundred 

feet. The body already on the drawer rocks over when I am 

halfway done and bottlenecks any progress. I practically have 

to climb over Philipo to push the other body away, and then 

it is a continuous balance to keep the one from overturning 

the other. Philipo feels soft, and even a little warm. He smells, 

By and about Gabriel Cade 

I was raised on a small goat farm in 

the mountains of North Carolina where 

my father was a family physician and 

my mother an ICU nurse. To avoid a 

hereditary career in medicine, I dropped out of college 

and wandered, walking 2200 miles along the 

Appalachian Trail, waiting tables and writing for a 

newspaper in Hollywood, climbing rocks and rafting 

in New Zealand, and fighting sand fleas and strangers 

on “Survivor: Marquesas.” A disjointed collection 

of skills and experiences ultimately led to Zambia, 

where I worked with my twin sister in a small AIDS 

hospice and orphanage. The experiences in Zambia 

and other parts of Africa convinced me to return 

to finish my undergraduate education and pursue a 

medical degree at the University of North Carolina at 

Chapel Hill School of Medicine. 

well, like Africa, like dirt and work and sunshine and dry 

grass and death. He makes the body next to his seem even 

more repulsive than usual. It is cold and clammy and stiff, and 

smells only like death. 

In this moment, I realize that the capacity of the morgue 

to comfortably house death has been tied to the capacity of 

my own heart to do the same. I realize I am so sick of death. 

I am so sick of it. I even try to throw it up, to purge myself of 

the aching in the pit of my stomach. I even try to scream. I try 

my own wailing to trounce the sorrow and pain around me. 

Nothing comes. There’s nothing there. I already feel so emptied 

by this work, by this never-ending work. I don’t want to 

see any more death. I don’t want to wait for any more patients 

to die. I don’t want to be there to help move the body. 

Philipo’s legs still stick out of the cooler. It looks grotesque. 

I yell at the four bodies. I won’t give them tears, just anger. I 

am so angry at them all for dying and leaving me to deal with 

their death. I’m angry that when I do sleep I dream of bodies 

piled on bodies, and that when I look at patients still alive in 

the clinic I can close my eyes and see them dead. I hate that 

the dead cling to the inside of my eyelids. I’m so angry that I 

can’t do anything to stop it and that, no matter how angry I 

get, I will just have to do this again tomorrow night. 

When I am home, someday, back in my home in America, 

am I going to wake up expecting that rap on my window? 

Am I going to sleep again and dream again? 


118 Milton Avenue 

Chapel Hill, North Carolina 27514 

E-mail: gcade@med.unc.edu 


Dr. Martinez-Maldonado (AΩA, Baylor, 1973) is executive vice president for research 

and professors of Medicine and Pharmacology and Toxicology at the University 

of Louisville. His address is: Office of Research, Room 200 Jouett Hall, University of 

Louisville, Louisville, Kentucky 40292. E-mail: m0mart01@louisville.edu. 

Burning Books 

Fire engine alarms woke up the stars. 

Red lights 

Glared on our window panes. 

We weren’t sure what to expect, 

The sky so bright, 

The heat searching for a way into our library. 

Over the fence leapt the first firemen— 

Axes in hand, superhero helmets 

Askance at the sight 

Of the spectacle shimmering over their 

heads. 

More sirens, men on the roof and on ladders 

Watering the walls, creating a fall 

Of liquid ambers. 

Once lame hoses snaked over asphalt 

Wet with morning dew, distended 

Like boa constrictors after a snack. 

Their id numbers 

Furiously overheated when the building, 

Crackling like an immense popcorn bag, 

Tumbled noisily into the uneasy silence 

Of the morning light. 

It fell away from our shattered windows 

Redolent of might, 

Aided by the cleverness of promethean 

Physicians with their water rays, 

Who saved Cecil, Harrison, Dickinson, 

Whitman, Pablo Neruda, Juan Ramón, 

And, among many others, Richard Wright 

And Richard Bright— 

From the burn. 

Manuel Martinez-Maldonado, MD, MACP

Jesse D. Woodard 

arat’s terror 

The author (AΩA, University of South Carolina, 2008) is 

a member of the Class of 2009 at the University of South 

Carolina School of Medicine. This essay won first prize in 

the 2008 Alpha Omega Alpha Helen H. Glaser Student 

Essay competition. 

When the prominent French revolutionary Joseph- 

Emmanuel Sieyes was asked what role he had 

during the French Revolution, he responded “J’ai 

vecu.” (“I survived.”) Thousands could not make that claim 

during the tumultuous decade from 1789 through 1799. The 

period was marked by fear, intrigue, and violence, and no life 

more closely paralleled the revolution than that of Jean-Paul 

Marat. During a decade of hostility he was L’Ami du Peuple 

(The Friend of the People), and even as his cries of Liberté, 

égalité, fraternité! rang through the streets of Paris, Marat’s 

assassination in 1793 showed that history is less a triumph of 

ideology than a series of tragic human atrocities. 

Marat, in his own time, was known as a madman, a fanatical 

demagogue, and the murderer of thousands. A mysterious 

skin disease earned him the stigma of a leper, but he is also 

remembered as a doctor, a frustrated scientist, and the subject 

of the period’s most memorable painting. The scene of 

his death in 1793 was immortalized in Jacques-Louis David’s 

masterpiece Death of Marat. The indelible depiction shows 

a Christ-like Marat lying dead in his bath, the evidence of his 

murder in plain view. Upon its completion, the painting was 

carried through the streets of Paris in tribute and Marat was 

worshipped as a god. 

Joseph Boze (1744–1826): Jean Paul Marat (1744–1789). French 

revolutionary. 1793. Painting. 

Location: Musée de la Ville de Paris, Musée Carnavalet, Paris, France. Photo credit: Alfredo 

Dagli Orti, Bildarchiv Pressicher Kulturbesitz/Art Resource, NY. 



History, though, designates him a villain. The years after 

his death are remembered as La Grande Terreur (The Great 

Terror), during which as many as forty thousand were guillotined 

in the streets of Paris, and Marat is remembered as “the 

father of all the horrors which followed his horrible reign.” 1p87 

Why did this physician abandon his role as a healer to become 

a revolutionary? What was his strange skin condition? And 

what led The People’s Friend to be disinterred, cursed, and 

burned in effigy only months after his ceremonial burial in 

the Pantheon? 

Marat—the physician and philospher with 

massive ego and ambition 

It’s only in Paris that people have eyes for Marat. In the 

other departments, he is regarded as a monster. 

—Charlotte Corday 2p738–39 

The Industrial Revolution of the late eighteenth century 

made necessary an elaborate division of labor, dividing commerce 

into distinct operations. Such was not the case early in 

the century, when men of means and education dabbled in 

varied branches of knowledge. John Locke studied philosophy, 

became a physician, and wrote an influential political treatise. 

Voltaire critiqued French society from England, Goethe 

reigned in Germany, and Franklin in America; all were versatile 

in a number of fields. 

Such was the life to which Jean-Paul Marat aspired. Born in 

Neuchâtel, Switzerland, in 1743, he was the son of a Calvinist 

father and a Swiss mother. 

Marat early applied himself to the study of philosophy, political 

theory, and physics, and he confessed an ungratified appetite 

for recognition. “From my earliest years I was consumed 

with a love of glory,” he wrote, “a passion which often changed 

its object in the divers periods of my life, but which has never 

left me for a moment.” 1p89 

In 1771 Marat published his Essay on the Human Soul, 

which was followed the next year by a larger treatise entitled 

A Philosophical Essay on Man. The work was a curious examination 

of the soul in terms of anatomy and medicine, and 

contended that the seat of the soul was in the meninges: 

Experience likewise daily confirms it; the slightest inflammation 

of the meninges occasions a delirium, and a 

temporary insanity. The irritation of the nerves by the fumes 

of wine from drinking to excess, or by the fumes of tobacco, 

is followed by . . . the loss of reason; this never happens to 

any other part of the head. 3p251 

Unlike the speculations of John Locke, Thomas Hobbes, 

and Jean Jacques Rousseau, Marat’s work was greeted with 

bitter ridicule in England and with contempt by the sacred as- 

sembly of the Philosophes in France. Undeterred, he resumed 

publication but continued to receive only a tepid reception in 

intellectual circles. The response convinced him that he was 

being persecuted. 

Marat left the ridicule of England and sought to create 

a new reputation in France. He was reported to have cured 

a women dying of tuberculosis and gained a reputation as 

the “Doctor of the Incurables.” His arrogance was evident in 

his “Essay on Gleets,” which boasted that no case of gonorrhea 

was beyond his ability to cure. 4 He secured an honorary 

doctorate from Saint Andrews in Scotland and received a 

position as physician in the household of the Comte d’Artois, 

the king’s brother. Though his experiments in electricity and 

optics earned him visits from Benjamin Franklin and serious 

discussion in scientific papers, he failed to win membership in 

the Académie des sciences. The glory he sought escaped him, 

and he never forgave the academy for his rejection, in later life 

blaming it for his frustrations. 

In time, he began to neglect his patients and commit 

himself to his laboratory work. “I devote only two out of 

twenty-four hours to sleep,” he wrote during this time, “and 

only one to my meals and domestic necessities.” 5pxxi Soon 

he was spending all his means on experiments and physics. 

Despite his enthusiasm, in 1784 he received a rejection from 

the academy after submitting a paper on Newton’s optics, and 

was also rebuffed by the Spanish Academy at Madrid. He became 

convinced that his genius was unappreciated and his list 

of enemies expanded. The jealousies and intrigues, imaginary 

or real, became necessary to support his sinking self- esteem. 

Marat resigned his position, or was asked to resign, as physician 

to the king’s brother. The devouring ambition that drove 

him to work twenty hours a day was now turned to a new 

enterprise: the politics of the French Revolution. 

After 1789 and the storming of the Bastille . . . 

anarchy in Paris 

Marat rose to prominence among the commoners of Paris 

relatively early in the Revolution. As a disciple of Jean-Jacques 

Rousseau, the France that Marat envisioned was based on 

the Enlightenment notion of the “equality of man.” He sought 

to bring this about by rejecting the divinely appointed rule 

of King Louis XVI and establishing a new polity based on 

Rousseau’s social contract. 

Marat was an extremist, while the majority of France was 

wary of abolishing the monarchy altogether. Faced with national 

bankruptcy, a constitutional monarchy was established 

in which Louis XVI remained on the throne while true authority 

rested with the Legislative Assembly. These representatives 

were a house split into two factions: the moderate Girondins, 

seeking to protect the constitutional monarchy, and the radical 

Jacobins, eager for a republic without church, nobility, or 

a king. 

18 The Pharos/Winter 2008

Marat’s daily rants against the aristocracy earned 

him the disdain of the privileged and the adoration of 

the poor. “To pretend to please everyone is mad,” 2p734 he 

wrote. His allegiances to the Jacobins were well known. 

He hated the monarchy, and his rhetoric against the 

throne galvanized the rebellion. 

In the years following the storming of the Bastille 

in 1789, anarchy descended on Paris. With the deposition 

and capture of Louis XVI in 1792, the notion of a 

constitutional monarchy was quickly abandoned and the 

hope of a republic spread through Paris. During this unstable 

time, the balance of power shifted from the failed 

Legislative Assembly to the Paris Commune, a body composed 

not of politicians, but of the working class. Many of 

the delegates were members of France’s most unpredictable 

faction, the “sans- culottes.” The term meant “without 

culottes,” the knee breeches worn by the privileged. The 

Paris Commune wielded merciless authority and had no 

more vocal leader than Jean-Paul Marat. 

1792—Purge of 

counterrevolutionaries by the 

Paris Commune 

The revolutionary government survived an early threat 

in September 1792. With the Prussian army marching on 

Paris, and faced with insurrection at home by those loyal 

to the imprisoned king, the Commune sought to rid the 

city of any trace of “counterrevolution.” Thousands of 

the accused were arrested, imprisoned, and beheaded 

on charges of rebellion during the bloody September 

Massacres. Others were set free, only to be raped, castrated, 

or disemboweled at the hands of mob violence. 

Hearts were ripped from the chests of men and eaten. 

The head of Princesse de Lambelle, the maid of honor 

to Marie Antoinette, was placed on a pike and paraded 

beneath the temple fortress where the royal family was 

held captive. Blame for these atrocities rested with no 

single man, but reputation placed the crimes at the feet 

of Marat. 

Marat’s newpaper—its appeal 

to the poor commoners 

Marat’s influence began simply. In early September 

1789, he initiated publication of a newspaper that became 

Jacques Louis David (1748–1825): Jean Paul Marat, politician 

and publicist, dead in his bathtub, assassinated by Charlotte 

Corday in 1793. Oil on canvas, 165 x 128 cm. 

Location: Louvre, Paris, France. Photo credit: Erich Lessing/Art Resource, NY. 

his signature in Paris, L’Ami du Peuple. It was here, 

among the common soldiers of the French Revolution, 

that he finally found the acceptance he sought. The paper 

was controversial from its first issue, marrying philosophical 

and political doctrine with violence, suspicion, 

and conspiracy. Marat openly denounced France’s most 

prominent men as traitors based on presumption: 

In order to judge men, you always need proof positive, 

clear, and precise. For me, their inaction or their silence 

on great occasions is sufficient. In order to believe in 

a conspiracy, you demand judicial evidence; for me, it 

is enough to see the general course of events, the relationships 

between enemies of liberty, the comings and 

goings of certain agents of power. 6p158 

Not surprisingly, Marat found himself with few political 

allies. Attempts were made to weaken his influence by 

the circulation of false L’Amis with exaggerated diatribes 

and bloodthirsty language. Ironically, Marat attacked 

these spurious writings as being too tame to be his own. 

Cut off the thumbs of the aristocrats who conspire 

against you, split the tongues of the priests who have 

preached servitude. 

To secure the public tranquility two hundred thousand 

heads should be cut off. 5pxxii 

This rhetoric did not go unnoticed, and Marat fled to 

London. His subsequent return to Paris found four journals 

in circulation claiming to be his L’Ami. Undeterred, 

Marat wrote “I warn honest men not to play with the 

‘People’s Friend,’ any more, as he is never likely to be their 

dupe.” 7p26 

Marat’s blistering, pruritic, 

painful skin disease—what 

was it? 

I saw him at one time address himself to Louvet; and, in 

doing so, he attempted to lay his hand on Louvet’s shoulder, 

who instantly started back with looks of aversion, 

as one would do from the touch of a noxious reptile, 

exclaiming, “Ne me touchez pas!” (“Don’t touch me!”) 

—John Moore 8p389 

Marat’s journalism was a clandestine affair. Though 

he was well known throughout France, the location 

of his publishing house changed often and was kept 

secret from his political enemies. Several times he was 

forced to abandon his publication for fear of arrest. He 

19


once reportedly avoided capture by hiding in the famously 

filthy sewers of Paris, an event recorded in Victor Hugo’s Les 

Miserables as Jean Valjean’s “descen[t] into the sewer is to enter 

the grave . . . in which we find vestiges of all the cataclysms 

from the shell-fish of the deluge down to the rag of Marat.” 9p64 

Around this time, Marat began referencing the skin condition 

that would later confine him to a daily medicinal bath, the 

scene of his assassination in 1793. He described his condition 

as an “inflammatory illness, the fruits of the long nights I have 

given myself over in order to defend freedom.” 10 History notes 

that the lesions were blistered, painful, pruritic, and initially located 

primarily in the perineum, later becoming widespread. 

Speculators have often assumed an infectious etiology, 

the result of his escape through the sewers. Marat, however, 

first noted the skin condition in 1788, two years before his 

flight. 11 Others argue that this event never occurred and that 

Marat simply hid in the attic of his friend. Thus, while his 

experience with the miasmas of Paris might have aggravated 

his condition, it cannot be assumed that the primary etiology 

was infectious. 

In an attempt to alienate him from mounting public support, 

Marat’s opponents claimed he suffered from either leprosy 

or syphilis. These diagnoses are, however, inconsistent 

with his symptoms. The lesions of leprosy are patches of diminished 

sensation accompanied by peripheral neuropathies. 

Furthermore, while little is known about the epidemiology of 

leprosy during this period, an examination of some five thousand 

skulls in Paris’s eighteenth- century catacombs, France’s 

largest mass grave at the time, reported no skulls with lepromatous 

bony changes. 12 This finding suggests that the prevalence 

was sufficiently low to consider the diagnosis rare. Little 

in this description suggests secondary syphilis, either, which 

classically presents as a transient, nonpruritic rash, involving 

the palms and soles. 

Several historians have assumed he suffered from scabies. 

Indeed scabies does itch. This, however, was one of the few 

infections for which accurate diagnosis and treatment was 

available at the time, and it is unlikely that Marat, a physician, 

would have allowed that disease to progress. 13 

Psoriasis and seborrheic dermatitis have been the most 

consistently offered diagnoses. While certainly not the classic 

presentation of either, both are known to affect the groin. 

At least one investigator offers the diagnosis of dermatitis 

herpetiformis, a cutaneous manifestation of gluten- sensitive 

enteropathy. 13 The role of bread in revolutionary France bears 

mentioning, as the rising cost of grain was, in many ways, the 

inciting event of the peasant uprising. History remembers, 

perhaps incorrectly, Marie Antoinette’s infamous response to 

the lack of bread with the famous reply, “Let them eat cake.” 

The diagnosis of hidradenitis suppurativa (HS) neatly accounts 

for Marat’s symptoms and should be added to the possible 

differential diagnoses. HS is an occlusive disease of the 

follicles classically located in the groin and axilla. In males, it 

commonly arises during early adulthood, and pruritis may be 

an early symptom. HS has a highly variable course, but abscess 

formation and draining sinus tracts are the norm. The lesions 

are often secondarily infected. If untreated, the disease can 

become quite debilitating, and patients may find themselves 

unable to walk or sit comfortably. 

A complex psychiatric illness that 

fueled Marat’s revolutionary fervor 

Some argue that investigation should focus on Marat’s 

psychiatric state. Dermatological manifestations of psychiatric 

disturbances are well documented. Moreover, psychiatric 

medications have been used in the treatment of dermatosis 

resistant to conventional treatment. Often, an inciting event 

leads to repetitive scratching and, later, excoriations and infection. 

These pruritic areas are generally located on accessible 

areas such as forearms, face, and back. 

Although Marat was regarded as insane, few attempts have 

been made to diagnose the psychiatric disturbance of a man 

who loved “carnage like a vulture.” 14 Marat’s grandiosity and 

sleep disturbance suggest a manic state and there appears to 

be an element of psychomotor agitation: 

In speaking in society he always appeared much agitated, 

and almost invariably ended the expression of a sentiment 

by a movement of his foot, which he thrust rapidly forward, 

stamping with it at the same time on the ground, and then 

rising on tiptoe. 7p4 

Though Marat was known to spend much time confined 

to his house, no specific periods of depression are recorded. 

Ironically, he was among the first proponents of electroconvulsive 

therapy for treatment of a host of conditions ranging 

from edema to eczema, and lead poisoning to paralysis. His 

preference for solitude also typifies the diagnosis of schizophrenia, 

most likely paranoid type. Supporting such a conclusion 

is Marat’s well- documented disheveled appearance. One 

historian considered the man “a Caesar draped in rags.” 15 We 

have, however, no clear evidence of hallucinations or severe 

thought disturbance. A diagnosis of delusional disorder best 

accounts for his supposed persecution, as Marat’s thoughts 

reflect a fixed false belief in the absence of frank psychosis. 

Marat also displays several traits of the cluster A personality 

disorders, and a diagnosis of paranoid personality disorder is 

most appropriate. 

Hated by many, a set up for 

assassination—Charlotte Corday, 

come forth! 


The name of Marat dishonors your race. He was a ferocious 

beast, who was about to devour the remains of France by 

the fire of civil war. 

—Charlotte Corday at trial 16p198 

As his skin condition worsened, Marat continued writing at 

a furious pace. He published a second journal, Junius François, 

in addition to numerous pamphlets. In 1792 he was elected as 

the people’s representative to the National Convention, the 

first legislative body of the newly formed Republic of France. 

He quickly learned that his friends were few as he addressed 

the Convention after his election: “ ‘In this Assembly I have a 

large number of Personal Enemies.’ ” The assembly cried back 

“ ‘All of us, all of us!’ ” 5pxxiv 

As his status increased, so too did his denunciations. They 

seemed almost random, and his most consistent position was 

hypervigilance. Though Marat seemed to hate any man in a 

position of prominence, his ire was most consistently aimed 

at those in the Girondin party, the ruling majority in the 

National Convention. They had initially enjoyed the backing 

of the people, but in the mood of the times, today’s radicals 

were tomorrow’s moderates. The Girondins had exhausted 

their support on a failed war against Prussia and the party’s 

reluctance to bring Louis XVI to trial. Inspired by Marat, the 

commoners of Paris had no such reservations, and their voices 

would not be denied—Louis was guillotined in 1793. In an effort 

to silence Marat, the Girondin-led Tribunal arrested him 

on the charge of inciting to rebellion. After his acquittal, he 

led the Convention to overthrow the Girondin leadership, in 

favor of the more radical Jacobin rule. It was a period of soaring 

rhetoric and rule by an iron fist, but the Jacobins held the 

promise of economic stability. The Girondins fled death, and 

many sought refuge in the northern city of Caen. 

Marat’s medical condition kept him confined to his baths 

but did not prevent him from working on a small table improvised 

from an upturned wooden box. On the twelfth of July, 

1793, the painter Jacques-Louis David visited Marat beside his 

tub to wish him a rapid recovery. He admired Marat, even if 

he did not fully understand him, and he held that the only true 

martyrs were revolutionary ones. Unknowingly, he was about 

to get his most famous subject. 

The next day a young woman claiming to be from Caen 

appeared at 30 Rue des Cordeliers and sought an audience 

with Marat. He refused her on two occasions but relented 

when she returned a few hours later, claiming to be in possession 

of the names of Girondin sympathizers. The woman was 

Charlotte Corday, a passionate admirer of the Girondin party 

and, though she had traveled from Caen, she had not come to 

betray her fellow patriots. When she began to recount to him 

the names of the traitors, Marat replied, “ ‘Good, in a few days 

I will have them all guillotined.’ ” 2p736 In an instant she leaned 

over the man, pulled a knife out from the top of her dress, and 

plunged it down hard into the Marat’s right chest. The knife 

By and about Jesse Woodard 

I am a member of the class of 2009 

at the University of South Carolina 

School of Medicine. I currently reside 

in Greenville, South Carolina, where I 

am completing my fourth and final year 

preparing for a career in radiology. In 

the few moments of my day that are not 

currently consumed with the residency 

matching process, I reminisce about how much happier 

I would potentially have been had I not abandoned my 

first love—cooking. I enjoy listening to folk music, eating 

fruit roll-ups in a single bite, and doing the crossword 

puzzle with my wife over a cup of coffee. 

pierced “between the first and second rib, traversing the upper 

part of the right lung as well as the aorta, and going into the 

left clavicle.” 3p258 He called for help but any aid was in vain. 

Corday did not attempt escape. Expecting her arrest, she 

carried her certificate of baptism and a letter to the nation of 

France explaining her actions. At trial she calmly defended 

her actions, “I knew he was perverting France. I killed one 

man to save a hundred thousand.” 16p198 Four days later she was 

guillotined. Immediately upon decapitation, one of the executioner’s 

assistants—a man hired for the day named Legros—is 

said to have lifted her head from the basket and slapped it on 

the cheek. 

David—a great painter with 

strong political views 

The responsibility of vengence fell to Jacques-Louis David, 

rightly regarded as the greatest neoclassical painter in France. 

A Jacobin member of the National Convention, David had 

voted for the death of the king, an odd career move since 

Louis XVI had commissioned his most famous work to date 

The Oath of the Horatii. The work had earned him a reputation 

for capturing the revolutionary spirit, and his depiction of 

The Death of Marat is a lesson in propaganda. 

David sought to portray Marat as a revolutionary martyr, 

painting him in a pose much like that of Christ in 

Michelangelo’s Pieta and Caravaggio’s Deposition of the Cross. 

So striking was this similarity that the work would later be 

known as “David’s Pieta.” The wound in Marat’s side and the 

linen clothes are clear references to Christ, as is the simple 

wooden desk which recollects the cross. 

Marat himself is idealized in the painting. His skin is fair. 

He appears peaceful, perhaps even smiling. The instrument of 




death lies harmlessly on the floor. The simple composition 

and subtle color forces the viewer to pity the man. The neutral 

space above the scene is too conspicuous to be incidental. 

Occupying nearly half the canvas, the space leaves the viewer 

feeling somber and oppressed. In his left hand, Marat holds 

the treasonous letter with which Corday gained her meeting; 

in his right, the pen with which he was to record the names of 

the traitors. On his desk lies an assignat, a banknote issued by 

the revolutionary government and Marat’s instructions for it 

to be given to a widow with five children whose husband had 

died for the revolutionary cause. 

Napoleon: “Vanity made the 

French Revolution” 

Marat has largely been overshadowed by other infamous 

names of the French Revolution, among them Marie 

Antoinette, Danton, and Robespierre. The man who brought 

an end to the Revolution, Napoleon Bonaparte, captured the 

period best: “Vanity made the French Revolution; liberty was 

only the pretext.” 17p505 

Jean-Paul Marat was no exception. Violent, unstable, and 

loud, his life typified the times. He was insane, and all of France 

with him. His uncompromising opposition to the throne made 

him both a hero and a villain. Perhaps what endeared Marat to 

ordinary men and women of France was that he truly wrote as 

a friend of the people, elevating Parisian concerns above the 

rancor of public debate and power plays. Marat summarized 

his own legacy in an address to the National Convention: 

My ideas, however revolting they might appear, tended only 

to the public good, for no person was ever more fond than 

myself of order, and the reign of just laws. If your ideas are 

not sufficiently elevated to enable you to understand me, the 

worse for you. 18p39 

In April 1941 Adolf Hitler issued a declaration that he 

intended to celebrate the New Year in the palace of the tsar 

in Leningrad, Russia. Thus began a bloody 900-day siege 

on the city, which ended with the death of more than one 

and a half million Soviet citizens. The port of Leningrad was 

defended by the Russian battleship Marat. Originally named 

the Petropavlovsk, the ship was renamed during the Russian 

revolution. In the battle, German Stutka pilots sank Marat. 

The vessel lay wounded in shallow water while retaining many 

of her guns. In the years that followed, the ship sustained 

the most brutal siege in the war but continued to serve as an 

Paul Baudry (1828–1886): Charlotte Corday. Oil on canvas. Inv. 

802. 

Location: Musée des Beaux-Arts, Nantes, France. Photo credit: Gérard Blot, Réunion des 

Musées Nationaux/Art Resource, NY. 

all- important Russian battery to withstand the German assault. 

Mortally wounded, the Marat refused to be silenced and 

defended the homes of those left in Leningrad from the fear of 

Nazi oppression. Like its namesake, the battleship continued 

to spew venom from a tub. 

Acknowledgment 

This paper would not have been possible without the guidance of 

Dr. J. David Woodard, professor of Modern and Classical Political 

Thought and the Strom Thurmond Chair of Political Science at 

Clemson University. Dr. Woodard’s insight into the French Revolution 

was as invaluable as his assistance in editing this paper. 

References 

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New York: Alfred A. Knopf; 1989. 

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In: Packard FR, editor. Annals of Medical History. New York: 

Paul B. Hoeber; 1920: 248–61. 

4. Marat JP. An Essay on Gleets: Wherein the defects of the actual 

method of treating those complaints of the urethra are pointed 

out, and an effectual way of curing them indicated. London: W. 

Nicoll and J. Williams; 1891. 

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rude/2005conference/Zizek2.pdf. 

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639 Bear Drive 

Greenville, South Carolina 29605 

E-mail: jwoodard@gw.med.sc.edu 


� �� 

You take me back 

To The Sound of Music, 

To the yodeling Von Trapps 

Orchestrating “The Lonely Goatherd” from above— 

marionette in my mind for the first time— 

But nothing compared to you, 

The C6 quad 

Who opens a jar of peanut butter 

Between two, once functionless, hands, 

Who brushes her golden hair 

One deliberate stroke at a time 

And lifts the steaming aroma 

Of Columbian coffee 

Toward eager lips 

With arms and hands 

That have found a voice again— 

Functional electrical stimulation— 

A fractured, incomplete language 

Of electrical words 

Running in subcutaneous wires 

From the implanted chest stimulator 

To the forearm motor, 

Brio to the listless, 

Like the strings of the velvet marionette 

Who dances the dance of the manipulator— 

Watching you move, 

I can’t help but twirl around, 

Looking for my invisible strings. 


The author (AΩA, Case Western Reserve University, 2003) is a 

Spine Fellow in the Department of Orthopaedics at the University of 

Pittsburgh. His address is: 36901 Beech Hills Drive, Willoughby Hills, 

Ohio 44094. E-mail: jdeubanks2002@yahoo.com. 

The Pharos/Spring 2009 25 

Illustration by Laura Aitken

Baloney Below knee 

Bed time kamood Bedside comode 

Buccal fracture Buckle fracture 

Cashews Cast shoes 

Café olé spots Café au lait spots 

Clot through Claw toe 

Crampy todactyly Camptodactyly 

Destruction osteogenesis Distraction osteogenesis 

Free jerks ataxia Friedreich’s ataxia 

Gate analysis Gait analysis 

Grandma seizures Grand mal seizures 

Hell fracture Heel fracture 

Herb palsy Erb’s palsy 

Insight to fusion In situ fusion 

Knot knees Knock knees 

Kind box syndrome Keinbock syndrome 

Kay ciel KCl (potassium chloride) 

Loose frank fracture Lisfanc fracture 

Mass of swelling Massive swelling 

Psychoceramic Psychosomatic 

Piggin toes Pigeon toes 

Plastic dysplagia Spastic dysplasia 

Partial phallectomy Partial patellectomy 

Pillow fracture, to low fracture Tillaux fracture 

Public harness, pubic harness Pavlik harness 

Range of emotion Range of motion 

Rotator cough Rotator cuff 

Screwliosis Scoliosis 

Tarsal collision, torso coalition Tarsal coalition 

Trigenital nerve Trigeminal nerve 

Thibula Fibula 

Tibua Tibia 

Unicranial cyst Unicameral cyst 

Waffle type chew Wassel Type 2 

Illustrations by Jim M’Guinness 

Cashews 

Cast shoes 

Screwliosis 

Scoliosis 


New medical 

TERMS 

James G. Gamble, MD, PhD, Theresa Pena, RN, 

and Lawrence A. Rinsky, MD 

The authors are members of the Packard Children’s Hospital at 

Stanford. Dr. Gamble (AΩA, University of Maryland, 1974) is professor 

in the Department of Orthopaedic Surgery. Ms. Pena is a 

nurse in the Pediatric Orthopaedic Clinic. Dr. Rinsky (AΩA, University of 

Cincinnati, 1970) is a professor in the Department of Orthopaedic Surgery. 

As part of the electronic medical record in teaching hospitals, residents and attending 

physicians use telephones to dictate notes of their clinical encounters 

with patients. These dictations are transcribed by voice recognition programs 

or by transcription services on the Internet. Before application of an electronic signature, 

physicians have an opportunity to review and correct their notes. However, with 

the hectic schedule of most residents and attending physicians, it can be difficult to 

review, in detail, each note before application of an electronic 

signature. Transcription errors thus enter 

the permanent medical record. Many of these 

terms occur repeatedly. 

The following list, with the original intent, 

relates mostly to the musculoskeletal 

system as the terms were discovered in 

pediatric orthopaedic clinical notes. The 

list is certainly incomplete and should be 

considered a work in progress. 

Editor’s note 

A paper I once dictated contained the 

phrase “Cell-free translation,” which came back 

as “Self retranslation.” I admit that the latter 

might have been more interesting to discuss. 

Send correspondence to: 

James G. Gamble, MD, PhD 

800 Welch Road, Suite 212 

Department of Pediatric 

Orthopaedics 

Stanford, California 94304-5709 

E-mail: jgamblemd@gmail.com 

Gate analysis 

Gait analysis 

Waffle type chew 

Wassel Type 2 


New medical terms 

Grandma seizures 

Grand mal seizures 

Hell fracture 

Heel fracture 

Knot knees 

Knock knees 

Piggin toes 

Pigeon toes 


Four Season Haiku 

S 

wirling snow tempest! 

Coating the crooked fingers 

Of dormant trees. 

Cherry blossom youth, 

Circle memorial to 

Young nation’s founder. 

Coneflower cafes— 

Serving royal pollen to 

Monarch butterflies. 

Aspen leaves scatter; 

Wind-surfing autumnal zephyrs 

Above mountain streams. 


Dr. Isenberg (AΩA, Indiana University, 1975) 

is assistant professor of Otolaryngology—Head 

and Neck Surgery at Indiana University School of 

Medicine. His address is: 1400 North Ritter Avenue, 

Suite 221, Indianapolis, Indiana 46219. E-mail: sisenberg@good4docs.com. 


Erica Aitken 

Larry Zaroff, MD, PhD 

Completing 

the 

circle 

The author (AΩA, George Washington 

University, 1956) is a consulting professor 

at Stanford University School 

of Medicine & Program in Human 

Biology and a senior research scholar 

at the Center for Biomedical Ethics. 

He has been a writer for the New York 

Times science section, and now works 

one day a week as a volunteer family 

doctor. In 2006 he was honored as 

Stanford’s Teacher of the Year. 

He had inoperable lung cancer, 

which had spread to the 

lymph nodes in the neck, as 

well as his liver and brain, and was in 

the city hospital for terminal care. 

No hospice was available in the 1950s. 

I was on the general medical ward, my 

initial rotation and exposure to clinical 

medicine. In costume: short white 

coat, a necklace of stethoscope, jewels 

of percussion hammer, tuning fork, 

otoscope protruding from pockets. The 

Merck Manual for support, making me 

ready, but with false credentials. Not 

a real doctor. Yet a thrill, intoxicated 

by the idea of the act. The days when 

I knew little but was asked to know 

everything about everything. As students, 

we expected to learn from our 

teachers, obtain the clinical clues that 

would allow a correct diagnosis and 

treatment. I thought patients were for 


learning on, not learning from. What 

could they know? I was wrong. Who 

understands a disease better than the 

patient? 

A first patient. A dying patient. 

With generosity and tolerance, he answered 

the many questions medical 

students were required to ask. When I 

put my cold stethoscope on his chest, 

he smiled and murmured, “Doc, you 

may want to warm that up next time.” 

The first of the lessons he taught me. 

He led my hand to the hard nodes 

above his clavicle, guided me to his 

swollen liver, and demonstrated the 

weakness in his left hand. 

It is easy to remember the details of 

that first patient. But after moving to 

cardiac surgery for twenty-nine years, 

then dropping out of medicine for ten 

years to climb mountains, and finally 

returning to Stanford in 1995 to study 

humanities and staying to teach medical 

humanities, I recalled little of general 

medicine. 

It seemed like a full life. I did not 

miss the operating room but missed 

the patient contact, the real doctoring 

that connected with my teaching— 

the literature that embraces illness. 

This year when a clinic opened for the 

low-income and minimally insured 

population of our town, I volunteered 

to help the two family doctors who 

took time from their busy private practices 

to work there. It was a tsunami of 

surprises, worse than I expected. I was 

as lost and confused as King Lear in 

the forest. I knew little of modern general 

practice. Fortunately the two doctors 

in our clinic were willing to teach. 

The first patient I saw was a man in 

his late seventies who was in the clinic 

for a routine visit and to renew his 

prescriptions. He was complicated. Not 

the single problem of a stenosed aortic 

valve or blocked coronary arteries I had 

encountered as a surgeon. Back pain, 

high blood pressure, asthma, elevated 

cholesterol. And then I noticed he was 

sitting in a wheelchair. “My leg, Doctor, 

I had polio.” I had not seen a patient 

with polio in fifty years. He explained, 

“Just missed the vaccine.” 

My first medical patient in twentytwo 

years had more diseases than I 

could imagine. I retreated humbly to 

the conference room and consulted the 

family doctor working that day. “How 

do you deal with so many diseases 

in one patient? How can you know 

enough? In my first go-around as a 

student we had few medications for 

high blood pressure, high cholesterol, 

asthma.” He smiled and suggested I take 

my time, go over each problem, then 

ask what was really bothering him. My 

patient sat quietly in his wheelchair, did 

not complain at my tardiness, allowed 

me to ask the dozens of questions he 

had answered many times. His blood 

pressure was slightly elevated, but his 

lungs were clear. He remarked, “Another 

cold stethoscope.” I was embarrassed. 

Twice in one medical life. I reassured 

him that his problems were well controlled. 

His last question was a surprise. 

“Doctor, could I have—I would appreciate 

some samples of Viagra. Might I 

have a few tablets?” Another shock. In 

my era not only did few doctors talk 

about sexuality, but rarely did a patient 

bring up the subject. My first patient, 

once again: enlightenment. That has 

not changed. Given the opportunity and 

the time most patients will reveal their 

complexity, their charm, and will teach 

us. He deserved samples of Viagra. 


433 Bridgeway 

Sausalito, California 94965 

E-mail: larryz.zaroff@gmail.com 


The half-tico, half-gringo robot 

Lindsey Finklea 

The author is a member of the Class of 2009 at Eastern 

Virginia Medical School. 

It was our sixth week teaching English in rural Costa Rica 

when my husband Patrick was bitten on the leg by a ferde-lance, 

a deadly pit viper. Alone in the jungle, I said a 

quick prayer before leaving him behind to search for help. 

Months before, back in the United States, we had dreamt of 

a journey that would allow us to give of ourselves to others 

less fortunate—the beginning of a vocation in social justice. 

Within a split second, our world turned over, and we became 

the recipients in need. 

Patrick, who spoke no Spanish, stood out for his overtly 

gringo appearance. Still, the elementary school children we 

taught flocked to him for his lively animations and notable 

ability to lift seven to eight children at a time. Now, six 

hours after the snakebite, he lay in the San José Emergency 

Department almost lifeless from shock, unable to communicate, 

and at the mercy of the hospital staff. 

The hospital was surrounded by armed guards. They kept 

order in the long lines that trailed around the corner of the 

building. Inside, where the humidity crept into the open-air 

hospital, doctors in their long-sleeved coats wiped the sweat 

from their foreheads. 

Filleting the dreadful compartment 

syndrome 

“They will cut the fascia to treat the compartment syndrome,” 

the doctor stated, nodding as if to indicate agreement. 

I did not nod back. 

“The what?” I replied. He sketched a swollen leg with a 

scalpel making incisions on either side. I nodded. 

I kissed Patrick on the forehead as he was taken to surgery. 

Afterwards he was placed in the intensive care unit. 

During the first of several blood transfusions, the surgeon 

informed me Patrick had a fifty percent chance of survival. 

The next morning I watched with joy tinged with embarrassment 

as the nurses struggled to bathe him and administer an 

asthma treatment. He was more than alive—he was yelling 

about Snickers bars and Coca-Cola. I began to laugh and to 

cry at the same time, and even though his eyes were swollen 


shut he recognized my voice and began to cry too. 

Relieved that I spoke Spanish, one of the nurses lamented 

briefly over Patrick’s obstinance and then left us for a moment. 

“Coca-Cola” is the same in English as it is in Spanish. 

Five minutes later she returned with a small glass. 

Over the course of two weeks Patrick became proficient 

at certain Spanish expressions. “I have pain in my leg” and 

“Can I have Coca-Cola, amigo?” were his favorites. But most 

important was the language the hospital staff learned to use 

with him. A reciprocal thumbs up or down meant everything 

was going well or poorly. Arms stretched out wide with 

eyes closed followed by adios meant it was time for another 

operation, seven in all. And tico, the word Costa Ricans use 

to refer to themselves, was notification that another blood 

transfusion was coming. The doctors often joked that he was 

half-tico, half-gringo. But as Patrick suddenly declined into 

hallucinations and a lung infection, this primitive system of 

words and gestures crumbled. 

Dr. Izaguirre, the head attending, was a thin man and his 

white coat was stiff with starch. As he grew more frustrated 

the creases deprived of a home on his coat burrowed thick 

and ominous into his forehead. 

Patrick’s most vivid hallucination cast him as the leg 

segment of a robot. We were merely props in his play, the 

setting and plot changing by the moment. Like a stagehand 

laboring to keep the lights on and the curtain from falling, 

Dr. Izaguirre swooped in and out of the room almost undetected. 

The rest of us struggled to keep Patrick calm and 

in bed. The infection was improving, but the hallucinations 

were not. The doctor was stumped. 

Two days went by—no change. 

Robotic mimicking and iatrogenic 

hallucinations 

On day three, Dr. Izaguirre entered and stood over 

Patrick’s bed. Like a mannequin from a display window, the 

doctor remained motionless in thought. Patrick lay watchful 

from below. After five minutes the doctor raised his hand deliberately, 

careful not to wrinkle his coat, and scratched the 


The half-tico, half-gringo robot 

top of his head. Patrick did the same. The doctor’s forehead 

creases grew deep as he lifted his eyebrows in surprise. In 

the same rigid, mechanical way, Dr. Izaguirre put both arms 

straight ahead. Patrick did the same. The creases moved into 

the corners of the doctor’s mouth as he began to smile. They 

mimicked each other’s robotic movements for some time and 

then began adding machine-like sounds to the narrative. I 

will never know what they communicated in this intermission, 

but Act Two had begun. 

With the same mechanical gestures and kindness, I 

watched the staff administer lung treatments, change bandages, 

and maintain a sterile environment for Patrick’s open 

wounds. In these moments humanity transcended language 

and the art of medicine rose above critique. 

Dr. Izaguirre ultimately discovered the source of the hallucinations: 

one of the medications used for pain. Patrick 

recovered in time for his birthday, which was spent in the 

hospital dining on cake and Coca-Cola. Two days later we 

flew home. 

We settled back into the comfort of our lives, but 

remained unsettled by the experience. We were changed. 

With an appreciative eye, I realized that medicine knows no 

gender, no age, and no language. I knew this was my calling. 

I am a fourth-year medical student. I am the shadow of 

my intern, the gatherer of lab data, the student baffled, humbled, 

and challenged by her attending’s knowledge. Tempered 

by the daily grind of medicine, my naïveté has been tested. 

Still, I see glimpses of humanity all around. 

I have not yet met another half-tico, half-gringo patient 

who thinks he is a robot—I probably never will. Instead, I 

see remarkable patients each with their own idiosyncrasies 

and challenges. The physicians who manage these patients 

preserve their stories in an imaginary toolbox equipped for 

the unexpected and extraordinary. For anyone unfamiliar 

with its therapeutic use, I recommend storing a few cans of 

Coca-Cola. 


4 Windy Knoll 

Grapevine, TX 76051 

E-mail: finlelb@evms.edu 


I learned from Dr. Lynn Carmichael that when you 

make a house call, you excuse yourself to go to the 

bathroom and peek into the medicine cabinet to check 

on the pills you’ve prescribed. And there they all were, 

in chronological order, unopened. 

From Seeing Patients: The Sketchiest Details by 

Alan Blum, M.D. 

From his earliest days as a medical student, Dr. Alan 

Blum (AΩA, Emory University, 1985), Gerald Leon Wallace MD 

Endowed Chair in Family Medicine at the University of Alabama, 

has captured thousands of patients’ stories in notes and drawings. 

The sketches and jottings bring back the essence of a 

conversation, a detail of personality, and the fragmentary clues 

patients give their doctor about the experience of illness. Dr. 

Blum’s address is: 26 Pinehurst Drive, Tuscaloosa, Alabama 35401- 

1148. E-mail: ablum@cchs.ua.edu 


Empty memory album 

discarded by the curb 

These poems are the winners of the Winter 2008 

contest to write a poem to accompany a photograph of 

a empty photo album on the curb. Congratulations to 

contest winners Ben K. Azman, MD, Babette B. Caraccio, 

MD, James L. Foy, MD, Helene Hubbard, PhD, MD, and 

Christopher Papa, MD. 

Gutted, abandoned 

the book with amnesia 

lost memories . . . lost lives 

James Foy, MD 

Dr. Foy was elected to AΩA at Loyola 

University Stritch School of Medicine in 

1977. His address is: 3940 Washington Street, 

Kensington, Maryland 20895. 

He loved her more than life 

His warm, attractive wife 

With her soft, angelic smile 

Destined to beguile 

The years they spent together 

Pledging their love to one another 

But then the joy, the laughter 

Would not last forever after 

One day her lips grew cold 

Her words became more bold 

And they would fight and fight 

Into the emptiness of the night 

Give up he would never 

Till he found she had a lover 

Broken by the hurt, the pain 

He felt he lived his life in vain 

So he tossed the photos into the fire 

Why cling to the memory of a liar? 

The empty album went out the window 

Lying by the curb, his love a forgotten shadow 

Ben K. Azman, MD 

Dr. Azman was elected to AΩA at the University of Alberta 

in 1967. His address is: 2435 Kaanapali Parkway, Suite H-7, 

Lahaina, Hawaii 96761-1980. E-mail: benazman@hawaii.rr.com. 

36 The Pharos/Date

Discarded and but not forgotten 

No place for photos or mementos, 

His heart is dead to mine. 

Icy and unforgiving 

Wind will chill the empty pages 

No soft breeze will comfort me. 

There is not cleansing for my soul 

Trapped in love and by love 

I live my days and nights alone. 

The sight of him pains me, 

The thought of him burns 

I cast away his image but not his memory. 

Who will trample these pages? 

Like worthless refuse 

As he has done to my heart 

Is there healing? 

Will the memories fade into peace? 

I hope but fear not. 

This album is cast away 

No more to haunt me 

Yet, he haunts me still. 

I, too, am a castaway 

Adrift in despair and loneliness 

Awaiting my end. 

Babette B. Caraccio, MD 

Dr. Caraccio was elected to AΩA at New York University 

School of Medicine in 1982. Her address is: 23 Mianus View 

Terrace, Cos Cob, Connecticut 06807. E-mail: babettecmd@ 

optonline.net. 

Empty memory album, discarded by the curb, 

Evokes an image dark, intended to disturb, 

But faded and lost photos, we knew would never last, 

Have now become the remnants of the techniques of the past. 

The albums of today, stored in many bytes and bits, 

Are in a fast computer that on a desktop sits, 

They’re all stuffed there within, a large and neat selection 

Of digital results, to forms just near perfection. 

They make their rounds with lightening speed, o’er electronic 

space, 

And unite the far flung family at very distant place, 

But there’s that special image which is quite hard to find, 

It’s stuck there in the neurons that pass for what’s my mind. 

My Dearest 

We shared so much so long 

Life bulged with unborn dreams 

Unexpected joy grew from gentle sweetness 

into hearty robust love 

Then you left 

And took me with you 

Except the plastic cover 

That hides my empty space keeping everyone 

from seeing I have gone 

Helene Hubbard, PhD, MD 

Dr. Hubbard was elected to AΩA at East Tennessee State 

University in 1986. Her address is 408 Manatee Avenue, East, 

Bradenton, Florida 34208. E-mail: hhub@kidsdoingbetter.com. 

Christopher M. Papa, MD 

Dr. Papa was elected to AΩA at UMDNJ—New Jersey Medical School in 1986. His 

address is: 17 Clover Hill Lane, Colts Neck, New Jersey 07722-1004. E-mail: doxite@verizon.net. 

The Pharos/Date 37

The physician at the movies 


Man on Wire 

Starring Philippe Petit/Paul McGill, Jean-Louis Blondeau/ 

David Damato, Annie Alix/Ardis Campbell. 

Directed by James Marsh. Rated PG-13. Running time 90 

minutes. 

On August 7, 1974, while the United States was preoccupied 

by the Watergate controversy that culminated 

in the resignation of President Richard Nixon the following 

day, Philippe Petit, a Paris street performer and magician, 

fulfilled a long-held dream. In 1968, while sitting in a dentist’s 

office, he had read about the construction of the World Trade 

Center (WTC) and became obsessed with walking on a wire 

suspended between the Twin Towers. Based on his book, To 

Reach the Clouds, this fascinating, fictionalized documentary 

©2008 Jean-Louis Blondeau / Polaris Images. 

or docudrama recounts the meticulous planning underlying 

this remarkable (and illegal) feat. Director James Marsh goes 

back and forth in time, intercutting interviews with Petit and 

the other principals. Petit comes across as child-like and selfcentered, 

but also filled with a courageous (or “foolhardy”) 

passion and radiating a charisma that enables him to get 

people to help him fulfill his dreams. A climber as a child and 

blessed with an extraordinary sense of balance and concentration, 

he was fascinated by wire walkers, not circus performers 

but those who did daredevil stunts as performance art. The 

perfect illustration of the French concept of sangfroid, he relates 

how one to two millimeters of error in placement of his 

foot or a quarter of a second of inattention can result in losing 

one’s life. He adds, “If I die, what a beautiful death! To die in 

the exercise of one’s passion.” 


Philippe, who was brought up strictly in a privileged environment, 

had a “bad boy” side. He enjoyed the aspect of 

illegality and the feeling that comes with attempting forbidden 

and “impossible” things. He likened himself to a spy as he 

reconnoitered entry to the WTC through various subterfuges 

and kept in character by watching bank- robber movies. He 

sought out co- conspirators who were not only supportive but 

had a little larceny in their hearts. 

Having walked on wire across the cathedral of Notre Dame 

de Paris and the Sydney Harbour Bridge in Australia, he was 

ready to tackle the highest manmade structure. Petit and his 

co- conspirators made numerous visits to the WTC to determine 

how to gain entry and to ascend the 110 floors to the top, 

over 450 meters (1476 feet) from the ground. They enlisted 

an insider with a top floor office where they could store their 

equipment. The film takes us back to a time when 

Americans were more trusting. He gained access 

to the top floors from the manager of the complex 

by posing as journalist for a French magazine seeking 

to interview the construction crew to learn 

about wind conditions and other potential hazards. 

While doing so, his two “magazine photographers” 

took pictures of the site to determine placement 

of the guy wire; in so doing they learned that the 

two corners to serve as anchors for the wire did 

not face one another, but were askew. At one point 

during his stay, he injured his ankle and had to use 

crutches, which paradoxically allowed him greater 

entrée as people were more concerned with holding 

the door for him than checking his identification. 

One of the most ingenious things was how the 

team got the guy wire or cable across to the conspirators 

in the other tower, 200 feet away. Petit’s friend 

Jean Louis Blondeau, who is the most sympathetic 

character in the film, learned to use a crossbow, and 

they adapted the wire so that it could be shot the 

required distance. As they got closer to the event, 

Jean Louis and the others began to think of being 

potentially responsible for a friend’s death and of 

being caught in a litigious America and charged 

with assisted suicide or involuntary manslaughter. 

How wrong they were! 

The day before the walk, they infiltrated the 

WTC and got the equipment in place. This, the 

most exciting part of the film, involved close encounters 

with the guards and a race against the 

clock to be able to do the stunt before the WTC 

came alive. Beginning at 7:45 am, Petit made an 

estimated eight crossings which he prolonged to forty-five 

minutes of theater as he knelt and lay down on the wire while 

eluding the policemen who were trying to capture him. Finally, 

as the wind began to pick up and a misty rain began to fall, he 

was warned that a helicopter was getting ready to scoop him 

up. He terminated the stunt and was arrested and ordered to 

be examined by a psychiatrist who pronounced him sane. The 

initial charges of illegal trespassing and disorderly conduct 

were dropped in exchange for him giving a show for New York 

City children. 

The most interesting thing was how the event affected Petit 

and his friends. The celebrity was immediate as he hooked up 

with a groupie on being discharged from jail, even before he 

returned to see his girlfriend Annie, Jean-Louis, and the others 

who had helped make it all possible. They and he admit 

that it closed a chapter in their lives as they became alienated 

from his now famous life. He is shown reflecting on how he 

has done sixty more performances including one on the Eiffel 

Tower. Vowing never to repeat himself, he follows his “passions,” 

living life “on the edge,” although admitting that his “life 

©2008 Jean-Louis Blondeau / Polaris Images. 

is a mess.” The other beneficiary of the stunt was the WTC, 

which had been vilified, but now became part of the public 

imagination and began to fill up with tenants. One wonders 

how much all of this attention influenced the terrorist plotters 

in 1993 and September 11. 


The physician at the movies 

Glenn Ford and Van Heflin in 3:10 to Yuma (1957). 

Columbia Pictures/Photofest © Columbia Pictures. 

Remaking a forgotten classic Western 

While channel- surfing one evening, I got drawn in by the 

acting in the original 3:10 to Yuma and I thought it might be 

fun to contrast it with the 2007 re-make to see what it says 

about filmmakers and audiences separated by half a century. 

3:10 to Yuma (1957) 

Starring Van Heflin, Glenn Ford, Leora Dana, and Felicia Farr. 

Directed by Delmer Daves. Not rated. Run time 92 minutes. 

Based on a short story by Elmore Leonard, the film opens 

with a stirring rendition of the title song by Frankie Laine, 

known for his recordings of “Mule Train,” “Cry of the Wild 

Goose,” and the theme from the television show “Rawhide.” 

Like High Noon, the movie focuses on a man’s willingness to 

do his duty and keep his word, no matter the cost and no matter 

the enticements to turn his back on it. The protagonist is 

rancher Dan Evans (Van Heflin), a Civil War veteran who went 

West with his wife Alice (Leora Dana) and their two children. 

After four years of hardscrabble existence and six months of 

drought that threatens the loss of his cattle and his ranch, he is 

a failure in the eyes of his family. While rounding up his cattle 

that had been dispersed by outlaw Ben Wade (Glenn Ford) 

and his gang, Evans and his sons come upon the gang robbing 

Russell Crowe and Christian Bale in 3:10 to Yuma (2007). Lionsgate/Photofest © Lionsgate. 

a stagecoach loaded with gold. After shooting a gang member 

being used as a shield, as well as the guard, Wade takes the 

Evans family’s horses and their canteens of water and heads 

with his gang to Bisbee. 

Passing themselves off as hired hands heading for Mexico, 

they report the robbery to mislead the sheriff and line up at 

the bar for a celebratory drink. Meanwhile, Evans and his 

sons get their horses, which Wade left two miles away, and 

herd the cattle back to the ranch. Evans decides to go to town 

to talk the banker into not foreclosing on his ranch, which 

is now worth more to the bank because of the railroad coming 

through. Coming upon the marshal (Ford Rainey) and 

Butterfield the stagecoach owner (Robert Emhardt), he tells 

them that Wade and his gang were headed to Bisbee. Realizing 

that they were duped, they return to Bisbee to find that the 

gang has cleared out, all except for Wade, who has dallied 

with the barmaid Emmy (Felicia Farr). Although captured and 

handcuffed, Wade is unperturbed because he knows that his 

gang will rescue him. The decision is made to pay two volunteers 

$200 dollars to take Wade to the town of Contention to 

catch the 3:10 to Yuma where the federal prison is located. 

Evans, desperately in need of the money, volunteers to do so, 

as does the town drunk Alex Potter (Henry Jones). 

The stagecoach drops Wade, Evans, and Potter at Evans’s 


homestead, and the sheriff and the rest head off as a decoy 

as if transporting Wade themselves. There are some excellent 

scenes around supper, the saying of grace, and Evans cutting 

the handcuffed Wade’s meat (no fat, please). Wade becomes 

acquainted with Alice and begins to get some insight into their 

family. The rest of the film involves their arrival in Contention 

and the interplay between Evans and Wade in the hotel’s bridal 

suite as they wait for the train. Two significant events, the saving 

of Wade by Evans and the arrival of Alice, set the scene for 

the well- choreographed and dramatic ending in which Evans 

must get Wade to the train as the gang positions itself to rescue 

Wade and kill Evans. 

3:10 to Yuma (2007) 

Starring Russell Crowe, Christian Bale, Peter Fonda, and Ben 

Foster. 

Directed by James Mangold. Rated R. Running time 122 minutes. 

The re-make, which is a half-hour longer than the original 

(and feels it) differs significantly. It opens with the Evans 

barn being burned by the banker’s hooligan. The elder Evans 

son William (Logan Lerman) expresses disdain for his father 

Dan Evans (Christian Bale) because he won’t do anything but 

simply grovel for more time before foreclosure. While they 

go to round up the cattle, they come upon the robbery of the 

stagecoach, this time loaded with paper currency, not gold, 

and with a lot more shooting and killing. The stage is carrying 

Pinkerton detectives, one of whom, Byron McElroy (Peter 

Fonda), is Ben Wade’s (Russell Crowe) nemesis. Wade shoots 

McElroy in the abdomen at point-blank range. As in the original, 

Wade spares the Evans family and heads for Bisbee where 

he is captured after dallying with the barmaid Emma Nelson 

(Vanessa Shaw). The filmmakers felt compelled to sprinkle in 

some profanity, which adds nothing to the dialogue, as well as 

partial nudity. The liaison between Wade and the barmaid was 

handled off-screen in 1957. There is a medical sidebar when 

McElroy is operated on without anesthesia by veterinarian 

Doc Potter (Alan Tudyk). Simply removing the bullet leads to 

a remarkable recovery and McElroy joins Evans, Doc Potter, 

and Butterfield the stagecoach owner (Dallas Roberts) in 

transporting Wade to Contention. 

The supper at the Evans homestead is more crowded and 

not as much a family event. Evans still cuts the handcuffed 

Wade’s meat but this time he’s asked to cut off the gristle. We 

also learn more about Evans’s Civil War record and that he 

lost a leg (not so in the original). Nonetheless, he is able to 

run like a deer in some key scenes. From here, the re-make 

diverges widely from the original as the film covers the trip 

to Contention, which the original did not. There’s a lot more 

violence, special effects, and issue- oriented dialogue that the 

director acknowledges in the DVD commentary was intentional. 

This includes vilifying the Pinkertons for presumably 

slaughtering Apache women and children, as well as the railroad’s 

exploitation of Chinese and Negroes. In contrast to the 

low-key performance by Richard Jaeckel as Charlie Prince, 

Wade’s second-in- command, in the original, Ben Foster gives 

a riveting performance as a vicious psychopath who is dedicated 

to Wade, although the feeling is not mutual. While I’m 

not a fan of psychopaths, Foster’s portrayal, which is reminiscent 

of Richard Widmark’s performance in The Killers, was, 

for me, the highlight of the movie. 

Evans’s wife is no longer involved in the ending, which 

is much different from the original although the last line is 

virtually the same. Director Mangold decided to drop her 

(whose role I much preferred) and made the elder son a main 

character. Both play the same role in humanizing Wade as he 

builds an appreciation of Evans and the importance of trying 

to preserve him for his family’s sake. In this version, Wade 

quotes the Bible, as many movie villains do these days. He 

confesses that his mother left him in a hotel room with a Bible 

and promised to return. He read it in three days, but she never 

came back for him. His favorite quotations are from Proverbs 

13:3 and 21:2. Crowe appears at times to be sleepwalking 

through the picture, but to give him his due, he does convey 

menace in ways that Glenn Ford did not in the earlier version. 

As Wade says to Matthew, who is enamored of Dime Novel 

western desperadoes like himself, “Kid, I couldn’t last five 

minutes leading an outfit like that if I wasn’t rotten as hell.” 

Yet he’s an artist and a philosopher, the prototypical post-’60s 

anti-hero. His exchange with Evans as to why he doesn’t do 

good deeds is particularly noteworthy. 

As one might expect of someone who came of age in the 

1950s, I much preferred the original, which features straightahead 

storytelling with a powerful performance by Van 

Heflin, who specialized as the solid second male co-star, most 

especially in Shane. Leora Dana’s role, though smaller, is essential 

in conveying the importance of character and family. 

Still, as noted, there are some excellent scenes and standout 

performances in the re-make, especially by Ben Foster, as well 

as Peter Fonda. I was also grateful for the re-make in that it 

led me to watch the older version. There are some interesting 

features on the DVD, especially the one that shows how the 

picture was made. Another, an altogether too brief survey 

of the Western outlaws gangs like the James Brothers, the 

Youngers, the Daltons, and the Earps, discusses how many of 

them walked the fine line between being lawmen and outlaws, 

periodically falling to one side or the other. 

Dr. Dans (AΩA, Columbia University College of Physicians and 

Surgeons, 1960) is a member of The Pharos’s editorial board and 

has been its film critic since 1990. His address is: 

11 Hickory Hill Road 

Cockeysville, Maryland 21030 

E-mail: pdans@comcast.net 



David A. Bennahum, MD, and Jack Coulehan, MD, Book Review Editors 

Geriatric Bioscience: The Link 

Between Aging and Disease 

David Hamerman 

The Johns Hopkins University Press, 

Baltimore, Maryland, 2007, 279 pages 

Reviewed by Denise Zwahlen- 

Minton, MD 

Get ready to clear out the cobwebs 

everyone! Geriatric Bioscience 

will take you back to the days of biochemistry 

and pathophysiology lectures 

and add in a couple more details. Dr. 

Hamerman describes the molecular 

process of multiple diseases associated 

with aging, including osteoarthritis, diabetes, 

osteoporosis, and more. The 

depth of knowledge presented 

is astounding. I found myself 

reading in small sections so 

I could fully process the 

information covered 

and I realized just 

how much our 

knowledge of aging and diseases has 

exploded due to research. 

This book is not meant to tell you 

how to treat your patient, but how to understand 

your patient’s illness and why 

certain treatments are recommended 

and, further, how to avoid the disease in 

the first place if at all possible. 

In the preface, Dr. Hamerman expresses 

his desire to pass on his vast 

knowledge and theories on aging by 

presenting a new term he calls “geriatric 

bioscience.” Dr. Hamerman defines geriatric 

bioscience as “the interrelations 

of the biology of aging and disease.” px 

His goal with this book is to “promote 

greater awareness of the biological basis 

of aging and related diseases; introduce 

the relevance of early origins of disease 

as part of overall development; and 

encourage geriatricians to be aware of 

assessing risk factors to permit timely 

interventions.” pxiii 

As a young geriatrician, I especially 

enjoyed the chapter covering the 

evolution of geriatrics, and that Dr. 

Hamerman calls on future geriatricians 

to continue the quest for knowledge in 

aging and prevention of disease. I have 

recommended that our geriatric fellows 

read Geriatric Bioscience to develop an 

appreciation of the history and future 

of geriatrics, as well as to increase their 

knowledge of aging, the chronic disease 

process, and how closely related these 

entities are. 

In the body of the book, Dr. 

Hamerman conveys the knowledge 

he has gained in the science of aging, 

spanning his half-century career in 

medicine and geriatrics. He covers the 

basic science of many common geriatric 

syndromes, and discusses how the normal 

aging process contributes to the 

development of disease and how common 

pathways lead to different disease 

processes. 

The covered geriatric syndromes 

were described individually, which 

made it easy to go back to find a disease 

process; but the discussion of common 

pathways between diseases could be 

better referenced to other chapters. It 

would be interesting to try fitting a patient 

with multiple co-morbidities into 

the pathways Dr. Hamerman presents 

and then discuss how the patient got to 

be in the shape he or she is in, as well as 

the key points for intervention that were 

missed by the patient or the physician. 

Overall, I enjoyed reading Geriatric 

Bioscience. I feel it is a must-read for 

young and in-training geriatricians. It 

will help to build knowledge on the 

molecular basis of the aging process 

and how aging affects chronic disease 

and its management and prevention. 

Geriatric Bioscience also inspires one to 

pursue knowledge in aging and chronic 

disease management through research. 

Dr. Hamerman has truly fulfilled his 

goal of conveying his knowledge, as well 

as inspiring future geriatricians to keep 

the torch of understanding of the aging 

process burning. 

Dr. Zwahlen-Minton is an assistant professor 

in the Division of Geriatrics at the University 

of New Mexico School of Medicine. 

Her address is: 

MSC10 5550 

1 University of New Mexico 

Albuquerque, New Mexico 87131 

E-mail: dminton@salud.unm.edu 


Life in the Balance: A 

Physician’s Memoir of 

Life, Love, and Loss with 

Parkinson’s Disease and 

Dementia 

Thomas Graboys, MD, with Peter 

Zheutlin 

Union Square Press, New York, 2008, 

224 pages 

The Light Within: The 

Extraordinary Story of a Doctor 

and Patient Brought Together 

by Cancer 

Lois S. Ramondetta, MD, and Deborah 

Rose Sills 

William Morrow, New York, 2008, 272 

pages 

Reviewed by Jack Coulehan, MD 

(AΩA, University of Pittsburgh, 1969) 

Once upon a time, pathographies 

(i.e., illness narratives) and physician 

memoirs were few and far between. 

Undoubtedly, the experience of illness 

raised existential questions for sufferers 

then as now, but the only people 

moved to communicate their encounters 

with illness for public consumption 

were those whose business it was to 

do so; clergymen and creative writers, 

for example. Likewise, while the occasional 

doctor published his memoirs, 

the public in general wasn’t consumed 

by a passion for reading about medical 

exploits. This state of affairs is difficult 

for us to imagine today because for 

several decades now pathographies and 

medical memoirs have been hot items in 

the publishing world. In the 1970s and 

’80s, many such books concentrated on 

anger, exposé, and condemnation, with 

physicians telling the terrible truth about 

medical training and patients documenting 

the inhumanity of American medical 

care. More recently, many doctor- and 

patient-writers have shifted their attention 

to the existential and spiritual 

dimensions of medical experience. 

Life in the Balance and The Light 

Within are interesting, and in some 

ways surprising, examples of this recent 

“greening” of medical nonfiction. 

In both, health care professionals and 

medical institutions come across as 

good guys rather than villains. And in 

both books the major theme is interior 

growth. Life in the Balance is the story 

of a cardiologist who develops progressive, 

disabling illness while at the peak 

of his profession. Speaking from the 

perspective of patient and doctor, Dr. 

Thomas Graboys struggles not only 

with the meaning of illness in his own 

life, but also with its impact on his patients 

and colleagues, and the difficult 

decision of when to retire from practice. 

The Light Within is co-authored by a 

gynecologic oncologist and an ovarian 

cancer patient with whom she established 

a close personal relationship. This 

“extraordinary friendship,” as described 

in the book’s subtitle, leads both women 

to discover deeper meaning in their 

lives and work. 

Life in the Balance 

An eminent Boston cardiologist, 

Harvard professor, and protégé of 

Bernard Lown, Dr. Thomas Graboys 

developed Parkinson’s disease while 

still in his late 50s. Shortly after his 

wife died of cancer in 1998, Graboys 

noticed unusual fatigue and physical 

and mental sluggishness. He naturally 

attributed these symptoms to grief. 

But they continued, and a couple of 

years later he experienced episodes of 

stumbling, falling, and syncope. Despite 

receiving a permanent cardiac pacemaker, 

these symptoms recurred in 

2002 around the time of his marriage 

to Vicki, a woman he had met a year 

or so after his first wife’s death. During 

2003 Graboys confided to his diary that 

it was “increasingly difficult to express 

concepts.” p30 He also noticed tremor, 

problems with dictation, and frequent 

loss of his train of thought, symptoms 

“typical of Parkinson’s.” p24 

While Graboys recorded these concerns 

in his diary, outwardly he denied 

that anything was wrong, even to 

family and close friends. He courted 

and married Vicki without revealing his 

symptoms or explaining their implications. 

When a long-time nurse colleague 

questioned him about his health, he 

replied, “I’m just tired.” p26 In fact, his 

denial remained intact until the day in 

2003 when the chair of Neurology at 

Harvard accosted him in the parking lot 

and pointedly asked, “Tom, who is taking 

care of your Parkinson’s?” p27 

Despite some improvement with 

treatment, Dr. Graboys faced an even 

more difficult challenge in 2004 when 

he developed the vivid, violent dreams 

and memory lapses that led to a diagnosis 

of Lewy body dementia, a form 

of progressive dementia sometimes associated 

with Parkinson’s disease. With 

the cat out of the bag at last, the author 

finally began to confront the issue of 

professional impairment. But initially 

the confrontation was indecisive. He 

wrote a letter telling his patients about 

his illness, cut back on his practice, and 

even had his neurologist certify that he 



“will be able to continue as an effective 

physician” p34 Finally, in mid-2005 

Graboys’s colleagues had to seize the 

initiative themselves. “I was told, gently 

but firmly, that it was the unanimous 

opinion of my colleagues that I was no 

longer fit to practice medicine.” p36 

Writing now with the assistance 

of journalist Peter Zheutlin, Graboys 

reviews these events with unblinking 

honesty. He acknowledges his betrayal 

of Vicki and the subsequent tension and 

distrust in their relationship. He confronts 

his anger over being ill and the 

prolonged denial that led to personal 

and professional isolation. At the same 

time, however, the author reveals the 

thoughtful, generous, and passionate 

side of his character: good friend, loving 

husband and father, a man determined 

not to give up. At one level he 

approaches the challenges of declining 

physical and mental ability with Stoiclike 

equanimity, while at another level 

he maintains fierce determination to 

fight as long as he can. 

“What will become of me?” This is 

the question that now lies at the center 

Dr. Graboys’ personal world. He knows 

that his loss of mental and physical 

control will worsen. With almost superhuman 

effort and his family’s strong 

support, he has been able to adapt to 

his limitations and maintain a sense 

of meaning in his life. Will that continue? 

In a chapter entitled “End Game,” 

he addresses the question of suicide. 

Reflecting on his condition, especially 

the dementia, Graboys asks, “Will I 

lose myself, my very essence, to this 

disease?” p161 Yet what end-of-life instructions 

should he give to his surrogate 

decision makers? “Who is to say 

how much dementia is too much to live 

with? Who will know what really goes 

on in my head when I lose the ability to 

communicate?” p166 

In the last chapter, Graboys acknowledges 

that he has no “simple prescription 

that will help you or someone you love 

live a life beyond illness, or tell you how 

to tap the hope that lives within.” p181 

Unfortunately, he then goes on to make 

several suggestions of the superficial 

advice-manual variety: “Use your family 

and friends as motivation to live life 

with as much grace as you can muster.” 

“Find a safe place . . . to unburden 

yourself of anger.” “Acceptance is key 

to defusing anger, stress, and self-pity.” 

“Use your faith in God, if you believe in 

God.” pp181–82 

I found the last comment dispiriting. 

Up until that point (six pages from the 

end of the book), Graboys says nothing 

explicit about the role of spirituality in 

coping with progressive illness. I use 

the term “explicit” here because in my 

opinion the kind of existential work the 

author describes qualifies as implied 

spirituality. So I don’t mind the absence 

of transcendent language or revelatory 

experience. No, I found the bland Godcomment 

disappointing because with it 

the author introduces a new character 

(God) who plays no role in his plot. 

Why toss belief into your recommendations, 

if you immediately dispose of 

it with such a truism? As noted in the 

previous paragraph, perhaps my major 

complaint about Life in the Balance is 

the disconnect between the engaging 

personal story that occupies most of 

the book and the advice manual last 

chapter. I guess Dr. Graboys felt that he 

owed his readers a summary take-home 

message. However, he didn’t. Trust me, 

his story speaks eloquently for itself. 

The Light Within 

The same is true, although in a much 

different way, for The Light Within. Dr. 

Lois Ramondetta was a fellow in gynecologic 

oncology at the M. D. Anderson 

Hospital in 1998 when she was called one 

night to the bedside of Deborah Rose 

Sills. Sills, a professor of comparative religion, 

had undergone surgery for ovarian 

cancer the year before and was now 

admitted for small bowel obstruction. 

Scheduled for surgery the next morning, 

she had refused to drink her laxative 

on the basis of being “already empty.” p3 

Dr. Ramondetta’s verbal intervention 

was successful. So, too, was the surgery, 

during which no recurrent cancer was 

found. Ramondetta and Sills hit it off 

well from that moment on. Their relationship 

developed over the next seven 

or eight years from doctor-and-patient 

to close friendship and eventually coauthorship 

of this intriguing memoir. 

In the early part of the book, the 

women’s stories remain largely independent, 

except for medical contacts. 

Dr. Lois writes about her early marriage 

to a medical classmate, its rapid 

unraveling under the stresses of residency, 

their infant daughter Jessica, 

and subsequently the complexities of 

her life as a single mother. (The women 

almost immediately begin referring to 

one another as “Dr. Lois” and “Deb,” 

a practice I’ll adopt here.) Deb’s sections, 

printed in italics, tell of a highly 

regarded university professor adopting 

a strange new life as an cancer patient. 

She struggles against reinterpreting 

herself as sick. As Dr. Lois writes, “One 

of the first things I learned . . . was how 

much she disliked to be defined by 

her illness.” p31 The women also reflect 

on their developing relationship. Deb 

writes, “the two of us [are] still dancing 

our way around each other.” p79 In 

a companion section, Dr. Lois observes 

that Deb considers friendship “an ongoing 

conversation.” p80 

The stories converge as the two become 

close friends. Some of their interactions 

take place at M. D. Anderson, as 

Deb first returns for a phase II clinical 

trial that requires a seven-month treatment 

protocol, highlighted by a bone 

marrow transplant, and later for management 

of recurrences and complications. 

Their friendship also blossoms in 

nonmedical settings, both in Houston 

and at Deb’s home in Santa Barbara. 

Among the stories they share is that 

of Dr. Lois’s courtship and marriage to 

Nuri, a local disc jockey. Another is the 

rock-solid support of Deb’s family. In 

addition, the friends begin to collaborate, 

first on a lecture and then on an 

academic paper about spirituality and 

ovarian cancer. This dialogue eventually 

leads to the book itself, completed only 

after Deb’s death in 2006. 


Dr. Lois relates one sobering incident 

in the realm of medical ethics. 

Toward the end of her life, when cancer 

had obstructed her ureters, Deb 

decides against having nephrostomy 

tubes inserted to prevent renal failure. 

“I’m not going to be medicalized,” she 

explains. p168 Deb’s choice comes as a 

surprise to Dr. Lois, who by that time 

had already been practicing medicine at 

least six years: “That conversation was 

a real eye-opener for me. With most 

patients, I had never thought of this as 

a choice.” p168 Not a choice? Hadn’t she 

ever discussed forgoing life-extending 

therapy with one of her cancer patients? 

I would hope that Dr. Lois had 

done so before Deb’s case, which occurred 

after she had completed several 

years of gynecologic oncology practice. 

Fortunately, Deb is then offered a stent 

rather than an external tube, an option 

she accepts, thus making her earlier 

decision moot. 

Although I found The Light Within 

interesting and competently written, I 

was disappointed because through most 

of the book the spiritual dimension—so 

often referred to by its protagonists— 

doesn’t come alive. Early in the text 

Deb introduces Dr. Lois to Buddhism 

and Ram Dass’s teaching, “Be here 

now.” Much later, Nuri, her fiancé, is 

helping her learn the same lesson: “to 

enjoy the present—to be in the now, 

as Deb had put it.” p156 In the chapter 

entitled “Spirituality and Cancer,” Deb’s 

ovarian cancer recurs and the question 

“How long do you think I have?” arises. 

Dr. Lois observes, with regard to their 

friendship, “I began to notice that some 

of my fellow oncologists were also being 

drawn—sometimes against their 

will—into similarly deep and spiritual 

relationships.” p167 Yet the narrative contains 

few reflections on human dignity, 

suffering, or the meaning of illness, and 

no attempt to evoke in words the spiritual 

experiences the authors refer to. 

Thus, I was taken by surprise when 

on page 197 I came to the episode where 

Deb reads a passage from the biblical 

book of Isaiah to Dr. Lois: “The voice 

said, Cry. And he said, What shall I cry? 

All flesh is grass, and all the goodliness 

thereof is as the flower of the field.” My 

reaction to this passage was immediate 

and visceral. I burst into tears. Not just a 

single sob or two, not just a crinkling of 

my eyes. No, I literally burst into tears, 

feeling a sense of loss and a deep yearning 

seemingly unattached to any specific 

object. As I read on, a quieter version of 

the same reaction occurred at page 218 

where Abby, Deb’s adolescent daughter, 

thanks her dying mother for being her 

mother and for fighting so hard to stay 

alive. I’m not sure how to interpret these 

reactions, and it is probably unprofessional 

for a reviewer to cite tears as data 

in a book review. Nonetheless, I acknowledge 

them because the spirituality 

I was looking for all along seemed to 

“click” for me in the last chapter of The 

Light Within. The authors’ stories may 

appear for most of the book to promise 

more than they deliver, but in the end 

they come together powerfully and, at 

least for me, they triggered a revelatory 

experience. 

Life in the Balance and 

The Light Within are 

two very different, but 

complementary, memoirs. 

Neither is stale or 

routine. Each is fresh 

and surprising in 

its own way. Both 

are tales that deserve 

our attention. 

Dr. Coulehan is a published 

poet and author. 

He is the book review 

editor for The Pharos 

and a member of its editorial 

board. His address is: 

Department of Preventive 

Medicine, HSC L3-086 

State University of New York at Stony 

Brook 

Stony Brook, New York 11794-8036 

E-mail: jcoulehan@notes.cc.sunysb.edu 

Office Hours 

A search for disease 

Amidst innocent chatter. 

Anxious eyes. 

Hidden fears. 

Disease selects a stranger, 

And merges our lives. 

Adding me to the broth, 

That sustains a life. 

Each subsequent visit; 

A sip of sustenance, 

Cratered in a bowl 

Of hope. 

Cupped by trembling hands, 

The bowl touches lips. 

Eyes speak, 

“OK to drink?” 

Eyes that occupy 

My pensive moments. 

My morning drive. 

My sleepless nights. 


Dr. Isenberg (AΩA, Indiana University, 1975) 

is assistant professor of Otolaryngology—Head 

and Neck Surgery at Indiana University School 

of Medicine. His address is: 1400 North Ritter 

Avenue, Suite 221, Indianapolis, Indiana 46219. 

E-mail: sisenberg@good4docs.com. 


The World Is Sleeping 

3:03 AM. The world is sleeping. 

Skin stretched over bones, 

her weight pretends to depress the hospital mattress. 

These waking hours are unbearable pain. 

Writhing and worming in bed, 

she digs her own grave. 

An exhaust fan sounds like tiny hands clapping. 

It makes a wind to kiss the sweat of her hairless skull. 

Tumors devour her. 

Mitotic spindles dance wildly 

a choreographed mayhem. 

Her body is indifferent to a half-empty syringe. 

Blood vessels protrude from her arms, 

calling Morpheus to ease her through— 

memories of 96 years need more than minutes to pass. 

Neon lights buzz to reveal her. 

A steady pulse barks out to the stethoscope. 

A needle prick, a rose blooms— 

a red flash hardens to crimson. 

Her heart is now a blood-soaked sponge. 

Each contraction rattles and cracks her crusted ribs. 

Minutes pass. Time slows. 

3:17 AM. The world is sleeping. 

Michael R. Bykowski 

Mr. Bykowski is a member of the Class of 2011 at The University of Pittsburgh 

School of Medicine. His address is: 2158 Fairland Street, Pittsburgh, Pennsylvania 

15210. E-mail: bykowski.michael@medstudent.pitt.edu. 


Announcing the 2009 Alpha Omega Alpha 

Robert J. Glaser Distinguished Teacher Awards 

These awards are based on a national competition conducted 

annually through the offices of the deans of U.S. 

and Canadian medical schools, and are designed to recognize 

distinction in medical student teaching. Each school 

may submit one application. Recipients are selected by a 

committee jointly appointed by ΑΩΑ and the Association 

of American Medical Colleges (AAMC). 

Up to four faculty awards of $10,000 each are made. 

In addition, each award winner’s nominating institution 

receives $2,500 for teaching activities. If that school has 

an ΑΩΑ chapter, a $1,000 stipend is awarded toward its 

activities. 

Nomination materials for 2009 have been sent to every 

medical school by the AAMC, which administers all aspects 

of the competition. The deadline for nominations is 

May 1, 2009. Information and nomination forms are available 

at www.aamc.org/about/awards/aoa.htm. Queries 

regarding nominations should be addressed to Henry 

M. Sondheimer, MD, at the AAMC, 2450 N Street, NW, 

Washington, DC 20037-1127; telephone (202) 828-0680; 

e-mail: hsondheimer@aamc.org. 

The awards will be presented during the annual meeting 

of the AAMC in Boston, November 6–11, 2009. 

Minutes of the 2008 meeting of the board of 

directors of Alpha Omega Alpha 

The meeting in Menlo Park, California, was convened at 

8:30 am by President Rae-Ellen Kavey, MD. 

Present were: Secretary-Treasurer C. Bruce Alexander, 

MD; member at large N. Joseph Espat, MD; President Rae- 

Ellen Kavey, MD, MPH; member at large Douglas S. Paauw, 

MD; councilor member Robert G. Atnip, MD; medical organization 

member John Tooker, MD; Executive Secretary 

Edward D. Harris, Jr., MD; Assistant Treasurer William F. 

Nichols; and national office members Mara Celebi, Ann 

Hill, Debbie Lancaster, and Carol Wong. Participating by 

conference call were Vice President Donald Wilson, MD, 

and student member Natalia Berry. 

Absent and excused were: members at large Michael V. 

Drake, MD, Ruth-Marie Fincher, MD, Don W. Powell, MD, 

and Joseph W. Stubbs, MD; councilor members Eric P. Gall, 

MD, and Amy Goldberg, MD; student members Smeeta 

Sinha and Kara Cavuoto. 

The minutes of the 2008 meeting of the board of directors 

were reviewed and approved. 

New board and honorary members 

Nominations for the 2008/2009 board of directors slate 

were reviewed and voted upon. Elected to a three-year 

term as member at large: Robert Atnip, MD, Pennsylvania 

State University. Re-elected to three-year member-at-large 

terms: C. Bruce Alexander, MD, University of Alabama at 

Birmingham; Donald B. Wilson, MD, Director, Minority 

Health & Health Disparities, Owings Mills, Maryland. Elected 

to a three-year term as councilor member: Anne Mancino, 

MD, University of Arkansas School of Medicine. Elected to a 

three-year term as student member: Cason Pierce, University 

of Texas Southwestern Medical School at Dallas. 

Honorary member nominations were reviewed and 

voted upon. Elected to honorary membership were: Lihadh 

Al-Ghazali, MBChB, MRCP, FRCP, FRCPCH, United 

Arab Emirates University, Al Ain, United Arab Emirates; 

Rodolfo A. Armas-Merino, MD, MACP, University of Chile, 

Santiago, Chile; Kai-Ming Chan, MBBS, FRCS (Edin.), 

FRCPS (Glas.), FHKCOS, FACS, The Chinese University 

of Hong Kong, Hong Kong Special Administrative Region, 

People’s Republic of China; Ronald Dorfman, MBBCh, 

FRCPath, emeritus professor of Pathology, Stanford 

University School of Medicine, Stanford, California; 

Ogabara K. Doumbo, MD, PhD, University of Mali, Bamako, 

Republic of Mali; Torello Lotti, MD, University of Florence, 

Florence, Italy; Prof. Dr. med. Dr. H. C. Thomas Ruzicka, 

Ludwig-Maximilian University, Munich, Germany; K. V. 

Thiruvengadam, BSc, MD, FRCP, FAMS, DSc, FCCP (US), 

FCAI, Madras Medical College, Chennai, India; Nuria M. 

Greenfield Tortosa, MD, University of Panama School of 

Medicine, Panama City, Panama. 

Reports of officers and programs 

Reports of the president, executive secretary, and managing 

editor were presented, followed by reports on the 

programs the national office administers. 

Ms. Celebi and Ms. Wong presented the report on online 

registration of new members. The board decided in 

2006 to require registration of new members on-line: 

�� 

dues to support AΩA programs. 

�� 


National and chapter news 

may only be inducted into the Society after the membership 

fees to the local chapter [if any] and to the national 

AΩA office have been paid.” 

�� 

AΩA web site, which the national office will use increasingly 

for communication with members. 

The new registration procedures resulted in 96 percent 

of all nominees having paid dues as of August 2008, compared 

with 38 percent at the same point in 2007, before the 

new registration procedures took effect. 

The board unanimously approved the following statement 

regarding nonpayment of dues by students elected 

to AΩA: 

As established in the AΩA Constitution (Article IV, 

Section 2f), a student chosen for membership in AΩA 

“. . . may only be inducted into the Society after the 

membership fees to the local chapter and to the national 

AΩA office have been paid.” 

The AΩA Board of Directors established at its annual 

meeting in October 2007 that all new member dues 

must be paid through a process of online registration 

using the AΩA website, effective with all subsequent 

chapter elections. This process has been successful at 

enrolling 97% of new members over the past 12 months. 

Students who do not initially pay their dues receive 

reminders from the National Office, both in person and 

through their AΩA Councilor. 

By unanimous vote, the AΩA Board now reaffirms 

that AΩA membership will not be granted to any student, 

who after a reasonable process of notification, has 

failed to satisfy the dues requirement prior to September 

1 of the year of graduation. After that date, a final letter 

of non-election will be sent to the Councilor and to 

the Dean of the medical school. It is expected that the 

Councilor will then make appropriate efforts to notify 

the candidate of his/her status. 

This action of non-election as a student will not 

preclude any candidate from future election to AΩA in 

other defined membership categories. 

Dr. Alexander and Mr. Nichols presented the financial 

review. AΩA’s financial health continues strong in spite of 

the problems in the stock market. The change in registration 

procedure resulted in a small improvement in dues 

income. National programs accounted for $1.27 million in 

actual expenses for the 2007/2008 fiscal year. 

New initiatives 

The proposal for the Professionalism Fellowship was 

discussed and approved. Announcement of the fellowship 

was sent to all chapter councilors and deans of schools of 

medicine having active AΩA chapters. 

A survey of medical students was completed. The survey 

sought to determine: 

1. Student awareness of AΩA as an organization: Is the 

student familiar with AΩA? Does the student understand 

its function as a medical honor society? 

2. Student understanding of AΩA: Does the student 

know about AΩA opportunities within chapters and nationally? 

3. Student perception of AΩA: Is the student associated 

with AΩA? Is AΩA a negative or a positive influence? 

Should honor societies exist in medical training? 

4. Visibility of AΩA on campus. 

The survey was designed and conducted by student 

member Natalia Berry of Dartmouth Medical School with 

the input of marketing professor Jackie Luan at the Tuck 

School of Busines at Dartmouth. Two groups of students 

were surveyed: junior AΩA students and a broader group 

of AΩA and non-AΩA students. 

Almost 200 third-year students, elected as juniors, 

completed the survey, as did an additional fifty senior 

students. Names and medical schools remain anonymous. 

Most reported first hearing about AΩA from elected students. 

Those reporting recognized scholarly achievement 

(95%) and professionalism/leadership/service (82%) as the 

primary functions of AΩA. Forty-seven percent listed help 

in obtaining a residency as a primary function. Of these 

elected students, 41% believed that AΩA was active and 

visible at their school. Of the small number of elected students 

(2% of those responding to the survey) who felt that 

there was no appropriate role for a honor medical society, 

the principal reasons were that it increased stress and pressure 

and competition. The attributes of membership most 

important to recently elected junior students were help 

with residency match (77%) followed by prestige. A number 

of written comments indicated that the lack of visibility of 

AΩA on campus resulted in the organization appearing as 

if it were a secret society. 

Presentation by Stanford Alumni Consulting Team 

AΩA’s board of directors decided at its 2007 board 

meeting to investigate ways to increase AΩA’s visibility, 

both in medical schools and generally, to enhance existing 

programs, and to generate revenue for additional 

important programs. A group of alumni from the Stanford 

University Graduate School of Business, the Stanford 

Alumni Consulting Team (ACT), provides pro bono management 

consulting services to nonprofit agencies. The 

group presented its report to the AΩA board of directors 

at this meeting. The board has taken ACT’s proposals under 

advisement and will implement selected recommendations 

over the next several years. 


I Am the Patient 

I give my name, 

Take a seat. 

It feels odd from this vantage. 

They call me Ms., ask me in. 

This is my turf, but I’m not in charge. 

Today I am the patient. 

My vitals taken, 

I sit, ill at ease not being in charge. 

There’s a reason I sought that degree. 

The doctor comes in, 

Asks my complaint. 

I try to be helpful, descriptive, 

Though I don’t enjoy being vulnerable, 

Or asking for my needs to be met. 

I need to be the patient. 

My visit almost complete, 

I recheck—did I miss anything? 

“I hope you feel better,” my physician offers 

And I thank him for seeing me as a walk-in. 

God, I just hope the cough will ease tonight 

And I can get some rest. 

I pay my copay, 

Get my prescriptions and note for work. 

“Oh, you’re a doctor,” the receptionist notes. 

I smile. 

Not today. 

Suzanne Minor, MD 

The Pharos/Spring 2009 49 

Dr. Minor (AΩA, University of Miami, 2001) lives in Florida. Her address is 

16555 NW 25 Avenue, Opalocka, Florida 33054. E-mail: suzieminor@aol.com.

Letters to the editor 

Locked-in syndrome 

I enjoyed the review of The Diving 

Bell and the Butterfly by my friend and 

classmate Peter Dans in the Autumn 

2008 issue of The Pharos. I would 

agree with his characterization of the 

film as outstanding and, as a neurologist, 

I found the depiction of a patient 

with the locked-in syndrome quite 

accurate. The protagonist showed 

remarkable inner strength and intelligence 

despite his desperate condition, 

being unable to move or speak and 

only able to communicate with eye 

blinks. Bauby, the patient, had a contract 

to write a feminine counterpart 

of The Count of Monte Cristo, presenting 

a powerfully ironic situation, 

as its author, Alexandre Dumas, père, 

penned the first literary depiction of a 

person with the locked-in syndrome in 

this novel. Whether or not the screen 

writer knew this is not clear. 

The description of “the paralytic,” 

who was in this state for six years, is as 

follows: 

M. Noirtier, although almost as immovable 

and helpless as a corpse, 

looked at the new-comers with a 

quick and intelligent expression . . . 

Sight and hearing were the only 

senses remaining, and appeared 

left, like two solitary sparks, to 

animate the miserable body which 

seemed fit for nothing but the 

grave. The speaking eye sufficed 

for all. He commanded with it; it 

was the medium through which his 

thanks were conveyed. 1 

As in the movie, there were 

several people who learned to 

communicate with Noirtier by 

attempting to interpret his 

eye blinks. His granddaughter 

Valentine, 

however, worked 

out a system much like that used by the 

speech pathologist in the film. She first 

recited the letters of the alphabet until 

Noirtier indicated that the first letter of 

the word he wanted was reached. The 

second letter of the word was than determined 

the same way. Valentine then 

held up a dictionary and ran her fingers 

down the columns until her grandfather 

signaled that she was at the word 

he wanted. 

Although rare, the locked-in syndrome 

occurs often enough that it 

needs to be considered in the differential 

diagnosis of any patient who has 

no voluntary movements but seems to 

have some level of wakefulness. These 

patients are individuals with whom reliable 

communication can be achieved, 

unlike patients with coma, the chronic 

vegetative state, or conditions associated 

with minimal consciousness. 

The same careful assessment needs 

to be applied to children, as the syndrome 

has been reported in pediatric 

patients. 2 Patients with amyotrophic 

lateral sclerosis and some other neuromuscular 

conditions can eventually 

become locked-in, but this does not 

occur calamitously as in the case of a 

stroke or traumatic brain injury. 

References 

1. Dumas A. The Count of Monte Cristo. 

Chapter 39, M. Noirtier de Villefort. 

2. Golden GS, Leeds N, Kremenitzer 

MW, Russman BS. The “locked-in” syndrome 

in children. J Pediatrics 1976; 89: 

596–98. 

Gerald S. Golden, MD 

(AΩA, Columbia University College of 

Physicians & Surgeons, 1961) 

Anatomy—with or without a 

cadaver 

It was a pleasure to read the 

Autumn 2008 issue of The Pharos. 

I read with great interest the article, 

“Bring out your dead?” by W. Roy 

Smythe (pp. 10–15). In Nepal, dissection 

is a necessary component of the 

gross anatomy curriculum for medical 

students. Students dissect certain 

regions of the body and are shown 

prosected specimens of other regions. 

During the practical examinations, students 

do not have to dissect the human 

body but are shown prosected specimens 

and identification of individual 

structures followed by a viva voce with 

the examiner. 

In Nepal, the basic science subjects 

of anatomy, physiology, biochemistry, 

pathology, microbiology, and pharmacology 

are taught in an integrated 

organ system-based manner during 

the first two years of the undergraduate 

medical (MBBS) course. A survey 

was carried out in a medical school in 

western Nepal to study the emotional 

impact of cadaver dissection using the 

appraisal of life events (ALE) scale. 1 

The loss, challenge, and threat scores 

were compared initially on first exposure 

to dissection and at the time of 

the study. The loss and threat scores 

declined over the course of study. The 

loss and threat scores were lower than 

that reported previously. The challenge 

scores were higher. Majority of students 

considered anatomy dissection as 

a significant positive life experience. 

The December 2004 issue of the 

magazine The Clinical Teacher had 

an interesting article about how a new 

medical school in the United Kingdom 

teaches anatomy without cadavers. 2 

The department decided that they 

would rely on living anatomy and 

medical imaging. Peer examination, life 

models, body projection, body painting, 

digital surface anatomy atlases, 

computer models, and simulations are 

among the various methods used. A 

major disadvantage of dissection ac- 


cording to the authors is that the color, 

texture, and smell of a cadaver is not 

like real life and cadavers cannot be 

auscultated, palpated, or usefully asked 

to change position. 2 

I am a medical educator and the 

medicine program coordinator in my 

medical school, and am interested in 

strategies to deal with the knowledge 

explosion in medicine. These days 

knowing “what not to teach” according 

to me is as important as knowing what 

to teach. A possible problem is that 

anatomists and anatomy teaching have 

concentrated on the requirements of 

surgeons and surgical specialties. The 

majority of medical graduates will not 

be surgeons and the anatomical knowledge 

they need and the way they approach 

the body may be quite different. 

During my undergraduate days I 

was taught the detailed relations of 

various nerves and blood vessels. I do 

not remember any of that now and 

also did not find it useful in practice. 

I personally feel that the procedures 

like peer examination, body projection, 

and other methods adopted in the U.K. 

school 2 will equip students with a more 

relevant knowledge of anatomy. A doctor 

while doing a physical examination 

(palpation) should be able to visualize 

what structures lie underneath the 

examining hand and should also know 

about the surface anatomy of different 

organs. With the widespread availability 

of CT scans and MRIs cross-sectional 

anatomy is becoming more important. 

In my undergraduate days, anatomy 

was taught in a traditional manner and 

was not clinically oriented. Dissection 

may be useful in that it is a group activity 

and learning takes place in consonance 

with adult learning principles. 

Students can also be introduced to 

death in a sensitive manner. However, 

this objective was not fulfilled during 

my undergraduate days. Most medical 

schools in South Asia do dissections 

as a mechanical activity which is mandatory 

as it has been included in the 

curriculum. I feel medical educators 

and doctors other than anatomists and 

surgeons should also be engaged in the 

important issue of curriculum design. 

This may also be required for other 

basic science subjects. Their broader 

and more holistic viewpoint can have 

a significant impact on the narrower 

viewpoint of subject experts resulting 

in a more relevant curriculum. 

Anatomy describes the setting of 

events, as rightly pointed out by the 

author. The questions are what methods 

to use to teach and learn about the 

body and to what depth to teach and 

which details are necessary and which 

are irrelevant and may be omitted. 

The guiding principle I feel is that the 

undergraduate course in most parts of 

the world prepares the student for a 

career as a primary care physician. The 

teaching of all subjects should keep 

in mind this important fact. Facts and 

details needed for various postgraduate 

courses can be better taught during the 

particular course and not during the 

undergraduate days! 

References 

1. Vijayabhaskar P, Shankar PR, Dubey 

AK. Emotional impact of cadaver dissection: 

a survey in a medical college in western 

Nepal. Kathmandu Univ Med J 2005; 

3: 143–48. 

2. McLachlan JC, De Bere SR. How we 

teach anatomy without cadavers. The Clinical 

Teacher 2004; 1: 49–52. 

Dr. P. Ravi Shankar 

Department of Medical Education 

KIST Medical College 

Lalitpur, Nepal 

AΩA membership—more than 

high GPA 

In recent years, the Gamma AΩA 

chapter at UT Southwestern had been 

making student nominations based 

strictly on GPA, and individuals were 

only nominated during their senior 

year of medical school. Last year, the 

chapter leadership made two important 

changes in its selection process. 

First, selection criteria were changed 

to incorporate leadership, research, 

and service activities as outlined in the 

AΩA Constitution. Second, for the first 

time in over a decade, members were 

nominated from the junior class. 

The benefits of making these two 

minor changes in the selection process 

have been tremendous. Weighing 

leadership, research, and community 

service in the selection process better 

insures that student members have the 

skill set and commitment necessary 

to foster a dynamic organization. By 

selecting a small group of members 

and student officers prior to the fourth 

year, the organization’s leadership has 

had more time to identify and organize 

projects that serve the community and 

that boost the visibility of the organization 

and its ideals on campus. 

After their selection last spring, the 

student officers met with the chapter 

councilor, executive committee, and 

outgoing student officers. Following 

this meeting, the new officers together 

came up with ideas for several new 

programs designed to improve the 

university community, serve the community 

at large, and strengthen the ties 

of its faculty and former student members. 

The officers then organized a 

meeting with the newly-selected junior 

AΩA members to discuss these project 

ideas, identify those ideas with the 

most member support, and delegate 

responsibilities for development and 

implementation. 

The AΩA student leadership and 

members identified several opportunities 

to provide service to the university 

community. The organization made 

one of its goals to encourage a collegial 

atmosphere among medical students. 

To achieve this goal, AΩA worked with 

the university administration to create 

a program where each of the forty 

AΩA members serves as a mentor to 

the small groups of first- and secondyear 

students within the newly created 

UTSW Colleges. These mentors 

provide support by assisting with instruction 

in performing different components 

of the physical exam, working 

with students to improve their patient 


Letters 

write-ups, providing encouragement 

and advice regarding Step 1 preparation 

and the residency application process, 

and by hosting their small groups of 

students for dinner. AΩA plans to 

make this partnership a cornerstone of 

its service activities and is working to 

improve the overall experience for all 

of the involved parties. 

In addition, the chapter leadership 

felt that, given the academic success of 

its members, the group was in a unique 

position to offer advice on study 

habits and exam preparation to first- 

and second-year medical students. 

Several AΩA members developed a 

survey instrument and polled their 

fellow members to determine those 

study methods and resources most 

consistently utilized. They then incorporated 

this information into several 

Powerpoint presentations and shared 

it with first- and second-year medical 

students during a series of lunch workshops. 

Several other members are still 

working to create a similar resource for 

second-year students related to Step 1 

and wards preparation. 

The chapter community service 

project involved partnering with a local 

nonprofit organization to provide free 

sports physicals for the school-aged 

children of north Dallas. AΩA student 

members advertised the event, helped 

with patient intake and discharge, 

and conducted physicals with appropriate 

faculty supervision. Physician 

volunteers were recruited from the 

local AΩA faculty. In total, the group 

saw sixty-nine patients during a single 

Saturday morning in early September. 

AΩA plans to make this community 

service activity an annual event. 

Moreover, the officers felt it important 

to strengthen the relationship 

between AΩA faculty, former student 

members, and current members. They 

contacted all current AΩA faculty 

members and asked for responses from 

those willing to serve as mentors to 

student members. They then compiled 

this list of mentors, organized it by 

area of medical specialty, and made it 

available for all of its student members. 

The organization is also working to 

acquire contact information for alumni 

members so they can be made aware of 

the various chapter activities. 

To further improve visibility and 

communication within the organization, 

the student leadership has made 

a significant effort to update and improve 

its chapter website. The new 

website features information about 

the various AΩA activities, a list of all 

current faculty AΩA members, those 

faculty members willing to serve as 

mentors for AΩA members, and all 

recent student members. It also contains 

downloadable copies of the “study 

tips” documents, the current selection 

process, and the AΩA Constitution. 

The chapter has also produced the first 

edition of what it hopes will become a 

biannual chapter newsletter for distribution 

to faculty, student, and alumni 

members. 

Several forces are responsible for 

this rapid and significant revitalization 

of the UT Southwestern Gamma 

Chapter. Strong faculty and administration 

support has been crucial. 

However, the main driving force for 

these recent changes has been greater 

opportunity for student leadership and 

greater student member involvement. 

This enhanced student involvement 

stems directly from the recent changes 

in member selection. We encourage 

other chapters to re-examine their selection 

processes and the organization 

of their student leadership so that they 

may better contribute to their local institutions, 

better serve their local community, 

and better promote the ideals 

of the national organization 

Cason Pierce, Chapter President, 

Gamma Texas 

(AΩA, University of Texas 

Southwestern Medical School, 2008) 

Dallas, Texas 

Editor’s note 

Prior to receiving Mr. Pierce’s letter, 

we sent out a reminder of AΩA selec- 

tion principles to each chapter councilor, 

and requested responses from 

each about his or her own chapter 

processes: 

Most chapters do indeed follow 

the guidelines in the constitution 

(Article IV, section 2) that stipulate 

that from the upper 25% of the class 

expected to graduate, one sixth of 

the total number may be nominated 

for membership. Up to one 

half of the total may be nominated 

in the spring of the junior year. 

Those chosen for nomination from 

the upper quartile by the following 

guideline (IV.2.c): “Scholastic 

achievement should be the primary 

but not sole basis for nomination 

of a student. Leadership capabilities, 

ethical standards, fairness in 

dealing with colleagues, potential 

for achievement in medicine, and 

a record of service to the school 

and community at large should be 

criteria in addition to the academic 

record.” 

There are several important 

points to stress: One is that 

“nomination/nominated” replaces 

“election/elected” because students 

(or faculty, residents, alums) nominated 

are not full members until 

they have registered online and 

paid first-year dues or lifetime dues. 

Another is that within the context 

of the constitution, each chapter is 

free to weight these less objective 

criteria (perhaps best summarized 

by the term “professionalism”) as it 

chooses. 

The message is a simple one: 

Those chapters that choose nominees 

for membership using only 

the Grade Point Average are in 

violation of the constitution, and 

must change. The evaluation of 

the subjective criteria does not sit 

squarely on the the shoulders of 

the councilor. Fellow students (e.g., 

when elected juniors are considering 

seniors) and, most important, 

faculty member assessments, are 

very important to gather. Members 


of numerous chapters have noted 

that the selection meetings have 

been very rewarding interactive 

experiences when input from many 

voices is heard. 


Editor 

Poetry—perhaps best read 

aloud 

I enjoyed reading your editorial, “It’s 

not a word I can put into feelings,” in 

the Spring 2008 issue of The Pharos. 

My older brother, Professor John 

Pick (born September 18, 1912), graduated 

maxima cum laude from the 

University of Notre Dame in 1933. He 

Significant Other, 

Late in Life 

we came together 

late in life 

two rivers mingling 

where each had been 

apart and unaware 

now flowing 

as one 

our bond 

holier than holy 

impossible to rend 

bound for 

a common sea 


then earned his PhD at the University 

of Wisconsin under tutelage of Helen 

C. White, PhD. He was editor of 

Renaissance, the Catholic Literature 

Critique, for at least twenty years. 

He taught graduate students various 

branches of English, but always insisted 

on teaching one undergraduate course 

in grammar, rhetoric, etc., so that he 

might keep up with any changes in 

punctuation, rules of paragraphing, 

etc., which helped him as an “editor.” 

He enjoyed teaching poetry, but his 

specialty was the Victorian novel. 

My reason for writing was to point 

out that John always insisted his students 

read poetry aloud, as a recitation, 

and I note your various editors have 

Dr. Pfeiffer (AΩA, Washington University in St. Louis, 1960) is a member of the editorial 

board of The Pharos. His address is: 3120 W. Hawthorne Road, Tampa, Florida 33611. E-mail: 

epfeiffe@health.usf.edu. 

also emphasized this. It makes sense, 

and emphasizes the real fundamentals 

of poetry by the auditory sense of the 

rhymes and rhythms of any language. 

All readers need to be reminded of this 

essential, because it leads to a greater 

appreciation of poetry as a means of 

communication. 

I have been leafing through my collections 

of The Pharos from over the 

many years, and have been surprised at 

the variety and frequency with which 

you have promoted poetry. Thanks. 

James W. Pick, MD, MS 

(AΩA, Northwestern University, 1938) 

Shorewood, Wisconsin 

Erica Aitken 


Alpha Omega Alpha elects 

honorary members 

Individuals who have contributed sub- 

stantially to medicine and fields related 

to medicine, but who are not eligible 

for membership in A!A as graduates of 

a medical school with an A!A chapter or 

as a faculty member of a medical school 

maintaining an active A!A chapter, may be 

nominated for honorary membership by any 

active member of the society. In 2008 Alpha 

Omega Alpha’s board of directors extended 

invitations to the following distinguished 

physicians and scientists. 


Executive Secretary 

Lihadh Al-Gazali, MBChB, MRCP, FRCP, FRCPCH 

United Arab Emirates University, Al Ain, UAE 

Dr. Al-Gazali, a British citizen born in Baghdad, Iraq, is 

Professor in Clinical Genetics and Paediatrics in the Faculty 

of Medicine and Health Sciences at Al Ain, United Arab 

Emirates. She graduated from Baghdad Medical College 

and went on to receive pediatric and genetics credentials in 

England and Scotland. Her goal in research is to identify and 

delineate genetic disorders that are prevalent in the UAE and 

Arab populations. Her group and collaborators internationally 

have identified more than a dozen recessive genes and has 

mapped four of these. Crucial for her research has been her 

establishment of a Registry for Birth Defects in the UAE. Her 

teaching expertise benefits both 

pediatric clerks and sub-interns, 

and she was honored with the 

Distinguished Performance Award 

at UAE University. She is a Fellow 

of the Royal College of Physicians 

of Ireland and the Royal College 

of Pediatrics and Child Health, 

United Kingdom. She is the winner 

of the 2008 L’Oréal-UNESCO 

award for women in science for 

Africa and Arab States. 

Rodolfo A. Armas-Merino, MD, MACP 

University of Chile, Santiago, Chile 

Dr. Armas-Merino is a Professor of Medicine at the 

University of Chile, and a gastroenterologist at the Hospital 

San Juan de Dios in Santiago. He served as the Chairman of 

the Department of Medicine at the University of Chile from 

1984 to 1994, and has been a Member of the Council of the 

Faculty at the University of Chile. In addition, he has been a 

member of the Editorial Board of the Revista médica de Chile 

and of Gastroenterologia y Hepatologia (Barcelona, Spain). 

Professor Armas-Merino has held many other academic 

and administrative positions in his career, including the 

Presidency (1986 to 1996) and Vice Presidency (1982 to 

1987) of the Superior Council of the Chilean Corporation 

for Certification of Medical Specialties; membership in the 

Council for the Technological Development of the Chilean 

Commission for Research in Science and Technology; a member 

of the Chilean Council for Research in Health since its 

foundation in 2003, and Vice President since 2007. 

He has served on a number of International Committees 

and belongs to many professional societies, including the 

Sociedad Médica de Santiago (President from 1983 to 1985); 

Colegio Médico de Chile serving as a Member of the Santiago 

Regional Council from 1969 until 1973, and the National 

Council from 1973 until 1975. In 1982 he became a Fellow 

of the American College of Physicians and served as the 

Governor of the ACP Chile Chapter from 1996 until 2000, and 

has been a member of the Chapter Council from 1994 until 

2008. He was made a Master of the ACP in 2001. He joined 

the Chilean Society of Gastroenterology in 1968 and was the 

Director from 1975 until 1990, he has been a member of the 

Chilean Academy of Medicine since 1989, was Treasurer from 


2001 to 2008, and became the Academy Secretary in 2008. 

He was President of the Chilean Society of Medical Societies 

since its foundation in 2000 until 2007. Professor Armas- 

Merino is held in the highest professional esteem in Chile and 

internationally. 

Kai-Ming Chan, MBBS, FRCS (Edin), FRCPS (Glas), 

FHKCOS, FACS 

The Chinese University of Hong Kong 

Hong Kong 

Dr. Chan is Professor and Chair of the Department of 

Orthopaedics and Traumatology at the Chinese University of 

Hong Kong, and director of both the Hong Kong Centre of 

Sports Medicine & Sports Science and the WHO Collaborating 

Centre for Sports Medicine at his university. As a mentor/ 

teacher he has overseen thirty graduate students, and his 

funded grants during his career have, to date, totaled almost 

$14 million. He has written 196 papers published in peerreviewed 

journals, been an editor or co-editor of twenty-five 

books, written fifty-two book chapters and assembled 570 

conference proceedings. International recognitions of his 

energy and accomplishments have included membership on 

the International Steering Committee of the WHO-endorsed 

Bone and Joint Decade, and being elected president of the 

International Federation of Sports Medicine (2002 to 2006). 

He is a Fellow of the American College of Surgeons and a 

member of the American Academy of Orthopaedic Surgeons 

and the American College of Sports Medicine. In 1995 he 

was honored by being named an OBE, Officer of the Most 

Excellent Order of the British Empire. 

Ronald F. Dorfman, MBBch, 

FRCPath 

Emeritus Professor of 

Pathology, Stanford University 

Ronald Frederick Dorfman 

is an Emeritus Professor of 

Pathology at Stanford University 

School of Medicine and one of 

the most noted hematopathologists 

in the world. He is a South 

African graduate of the University 

of the Witwatersrand and 

Medical School in Johannesburg. 

His pathology training was at the 

South African Institute for Medical Research in Johannesburg. 

His major interest for nearly fifty years has been in diseases 

of the lymphoid system, making early major contributions 

to the role of enzyme histochemistry in the understanding 

of Kaposi’s sarcoma and, after moving from South Africa to 

Washington University in St. Louis in 1963, reporting the first 

case of Burkitt’s lymphoma outside of Africa. During the 

same period, he and his colleague Juan Rosai described what 

has become the well-recognized entity of sinus histiocytosis 

with massive lymphadenopathy commonly referred to as 

“Rosai-Dorfman Disease.” 

He was recruited to Stanford University in 1968 and, 

for thirty-five years co-directed the Laboratory of Surgical 

Pathology. During this time, he was a major participant in 

seminal clinicopathologic studies of Hodgkin’s disease and 

other lymphomas carried out at the University. He was, as 

well, one of six expert pathologists involved in a worldwide 

study that eventuated in “The Working Formulation of non- 

Hodgkin Lymphomas for Clinical Usage.” He is the author of 

over 170 peer-reviewed publications and many book chapters 

and has trained more than a generation of hematopathologists 

including Dr. Roger Warnke who is the current Ronald F. 

Dorfman, MBBCh, FRCPath, Professor of Hematopathology 

at Stanford University. 

Ogabara K. Doumbo, MD, PhD 

University of Mali 

Dr. Ogobara Doumbo has been the Director of the Malaria 

Research and Training Center in Bamako, Mali, since its inception. 

He is also Chair of the Department of Epidemiology 

of Parasitic Diseases at the University of Mali. Awarding him 

honorary membership in AΩA recognizes his excellence in 

service through the Malaria Research and Training Center 

(MRTC). 

The MRTC is a collaborative effort between the staff of 

the Faculty of Medicine, Pharmacy and Odonto-stomatology 

(FMPOS) and the National Institutes of Health (NIH) in the 

United States. This program has also received significant support 

from a number of USAID programs including the USAID 

Mission in Bamako. This is a uniquely African operation in 

which the work is planned, directed, and executed by the local 

staff. 

In March 1998, President Clinton recognized the MRTC 

and made a promise for continued support. A site visit in 

October of 2007 clearly demonstrated that the MRTC presence 

and its protocols in the treatment of malaria have upgraded 

the health of the region under the leadership of Dr. 

Doumbo. Dr. Doumbo has contributed hgreatly to the health 

of the citizens of Mali and the success of the MRTC. The basic 

tenet of AΩA is to be “Worthy to serve the suffering,” and Dr. 

Doumbo certainly fulfills this mission. 

Torello Lotti, MD 

University of Florence, Florence, Italy 

Torello Lotti graduated from the Universita di Firenze and 

specializes in Dermatology. He is a Professor in the Faculty of 

Medicine at the University of Florence. He embodies the spirit 

of AΩA. In addition, Torello is a force in organized dermatology 

in America and worldwide. He is acknowledged internationally 

as an expert clinician. He has the titles of Visiting 

Professor at three American medical schools (Bowman Gray, 


Honorary members 

Medical University of South Carolina, and the University of 

Louisville), and is an honorary member of eight international 

dermatology societies. He is the founding editor of Journal of 

the European Academy of Dermatology. 

Prof. Dr. med. Dr. H.C. 

Thomas Ruzicka 

Ludwig-Maximilian 

University, Munich, 

Germany 

Prof. Dr. med. Dr. H.C. 

Thomas Ruzicka, Professor 

and Head of Dermatology at 

Ludwig-Maximilian University 

in Munich, exemplifies the attributes 

we expect of AΩA 

honorary members, being a 

respected leader in academic 

medicine who cements with 

towering leadership the academic excellence of what may be 

the finest dermatology department in the world. Professor 

Ruzicka is an internationally renowned authority on atopic 

dermatitis with more than 500 full articles and a number of 

highly regarded books. He has led world dermatology with 

aplomb, beginning a new Munich tradition that has attracted 

English speakers in the same way that the Fortbildungswoche 

für praktische Dermatologie und Venerologie has been a magnet 

for German-language physicians to update their medical 

knowledge. His life exemplifies academic excellence, clinical 

acumen, and inspirational teaching at all levels with a warmth 

and graciousness that marks him in the first order of wonderful 

human beings. 

K. V. Thiruvengadam, BSc, MD, FRCP, FAMS, DSc, 

FCCP (USA), FCAI 

Madras Medical College, Chennai, India 

KVT, as he is popularly known, is in his eighty-second year, 

having enjoyed an outstanding academic record as Professor 

and Head of the Department of Medicine at Madras Medical 

College in Chennai. Earlier he had a distinguished academic 

career at the Stanley Medical College, Chennai, India, as the 

best outgoing student of the college and also of the University 

of Madras in 1950. 

KVT’s primary areas of expertise have been clinical allergy, 

infectious diseases, and occupational medicine. 

For the past nearly fifty-three years he has focused his 

attention on teaching undergraduates and postgraduates— 

for nearly thirty-one years in the State Medical Service and 

later in private medical institutions for nearly twenty years 

to date. Indeed, KVT is a legendary teacher at the bedside, 

in small groups, and the lecture hall, and was recognized by 

the Medical Council of India with the Dr. B.C. Roy award 

for eminent medical teacher. His medical school alma mater, 

Stanley Medical College, honored 

him with the Star of 

Stanley Medal. Many of his 

former students have distinguished 

themselves in India, 

the United States, the United 

Kingdom, and elsewhere. 

A prize in his name was 

established at Stanley for 

the senior student graduating 

with the highest GPA in 

both physiology and medicine. 

Lectureships in his name 

were instituted at Madras 

University and Madras Medical College. An award in his name 

was established by the Rotary Club of Chennai. 

Along with his teaching efforts, KVT has published more 

than 100 peer-reviewed papers. He has given a number of 

prestigious lectures on chest diseases, allergy, and internal 

medicine. He served as Regent of the College of Chest 

Physicians of India, and is a Fellow of the Royal College of 

Physicians, Edinburgh. 

KVT has been Honorary Physician to the President of 

India. The government of India bestowed on him the honorific 

“Padma Sri” in 1981. 

Nuria M. Greenfield 

Tortosa, MD 

University of Panama School 

of Medicine, Panama City, 

Panama 

Nuria M. Greenfield 

Tortosa just completed 

four years as Governor of 

the American College of 

Physicians for Panama and 

has done a remarkable job as 

advocate for outstanding patient 

care and raising the level 

in quality of care in her country. She went to medical school 

at the Faculty of Medicine at the University of Panama, graduating 

in 1969. She did her internship at the Hospital Santo 

Tomas in Panama and then a rural internship at Area Sanitaria 

de David, Panama, followed by her residency in Internal 

Medicine and a residency in Nephrology. She has served as a 

Clinical Professor at the University of Panama since 1993 and 

an Adjunct Professor in Internal Medicine at the University of 

Guadalajara. She served as the president of the Panamanian 

Society of Internal Medicine from 1995 to 1997, and as governor 

for the American College of Physicians, Panama Chapter, 

from 2004 to 2008. It is hard to convey the importance of this 

person to her country’s medical establishment. Dr. Tortosa has 

an energy that lifts everyone around her. 


Full Nelson 

Under the state tournament banner 

He wears a wrestler’s 

String bikini helmet 

And a singlet whose leg holes 

Reveal two stumps 

Emerging like wary prairie dogs 

From their underground dens 

As he balances his torso 

On truncated arms 

That lost necrotizing hands 

Twelve years ago. 

To me he seems half a man 

Until I see him in his circle 

Where he escapes my limiting hold— 

Reversal— 

Just as he did the nights of tears 

And the endless days of “stumpy” and “freak” 

To place me beneath him 

Like the struggling wrestler 

Wrapped in his twitching elbows, 

Twisting on the mat 

Whose painted circle 

Belies the geometry of this man, 

Complete in his abridgement, 

A four limb amputee 

Who is both beast and being 

In his victorious, gymnasium roar, 

A mouth stained red 

In the invigorating blood 

Of a long-awaited kill. 


The author (AΩA, Case Western Reserve 

University, 2003) is a Spine Fellow in the 

Department of Orthopaedics at the University 

of Pittsburgh. His address is: 36901 Beech Hills 

Drive, Willoughby Hills, Ohio 44094. E-mail: 

jdeubanks2002@yahoo.com.

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Fashioned from fine silk by Vineyards Vines 

of Martha’s Vineyard, Massachusetts. 

Necktie, $45.00 

Bowtie, $38.00 

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Alpha Omega Alpha 

525 Middlefield Road, Suite 130 

Menlo Park, California 94025 

Or order online at 

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4 - Alpha Omega Alpha

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