Letters

IIt's too bad there's not a lottery for magazine editors—we might have hit the jackpot with our Spring issue if reader feedback came in the form of whirling lemons and cherries instead of letters to the editor. That's because all three of our Spring features drew a flurry of feedback, and several of the news sections came in for comment as well. But, come to think of it, letters to the editor really are the coin of the realm when you're putting out a magazine. So remember that we always appreciate hearing readers' thoughts about our contents. Just picture us thinking "ka-ching" as your feedback lands in our mailbox and our e-mail in-box.

Care package
I was very moved by the beautiful narratives written by the five Dartmouth medical students ("Patient Teachers" in the Spring 2009 issue). What wonderful, caring people they are.

Mary-Therese Braun
Lebanon, N.H.

What a nobody knows
The Spring 2009 issue of Dartmouth Medicine was truly outstanding—probably the best ever! I thoroughly enjoyed it!

I was particularly struck by the "confessions" by the five DMS students regarding memorable patient-care experiences they'd had during their medical education.

Their stories reminded me of an encounter I had years ago with a first-year resident who rose above endangering her career to save my granddaughter's life. I thought your readers might appreciate its reinforcement of the point made in that article.

My 11-month-old granddaughter, Hilary, was in a major university hospital—seriously ill, unresponsive, perhaps dying—but no one could figure out what was wrong with her. Their best guess was that is was a neurological problem of unknown origin.

One day five chiefs representing various specialties—doctors of prestige and authority—came to consult on her case as I sat beside her crib. They examined her, then huddled at the end of the ward to confer. While they talked, a young resident who was accompanying them came back to examine Hilary in her crib once more.

Suddenly this young resident hustled over to the chiefs. They ignored her. She tried to get the attention of their leader. He rebuffed her. It was clear he didn't appreciate being interrupted by a "nobody."

The resident returned to Hilary's crib and examined her again, then hurried back to her superiors. This time she was told off in no uncertain terms and physically shoved away. At this point, most young doctors would have crawled into a hole. Not this one!

For the third time, she returned to Hilary's crib and then practically ran back to the huddle, took the arm of the leader, and dragged him across the room to Hilary's crib. His face was swollen with fury and he told off the young resident in no uncertain terms. Had I not been there, I suspect the outcome would have been very different.

As it was, the resident took his hand and forced him to hold it on Hilary's abdomen. In a flash, the fury drained from his face, and he turned to the group and shouted, "Get OR 10 ready for surgery! Get prepped stat! Let's go!"

I later learned from the leader that Hilary had, at best, 24 hours to live. She had an intussusception—a portion of her intestine had folded into itself, creating a total blockage.

Her case was the subject of a grand rounds just before her discharge. The leader explained how they'd missed the diagnosis and how they'd repaired the problem. He finished his lecture by saying, "I think we all learned a lot from this case, and not all of it was strictly medicine." After a reflective pause he added, ". . . particularly me." Then he turned to the young resident, put his hand on her shoulder, looked her straight in the eyes, and said, with utmost sincerity and humility, "Thank you."

Today, Hilary is a magna cum laude graduate of Brown University and is about to finish a master's degree at the University of Pennsylvania.

Donald Carpenter Goss
Dartmouth College '53
West Lebanon, N.H.

Honest to goodness
I didn't know how much I liked you! As I opened today's mailbox, I actually grinned when I saw the Spring '09 issue of Dartmouth Medicine. That led me to question myself: is it that good?

Well, I've already read half of Discoveries, some of Vital Signs, and all of "The Supply Side of Medicine". That affirms it: this is a really good mag!

Congratulations. And thanks.

Hopkins Holmberg
Dartmouth College '61
Concord, Mass.

Supply article is in demand
"The Supply Side of Medicine" was an excellent article! As a physician heavily involved with health-care reform issues in Colorado, I have been following the work of Dartmouth researchers for years. The Dartmouth Atlas of Health Care, as well as the other information coming from the Dartmouth Institute for Health Policy and Clinical Practice, is priceless.

I practice in one of the geographical areas that scored the highest in the Dartmouth Atlas, and we are still investigating and reviewing the reasons for our high score (we do have a good idea why—a limited number of physicians is one of the reasons). In addition, state and federal health-care officials have been interested as well.

Your article provides further evidence of the need for doctors to be honest about the role that we play in health-care costs. Thank you for highlighting this subject. I plan to share your article with my friends at the Colorado Medical Society.

Michael J. Pramenko, M.D.
DMS '95
Grand Junction, Colo.

See "Road to Reform" for some thoughts from Pramenko on health reform.

Timely topic
I want to extend my congratulations on another fine issue of Dartmouth Medicine. As a former staff physician at DHMC, I find the magazine a wonderful way to keep track of friends' careers. I particularly enjoyed the article in the Spring issue on the physician supply. This is a timely article from any perspective, and I thought it captured both sides of the debate nicely.

Alex Mamourian, M.D.
Philadelphia, Pa.

Story line
I'm not a Dartmouth Medical School alumnus, but I did graduate from Dartmouth College (in '74) and am a doctor (Albert Einstein '88). For reasons known only to Dartmouth, I receive every issue of Dartmouth Medicine in the mail. It's a wonderful magazine, which I feel connected to because of its open-minded and humanistic approach to medicine.

I'm still making my way through your Spring 2009 issue. I loved the cover story ("My Story"). I loved the short piece on cancer remission ("Study reveals surprising cancer remission rate"). The piece about the physician supply is fabulous—it's the type of original perspective our national discussions about health care so desperately need. And I was touched by the tribute in the Editor's Note to Laura Carter and the other members of the magazine's staff.

I'm writing because it occurs to me that some of your readers might be interested in an online publication of which I am the editor-in-chief. It's called Pulse—Voices from the Heart of Medicine. It was launched by the Department of Family and Social Medicine at Albert Einstein/Montefiore Medical Center, along with colleagues from all around the country. Every week we e-mail subscribers one first-person story or poem about giving or receiving health care. The writers are patients, health professionals, and students. The stories are compact—about 800 words. They're engaging, accessible, and usually very moving. And subscriptions are free.

The goals of this endeavor are many—to humanize medicine, to foster communication among and between health professionals and patients, and to find a language with which we can discuss the elephant in the room—our health-care system. I invite your readers to peruse the Pulse website. We just celebrated our first birthday, and during that time our circulation has risen to more than 3,000.

And thank you again for the kinds of personal stories you run in Dartmouth Medicine.

Paul Gross, M.D.
Dartmouth College '74
Bronx, N.Y.

Kindred souls
I just read "My Story" by P.J. Hamel, and I can't tell you how much I enjoyed it. What an article! She truly is a fantastic writer; her heartfelt story really touched my heart and soul!

I have a friend who was recently diagnosed with breast cancer, and I sent her the link to this story. I believe it will be a tremendous help for her to read this excellently written article!

Cindy Martin
Exeter, R.I.

An account to remember
I want to thank P.J. Hamel for her beautifully written account of her experience with breast cancer. I was deeply moved by the description of her ordeal and the range of emotions it evoked, from terror on first hearing her diagnosis to joy on finding she had survived—all told with unflinching honesty.

And I felt proud of DHMC upon reading her expression of gratitude to the people there who helped her. I'm inspired by her courage and am holding her in my prayers.

Daniel Lederer, M.D.
Housestaff '72-73
Providence, R.I.

Abiding appreciation
I thoroughly enjoyed the article by P.J. Hamel in the Spring issue of Dartmouth Medicine. I am also a survivor of breast cancer (it's been two years since I finished chemotherapy) who was fortunate enough to receive my treatment at the Norris Cotton Cancer Center.

I personally identified with much of P.J.'s story, especially the very positive impact that surviving cancer has had on her life. A fellow survivor once told me that she believed her cancer was a tremendous gift. At the time I was in the middle of my chemotherapy regimen, and I could not comprehend what she was talking about. But now that I have come through the ordeal, I know exactly what she meant. Living through breast cancer has given me a deep and abiding appreciation for life that I did not have before that experience.

I feel truly blessed to have been diagnosed in an era when the treatments are so effective, and I feel deep sympathy for those who have lost a loved one to this disease.

Like P.J., I also feel blessed by the amazing team of professionals I encountered at DHMC. I cannot say enough good things about the entire team at Norris Cotton—especially Rick Barth, Gary Schwartz, Dale Collins, Petra Lewis, Margie Cole, all the anesthesia docs, and every nurse who helped me along the way. Everyone I encountered demonstrated a rare blend of professionalism, expertise, and compassion that helped me feel confident and calm during a very trying year.

I would highly recommend the Norris Cotton team to anybody struggling with breast cancer who lives anywhere near the Upper Valley. Don't go to New York or Boston and hassle with city life—the best care imaginable is right here at DHMC. In fact, I called the head of the National Cancer Institute to get his opinion, and he agreed.

Thanks again to P.J. for sharing her brave and inspiring story, which reminded me of how great it is to be alive and well!

Robin Bennett Osborne, Ph.D.
Thetford, Vt.

Osborne is an adjunct assistant professor of psychiatry at DMS.

What a trip
I would like to offer my congratulations on P.J. Hamel's excellent article in the Spring issue of Dartmouth Medicine. It was probably the best recollection of a trip through breast cancer that I have read. Kudos to her!

My own trip was much like P.J.'s except for reconstruction. I am sending the article to my family and friends.

Priscilla Robichaud
Lebanon, N.H.

Make that the A-list
My attachment to DHMC has been tenuous at best: I was operated on about 10 years ago for a plaque-infested carotid artery—very successfully—by Dr. Robert Zwolak, a Dartmouth vascular surgeon. I return for a check-up every nine or so months.

Somehow, I got on the list of subscribers to your magazine, and I find it fantastic. It contains great articles, serious stories, excellent letters, and so forth.

I am writing to ask you to please keep me on your mailing list. Out of the flood of magazines that I receive, yours is one of the very best.

Donald R. Hart, Jr.
Salisbury, Conn.

Appetite for history
I read with great interest the article by Dr. Lee Witters in the Winter 2008 issue ("Diabetes Detectives"). I wish I'd known while I was a student that there's so much historical material about medicine in the Dartmouth archives.

I've always been fascinated by the history of medicine, and my interest was given a boost after I read Constance Putnam's history of DMS (The Science We Have Loved and Taught, published by University Press of New England). Dr. Witters's article whetted my appetite even more. Thank you for publishing a very interesting read.

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

DHART on board
I enjoyed the article about the rollover incident on I-91 and the DHART response to it ("Help from on High"). I posted it on the bulletin board at the Killington, Vt., Firehouse because Alf Rylander, who figures prominently in the story, was our first-response instructor for several years; we're proud to have been associated with him. I also sent a copy of the article to my son, who is a Blackhawk medevac pilot with the Vermont Army National Guard.

Thank you for the great story.

Debbie Burke
Killington, Vt.

Reading matter
My husband and I would like to be placed on the mailing list to receive your magazine. Our granddaughter has been in treatment for cancer at Dartmouth for the last year, and I have read your many informative articles during our long visits. Thank you.

Richard and Donna Moore
Chichester, N.H.