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Letters


Fans of baseball, of poetry, and of clear data about over-thecounter drugs—talk about a range of subjects!—were among those who asked questions or shared observations about articles in previous issues of the magazine.

A matter of facts
I just finished reading "Patients deserve data about drugs" and also watched all of the associated web-extras. What an excellent reporting job on this important work being done at Dartmouth!

I am always surprised by the lack of context the public seems to have around nutrition and food; my work is focused on bringing that insight to the members of the Hanover Consumer Co-op. It's inspiring to see it happen with drug information on the scale Woloshin, Schwartz, and Welch are doing it.

I have one question. For over-the-counter (OTC) drugs, a drug facts box is currently provided on the package—as illustrated on the FDA website—but it doesn't include the effectiveness data that the Dartmouth group recommends for prescription drugs. When the FDA approves the drug facts box for prescription medications, will it also cover OTC drugs?

Mary Saucier Choate, M.S.
Hanover, N.H.

Choate is the food and nutrition educator for the Co-op Food Stores in Hanover and Lebanon, N.H. The Dartmouth researchers who are testing the drug facts box responded to her question as follows: "We are currently working only on prescription drugs (we were not involved with the existing OTC box). It would be great to do it on over-thecounter drugs, too—which, as this letter-writer notes, currently don't provide such information—but that will be a whole other project!"

Making prognostications
The essay in your Spring issue about Lou Gehrig caught my attention because I knew the physician who cared for him at home in the final stages of his illness. The physician's name was Dr. Caldwell Esselstyn, and he was medical director of the Rip VanWinkle Clinic in upstate New York.

He spoke with me on several occasions in the 1970s about what a great man and patient Gehrig was, and what an honor it had been to care for him and to be supportive of him and his wife, Eleanor. He said Gehrig was very aware of the facts about his illness and its dire prognosis.

While I can imagine Caldwell doing everything in his power to be supportive and caring, I cannot imagine him ever misleading Lou and Eleanor Gehrig when the patient's trajectory went downhill.

Also of note regarding the last issue is the fact that Dr. Bill Boyle, who is pictured on page 11 (see "Memo to supply room: Order more halos"), is the son of a former patient of mine.

Joseph L. Dorsey, M.D.
DMS '62
Walpole, Mass.

Were we out in left field?
I particularly liked the essay in the Spring issue about Lou Gehrig, whom I so idolized during my boyhood that I tried, without success, to learn how to throw a ball with my left hand.

I thus couldn't help but wonder why the picture chosen to accompany the piece was not a left-handed first-baseman's mitt instead of a right-handed fielder's glove.

Harvey Mandell, M.D.
DMS '48
Norwich, Conn.

Oops—it appears that we struck out on this one. We fact-check our contents carefully, but somehow it didn't occur to any of us to correlate the kind of glove in the illustration with the kind that Gehrig wore.

When we shared Mandell's astute observation with the essay's author, medical historian Barron Lerner, M.D., Lerner responded as follows: "Don't feel bad. Gary Cooper [who played Gehrig in the movie Pride of the Yankees] was right-handed, which caused all sorts of problems for the movie's director. One account of it notes that 'Cooper had one liability, though; he was right-handed, while Gehrig was lefthanded and batted accordingly. Cooper had to be able to bat lefthanded to look realistic, but he was unable to develop a natural-looking swing. In the end, film editor Danny Mandell came up with a solution. Cooper batted right, but ran to third base rather than first. The film was flipped over in the editing process for those few shots, which gave the impression of a left-handed batter running to first.'"

Many thanks to Mandell for his good . . . ahem . . . catch. We'll try to be more on the ball in the future.

Indelible impression
For some years now I've received Dartmouth Medicine regularly but never quite understood why, I never attended Dartmouth Medical School, nor do I remember ever giving money to DMS. I did go to Dartmouth College but was a French major and stayed well away from any courses that could be considered prerequisites for medical school (which I attended only some years later).

I'd like to thank you for sending me DM nonetheless. I do read it and sometimes find in it an article of unique value as, for example, the cover feature ("The Poetry of Caregiving") in the Spring issue—about poet Donald Hall and his wife and fellow poet, Jane Kenyon, who died in 1995.

The story, as told by Susan Salter Reynolds and photographed for DM by Jon Gilbert Fox, is indelible. Please convey my thanks to all concerned and, above all, to Donald Hall.

Frederick Hecht, M.D.
Dartmouth College '52
Scottsdale, Ariz.

Poetry and passion
Thank you for your timely and pertinent story about Donald Hall and the poetry of caregiving. It is timely because the professions of medicine and nursing are under unprecedented technologic, financial, and organizational stresses that are inexorably diluting the intricately human vocation of giving care.

Today, it is all too easy for true caregiving to be minimized or displaced. This remains a subtle but real threat to what is the best in all of us. Donald Hall and Jane Kenyon for many years represented the epitome of poetry and passion, but they always seemed like our New Hampshire neighbors. Hall's caring for his wife as she lay dying at DHMC and his subsequent loving elegies, which connect her nursing and medical caregivers to this remarkable couple, seem extraordinary in a very natural way.

It seems right that Donald Hall, who could eloquently bring an autumn hayfield to vibrant life, could link us so easily to the depth of grief and loss that he felt at our doorstep. It seems right that this couple, our neighbors, would experience not just calamity but ultimate caring here with our people.

Hall and Kenyon are not merely our neighbors or our patients—they are us. Their story is our story. Their caregiving is our caregiving. Their gift is our gift. Their gift echoes our privilege, the privilege thatmust never be assumed or minimized or displaced, no matter how oppressive the stressors. This privilege is why we caregivers go to what we call our work, this privilege to care while we give care.

Our neighbors, Don Hall and Jane Kenyon, gently remind us of how we, in turn, quietly receive care in each of our caregiving moments. Thank you for your story reminding us of their, and our, love stories.

William Toms, M.D., M.P.H.
Keene, N.H.

Toms is the retired medical director of the Dartmouth-Hitchcock Clinic in Keene and a poet himself. As it happens, a collection of his work makes up one of the features in this issue—see "So Can You".

Grateful for expertise
Kristine Pattin [a graduate student in molecular and cellular biology and the author of a piece in our Winter 2007 issue about her experience with Cushing's disease] is my daughter. My husband and I wish to acknowledge the team of doctors involved in her treatment and ongoing recovery.

We were not familiar with Cushing's disease and were overwhelmed and frightened by the diagnosis of a pituitary tumor and the numerous side effects Krissy experienced. We'd like to thank Dr. Lee Witters [a DMS endocrinologist and the author of an associated feature about neurosurgeon Harvey Cushing and DMS's founder, Nathan Smith] for referring Krissy to Dr. Jack Turco. We are forever grateful to Dr. Turco for his expertise in Cushing's disease, for the personal care and endless hours he made available to Krissy, and for his kind demeanor in helping to allay our fears.

We are also appreciative of the phenomenal team that operated on Krissy at DHMC—neurosurgeon Dr. Nathan Simmons, otolaryngologist Dr. Benoit Gosselin, and laparoscopic surgeon Dr. William Laycock. All of them have contributed to Krissy's progress and ongoing recovery from her illness. They have allowed her to be proactive and to interact with them in determining her course of treatment. We felt confident and comfortable with the skilled surgical care they provided our daughter.

I'd be remiss if I didn't also mention the competent care and attentiveness Krissy received from the nurses and other staff during her hospitalizations.

My husband and I thought Dr. Witters's article about Cushing was exceptional. We enjoyed learning more about this great neurosurgeon who pioneered the surgery Krissy had and about his connections with Dartmouth. We are grateful that Krissy had the opportunity to relate her experiences with Cushing's disease in Dartmouth Medicine and hope that her article may help others who face the same illness.

Finally, we are very proud of Krissy's positive attitude, determination, and proactive approach in dealing with her illness and are most appreciative for all of the support she has received while at Dartmouth.

Maryann Pattin
Mendon, Mass.

A tale about tails
Many thanks for, and heartiest congratulations on, the feature about Elmer Pfefferkorn in your Spring issue. The writing and the many fascinating facts, as well as the layout, were exceptional.

I would like to add one brief story not mentioned in the article: In 1989, when Michael Bishop won the Nobel Prize in Physiology or Medicine, he not only credited Elmer with getting him started in research, but he invited Elmer to Stockholm for the Nobel ceremony. Elmer accepted and went, white tie and tails and all! Next to winning a Nobel oneself, it was perhaps the finest recognition one can receive for a career in research and teaching such as the one Elmer has personified.

Heinz Valtin, M.D.
Alexandria, Va.

Valtin is DMS's Vail and Hampers Professor Emeritus of Physiology and a former chair of physiology.

Another fan of Pfeff
Thank you for making my day with your story on Dr. Pfefferkorn. I'd forgotten the Hepatitis A story until I started reading the article. Then it all came flooding back, and I ended up with a big smile on my face.

I have since shared this article with several colleagues in medicine, as well as with friends who are not in medicine. Please forward my regards to Pfeff.

Ariel Vitali, M.D.
DMS '94
Lubbock, Texas

Complementary efforts
I enjoyed Dana Grossman's Editor's Note in the Spring issue, about her start in publishing and the magazine's transition to producing award-winning multimedia. I can relate, since I started out as a print journalist in the 1960s and ended up launching the first military broadcasting website to complement our radio and television networks. We did not win any awards, though.

I also was interested to see the article about a study of surgery for spinal stenosis. My father just had that procedure at age 89. He was able to have the operation only because he finally found a doctor who wasn't afraid of performing it due to his age. He had a minimally invasive procedure, and the effects were immediate. He's pain-free in his hip for the first time in about five years (it had been steadily getting worse).

Now he just has to build back his muscles, which were weakened by his lack of desire to move around. I plan to send him the article.

Ann Mulligan
Albany, Ohio

Can DMS take a breather?
I just read in your Fall 2006 issue an article about sleep disorders that mentions recycling CPAP machines [see the article about two DMS students who established a sleep medicine program at the local free clinic; CPAP (continuous positive airway pressure) devices help people with obstructed breathing to sleep better].

I have a CPAP machine that I recently replaced because it was becoming noisy. Instead of simply throwing it away, I wonder if there's a program that takes and repairs them and then donates them to people who may not be able to afford a new one. I'd be glad to pay delivery costs if someone could make good use of it.

Bill Prescott
Dunedin, Fla.

We forwarded Prescott's offer to Narath Carlile, one of the medical students who developed the free clinic's sleep medicine program. "Thanks for the message about the offer of a CPAP machine," Carlile responded. "We'd be glad to take it and see if we can rehabilitate it. Please thank him for us!" Carlile also added an update on the program, noting that they have recently established a group called CPAP Advocates—a list of patients who have learned to use CPAP successfully and are willing to advise people more recently diagnosed with sleep apnea.

Mail order
My wife, a current patient of the DHMC Multiple Sclerosis Clinic, and I, a former DMS employee who's now retired, both thoroughly enjoy reading Dartmouth Medicine (and learn a lot) on our all-too-frequent visits to DHMC. Sometimes, however, we neglect to get the current issue and feel deprived. We'd very much like to be placed on your mailing list, if you please, so we don't miss any issues. Thank you.

Carolyn and Robert Hackwell
Hopkinton, N.H.

Fast-forward
I have a subscription to Dartmouth Medicine, which I enjoy very much.

We go to Florida during the winter, and since the magazine is not forwardable I don't get the Winter issue. From the letters in Spring, it sounds like Winter 2007 contained an outstanding tribute to John Wennberg. Because I am very interested in the subject of health-care policy and overtreatment, I hope you can sendme another copy of that issue—please. Thank you!

Sue Broderick
Hendersonville, N.C.

Le style, c'est le magazine
Please enter a complimentary subscription to Dartmouth Medicine magazine for me.

I usually pick one up at the hospital, but on recent visits I did not see any. The content, as well as the style and format, make this a very valuable and fascinating read for me. Thanks for your excellent publication.

Robert C. Pantel
Windsor, Vt.


If you'd like to offer feedback about this article, we'd welcome getting your comments at DartMed@Dartmouth.edu.

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