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Letters

AAll three of the features in our Spring issue came in for comment, as did another article in Spring plus several in previous issues, and from readers of all stripes—alumni, faculty, patients, and residents of the region.

We're always glad to hear from readers about matters pertaining to medicine at Dartmouth or to the contents of past issues of Dartmouth Medicine. Letters to the editor may be sent to DartMed@Dartmouth.edu. Letters may be edited for clarity, length, or the appropriateness of the subject matter.

Good stories from small places
I enjoyed the article "Just Kidding" in your Spring issue by Dr. Conner Moore, about his practice on the Maine coast beginning back in the 1960s.

A number of other Dartmouth alumni worked in the New Hampshire-Maine seacoast region during that era. One was Dr. Allan Handy, DMS '49, who around the same time pioneered the development of pathology and clinical laboratory services in several small community hospitals in the area (Dover and Rochester, N.H., and York and Sanford, Maine). I joined Dr. Handy's group in '66 and covered the hospitals in York and Sanford from '66 to '67.

Back then, Red Cross blood services had not been extended into Maine, so every day the lab would have to call donors and draw blood for any surgery scheduled for the next day.

I was somewhat surprised at this practice. I recall asking the chief tech in the lab at the Goodall Hospital in Sanford, "How do you handle an emergency like a leaking aneurysm or a major auto accident?" She assured me that was no problem—they just blew the fire whistle and picked out the blood type they wanted when the donors come through the door—because she knew everyone in town by their blood type!

Another day, I was looking through the refrigerator and saw an unlabeled bottle with a brown liquid in it. Standard lab policy was that any unlabeled bottle was to be thrown out. When I asked, "What is this?" she exclaimed, "Don't throw it out! It's the booze!"

"Booze!" I exclaimed. "What is booze doing in the lab refrigerator?" She quickly explained that it was for blood donors who came from up north. Loggers from the north country would willingly drive 40 miles to donate blood in return for a free shot of booze!

RhoGAM [a treatment for a baby with Rh-positive blood who is born to an Rh-negative mother] was introduced about that time. One of the old-timers didn't believe in it (he didn't understand the rationale) and refused to use it. So I set up a protocol that if an Rh-positive baby was delivered to an Rh-negative mother, the mother would be automatically sent for RhoGAM. If the attending physician or the mother objected, they would be required to sign a release that the use of RhoGAM had been explained and declined. Needless to say, the old-timer was not pleased with the "young whippersnapper pathologist" telling him how to practice.

A number of readers enjoyed DMS alumnus Conner Moore's evocation of practicing pediatrics in a small town on the coast of Maine beginning in the 1960s.

I also recall once when a patient needed a spinal tap but her (old-timer) physician didn't feel qualified to do it. Since I had served a rotating internship in a university hospital, I ended up doing the tap.

It was all part of a day's practice for a GP (that is, a general pathologist)!

Dennis J. Carlson. M.D.
Housestaff '60-64
Swanzey, N.H.

Moore like it
I enjoy reading your magazine very much. I especially liked the article by Dr. Conner Moore, the small-town doctor in Maine.

I am old enough to remember when doctors in the local area (Lebanon and Hanover, N.H., and White River Junction, Vt.) used to make house calls on a regular basis. The doctor my parents had was Dr. Charlie Cuson of White River. Many times he made house calls rather than asking people to sit in his small waiting room. He knew all his patients and wasn't the least bit afraid of sitting down and chatting after the house call.

I know things are different now, but I have been going to the same GP for 30 years, and I'll bet he knows nothing about me except what he reads on my chart before he walks in, spends 15 minutes, and leaves.

It really is a shame that things have changed so much. I would assume that medicine is about the most important thing in today's world, but how can doctors know their patients with the "15 minutes and out the door" that seems to be the way of the world now?

I do realize that there are time constraints as well as money concerns, but when patients go to a doctor's office, perhaps they should find more Dr. Moores and fewer businessmen.

Richard Dupuis
Wilder, Vt.

More on Moore
I just finished reading "Just Kidding" in the spring issue of Dartmouth Medicine. I don't want to flatter Conner Moore too much (he's an undergraduate classmate of mine), but I found it one of the nicest magazine articles I can remember reading in a long, long time.

The first paragraph had me almost in tears, and what followed was fascinating and entertaining both. What a great career he has to look back on. I wonder how it compares with the experiences of some of his colleagues who opted for the big city and big hospitals.

It was a beautiful tale, beautifully told—he has a great way with words. Thanks for providing such a wonderful, if too short, reading experience.

Dennis Goodman
Dartmouth College '60
Etna, N.H.

In another Spring feature, two DMS students shared their experiences as volunteers in Israel with a program serving children with serious cardiac problems

And even Moore
The Spring issue of Dartmouth Medicine was superb—especially the article by my classmate Conner Moore (I loved the title "Just Kidding") and the stories about the DMS students' experiences volunteering in Israel.

Sol Rockenmacher, M.D,
DC '60, DMS '61
Bedford, N.H.

Present perfect
A colleague at Exeter Hospital happened to loan me a copy of the Spring 2011 issue of Dartmouth Medicine. I was especially interested in the article titled "Simply Present", about palliative care at Dartmouth-Hitchcock. I did an observership with the DHMC palliative-care program, and it was wonderful to see everyone's faces and to recall the work they are doing.

In fact, I truly enjoyed the whole magazine and found it inspiring and informative. I'd like to be added to your mailing list.

Wayne E. VanGundy, D.Min.
Exeter, N.H.

One of 55 in '55
The "Then & Now" column on page 10 in the Spring 2011 issue noted the number of DMS faculty in 1838 and in 2010.

It would be interesting to see a "Then & Now" box listing the number of M.D.'s at Hitchcock in 1955 (not counting interns and residents)—because there were exactly 55. And I wonder how many M.D.'s practice at Hitchcock now?

I was one of the 55 in '55. The staff at that time was as dedicated as they are today.

Robert C. Shoemaker, M.D.
Claremont, N.H.

Many thanks to Shoemaker for taking the time to point out this delightful numerical coincidence. See this issue's "Then & Now" for more on this fact.

Senior counsel
The title of the article on page 17 in the Spring issue of Dartmouth Medicine, "DMS students find elders 'kind' and 'witty'" caught my attention, because I am an elder who fits that description. However, elders are much more than "kind" and "witty." Elders are active in their communities; attentive to the world around them; possessed of knowledge, skills, and abilities that the community can, and sometimes does, call upon; and much, much more.

It is unfortunate that DMS students are apparently unable to connect with their own grandparents and other elders. It is also unfortunate that DMS students aren't afforded the opportunity to spend some time with DHMC volunteers. Then they might not have been surprised at what they found during their one-day experience at Kendal. Most likely, they also would have not had the perception that "geriatrics is stodgy."

You see, elders possess most of the same qualities and zest for life, interaction, and activity as "youngers." We've just had more time to practice.

Alan Tanenbaum
Grantham, N.H.

No issue
I missed two issues of Dartmouth Medicine and have only recently seen the article about myself as the first woman student at DMS and the letters in response. The otherwise mostly accurate article said that I "was met with open resentment." That was not the case. Some of my classmates thought that a wait-listed DC student should have been admitted instead of me. Even so, they were uniformly nice to me. I made good friends among my classmates—they looked out for me, showed me the ropes, made me welcome in the AKK house, and even taught me to ski.

My only challenges with my classmates—most of whom, as undergraduates, had seen women primarily on dates—were 1) to get them to stop holding the door open for me so I could go out first after class, and 2) to persuade them that it was okay to joke around me.

Being the first woman at DMS was a privilege and a delight. I thoroughly enjoyed my whole DMS experience, including, and especially, my wonderful classmates!

Valerie L. Graham, M.D.
DMS '62
Charlotte, Vt.

That's another story
I was at Dartmouth too early to know Joe O'Donnell, but I enjoyed his essay on stories in the Winter issue and the two letters it spawned in the spring issue.

The collaborative and multidisciplinary nature of the palliative-care program at Dartmouth-Hitchcock was the focus of this photo-feature in the Spring issue.

Listening to the stories patients have to tell brings a huge benefit in addition to what the auditor gains; that is the pleasure of the person speaking that someone is indeed listening. The complaint I hear most often these days is that doctors have their eyes glued to the computer, and patients can't tell if they're really listening.

When, as a former New Yorker, I began practicing in a small New England town many years ago, I should have had a tape recorder with a concealed button to activate it under my desk a la James Bond. But I didn't, and the rich accents and local terms escaped unrecorded. Most of the stories I heard have vanished with the years, but I still remember a few bits of the peculiar local terminology: "shock" (pronounced "shawk") for stroke, "spleeny" meaning timid, "fell out" for syncope or dropping dead, and many others. I never forgot the terms or the patients who uttered them.

Thirty years later, in a southern emergency room, a patient said, "Careful, Doc, I'm spleeny." I replied, "Where in New Hampshire are you from?"

My point is that no matter what technology one uses and no matter how scientific one's approach, what the patient takes away from the interaction is that someone was (or was not) listening.

Jerome Nolan, M.D.
Housestaff '52-54
Wilmington, N.C.

Share-ware
I recently read the Winter 2010 issue of Dartmouth Medicine and would like to be added to your mailing list. I found it very interesting and informative and plan to share the magazine with family members, too.

We have had wonderful experiences with the doctors, surgeons, and other staff at Dartmouth-Hitchcock.

Catherine J. Greene
Keene, N.H.

Heart-y thanks
Please add us to the mailing list for Dartmouth Medicine. Every time we have appointments at DHMC, we look for the latest issue and read every word in it. What a great educational magazine, not only for alumni, physicians, and students, but also for the patients who frequent your facility.

I was stricken with a myocardial infarction (a heart attack) at the age of 52, was transferred to DHMC, and had excellent care, including insertion of a stent. I am now 67 and going strong. I would not be writing you today without the great care I received.

I truly do love your magazine and have passed along several articles to friends and to my husband. He also visits DHMC often for appointments with Dr. John Yost, the greatest rheumatologist one could wish for. He volunteers in Nepal, he teaches at Dartmouth Medical School, and he treats his patients as friends. He is truly interested in making his patients comfortable in spite of the grueling pain of rheumatoid arthritis.

Thanks for all you do to produce this great magazine.

Irene Stewart
Montpelier, Vt.


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