Something the Lord Made

At first, no one at Hopkins could quite picture actor Alan Rickman—aka Professor Snape in the popular Harry Potter movies—taking on the role of heart surgery pioneer Alfred Blalock. Even more mind-boggling was the idea of rapper Mos Def portraying Blalock’s brilliant surgical technician, Vivien Thomas.

But as filming of the upcoming HBO movie Something the Lord Made progressed last fall and winter, the two actors began to ease the doubts of some of the toughest critics imaginable: Hopkins veterans who’d worked with Blalock and Thomas and knew inside and out the details of their remarkable 37-year partnership.

The film tells the story of how, in 1944, Hopkins’ 45-year-old surgery chief successfully operated on the heart of a “blue baby”—a little girl born with an invariably fatal defect called tetrology of Fallot that was starving her blood of oxygen. The radical idea for repairing the flaw had come from pediatric cardiologist Helen Taussig (played by Mary Stuart Masterson). Blalock, intrigued by the challenge, worked with his long-time African-American assistant—a former carpenter’s apprentice with only a high school diploma—to help him figure out a procedure that would work. Their feat launched the modern era of cardiac surgery.

Even though HBO writers had been working on the project for years (tapping, among other resources, the Hopkins Medical Archives), the script that Blalock’s former colleagues first saw, just days before filming was to begin, made them uneasy. The surgeons were so taken aback by the dramatic license in some scenes that they were ready to distance themselves and Hopkins from the production unless some of the most serious concerns were addressed. To their surprise, HBO decision makers not only listened, they agreed to make numerous changes for the sake of accuracy.

Alex Haller, emeritus professor of pediatric surgery, who ended up devoting more than 55 hours to the project, was especially pleased with the actors’ dedication. At one point, Rickman asked to borrow surgical clamps so he could practice using them the way Haller suggested Blalock would have done. Rickman also invited Haller to his hotel room to help him hone details of the blue-baby operation. “The two stars,” says Haller, “read extensively and really got a good feel for their characters. I was impressed with their insights.”

With This Ring

> Ciro Martins and Tom Koenig: Their future still hangs by a piece of paper.

Uncertainty has dogged every one of the 16 years that Ciro Martins and Tom Koenig have been a couple. It’s not their relationship—they knew almost immediately they were right for each other. The problem is the ever-present worry that Martins, a Brazilian, won’t be able to get his visa renewed. If he or Koenig were a woman, they could have married long ago, ending the U.S. government’s interest in whether Martins can or can’t remain in this country.

“As far as we’re concerned, we are married,” says Koenig, an assistant professor of psychiatry who was a fourth-year Hopkins medical student when he met Martins, a dermatologist on leave from his faculty appointment at the University of Sao Paulo to do a postdoctoral fellowship here. “We began making life plans after our first six months.”

Koenig had intended to begin his psychiatric residency at Hopkins right away. But Martins was heading to the Medical College of Wisconsin, so Koenig switched his internship there. At the end of that year, when Martins had to return to Brazil, Koenig postponed the start of his psychiatric training again and went with his partner. But now it was Koenig who faced the visa issue, and six months later, he flew back to Baltimore alone. If they wanted to stay together, the couple had only one card left in their deck: Martins could join the Hopkins faculty if he would repeat his medical internship and dermatology residency and retake his boards. It was a price he was willing to pay.

“When you look at what he’s done and what he’s given up, we’re not talking about Britney Spears in Las Vegas,” says Koenig. “To go from attending dermatologist to being on call every third night in an ICU—that’s commitment.”

Martins, of course, could have arranged a contractual marriage to an American woman, thereby becoming a U.S. citizen. But, says the assistant professor and director of dermatology education, “I wasn’t willing to lie. And I wasn’t willing to deny my relationship with Tom. We’re totally out with everybody: deans, students, department directors, faculty. We attend faculty functions together, and nobody bats an eye. We’re treated as a couple.”

Both men credit Hopkins for helping them get through tough times. The institution was not only in the forefront in offering domestic partner benefits, says Martins, it helped him obtain a semi-permanent visa. But the one thing Hopkins can’t do is give him immigration rights. Even so, says Koenig, the two are hoping to get married this year in Massachusetts.

As for their rings, they made that exchange more than a decade ago.

MAA

Coming Soon: A Neighborhood Reborn

> Jack Shannon: Turning around the neighborhood

As the massive job of rebuilding 80 decaying acres just north of the medical campus moves forward, the most emotional part has been relocating residents. To ease the way, federal grants and $5 million contributions from Hopkins and the Annie E. Casey Foundation paid homeowners the appraised value for their houses, cash toward buying a new home and moving expenses.
“We are compelling families to move,” Jack Shannon told the Baltimore Sun, “so it is our moral responsibility to make it is as stress-free as possible.” Shannon, president and CEO of East Baltimore Development Inc., more than anyone else, may hold the power to turn around the neighborhood. EBDI is charged with implementing the 10- to 15-year revitalization that calls for constructing hundreds of new homes and businesses and a 2-million-square-foot life sciences and technology park to serve as anchor.

Adding new life to a vicinity abutting an academic institution is nothing new to Shannon. In his previous job at the University of Pennsylvania, he helped spearhead a live-near-your-work program, handled the politically charged clash between on-street vendors and retailers near Penn’s campus, acquired properties and launched a statewide, $100 million program to boost biotechnology business.

After arriving in Baltimore a year ago, Shannon immediately moved his offices into the neighborhood. Since then, decrepit rowhouses have been coming down and grass has begun to show. Drawings picture a future neighborhood with townhouses, outdoor cafes and 50,000 square feet of shops and parking. By fall, a developer will be selected, and construction of the life sciences and technology park will get under way. Eventually, the park is expected to add thousands of jobs and hundreds of biotech businesses to the area. Many should be start-up companies by Hopkins faculty.

Shannon says nothing could really have prepared anyone for the size of the job that lies ahead, among the largest urban redevelopment undertakings in the nation. “It’s so huge, so ambitious,” he says “but so critically important.” And it is happening.

Getting Prepared

The Hopkins Medicine disaster experts who plan this institution’s response in case of the unthinkable—a widespread catastrophe—are now performing that role for other hospitals. CEPAR, the Office of Critical Event Preparedness and Response, has received more than $3 million in federal grants to develop responses for health care facilities around the nation in case of bioterrorism, infectious disease outbreaks or other disasters.

Funded projects include devising a system that pre-identifies inpatients who could be discharged to provide space for bioterrorism or disaster patients; developing Web-based training for community health care providers in bioterrorism and disaster response; and studying the rapid detection of infectious, acute pulmonary diseases.

Physicians Speak

Are community doctors happy after sending their patients to Hopkins for specialty care? The answer is yes. And no. When the institution culled results from 15 focus groups, it found that these physicians continue to feel the same way about Hopkins as they have for years.

On the plus side, they send patients here because of Hopkins’ reputation for superb medicine. But they said specialists often don’t keep in touch with them. They forget to send discharge summaries and have a spotty record of returning phone calls.

Hopkins Medicine has taken the survey results as a wake-up call. Bill Baumgartner, who heads the Clinical Practice Association, has made referring physician issues a priority. Communication is the key to improving, he said. “We have a lot of work to do on that.”

Adds Steven Arenberg, director of business planning research: “We have to treat referring physicians as carefully as we treat patients. Otherwise, we won’t have their patients to treat.”

Patrick Gilbert

After the Nobel

Some people might just sit back and bask; others might become insufferably smug.

Peter Agre has returned to high school.

In the months since he became a Nobel laureate for his discovery of aquaporins, the proteins that allow water to move into and out of cells, the amiable professor of biological chemistry has been flooded with speaking invitations. His 2004 calendar is already packed, and 2005 is shrinking fast. But almost from the moment he learned last fall that he had a date in Stockholm to accept the 2003 chemistry prize, Agre has been determined to cash at least some of his fame chips on a theme that’s dear to his heart: getting young people interested in science.

In February, the 55-year-old returned to his native Minnesota, where his first stop was his alma mater, Roosevelt High School in Minneapolis. If the students there expected a stodgy, unapproachable brainiac, Agre quickly eased their fears by pulling his nearly half-pound gold Nobel medallion from a crumpled plastic bag and asking them to pass it around.

“This is what all the commotion is about,” he said. “I think it’s a lot more valuable when people touch it.”

Agre also toted along his medal to share with Baltimore city science teachers who’d gathered at Dunbar High School, which sits just at the edge of the Hopkins medical campus, for an in-service training day in March. Amid one of the worst budget crises in the history of the city school system, his presence and his message went a long way toward restoring morale.

“I’m here to honor you,” he told the crowd of attentive teachers. “The fact is, public education can be outstanding.” Mary Ann Ayd

To Be or Not To Be

> Andy and Kelly Muck want Anna Beth to have time with her dad.

To find out whether the School of Medicine’s fourth-year students factored such considerations into their residency decision making, we conducted our own highly unscientific survey at this year’s Match Day. (We approached any student whose cluster of huggers and high-fivers had thinned to two or less and asked point blank, Did lifestyle play a role in your choice of specialty?)

Of the nine people we were able to nab before the celebration ended, all said their main consideration was choosing a specialty they loved. And for six of them—two heading for cardiology, two, pediatrics; one, orthopedic surgery and one, ophthalmology—that was their only consideration. Three, however, agreed that lifestyle unequivocally influenced their final choice.

“It was definitely a consideration,” said Melissa Wahba, who matched at Baylor for plastic surgery, a specialty that should eventually allow her to control her schedule. “I want a family. I was fortunate to fall in love with a specialty that hopefully will allow me to have one.”

James Brown, who’ll arrive newly married at Duke this summer to begin his orthopedic surgery residency, agreed. He and his fiancée expect to settle in the Southeast, where, they said, the climate and cost of living suit their plans for starting a family.

And for Andy Muck, holding his 6-month-old daughter as we spoke, having predictable time off was a sine qua non. “I need shift work so my family won’t suffer,” said Muck, who opted for emergency medicine training with the San Antonio Uniformed Services Health Education Consortium. “I liked all my rotations, so I had the luxury of choosing a specialty that would be family friendly.”

Still, what if the pursuit that makes you happiest is virtually guaranteed to mean scant time for much else? Perhaps David Shook, who’s staying at Hopkins for pediatrics, said it best: “I liked who I was as a pediatrician.”

Mary Ann Ayd

Works in Progress

Ask Dan Munoz if his School of Medicine courses really helped get him ready to interact with patients, and the class of ’04 member responds with a resounding yes. And no.

About his rookie months taking medical histories and examining patients under faculty supervision, this magazine’s med-student columnist says, “Hopkins does an excellent job of arming you with the basic skills. But there’s no amount of training that can prepare you for what it’s really like—to inform someone they have cancer, or to tell a patient’s family their loved one is going to die. During the first clinical rotations especially, you are more aware than anyone of gaps in your knowledge.”

Maybe not, says Eric Bass, a Hopkins associate professor of medicine who’s discovered that clerkship directors also are well aware that students may still be too green when they start seeing patients. Bass is the senior author of a national study that asked those in charge of overseeing medical students’ practical introduction to internal and family medicine, pediatrics, surgery, and gynecology/obstetrics whether med students are adequately prepared when they enter this phase, typically in their third year (at Hopkins, it’s in April of their second year). Thirty percent to 50 percent said the students needed more training before they hit the wards.

“Historically, schools have taken for granted they’re teaching how to take a patient’s history, do a physical exam, communicate well,” says Bass, who’s long delved into ways to improve medical education. “I’m not sure even students can appreciate deficiencies in their own training.” But beefing up their competence is critical, he adds. “These are core skills in being a doctor.”

With precisely that thought in mind, the School of Medicine this year incorporated a physician-patient communication program into the second-year clinical skills course. The major clinical clerkships have also expanded their standardized patient programs.

Mary Ann Ayd

Three's Company

By the thinnest of whiskers, U.S. News & World Report’s annual ranking of the nation’s 125 accredited medical schools put Hopkins third on the list, ending 13 consecutive years of its holding the No. 2 spot. With a score of 96, Washington University in St. Louis edged Hopkins by one point. Harvard, meanwhile, kept its hold on first place.

This year, we’ve been ranked by medical school deans and senior faculty at peer schools as No. 1 in internal medicine, drug/alcohol abuse and geriatrics; No. 2 in AIDS and pediatrics; and No. 4 in women’s health.

Nips and Tucks

> Johns Hopkins in an 1853 portrait.

> As he might have looked after a visit to the Cosmetic Center.

If Johns Hopkins were alive today and decided to have “a little work done,” he would almost certainly repair to the Cosmetic Center where about a dozen dermatologists, plastic surgeons and other specialists would be standing by to provide the face and forehead lifts, rhinoplasty (nose), blepharoplasty (eyelids), Botox injections and all manner of procedures the venerable philanthropist might require.

But elective cosmetic surgery at the scholarly Johns Hopkins Hospital? Whatever would its founding father think? That, in essence, was the theme of a recent article in the Washington Post exploring this latest trend at the Baltimore institution. The piece ran with the illustration above, created by medical digital imager Aprille Kelly (aprille.com).

The multidisciplinary Johns Hopkins Cosmetic Center at Green Spring Station, directed by plastic surgeon Craig Vander Kolk, who’s made his mark in craniofacial surgery, and dermatologist Patrick McElgunn, opened last June. Now it sees about 120 patients per day. Clearly, these people trust their image, as the center’s slogan goes, “to medicine’s most respected name.”

Anne Bennett Swingle