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Patricia Dillon, M.D., M.P.H., '86: One for all

By Laura Stephenson Carter

Dr. Patricia Dillon is giving advice over the phone about what to do with 10 severed heads in a garbage bag. Ten raccoon heads, that is. The caller is a rabies control officer who's upset that the heads weren't delivered the way suspected rabies-infected materials are supposed be—in separate containers that can be shipped directly to the state lab for testing. The officer is worried about his staff having to handle the heads.

"Do you have face shields?" inquires Dillon, who is acting director of public health for New York's populous Suffolk County. "Go to Home Depot and get spackling buckets" to pack the heads in, she adds.

Moments later, she's phoning a state biologist, asking him to work with the rabies officer to safely get the heads to the state lab. Rabies has been spreading through the raccoon population in Suffolk and Nassau Counties on Long Island for about three years. Dillon helped to develop and run a program to vaccinate raccoons, using edible fishbait cubes containing a liquid rabies vaccine. Last fall, some 400,000 cubes were distributed via helicopter, as well as by hundreds of volunteers trained by a Cornell expert to "think like a raccoon," she says, so they'd know where to scatter the bait.

In her typical hands-on fashion, Dillon—who's also medical director of communicable diseases—pitched in and worked alongside the volunteers. "Of course Dr. Dillon was behind the scenes, getting funding from the legislators," too, says Dr. Sal Scarpitta, a county health department scientist. "She knows how to play the system and get what she wants [to] serve the public interest."

Playing the system is something Dillon is good at—whether it's securing funding for bioterrorism exercises; getting state and federal officials to respond quickly to emerging crises; or negotiating a creaky bureaucratic system to get the medications, supplies, and equipment her staff needs to do their jobs. "Her principled stances on publichealth issues, coupled with her tenacious attention to detail and follow- up, make her the model of what a public-health official should be," says her boss, Paul Sabatino, chief deputy county executive.

After handling the rabies calls, Dillon heads off to a meeting. She zips through a maze of cubicles, stopping to say hello to staff members along the way. Tireless and upbeat, Dillon has a knack for infecting people with her can-do attitude.

Her staff shares her enthusiasm for doing whatever it takes to ensure the public's health and safety. At a meeting earlier that day, Dillon and the department's nurses met with representatives of a state immunization program eager to run flu vaccination clinics in minority communities. But many African-Americans are fearful of government medical programs because they recall the Tuskegee Project, an experiment conducted by the U.S. Public Health Service between 1932 and 1972 on black men with syphilis. Dillon and several of her nurses are quick to volunteer to run Sunday clinics at churches where the pastors can encourage congregants to get their shots.

"That's why I love Suffolk," says Sandra Spencer of the state immunization program. "It's my favorite health department." The department, made up of physicians, nurses, inspectors, engineers, and other public-health specialists, is charged with assuring the health and well-being of Suffolk County's nearly 1.5 million residents. Dillon and her crew aim to prevent disease, monitor and control outbreaks, and prepare for emergencies such as pandemic flu.

For example, a force of 25 sanitarians oversees the food safety and restaurant inspection programs. "They walk in unannounced," says Dillon. "They immediately start taking temperatures [of the food]. They look for violations" in food handling and preparation.

And when, despite their best efforts, a food-borne illness does take hold, the department investigates it. In December, Dillon's office had to chase down the source of an E. coli outbreak. The first case was reported on a Friday afternoon. By that evening, there were five more confirmed cases from three separate labs. After exhaustively questioning the infected individuals, Dillon and her staff realized that all of them had eaten at a Taco Bell restaurant. Within days there were 12 confirmed cases and over 100 under investigation in Suffolk County, plus more confirmed cases in neighboring Nassau County and four other states. All were tied to Taco Bell. The story made national headlines. Dillon was interviewed by the New York Times, Newsday, and Nightline. Eventually the Food and Drug Administration identified the likely culprit—shredded lettuce.

Dillon loves her job. Growing up in rural upstate New York, however, she never imagined she'd one day be responsible for the health of so many people. In fact, she wouldn't be if she'd listened to her high-school guidance counselor. The elderly, blue-haired woman scolded Dillon for wanting to be a hospital administrator and advised her to consider secretarial or nursing school instead.

"I was so embarrassed. She just dressed me down," Dillon recalls. "I thought, 'I'll never tell anyone my interests again.'"

Luckily, another guidance counselor overheard the exchange and discreetly encouraged Dillon to skip her senior year in high school and enroll at a nearby community college instead. Dillon took his advice, went on to graduate from Syracuse University's School of Science and Forestry, and eventually made her way to Dartmouth Medical School.

Dillon thrived at DMS. "When I look back at my time at Dartmouth, and describe the experience to others, I am not sure if I'm speaking of the faculty as instructors, mentors, or friends," she says, "as they were all of these things to me. Dartmouth taught me not to just learn from the books and lectures, but to seek out intelligent individuals committed to their field and learn from them."

One person she sought out was Ray Bayles, an administrator at a Navajo reservation in Gallup, N.M. A Native American herself, Dillon desperately wanted a summer job on a reservation. At first Bayles turned down the second-year medical student because she didn't have any clinical experience. Dillon pestered him—offering to do anything, even type—until he agreed to hire her. Before long he was giving her challenging assignments, and she also volunteered in the emergency department at Gallup Indian Medical Center.

She returned to the reservation whenever she could during the rest of medical school—and beyond—and worked with Bayles on a plague manual, a communicable disease reporting system, an immunization tracking system, and other programs. "Ray encouraged me to go into public health," she says, "and I still turn to him now for advice."

She got another taste of public-health work doing an elective in Washington, D.C., with Dr. C. Everett Koop, then U.S. surgeon general. "He completely opened up everything for me," she says. Whatever he did—meeting with government officials, doing media interviews, or delivering his surgeon general's report to Congress—Dillon went along. She never forgot the way he described his career: first taking care of patients one at time as a pediatric surgeon, then taking care of whole populations at a time as surgeon general. "That's where I really started to think about public health," she says. She intended to go into surgery as Koop had, too.

Her interest in serving the public was already evident at DMS, where she was elected president of the student government, negotiated with the administration for a better student lounge, and was chosen as a Rolf C. Syvertsen Scholar. She didn't quite realize the impact she was making until one of her residency interviewers read aloud a portion of a reference letter. Dillon recalls that the letter referred to her as "phenomenal" and said something like, "The halls of Dartmouth will remember Patricia." Taken aback, when the interviewer asked her what she thought of the assessment, she joked, "I...I wasn't into graffiti." She laughs as she remembers the incident.

Dillon went on to a surgery residency at a then-new program at SUNY-Stony Brook. She'd only completed two years, however, when the program floundered and was put on probation. She began working as a house physician at a nearby hospital while she decided where to continue her training and whether to stay in surgery.

That Christmas eve, her decision became clear. Dillon relates the story of a mortally wounded 12-year-old boy who was brought into the emergency room. He'd gotten caught in the middle of a gun battle between rival gangs in a movie theater, and the back of his head had been blown off. The neurosurgeon couldn't save him. "My whole goal that night was to stabilize him enough to let his family say goodbye to him." But he died before they could do that. When she finally brought the family in, "his older brother goes in and starts yelling at him, 'I loved you! I loved you!' So everyone's crying," Dillon says, crying herself as she tells the story. Before the family left, she recalls, the boy's father "turns around and . . . says, 'I want to thank each and every one of you. You did your best.'"

Dillon had chosen surgery "because I wanted to make a difference," she says fiercely. But that night "I decided that I wanted to do something before they get to be in surgery." So she earned a master's in public health and did a preventive medicine residency. In 2001, after several years in occupational medicine at Brookhaven National Laboratory, she joined the Suffolk County Health Department—initially to develop a bioterrorism preparedness program.

She still takes care of a few patients one at a time, working a few hours a week at a Veterans Affairs hospital in Northport, N.Y. But mostly, she now takes care of whole populations at a time.

Laura Carter is the associate editor of Dartmouth Medicine magazine

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