Spring/Summer 2001
 
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Face-lifts Even at Hopkins

The division of plastic surgery, long recognized for expert reconfigurations of cranial and facial deformities as well as operations like breast reconstructions and injury repairs, now has refashioned its own profile to include aesthetic procedures. Henceforth, not even a common blepharoplasty (brow lift) or routine rhinoplasty (nose job) will be too banal for this venerable division.

The beauty-enhancing part of plastic surgery will fall under a new umbrella group called the Johns Hopkins Cosmetic Center based at suburban Green Spring Station. The Center is targeting well-heeled 35- to 45-year-olds interested in body contouring, liposuction and breast augmentation, as well as 45- to 65-year-olds who find themselves too focused on the effects of gravity on their bodies. Catering faithfully, even fiercely, to the consumer, the center will seek to give patients just what they want from beginning to end (or top to bottom, as the case may be).

According to medical director Craig Vander Kolk, a specialist in pediatric craniofacial reconstruction, the patient-physician encounter starts with an all-important frank talk in which the plastic surgeon asks the patient what pains him-her most when she-he looks in the mirror. Once the flaws in question have been pinpointed, the two move into the picture-taking phase, and images of the problem area(s) flash onto a computer monitor. "We point out through computer imaging what they have verbalized," Vander Kolk explains. "Then, we show them what we can do for them."†

For the aging complexion, this could be something as simple as skin care—Retin A, peels or laser. Or it might involve elevating and then redraping the skin, lifting the skin and repositioning fatty tissue with sculpting sutures, or even lifting the muscles.

What's new, says Vander Kolk, is that face-lifts are less invasive and more individualized. "In the past surgeons were just lifting. Now we're repositioning tissues to achieve a more natural look." Relatively simple procedures like botox and collagen injections and eye lifts are "outpatient." More invasive surgeries are done in a special plastic surgery suite and recovery room on the main medical campus.

The center also has a research component. Vander Kolk plans to pilot the use of 3D cameras to examine structures and investigate the merits of "anti-aging" skin remedies. If it all seems unabashedly consumer-oriented, that's okay with Vander Kolk. "When our patient population asks for a service, we should provide it," he maintains.

Anne Bennett Swingle

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Cleaning Up the Four Doctors

The Four Doctors, John Singer Sargent’s MasterpieceSince 1929, John Singer Sargentís masterpiece, The Four Doctors, has hung in the West Reading Room of the Welch Medical Library where it has darkened considerably over the years due to a buildup of dust generated by an adjacent air vent. Now, thanks to an anonymous donor, the immense portrait of the School of Medicineís first clinical faculty will be restored to its original vitality. The famous painting, part of the art collection managed by the Alan Mason Chesney Medical Archives, was examined last year by a conservator hired to perform a comprehensive study of it and its environment. It was found to be in stable condition but very dirty. The recommendations? Clean the canvas, repair the frame and improve the environment by relocating the air vent and adding UV filters to nearby lights and windows. That work is now progressing nicely.

ABS

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Bringing Beauty to Weinberg

Gallery-hopping with Peggy and Ted: Art buyers for Hopkins Medicine find top picks in our own backyard

When Oncology director Marty Abeloff outlined his ideas for amassing an art collection to line the walls and decorate the open spaces in the new Weinberg Building, he made clear that the paintings and sculpture would be selected solely on the basis of quality. Abeloff's edict led some automatically to conjure up art-buying trips to Washington and New York. But Peggy Heller, a longtime friend of the Cancer Center and the arts patron who had been asked to pull the whole thing together, had other ideas.

"Let's look carefully in Baltimore first," Heller told Ted Cohen, the consultant hired to help her.†

"I was a little nervous about that," confessed Cohen, who previously assisted Stanford University in putting together its hospital art collection. "I had never been to Baltimore, and I was concerned that I wouldn't be able to find the kind of quality pieces they were looking for."

Healing Shawl, Elizabeth Talford Scott
Healing Shawl,
Elizabeth Talford Scott

The two, however, immediately began poking around in midtown galleries, artists' studios and museums in the Baltimore region, and before long Cohen was swooning over what he saw. "I was thrilled to death," he says. "Baltimore has an incredible, eclectic arts scene. Overall it represents a wonderful cross-section of great works."

Then they began to buy. At Cohen's "absolute favorite" gallery, Baltimore's Visionary Arts Museum, a repository of works by the untutored, they spotted the glass and glitter collages of Paul Darmafall, a diagnosed schizophrenic who worked from a studio on city streets. They also recognized in the museum's architectural details the hand of a master, David Hess, which led them to look at tables and benches created by Hess, elegant works of sculptured steel that now grace Weinberg's bridge entrance. From a dealer on Charles Street the duo purchased an early oil by abstract expressionist Grace Hartigan, the so-called dean of Baltimore painting. At a Baltimore Museum of Art exhibit they came upon Three Generation Quilt by Joyce Scott, an African American artist who works in all media. Then they bought Healing Shawl, a work of textured fabrics by Joyce Scott's mother, Elizabeth Talford Scott. From photographer Neil Meyerhoff came scenes of Baltimore and Baltimore County for the outpatient waiting areas. Cohen eschewed the truly avant garde ("I felt it was not appropriate for a hospital") but did not forget the work of longtime Maryland artists like Christine Neil and Raoul Middleman.

One Room Apartment on Wheels, Paul Darmafall, aka "The Baltimore Glassman"

One Room Apartment on Wheels,
Paul Darmafall, aka "The Baltimore Glassman"

Before long, Cohen and Heller had amassed a remarkable collection of some 200 prints, photographs, paintings and furniture, most by local artists. The Wolf Kahn on the first floor, photographs by Pacific Northwesterner Allan Bruce Zee and a series of 30 images (92 photographs) from the estate of Ansel Adams that hang in patient rooms are among the few non-Baltimore picks.

Valued at more than $500,000 and made possible largely by a gift from Lorraine Levin in memory of her husband, the collection was inspired by Abeloff's determination to assuage with art, music and flowers the difficult experience of being a cancer patient.

"These works can make you think, they can make you laugh, or feel peaceful or pensive," Heller says. "Marty took a courageous, far-sighted approach in believing in the importance of art and beauty in the building."

ABS

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Day Care, At Last

Hopkins Says Yes to Child Care—Finally

At one point in 1997, Allen Walker and the rest of the Medical School Council had resolved they were ready to throw in the towel over the issue of an on-campus child care center. For more than 10 years, one administration after the other had endorsed the idea of setting up such a facility but done nothing to implement it. "We agreed to ask one last time," recalls Walker, director of pediatric emergency medicine. Should the answer be no, the Council, the body that represents the faculty to the administration, voted to call a halt for five years on any further work to get a child care center. "We felt that enough time had been spent on something that was becoming increasingly frustrating," Walker says.

The stars, though, appear to have been positioned correctly. At that moment, a new administration had taken over the Hopkins Medicine helm, and Dean/CEO Edward Miller and Hospital and Health System President Ron Peterson didn't waffle. They not only pledged their support for Hopkins day care but said they would find the money and the space to make it happen.

And so, this summer, when dignitaries finally cut the ribbon on the long-awaited child care center, the East Baltimore campus will at last boast a workplace amenity typically found at companies hailed as America's best employers. The service will be run by an organization — Bright Horizons Family Solutions — which itself has earned a spot on Fortune magazine's annual list of the country's 100 best companies to work for.

The 18,000-square-foot facility will be available to offspring of full-time Hopkins employees and students and will occupy the first and second floors of the former Church Home medical office building,† which the University has leased long-term. Located on Broadway just two blocks south of the medical campus, the center will accommodate 156 children: 24 infants, 24 toddlers, 27 2-year-olds and 81 preschoolers (ages 3 to 5 years). And in keeping with parents' clear preference for top-quality care with a strong educational bent, all areas will be designed to foster age-appropriate learning, a Bright Horizons hallmark.

"It's a tremendous sense of relief and excitement to know that we're this close," Walker says. Then, catching his enthusiasm, he adds: "When I see the ribbon cut and the first child walking through the door, I'll really know it has come."

Mary Ann Ayd

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Tool Time

Hopkins Medicine Dean/CEO Edward Miller takes a spin in one of the excavators thatís taken up residence outside his office. The equipment is making way for the 380,000-square-foot Broadway Research Building thatís slated to open in 2003 at the corner of Broadway and Madison.

Hopkins Medicine DEAN/CEO Edward Miller takes a spin in an escavator.

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A Book on the Christ Statue

Stories from the Foot of the Statue

A just-published book chronicles the ordeals behind the prayers, messages, flowers and tokens left daily in Hopkins Hospital's rotunda.

The Century-Old Statue, "Christus Consolator"For years, the idea circulated around Hopkins of a book based on people's experiences with the 10-and-a-half-foot marble sculpture of Jesus adorning the Broadway entrance to Hopkins Hospital. The century-old statue, "Christus Consolator," which stands on the first floor of the administration building under the famous dome, has evolved into a sort of spiritual touchstone. Patients leave notes at its feet. Visitors stare in awe. Even doctors rushing through the hospital slow down as they enter the orbit of the giant outstretched arms and bowed head.

After an article about patients' relationships with the statue appeared in the Baltimore Sun in 1996, Elaine Freeman, executive director of Hopkins Medicine communications and public affairs, began championing the book project in earnest. "We kept hearing that this is such a cold, high-tech place," Freeman says. "But it's very moving to watch how this statue affects people."

This spring, Freeman's book idea became a reality. Published by Doubleday and written by Randi Henderson and co-author Richard Marek, Here Is My Hope offers 10 vignettes grouped into three categories — hope, consolation and thanks — exploring the trials that bring people to the statue. By their very nature, the accounts could be maudlin and very Christian. Instead, Henderson, who is Jewish, dwells on the compassion and humility that all religions honor and which this spiritual icon has come to represent.

The book's last chapter offers a sampling of prayers left at the statue, as well as traditional prayers of many religions (including Buddhism), passages from the Bible and Koran. The ecumenical nature of the messages is intentional, Henderson says. "The statue is a piece of art that reflects a human need. It gives off such a feeling of comfort — what people long for when they're in the hospital."

MAA

Here Is My Hope (Doubleday; $23.95), a Guidepost selection and Book of the Month Club alternate selection, is available at The Johns Hopkins Hospital Gift Shop, Matthews Medical Bookstore, www.hopkinsmedicine.org/onlinepurchasing.html, and other bookstores and online book sites. A portion of the proceeds will benefit the Pastoral Care Department at The Johns Hopkins Hospital.

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New M.D. Position

Lightening the Load for Junior MD's

To give junior faculty physicians protected time for scholarly activities they need for promotion, Johns Hopkins Medicine has approved a new non-faculty position called a clinical associate. Departments now will be able to hire these highly trained physicians either full or part time to lighten the patient loads of junior faculty. By sanctioning the clinical associate jobs, Hopkins is coming to grips with a problem facing medical schools throughout the nation — with the rise of managed care, faculty physicians find themselves pressured to see increasing numbers of patients to bring in revenue to support academic endeavors like teaching and research.

The new M.D. position was proposed by a committee of mostly clinical-department directors that studied the Future of the Faculty Report produced by the Medical School Council in 1998. The report stressed the difficulties Hopkins physicians find in juggling heavy clinical loads with scholarly work they need to climb the academic ladder.

Pediatrician Maria Oliva-Hemker, chair of the Medical School Council, the body that represents faculty interests to the administration, says the new position is a positive step toward solving some of those issues. But she adds, "I don't want faculty to get the impression that our efforts will stop now that this position has been approved."

Patrick Gilbert

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Dot Com Entrepreneur

The Lowdown on Med Schools, Courtesy of Graham Redgrave

Students seem serious and motivated, but not super-competitive or stressed out...The dorms are terrible!...Research facilities: A+. Each of these comments pertaining to the Johns Hopkins School of Medicine are culled from a Web site where medical school applicants post comments about their interview experiences. Called InterviewFeedback, the site was created by Graham Redgrave (M.D.-1999), now a second-year psychiatry resident at Hopkins, when he was applying to medical school in 1994.

Graham Redgrave at his InterviewFeedback site.
Graham Redgrave at his InterviewFeedback site.

Redgrave was working as a computer programmer in San Francisco, already married and a father. Decidedly out of the loop compared to plugged-in college seniors when it came to the lowdown on the slew of medical schools out there, Redgrave felt elated when he surfed the Internet and found a newsgroup where angst-ridden souls like himself were communicating. He posted a message describing his first med-school interview and expounded on subsequent ones as they took place. Then, he wrote a software program allowing all applicants to type comments about their interviews into a questionnaire. InterviewFeedback was born.

When Redgrave came to Hopkins, he found a home for his pages on a University server. He didn't require users to register, pay or identify themselves, so they'd be sure they were reading"unfettered" opinions. He only deleted all material he considered "offensive" and answered queries via e-mail.

By the time Redgrave earned his M.D., admissions people all over the country were taking note of his mushrooming database, and Redgrave began wondering if he could turn a profit. He switched to another server, joined a large network of resources for college students and began bringing in advertising. Suddenly, he was splitting ad revenues 50/50 with the network.

InterviewFeedback has blossomed along with the World Wide Web and now outdistances all competition. Its database contains 11,000 pages of descriptions of visits to one or another of the nation's 125 medical schools. Applicants trying to get a bead on various schools, in fact, can barely afford not to click on the site.

One thing more is clear: the entrepreneurialdot-com world has gotten a hold on Redgrave. "I gave up a lot of autonomy when I came to medical school," he says. "This was the one area of my life I had control over."††††

ABS

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When MD's See the Doctor

MD's, It Appears, Don't Always Practice What They Preach

Doctor, heal thyself.† That at least is the preferred way to receive medical care for 252 out of 915 graduates of the School of Medicine who took part in a study which appeared recently in Archives of Internal Medicine: All 252 said they were unlikely to see a physician regularly, that they handled their own primary care and considered their health a matter of luck.

What's really interesting is that 39 percent of these doubting doctors were internists, the category of physician most closely linked with preaching prevention practices to patients. A mere 55 percent of the internists themselves had undergone the colon cancer screenings they recommend to patients, and just 44 percent of the female internists had had a mammogram.

The study, directed by Michael J. Klag, interim chairman of the Department of Medicine, was conducted two years ago, with Cary P. Gross acting as the lead author. Gross is now an assistant professor of medicine at Yale. Subjects in the study have been answering questions for years from the long-running Johns Hopkins Precursors Study, an investigation of the life styles and health of 1,337 physicians, mostly male, who were enrolled at the medical school here between 1948 and 1964.

Many physicians in the study, of course, were more prudent than the 34 percent. The decision not to sign on with a primary care doctor appeared unrelated to age or gender but did vary widely by specialty. Only 21 percent of† psychiatrists, for instance, went without regular care from a physician. But in the case of pathologists, that number skyrocketed to 46 percent. Internists were the most likely to treat themselves.

Karen Blum

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The Man Who Knew Welch

At 98, a renowned medical historian thinks back to his flight from Nazi Germany to Hopkins.

Owsei Temkin is bringing out another book — at age 98ýa collection of essays with a new introduction by him. The former director of Hopkins' Institute of the History of Medicine (1958 to 1968) is a towering figure in medical history and author of many of the field's classics.

Born in the Byelorussian capital of† Minsk in 1902, Temkin emigrated to Leipzig, Germany, with his parents in 1905, when the Russians began pogroms against Jews. Temkin studied medicine and the history of medicine at the University of Leipzig, but in 1928 he was declined a residency with a terse note:"Your services are not needed." Eventually, he found work at Leipzig's Institute of the History of Medicine as an assistant to his former teacher, the eminent medical historian Henry E. Sigerist. When Sigerist was recruited to Johns Hopkins in 1932 to succeed William H. Welch as director of the Institute of the History of Medicine, he brought along his protégéΘ.

Tenkin in the early '60s.
Tenkin in the early '60s.

These days, Temkin lives in a retirement home in north Baltimore. His back ails him, but "from the neck up, I'm reasonably okay," he says. In fact, his intellect is still dazzling. At a moment's notice, he segues into a philosophic discussion on subjects like the effects of the 19th-century European movement "therapeutic nihilism." Temkin, the William Henry Welch Professor Emeritus, also is one of the few left on earth who remembers what it was like to work with the great Welch, first dean of the Johns Hopkins School of Medicine.

"I first met Dr. Welch at the Institute in Leipzig in 1928 when he was making plans to purchase books for his new venture at Hopkins, the Institute of the History of Medicine. He buttonholed me and asked if I would like to come to the United States. I didn't quite know what to think.

Then in 1932, Dr. Sigerist was on a lecture tour in the United States when he was offered a position as professor and director of the new Institute. Sigerist offered me a job as an associate. I was happy to come to the United States. Hitler had not yet come to power, but it was so threatening, so bad, so dark that I was glad to get out of Germany. After I was offered the job, I married on July 15, 1932ýI couldn't have married on my German salary — and in September, my wife and I embarked for New York. What came to me then was a really new life.

I got a wonderful welcome at Hopkins, partly due to Welch's influence. He was the man in the medical school in those days, and there I was, working in an office next to his. He was very kind to me and my wife and always inquired after her and asked what I was working on. Even though I was a newcomer, he took me seriously.

Welch was a jovial man with a half-smoked cigar between his fingers, but it's funny, I don't remember him actually smoking that cigar, or lighting it. They called him "Popsy," but not to his face. He had a sort of internal dignity, which did not show itself in any pomposity but in his many interests and all the different things he liked to talk about. I think Sargent caught this sense of innate dignity very well in his portrait The Four Doctors.

Welch appreciated the good things life had to offer. He loved the luscious oysters on the half shell (which were much more luscious in those days than now) that we used to have at dinners preceding the meetings of the Medical History Club, which Osler and Welch founded in 1890. If I remember right, these meetings took place in a big hall. There were only a small number of people, the doors would open and in would come the speaker, some invited guests and Welch.

I am annoyed that Dr. Welch is practically forgotten today. Not at Hopkins really, but elsewhere. He wasn't flamboyant like Osler. Osler may have done more for the general fame of Hopkins, but after he left, he was more or less burnt out. Welch, though, was always a man of many broad interests. In the 1890s, he brought the idea of medicine based on science to the United States. The idea for a school to go along with the hospital might have been Gilman's and John Shaw Billings', but it was Welch who translated that concept into a feasible medical school."

ABS

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