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Letters from Readers

Two articles in the Spring issue are still generating comment: a story that illuminates some of the complexities involved in clinical decision-making, and a photoessay about the many behind-thescenes workers who make that clinical work possible. The cover feature in the Summer issue, about children with chronic illnesses, has also touched a chord with readers.

Durable goods

I came upon Helen Barkan's "A Story About Fish" in the Spring 2002 issue of Dartmouth Medicine while waiting for my car to be serviced in Lebanon. A rather well-worn copy was in the customers' lounge. Of course I receive my own copy at home, but I had scanned it without reading much of its content—information overload.

But this story impressed me for the quality of the writing, and especially for its insights—so many of which resonated with my own recollections of clerkships, internships, and residencies at Mary Hitchcock way back in the early '50s. And since I'm also the owner of an ever-enthusiastic and mischievous border collie, her mention of her border collie hit home, too.

These thoughts come from a retired member of the Hitchcock Clinic and the DMS pathology department who spends his time jousting with various windmills as well as writing (and publishing) fiction, nonfiction, and poetry. It's not a bad way to move on—there is life after medicine.

So congratulations on publishing a touching story well told. I hope Helen Barkan keeps writing and never forgets that "Litera scripta manet"!

Robert Christie, M.D.
Housestaff '51-53
Lancaster, N.H.

The Latin phrase Christie quotes means "the written word endures."

Cholesterol-laden salad days

I particularly enjoyed the omnibus description in the Spring 2002 issue of the "behind-thescenes" work and workers at the Medical Center. On page 39, there is a depiction of an employee with a protective visor sorting waste material for recycling and disposal.

It reminded me of my salad days in 1947 and 1948, while I was a junior at the College. I was "lucky" to obtain a job that provided me free breakfast, lunch, and dinner at the Mary Hitchcock Hospital dining room. My duties consisted of collecting all the trash (there were no "recyclables" in that era) from the bins on each floor and in every ward, flinging the bags over my shoulder, transporting them manually by elevator to the basement, emptying their contents on the cement floor adjacent to the hospital incinerator, opening the incinerator door, and then shoveling the contents into the roaring incinerator.

My mother was shocked after I reported to her the nature of my duties. She feared bodily contamination from infectious medical wastes and wanted me to quit. My immigrant grandmother, a practical woman who was delighted by my tales of abundant quantities of meat, butter, and eggs in the dining room, declared that I should secure a "muzzle" for my mouth and not quit. There was no "muzzle" available and I did not quit. Eventually, I was "promoted" to delivering meal trays by dumbwaiter to patients on special diets. I believe I survived infectious medical waste. At least I was able to graduate from the College in 1949 with all that diningroom cholesterol in my system.

Quentin Kopp, DC '49
Redwood City, Calif.

We're always glad to hear from readers —whether it's a letter from a longtime subscriber who's weighing in with an opinion, or a note from someone who would like to become a longtime subscriber. In fact, we are happy to send Dartmouth Medicine—on a complimentary basis—to anyone who is interested in the subjects that are covered in the magazine. We regret, however, that the complimentary subscription offer can be extended only to addresses in North America. Both subscription requests and letters to the editor may be sent to: Editor, Dartmouth Medicine, One Medical Center Drive (HB 7070), Lebanon, NH 03756, or via e-mail to: dartmed@dartmouth.edu. Letters for publication may be edited for clarity or length.

Prishtina partnership

I am a fourth-year medical student at the University of Prishtina in Kosova. Our medical faculty and Dartmouth Medical School have a partnership program since three years ago, and three medical students from Dartmouth came this spring for a month in our medical faculty. They delivered a few copies of the Spring 2002 edition of your magazine to the students here. I read it and found it very interesting. The story I liked the most was the one written by Helen Irene Barkan, M.D., called "A Story About Fish."

The medical students here in Prishtina also publish a magazine. Its name is Pulsi (in English it means Pulse). It took long effort to publish it again after the war, and I used to write some medical stories there. Although I am not in charge to talk for the Pulsi policy, because I am just a contributing writer, I would like so much to have some cooperation between the two magazines. If our two faculties already have a partnership, I am sure another one between the two magazines would be very beneficial.

Every kind of cooperation is very welcome because we intend to expand our magazine and make it a strong voice of the students and a magazine that will promote medical values and enrich the spirit of discussing, exploring, and discovering. Because it is just 30 years since our medical faculty was established in Prishtina, and the Kosovar medical system needs a lot of improvements since this is a postwar country, we need to know and publish many things about how to improve our system, how the publishing policy should be adapted in the new circumstances created since the war, and, most important, what we should do to trigger medical students to do independent research that in the future could lead to important discoveries.

The Kosovar students, beginning with me, are very thirsty to read about Dartmouth and the American system, and especially about new medical discoveries that are being made. I saw that in your magazine there is a lot to read on these special issues.

I think that there is a lot that could be discussed between our two publications. We need to know a lot because we are determined to change and make the Kosovar medical system into something that could be compared with Western systems, something that would offer the best treatments that are possible for Kosovar patients.

There are four medical students from our faculty who are coming to Dartmouth for a month at the end of August. The exchange program is very competitive; the selection is made according to average marks, English proficiency, and scientific works. I applied but the program was possible only for fifth- and sixth-year medical students; since I am a fourth-year student I was not eligible. I am optimistic that in the next year, if I manage to keep my average mark as it is now and if I finish the scientific work I was doing recently, I will be a potential candidate.

Gani Abazi
Prishtina, Kosova

A story on the DMS-Kosova program was the cover feature in our Winter 2001 issue. We have published other stories on the exchange as well—including one on page 13 in this issue. We look forward to continuing to write about the program and to sharing Dartmouth Medicine with the Kosovar students, as well as to exploring a partnership between the two magazines.

Two readers shared their reactions to this Summer Issue feature, which explored some of the complexities for children and their families when kids have chronic illnesses.

Compelling cover

When I saw the cover of your Summer issue while at Gifford Medical Center in Randolph, Vt., I asked if I could take the issue home with me. The subject of kids and chronic illness is important to me for both personal and professional reasons.

The personal perspective comes from the two ends of my life. When I was 18 months old, my three-year-old brother, Gerie, was diagnosed with a congenital heart defect. The prediction was that he would not live past his eighth or ninth birthday. When Gerie was eight years old, in January of 1964, he had open-heart surgery at Jefferson Hospital in Philadelphia. Heart surgery was a brand new field back then for adults, let alone for children.

Gerie died in April of 1964, just two weeks short of his ninth birthday. I still miss him. I know how having a child with a chronic illness affected our family. (I have since learned that the defect that Gerie had can now be "easily" repaired with surgery. One of my hopes is that things the medical community learned from Gerie were part of what made this possible.)

Now, at almost 45, I have also had my own chronic pain and disabilities to deal with, and I know the frustration and weariness they sometimes bring me.

Professionally, I work for the Vermont Assistive Technology Project as an assistive technology access specialist. (My background is in rehabilitation engineering technology.) Through my work, I know many children with chronic illness or disabilities. They deal with so many issues, whether their disability is physical or cognitive. Sometimes the "invisible" disabilities, such as learning disabilities or depression, are even harder for people to accept and work with.

The one comment I would make to improve this and future articles is to avoid phrases such as "confined to a wheelchair." A person with a disability uses a chair or any other device as a tool to empower them, not to confine them. Eyeglasses are a common example. In fact, they are so common that people just see them as tools and not as con- fining someone's sight.

But the article was well written and definitely put the children first. Disabilities were spoken of as part of them, not the whole definition of their being. I would like very much to be able to make copies of the article for both my professional and personal use. (An example of personal use would be to share it with the Randolph Area Living Wage Committee, since that obviously made a difference in treatments and attitudes.)

Eileen Haddon
Randolph, Vt.

Readers of Dartmouth Medicine are welcome to make a few copies of articles for either personal or professional use. If someone wishes to make a large number of copies, we would appreciate knowing of it, and in some cases permission from contributing copyrightholders may be required. And we appreciate the feedback about the phrase "confined to a wheelchair" —it's an excellent point about an expression that many people use unthinkingly.

Poignant storytelling

I recently sat down with my cat and a cup of coffee to read "Lost Boys" by medical student Gary Maslow. As I read, my eyes became wet: nine-year-old Sam—a kid with cancer—has a community so supportive, yet his parents' sadness is inconsolable; Tommy, an 11-year-old with muscular dystrophy, has a mom more isolated but is rich in complete, unconditional love. Then came the phrase "the joy they find in everyday life." What poignant storytelling, what a gift from the heart.

You will be a fine physician, indeed, Gary Maslow, with your great compassion and caring. It's a mystery why so many with so much cannot find the very joy you describe so personally.

Kate Geurkink, A.R.N.P.
Hanover, N.H.

Geurkink is a nurse practitioner at DHMC as well as the coordinator of DHMC's Poetry Project. See page 14 for further insight into and a sample of her work.

Ruminations on research

Scientists now know much about the action of atoms, which depends on the electrons in orbit. And much is also known nowadays about the basis of cellular action, such as that sodium is in the extracellular fluid.

I don't know what Professor Bolser, who taught us physiological chemistry at Dartmouth Medical School 60 years ago, would think of all the many advances in science were he still living. He once told me he was glad to retire so he could spend time on research projects that he had always wanted to do.

I once went to a meeting where the topic of discussion was how a medical faculty member does operations, teaches, sees patients, and does research. I was interested because I had done that at Madison. I also went to a lecture by Dr. Judah Folkman where he told of being tapped on the shoulder by Dr. Gross and told to do research; he did and is now considered "the father of angiogenesis."

My father told me that two Dartmouth faculty members, Dr. Lord and Professor Proctor, did research of a wholly different sort—on ski bindings. My siblings and I took ski lessons from Dartmouth's ski coach, Otto Schniebs. He always said, "A good stemmer is a good skier." The trouble was that if you turned, your skis came off! But my classmate Jimmy Cummings taught me to christie and opened up a whole world of skiing. Jimmy was a nephew of Dr. Percy Bartlett, who was a DMS faculty member, and he and I took French lessons from Jimmy's mother, a very nice person.

Addendum: One reason sodium is in the extracellular space is because life evolved in contact with the ocean. Now the cell is bathed in its own ocean, even though we have migrated to land. The liquid state of both extra- and intracellular matter allows chemical action not possible in the solid state.

Rowland French, M.D.
DMS '42
Eastport, Maine

Laughing and weeping

Please change the mailing address on my Dartmouth Medicine subscription, as I recently moved.

I enjoy reading your excellent magazine and laugh and weep over the stories and the memories that they evoke. I admired DHMC long before I came to work there in the early '90s and find Dartmouth Medicine a fine way to keep up with progress there since I left. I learn much every time I read it and continue to admire what's happening at the Medical Center and the Medical School, even though I am no longer there.

Keep up the good work!

Lydia Johnson, C.T.
Clearwater, Fla.

Johnson worked in the cytopathology laboratory at DHMC in 1992 and 1993.

Human connections

I would love to subscribe to your magazine. Over the past several years I have served as "support crew" to my husband and my father while both were receiving excellent care at DHMC. During my hours hanging out there, I would often read Dartmouth Medicine. I love the variety of topics, the excitement of the latest research, and always the human connections. Thank you.

Jennifer Frost
Meredith, N.H.

We are happy to add new subscribers to our mailing list (and to update the addresses of longtime ones). See the boxes above and on page 23 for details.

Be sure to tell us when you move! If your address changes and you want to continue to receive the magazine, just tear off the back cover of the most recent issue, write your new address next to your old one, and mail it to: Dartmouth Medicine, One Medical Center Drive (HB 7070), Lebanon, NH 03756. It helps us greatly—since our mailing list is drawn from seven separate databases—if you send the actual cover (or a photocopy), rather than just your new address. Note, too, that if you receive more than one copy of the magazine, it's because of those seven databases. We're happy to eliminate duplications, but once again it's a great help if we have the address panel from the cover of all the copies you receive, not just the one(s) you'd like deleted.

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