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The Docent of the Dome
There are tours of Hopkins-for the newly employed, for donors, for sightseers-but only one includes a trip to the pinnacle.

By Mary Ann Ayd Photography by Keith Weller

Before he received the National Medal of Science (2002) and the Lasker Award (1997), before he published the first edition of Mendelian Inheritance in Man (1966), co-founded the Short Course in Medical and Experimental Mammalian Genetics at the Jackson Laboratory at Bar Harbor, Maine (1960), established the School of Medicine's Division of Medical Genetics (1957), earned his medical degree (1946) or even traveled south of New England-63 years ago, Victor McKusick fell in love with Hopkins.

It was January 1939, and the man who would launch an entire branch of medicine was a 17-year-old devouring a Time magazine cover story on Henry Sigerist, the charismatic head of Hopkins' Institute of the History of Medicine. "That article is the reason I'm at Hopkins," says McKusick, the acknowledged father of medical genetics. "I became fascinated with the history of the place. It was the saga they told of the four doctors and how William Henry Welch discovered Sigerist in Leipzig and recruited him here. I decided then, that was the place for me."

Feb. 22, 1893, was School of Medicine Founders Day, and McKusick arrived exactly 50 years later, admitted under a wartime program that allowed him to bypass his senior year at Tufts University ("Part of my reverse snobbery," he deadpans, "is that I'm a college dropout"). History of medicine was a required course, taught by the famous Henry Sigerist himself, complete with guided tours. "At that time, it was easier to get a feel for the history here," says McKusick, "because the medical school wasn't that old. But even then, it had an historical aura."

McKusick not only lapped up every detail, he began a ritual that, like his medical work to come, would make its own Hopkins history. "I've been going up to the dome," he says, "ever since I've been here. I own the franchise."

The ornamental structure that tops Hopkins Hospital's original administration building was intended from the get-go to make a statement that this was going to be a very special institution. "There was tremendous hype about the hospital, even before it opened in 1889," says McKusick. "The dome was an advertisement. You could see it from the harbor. Next to Ellis Island, the largest number of immigrants from Central and Eastern Europe entered the United States through the Port of Baltimore."

About every three weeks, schedule permitting, McKusick arrives under the towering portrait of Johns Hopkins to share his wealth of institutional lore. His talks are peppered with dates-history's data points, as he calls them-and factoids. Did you know that Hopkins Hospital designer John Shaw Billings, whose portrait hangs opposite Hopkins' in the old hospital entrance, not only created the forerunner of the National Library of Medicine, but helped design Peter Bent Brigham Hospital in Boston, where Hopkins neurosurgery pioneer Harvey Cushing later became its first professor of surgery?
From start to finish, the McKusick tour is a climbing tour. "Anne and I lived here for two years, from '50 to '52," he says, referring to his wife. "We'd stumble up to the fourth floor at night, so tired. They said there was no way to put an elevator in this building. Of course, once the residents moved out and there were more administrative offices, they had an elevator in two weeks. I wouldn't think of using it."
During two of his residency years, McKusick lived under the dome, on the building's fourth floor. In those days, he says, no one worried about security, and the door leading to the dome was never locked. With the U.S. entry into World War II in 1941, the skylight and windows had been painted over (and weren't cleaned off until 1983), making the interior very drab. But it wasn't being inside the dome that repeatedly beckoned the lanky young scientist-though part of the adventure, of course, is winding up the increasingly steep and narrow stairs. The goal then, the goal still, is emerging on the cupola, where the reward is a sweeping, 360-degree view of Baltimore.

McKusick's forays to Hopkins' physical summit remained informal for years, until he was tapped in 1973 to become William Osler Professor and chairman of the Department of Medicine.

"Victor took Tom and me up to the top of the dome," says Hopkins cardiology professor Stephen Achuff, who along with Thomas Inui (now head of the Regenstrief Institute at Indiana University School of Medicine) shared the distinction of being McKusick's first chief residents. "We think we're the first of his house staff to go there with him. I was terrified. I hate heights. In all these years, I've only been up there one other time. But, despite the terror, we thought it was very special for us."

They also learned to respect McKusick's other talents. When he took over as physician in chief, says Achuff, "Tom and I thought since he'd been in genetics and out of mainstream medicine for 15 years, we'd have to re-educate him. But he was terrific about being on the wards. He could do a better physical exam than we could! Phil Tumulty was the master clinician of the era, and the four of us would meet every weekday morning."

McKusick's lasting contribution to the department is the firm system, a concept born during those morning meetings. Over the years, the size of the house staff had become unwieldy, so McKusick divided the medical service into what amounted to four group practices-dubbed firms, from the British term for a unit of care givers-each with its own chief resident, house staff, nurses and hospital space. (Ever the Hopkins historian, McKusick named the firms Barker, Janeway, Thayer and Longcope, after the four men who chaired the Department of Medicine between the original chief, William Osler, and McKusick's immediate predecessor, A. McGehee Harvey). As the chief of medicine rotated through each of the firms on rounds, he started taking the members on his now-legendary trip. By that time, the door leading to the dome was kept locked, but McKusick simply arranged with Facilities to open it for him whenever he had a group. Eventually, Ed Halle, now emiritus senior vice president of administration for Hopkins Hospital and Health System, had duplicate keys made just for him. He's been using them ever since.

"I've probably been up 130 to 140 times," says McKusick, "with 10 or 12 people at a time. I've escorted at least 1,500 people-and that's probably an excessively conservative estimate."

One of those people was horror writer Stephen King, author of such thrillers as Carrie and The Shining. During the climb, McKusick asked his guest if he was afraid of heights. "With a perfectly straight face," says McKusick, "King replied, 'I'm afraid of everything.'"

Although McKusick does accept special requests, his most consistent group now consists of third- and fourth-year medical students enrolled in the elective radiology course taught by radiology and orthopedic surgery associate professor Donna Magid. That tradition started when Magid's predecessor, McKusick's good friend John Dorst, asked him to reinstate the tour, which had fallen off somewhat after he stopped running the Department of Medicine and became University Professor of Medical Genetics in 1985.

Though McKusick asks members of his entourage to count the number of steps from the Christ statue to the cupola, it's easy to get distracted. There are 20 to the attic, eight on the metal ladder bolted to the wall (or is it eight plus a giant step up?), 61 around the perimeter, one to the platform leading to the final 66 where you have to turn your feet sideways. McKusick, 80, is not even winded (he later admits that pausing to unlock the trapdoor lets him catch his breath). Suddenly, the city is at your feet, and McKusick begins pointing out landmarks. "There's Fort McHenry," he says. "There's Bethlehem Steel, Bayview is straight to the east on top of the hill, over here is Ravens' stadium." From the top of the dome, there's a clear view of City Hall, the Shot Tower, the Washington Monument, even the Cathedral of Mary Our Queen and the high-rises in Towson.

Before he leads his followers back down, McKusick snaps a group photo, which he'll file chronologically with all the others he's taken over the years. "One former student," he says, "told me that made him feel good, like I knew they were going to become famous. We do have great expectations around here."

The 90-minute excursion begins at the old Broadway entrance to the hospital, includes stops in the rotunda by the Christ statue and the Osler Textbook Room on the second floor, and culminates, 150 feet up, on the cupola, with McKusick providing running historical commentary throughout. "The spiel," he quips, "is part of the franchise."

"It's different every time," says Magid. "He always has different anecdotes. As many times as I've been, I learn something new. The students love it. They're very impressed that a senior faculty member would take that time. I do prep them on questions he's going to ask [such as, When did the hospital open?], and I tell them, Notice the absolute perfection with which he uses the English language, the absolute lack of slang. This is as good as English gets."

"Dr. McKusick paints a picture that from the beginning, Hopkins was intended to be a focal point in medicine," says fourth-year student Brad Sutton, who took the tour in February. "To hear it first-hand-he's sort of the legacy of Osler-it's a neat perspective. And I was very impressed with how well he was able to jump up all the steps."

Magid had tried to summon the courage to take the tour when she herself was a Hopkins medical student and resident, but, she says, fear prevailed. Then, in December 1999, McKusick fell down the back stairs at his home and broke his hip. "One day after his operation," says Magid, "he apologized to me because it was the day he was supposed to do a tour. He wanted me to bring the students that day! About a month later, I did bring students by. He gave the talk, then I took them up."

The accident sidelined McKusick for about 10 months, and Magid took his place while he was mending. "One tour," she says, "he showed up with his sneakers and wanted to go up. I told the students, If you let him set foot through the attic door, you will fail this course. Do you know how terrible I would feel if something happened to him? He's a national treasure. It was September before I let him go, although he probably went before that without my knowing. McKusick does what he wants to do."

"I was chomping at the bit to take new students," says the octagenarian. "I'm very attached to this exercise. If I can't do it for physical reasons, I'll have to retire."



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