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GrandRounds

Spring 09 Saint Louis University School of Medicine

e-vailability

The Library Revolutionizes Journal Access

The MOHS Advantage

Remembering Dr. Vallee Willman

Match Day

From the Dean |

Though its hard for me to believe, Ive been at Saint Louis University Medical Center for a full 12 months. Its been a busy and good first year. A number of highlights are profiled in this issue of Grand Rounds, including the School of Medicine re-accrediation by the Liaison Committee for Medical Education (LCME), the major expansion of our Simulation Cener and a number of advances in both clinical and basic science. Its been a great year for our students. During Match Day ceremonies last month, members of the Class of 2009 learned where they would be continuing their medical educations. As you can read in this issue, our graduates are headed to strong medical institutions throughout the country. The successful re-accreditation of the school for eight years the maximum length of time granted by the LCME reinforces our efforts as we now turn our attention to the three classes of students who will move soon to the next stage of their training and to the new arrivals in the Class of 2013 who will join us in August. We recently announced the creation of three endowed chairs that will advance and support clinical and basic research, patient care and treatment. Those chairholders - Drs. Dennis Vane, Salvador Cruz-Flores and Oscar Cruz are helping lead the growth that is occurring here in clinical care, education and research. Many others also are contributing to this growth. Several of our leaders are cited in this issue, including three of our liver disease specialists who are receiving national and international acclaim for their discoveries. These successes are possible, in part, because of the support of alumni and friends. To continue to grow and to be more widely recognized as leaders in academic medicine, we continue to need your support. Accordingly, were always looking for new ways to reach out to you, to provide news and to learn your thoughts about the many challenging issues facing academic medicine. For example, were working on a new approach to open lines of communication with you through the Internet. Youll be hearing more about it later in the year. Sadly, in this issue of Grand Rounds, we also say goodbye to three of the schools most outstanding past leaders: Dr. Vallee Willman, Dr. Thomas Aceto Jr. and Dr. Francis X.Paletta Sr. Although Dr. Willman had retired by the time I joined the school, Ive been impressed by what those who knew him have said and written about Dr. Willman. A number of their relfections appear in this issue. In closing, Id like to thank the alumni Ive met thus far for sharing their thoughts with me about how we can foster the School of Medicines continued growth. I look forward to meeting more of you in the months ahead.

Grand Rounds is published biannually by Saint Louis University Medical Center Development and Alumni Relations. Grand Rounds is mailed to alumni and friends of the School of Medicine. Dean Philip O. Alderson, M.D. | Saint Louis University School of Medicine Schwitalla Hall M268 1402 S. Grand Blvd. St. Louis, MO 63104-1028

On the cover
Ancient and current medical journals are made available to faculty and students in minutes with a revolutionary electronic delivery system. See page 12.

Grand rounds Editorial Board

Terence A. Joiner, M.D. 82 Philip O. Alderson, M.D. Edward J. OBrien Jr., M.D. 67 Thomas J. Olsen, M.D. 79
Coordinator

Marie Dilg | SW 94
dEsiGnEr

writEr

Dana Hinterleitner Laura Geiser | A&S 90 | Grad 92 Nancy Solomon Carrie Bebermeyer | Grad 06 Sara Savat | Grad 04
ContriButors

Steve Dolan | 4, 16-18, 20 Sara Savat | 10 Stephanie Stemmler | 8 2009, Saint Louis University All rights reserved

Photo CrEdits

GrandRounds
Spring 09
Vol. 7 No. 1 Saint Louis University School of Medicine
2009 moves on.

For more information about the magazine or to submit story suggestions, please contact 314 | 977-8335 or grandrounds@slu.edu.

Match Day The Class of


| page 10

Vital signs |

page 2

Philip o. alderson, M.d. Dean | Saint Louis University School of Medicine Vice President | Health Sciences
page 6

The medical center library revolutionizes journal access. | page 12

e-vailability

alumni Pulse living the Mission

| page 20

The MOHS Advantage Helping skin


| page 16

Profile of Philanthropy |
page 18

back cover page 17

Compassionate Physician... Dedicated Teacher


SLU remembers Vallee Willman. | page 6

cancer patients cure tumors while saving face.

Poised for Discovery

SLU researchers are fighting liver disease before and after it strikes. | page 18

page 20

VitalSigns
January, University President Lawrence Biondi, S.J., announced administrative changes at the Medical Center designed to increase efficiency and enhance interprofessional activities. In addition to serving as dean of the medical school, Philip O. Alderson, M.D., was appointed vice president for health sciences. In this expanded role, Biondi said the deans of the three other colleges and schools on the medical center campus Charlotte Royeen, Ph.D., dean of the Doisy College of Health Sciences; Teri Murray, Ph.D., dean of the School of Nursing; and Homer Schmitz, Ph.D., interim dean of the School of Public Healthwill report directly to Alderson. Provost Joe Weixlmann and I believe this organizational change will provide improved efficiency at the Medical Center and allow for even better integration of medical and health sciences education and research, Biondi said. Phil already is a member of the Universitys executive staff and Presidents Coordinating Council and will be a strong advocate for growing all of our academic programs at the Medical Center and expanding our research opportunities and programs. Academic appointments and issues related to the awarding of rank and tenure at all of the Universitys colleges and schools will con-

Administrative Changes Improve Medical Center Integration | In

tinue to be handled directly by the provosts office. I believe this new administrative structure will allow us to better communicate the value of SLUs medical and health sciences programs as part of an integrated center that is providing the best possible education across a broad spectrum of health care and health-related topics, Biondi said. For those outside of the University, this kind of integration will serve us well in attracting new students and research dollars. Biondi also announced that Robert Heaney, M.D., senior associate dean of the medical school, was named assistant vice president for health sciences in recognition of the work he will be assuming in support of Aldersons efforts to increase efficiency and interprofessional integration at the Medical Center.

Gene Therapy Offers Hope for Heart Failure Patients | SLU

cardiologists are participating in the first-ever clinical trial of gene transfer to treat severe heart failure. The research study will investigate whether MYDICAR, a genetically targeted enzyme replacement therapy, can repair heart muscle that was damaged by either a prior heart attack or cardiomyopathy by using gene transfer to reprogram the cardiac muscle cells to work differently. MYDICAR is delivered directly to the heart through a simple outpatient procedure performed in a cardiac catheterization lab.

MYDICAR has not been approved by the Food and Drug Administration. Were testing a new treatment that may be able to improve the pumping function of damaged heart muscle, said Arthur Labovitz, M.D., the Jack Ford Shelby Endowed Professor in Cardiology, director of the division of cardiology and principal investigator. The goal of the research is to determine whether this investigational treatment may improve the symptoms of heart failure and restore physiologic function. SLU is one of 13 centers in the world, and the only medical center in the region, to participate in the Calcium Up-Regulation by Percutaneous Administration of Gene Therapy in Cardiac Diseases, or CUPID, trial. The investigational therapy is geared toward correction of a basic underlying cellular deficit; in particular, the replenishment of a protein involved in calcium cycling, a key event in both contraction and relaxation of the heart, explained Paul Hauptman, M.D., professor of internal medicine in the division of cardiology and a co-investigator. Heart failure affects approximately 5 million people in the United States. Common symptoms include shortness of breath, tiredness and swelling in ankles, feet and legs. Because hearts with damaged muscle do not pump as hard as healthy hearts, individuals with heart failure are at an increased risk for irregular heart beats or sudden cardiac death, Labovitz said. Gene transfer allows us the potential of offering meaningful therapy for people who do not benefit from standard medical therapy cur-

rently available, said Michael Lim, M.D., associate professor of internal medicine in the division of cardiology and a co-investigator. The CUPID trial is funded and administered by Celladon Corp., makers of MYDICAR. Celladon is a privately held biotechnology company that is dedicated to the development of molecular therapies for the treatment of heart failure.

Medical School Granted Re-Accreditation |

The School of Medicine has received re-accreditation for eight years, which is the maximum length of time granted by the Liaison Committee on Medical Education (LCME). Our accreditation shows that were providing quality medical education that meets the high standards of the LCME, said Philip Alderson, M.D., dean and vice president of health sciences. The LCME praised the School of Medicine for its substantial investment in research. Dedicated in 2007, the Doisy Research Center is the largest building project in the history of the University and gives scientists state-of-the-art laboratories worthy of their cutting edge research. The accrediting body acknowledged the extensive and varied clinical learning opportunities available to SLU medical students, which are supported by the schools conveniently located affiliated hospitals. The LCME also highlighted the strong commitment to volunteerism and community service shown by the medical students values that reflect the Jesuit tradition of a SLU education. These experiences reinforce professional values

of altruism and dedication to patients and strengthen student understanding of health care issues faced by those who are medically underserved. The strengths of our medical school that LCME highlighted show some of the attributes that differentiate a Saint Louis University education, Alderson said. The accreditation process involved rigorous self-study and careful reflection on ways to improve. A team of experienced volunteer external evaluators conducted a site visit last October. The next full survey will take place in 2016-17.

for diagnosing neuropathy, a common nerve condition that affects about one in 50 Americans, suggest a combination of blood and nerve tests works best to find the root cause of the disease. Because there are many diseases or conditions that cause neuropathy, its important to find the underlying reason for the condition, said Laurence Kinsella, M.D., professor of neurology and a member of the research team that studied which tests should be ordered for patients who have symptoms of neuropathy. Once you know the cause, in some cases you have exceptionally good therapies. And even when there arent good treatments for the cause of neuropathy, a physician can always treat symptoms of pain and discomfort and make it easier for a patient to function.

Understanding Foot Pain | Doctors Recommend Certain Tests To Detect Common Nerve Disease | New guidelines

The guidelines for diagnosing neuropathy were developed by the American Academy of Neurology and we are published in the Dec. 3 issue of Neurology. The findings were based on a study of all scientific research on neuropathy. As the population ages and as more people develop diabetes, the most common cause of neuropathy, the prevalence of neuropathy is rising, Kinsella said. For years, doctors have not known the best tests to determine whether a patient is suffering from neuropathy, which also can be caused by heredity, alcohol abuse, poor nutrition, autoimmune disorders and other factors. A large proportion of all neuropathies are hereditary, Kinsella said. In some cases, people with neuropathy never realize they have the condition. They may chalk up their difficulty with rolling ankles or finding comfortable shoes as one of those things, particularly if their parents had the same difficulty. All patients who have numb or painful feet should have certain blood tests to screen for neuropathy, according to the new guidelines. Blood tests for levels of glucose, vitamin B12 and serum protein can point to common causes of neuropathy, Kinsella said. Other specialized tests known as autonomic tests that measure the action of tiny nerves that control body functions such as sweating, heart rate and blood pressure also can be helpful, he added. The American Association of Neuromuscular and Electrodiagnostic Medicine and the American Academy of Physical Medicine and Rehabilitation collaborated on the new guidelines.

Biomedical Research: Its in the Greens |


When Eric Green came home to St. Louis last September he performed a rare scholarly honor and a sons pleasure: He delivered the first lecture named for his father, Maurice Green, Ph.D., professor of molecular virology and chairman of the Institute for Molecular Virology at the School of Medicine. Eric Green, M.D., Ph.D., is the scientific director at the National Human Genome Research Institute, which is part of the National Institutes of Health. It crossed Eric Greens mind that some might construe his fathers recommendation for the inaugural Maurice Green Lecture as paternalistic. The elder Green explained his choice as a logical one, contending that his son is the natural choice. He has unbelievable insights, hes fun, and hes a spokesman for the future of human genomics. Still active in the field of virology at 82, Maurice Green pioneered early studies that introduced breakthrough techniques and concepts in experimental virology. He currently is exploring the molecular function of the human adenovirus E1A oncogene, which has implications for breast cancer treatment. Maurice Green is convinced that genomics holds the key to future biomedical discoveries in this area. It wasnt clear early on whether Maurice Greens love of science would leave an imprint on his son. At the age of 8 or 9, Eric was hired by his father to send out reprints of his journal articles requested from scientists throughout the world. I thought it was a cool job first because I got paid, but also for the opportunity to collect international stamps, said the younger Green. I would occasionally flip through one of the reprints, and think this science stuff is boring and full of gibberish. I couldnt fathom why anyone would read it. Fast-forward to today, and clearly something did stick. The title of Eric Greens lecture was, Fulfilling the Promise of a Sequenced Human Genome. He gave examples of his research, which involves interpreting the human genome sequence and applying large-scale DNA sequencing to clinical research projects. Erics not only a scientist and physician, but he is accomplished in debate and music, beamed his father. And he calls his mother twice a week!

Grand Rounds Saint Louis University School of Medicine

Medical military personnel headed to Iraq and Afghanistan and SLU medical school students will get a dose of reality as they hone their skills at a state-of-the-art simulation lab. The new Emergency Medicine Trauma Simulation Lab, which is located in the Clinical Simulation Center of the Learning Resources Center, was dedicated in February. Philip Alderson, M.D., dean of the School of Medicine and vice president for health sciences, emphasized the importance of simulators at the dedication ceremony. Computerized, life-like medical simulators are the wave of the future in medical education, Alderson said. Like flight simulators used to train airline pilots, these medical simulators can put our students and military medical personnel in critical situations and train them to better respond to and help patients. The new simulation lab grew out of a six-year partnership between the School of Medicine and U.S. Air Force C-STARS (Center for Sustainment of Trauma and Readiness Skills), one of three such cooperative arrangements in the country. The same educational facility used by C-STARS to train military medics also is a teaching lab for SLU medical school students and house staff, giving them a leading edge environment in which to learn trauma care.

Observation Room

Medicine researchers have identified a novel way of getting a potential treatment for Alzheimers disease and stroke into the brain where it can do its work. We found a unique approach for delivering drugs to the brain, said William A. Banks, M.D., professor of geriatrics and pharmacological and physiological science.

Hormone Shows Promise in Reversing Alzheimers Disease and Stroke | School of

Were turning off the guardian thats keeping the drugs out of the brain. The brain is protected by the blood-brain barrier, a gate-keeping system of cells that lets in nutrients and keeps out foreign substances. The blood-brain barrier passes no judgment on which foreign substances are trying to get into the brain to treat diseases and which are trying to do harm, so it blocks them without discrimination. The problem in treating a lot of diseases of the central nervous system such as Alzheimers disease, HIV and stroke is that we cant get

drugs past the blood-brain barrier and into the brain, said Banks, who also is a staff physician at Veterans Affairs Medical Center in St. Louis. Our new research shows a way of getting a promising treatment for these types of devastating diseases to where they need to be to work. The therapy known as PACAP27 is a hormone produced by the body that is a general neuro-protectant. The scientists isolated the particular gatekeeper that evicts PACAP27. Then they designed an antisense, a specific molecule that turned off the impediment. They used mouse models of Alzheimers disease and stroke to test what would happen if PACAP27 could get into the brain. We reversed the symptoms of the illnesses, Banks said. The mice that had a version of Alzheimers disease became smarter. And in the stroke model, we reduced the amount of damage caused by the blockage of blood to the brain and improved brain recovery. Simply turning off the gatekeeper that kept PACAP27 out of the brain allowed enough of the hormone that already is in the body to get inside the brain, where it effectively treated strokes. However, the mice that had a version of Alzheimers disease needed both an extra dose of PACAP27 and the antisense that turned off the gatekeeper to improve learning. These findings could have implications in treating many diseases of the central nervous system, said Banks, whose research was published in a November issue of the Journal of Cerebral Blood Flow & Metabolism.

The School of Medicine is proud to announce the creation and installation of three new chairs. Dennis W. Vane, M.D., M.B.A. | chief

of the division of pediatric surgery at the School of Medicine and surgeonin-chief of SSM Cardinal Glennon Childrens Medical Center, has been named the inaugural holder of the J. Eugene Lewis Jr., M.D., Chair in Pediatric Surgery. Funded by the board of governors of Cardinal Glennons Childrens Foundation, the chair is named for James Eugene Lewis Jr., M.D., who served as the chief of pediatric surgery from the time Cardinal Glennon opened in 1956 until his retirement in 1983. The honor of being the inaugural named chair is truly humbling, and the fact that this chair is named for an individual like Dr. Vane Lewis makes this even more humbling and certainly the highest honor of my career, Vane said. Vane joined the School of Medicine last August. Prior to that, Vane had been chairman of pediatric surgery at the University of Vermont and surgeon-in-chief at Vermont

Childrens Hospital. He also served as associate professor of surgery and pediatrics at Indiana University. A native of New York City, Vane earned his bachelors degree at Cornell University and his medical degree at the Universite Libre de Bruxelles in Belgium. He completed his general surgical residency at Indiana University College of Medicine and his residency in pediatric surgery at the Ohio State University. He also received a masters degree in business administration at the University of Vermont. Vane is a nationally renowned pediatric surgeon who holds appointments as an officer or member of more than 20 international professional organizations. He has written more than 100 manuscripts and book chapters about experimental and clinical research for the care of children. He serves on the editorial boards of multiple peer-reviewed journals and has been recognized as an outstanding teacher and educator. His research interests include trauma care and emergency medical services for children.

Salvador CruzFlores, M.D. | professor

of neurology at Saint Louis University, was invested in February as the inaugural holder of the Sidney W. Souers Endowed Chair in Neurology. Having come from Mexico to Saint Louis University for my neurology training with nothing but dreams, my wife, a child and 15 pieces of luggage, its hard to imagine that 17 years later, I am going to hold an endowed chair, Cruz said. This institution has been good to me.

A professor of neurology and psychiatry, Cruz specializes in treating stroke patients. He directs SLUs Souers Stroke Institute and the hospitals Cruz-Flores MidAmerica Stroke Network, which extends acute stroke care to rural, community and critical access hospitals throughout Missouri and central and southern Illinois. Cruz also is the local stroke ambassador for the American Heart Association/ American Stroke Association, serving as the official local spokesperson and adviser for stroke education and stroke care. The chair Cruz occupies is named for Admiral Sidney W. Souers, who was president and chairman of General American Life Insurance Co. for 40 years. Souers served in the Navy, working primarily in intelligence, and rose to become designated deputy chief for naval intelligence with the rank of rear admiral. After Souers died of a debilitating stroke in 1973, his wife Sylvia honored his memory by creating an endowment that lead to the formation of the Souers Stroke Institute. This comprehensive stroke program focuses on preventing stroke and improving rehabilitation in stroke patients. Cruz has published more than 50 peer-reviewed manuscripts and monographs; presented at national and international meetings; and participated in many national and international landmark studies in stroke care. Recognized by neurology residents

as an outstanding teacher and lecturer, Cruz has received multiple awards for his excellent and compassionate medical care. Its a great honor to be recognized with this chair, which will provide the support for me to focus my research on how to improve access to stroke care in the greater bi-state region, Cruz said. Many people at Saint Louis University have mentored me and have helped me to reach this place in my career. Now I hope to become the mentor to others to help them reach their goals.

chairman of the department of ophthalmology was invested as the inaugural holder of the Anwar Shah Endowed Chair in Ophthalmology in March. I first came to an academic institution because I love to do research and teach the next generation of eye doctors, said Cruz, who is a SLUCare pediatric ophthalmologist. Holding the Anwar Shah Endowed Chair will allow me to pursue my passion and to meet the goals of my department, he said. Cruz I enjoy teaching and came to SLU because I wanted to be at a place where teaching is important. Anwar Shah, M.D., an ophthalmologist who specialized in treating retinal diseases, long-time benefactor and former School of Medicine faculty member, endowed the ophthalmology chair last June.

Oscar A. Cruz, M.D. |

Anwar Shah was a visionary leader in ophthalmology in St. Louis, Cruz said. Its an honor to be the inaugural holder of the chair that bears his name. A middle school teacher before he became a physician, Cruz has been on the faculty of School of Medicine in the departments of ophthalmology and pediatrics since 1992. He was named director of pediatric ophthalmology at SSM Cardinal Glennon Childrens Medical Center in 1993 and appointed chairman of the department of ophthalmology in 2000. Cruz conducts clinical research into the causes and treatments for strabismus and amblyopia. His research on pediatric eye diseases has been funded by the National Institutes of Health. Cruz also researches educational policy questions at academic medical centers. He is the author of numerous articles, abstracts and book chapters, and is a frequent presenter and invited lecturer at local and national ophthalmology meetings. In 2008 Cruz received a gubernatorial appointment to serve as vice chair of Missouri Childrens Vision Commission. A member of the St. Louis Ophthalmology Society, Cruz serves on the professional advisory board of the Delta Gamma Center for Children with Visual Impairments.

Saint Louis University School of Medicine Grand Rounds 4

VitalSigns

compassionate physician...dedicated teacher


by Nancy Solomon
The School of Medicine lost one of it most outstanding and memorable educators in February. Vallee L. Willman, M.D. (51), chairman of the department of surgery from 1969 to 1996, and the first surgeon in the Midwest to perform a heart transplant, died at his home. He was 83. Keith Naunheim, M.D., director of cardiothoracic surgery and holder of the endowed chair in surgery named for Dr. Willman and his wife Melba, worked closely with Dr. Willman for 18 years. Val Willman embodied all the best aspects of medicine, Naunheim said. He was a world-class surgeon, nationally recognized ethicist and, most importantly, an outstanding human being. For over three decades he set the standard in St. Louis for surgical expertise and compassionate patient care. He was Mother Teresa in scrubs. Youd be hard pressed to find anyone who didnt think Dr. Willman was a saint. Robert Johnson, M.D., chairman of the department of surgery, painted much the same portrait of a man who captured the Jesuit tradition of service to others. Dr. Willman personified the priest without the collar, Johnson said. I dont think anyone was more dedicated to his students, patients and research. Dr. Willman performed the first heart transplant in the Midwest in 1972, and attracted a team of top-notch cardiac surgeons to create one of the most prominent cardiac surgery programs in the world. Under Dr. Willmans leadership, Saint Louis University helped pioneer some of the procedures that led to the coronary bypass surgery. SLU surgeons spearheaded the use of the left ventricular assist device, a surgically implanted mechanism that boosts a damaged hearts ability to pump blood until a heart can be transplanted.

Spiritual Leader

Training Thinkers

Lifelong Learning

Dr. Willman spent all but one year of his medical career at Saint Louis University from his first year of medical school in 1947 to his retirement as chairman of surgery 49 years later. Even in retirement, he remained devoted to SLU taking classes in ethics and philosophy and inspiring others at the University through presentations on the Jesuit mission of service and on the importance of health care ethics. Mentored by C. Rollins Hanlon, M.D., chairman of the department of surgery, Dr. Willman first became interested in cardiac surgery as a resident and research fellow from 1952-57. With his friend Theodore Cooper, M.D., Ph.D., who shared Dr. Willmans passion for research, he began an experimental cardiac transplant program at Saint Louis University in 1961.

Renowned for his surgical prowess, Dr. Willman also was revered by his students as a professor who not only taught them how to be physicians but how to think critically. Perhaps his greatest legacy at Saint Louis University is the hundreds of young surgeons he trained who have done their best to emulate him, Naunheim said. He was loved and respected, and will be missed by all who came in contact with him. His Saturday teaching rounds for medical students were legendary. On them, he would push students to answer a continuous stream of Socratic questions to hone their reasoning skills. They feared him, and they loved him. They revered him and absolutely worshipped him, Johnson said. At the same time, he was humble. Other people put him on a pedestal. He didnt climb up there. Dr. Willman typically started his day at 4 a.m., and saw patients at the hospital before he attended 5 a.m. Mass. He spent his Saturday mornings in his office, catching up on reading. One week youd come in and hed have a thoracic journal. The next week, hed be reading a philosophy magazine, the next week a basic science journal, Naunheim said.

Dr. Willman also was a prolific researcher who encouraged his colleagues to step into the spotlight for recognition for discoveries. He authored or collaborated with colleagues on more than 260 published research projects. He wasnt the kind of guy to continue to demand his name be put on the banner head, Johnson said. He would promote his colleagues. Dr. Willman was born in Greenville, Ill., served in the Naval Aviation Program during World War II, and graduated from the School of Medicine in 1951. He was married for 57 years to the former Melba Carr. He also is survived by eight children and 18 grandchildren. A son preceded him in death. Dr. Willman received numerous honors including Phi Beta Kappa at the University of Illinois; Alpha Omega Alpha in his fourth year of medical school at SLU; the Distinguished Service Award from the American College of Surgeons in 1987; and the Alumni Merit Award from the Saint Louis University School of Medicine. Throughout his career as an academic surgeon my father had a humanistic approach to patient care and teaching, said Jane Willman Turner, M.D., Ph.D., associate professor of pathology at Saint Louis University and one of Dr. Willmans daughters. His profound faith in God and his lifelong study of ethics served as the foundation for everything he did for his patients, students, residents and faculty at Saint Louis University. His giving spirit and humility resonated with his colleagues. Naunheim recalled a Saturday when a patient came in with an esophageal perforation and required the kind of surgery that he typically performed. Dr. Willman, whose specialty was heart surgery, insisted on staying to do the surgery so Naunheim could go home to be with his children. Its an honor to hold his chair, Naunheim said. He was a remarkable Renaissance man and a mentor to me and all of the young faculty who started with him. His patients always came first.

Saint Louis University School of Medicine remembers

Vallee Willman, M.D., 1925-2009.


Grand Rounds

Readers may recall that in the Do You Remember? section of the last issue of Grand Rounds, we asked alumni to share with us their memories of Dr. Hanlon and Dr. Willman. Due to Dr. Willmans passing, we decided to share your stories about Dr. Willman and hold your memories about Dr. Hanlon until the next issue. dr. willman with his third-year medical students during Saturday rounds in the ICU.

I clearly remember and carry with me appreciatively many of the things that Dr. Willman taught me. He impressed upon me the importance of clear, concise and logical thinking processes with a common sense basis. For example, he liked to ask, Do you know why Willie Sutton robbed banks? After a period of silence he would answer himself, Because thats where the money is! Jeffrey l. weingarten, M.d. 82 Bloomfield Hills, Mich.

life. His rigid determination to do what is right for the patient in spite of any inconvenience to himself is a principle that medicine in general still needs. He should be remembered at SLU, and I am sure will always be revered by so many students, physicians, faculty members and especially by patients. richard B. whiting, M.d. 65 Chesterfield, Mo.

.alumni memories
Striding down the hall in his starched white coat, Dr. Willman always appeared to be a man on a mission. The first to arrive at the hospital in the morning, he gave the impression of unhurried thought and deliberation. Organized was his mantra. But there was one morning that things were out of sync. Late on arriving at the hospital, Val looked disheveled. Perspiring, with his hair askew, his collar unbuttoned, tie undone and his white coat wrinkled and soiled. I need the tranquilizer dart gun from the animal lab, quickly, was his hasty request. Can I help? I queried. No, unless you want to help get the monkey out of the tree at my home. Monkey? Dont ask. Just get me the tranquilizer dart gun. The next day Val arrived at the hospital his usual self. I assume he got his monkey. I didnt ask. reilly Maginn, M.d. 60 | Daphne, Ala. I was a senior at SLU in the College of Arts and Sciences. Because I wasnt in pre-med prior to going to medical school I was asked to see Dr. Willman. After a few minutes into the interview Dr. Willman said, I notice on your application that you have a major interest in philosophy. Is that true? Yes, I replied. Would you please explain what Jacque Maritain means when he writes that ethics is a subaltern science? Fortunately, Jacque Maritain was one of my favorite philosophers so I knew the answer. I was so impressed that I was asked such a technical philosophical question that if accepted I was going to SLU. richard sposato, M.d.68 Lincoln, Neb.

In 1983 I was in my third year doing my cardiovascular surgery rotation at what was then called Firmin Desloge Hospital. As was the practice at the time, we admitted a patient a day in advance of surgery, and I was to do a pre-op physical. The male patient would not allow me, a female, to examine him. When we rounded with Dr. Willman I reported to him, with great trepidation, that I had been unable to examine the patient and told him why. Im not sure what I expected, but it was not what ensued. He turned on his heels and marched into the patients room. He told the patient, in no uncertain terms, that if he was going to be operated on at this hospital by this cardiac surgeon, he was going let this female medical student examine him. When Dr. Willman came out he told me to go do the physical. I did, and the patient complied. I was a small cog in the wheel at the Medical Center but he made me feel valued that day. It was clear that my education mattered to Dr. Willman. Joelle M. lambert, M.d. 84 Santa Clara, Calif.

Every medical student and resident found Dr. Willman to be a personal mentor during his or her time on the surgical service. We were inspired by his total dedication to the academic, educational and investigative facets of the institutional umbrella. Most impressive to me was his unselfish approach to all of these tasks. Despite his incredible and self imposed workload, he did not expect or ask us to contribute more of ourselves. In fact he frequently would inquire as to whether we were happy with how things were and whether he could facilitate our situation in any way. This was and continues to be remarkable to me, as most of us have limits on our ability to give, in whatever way. I considered myself to be reasonably unselfish in terms of time, effort and compassion but this paled when compared to Vals inquiry, Is there anything you need or that I can do for you? As if he werent doing enough. hendrick Barner, M.d. Cardiac fellow 1965-66 St. Louis

I was in training at SLU in the mid 80s and remember Dr. Willman very well. Of the many surgeons under which I had the pleasure to train, Dr. Willman was one of the most influential. He always instilled strong medical and surgical ethics as well as a deep sense of responsibility toward every patient. It was consistently clear that Dr. Willman wanted the best efforts from everyone on the medical team at all times. I was always impressed not only by his technical skills, but also his passion for medicine and surgery. I feel it a great personal honor to have been able to train under him. He gave me excellent fundamentals from which to build upon and incorporate into my own style of patient care. Gary s. Flom, M.d.89 Stockbridge, Ga.

I was a student from 1952 to 1956 when both Dr. Hanlon and Dr. Willman were at the school. They were much disciplined, knowledgeable and attended Mass daily. Both were scrubbed on a case I witnessed the pulmonary artery had been nicked. How they remained calm and held on after numerous pints of blood Ill never know. The patient survived. I learned to discipline myself from their example and will always remember them. robert J. Keene, M.d. 56 Washington Crossing, Pa.

I had the privilege of spending some of my medical school surgical rotation and six months of my internship surgical rotation at SLU when Dr. Willman was department chair. I was able to scrub in with him on a number of cases. His calm, skillful and confident demeanor in the operating room, and his dignified and respectful treatment of patients, students and staff, set a great example. He taught me the proper way a physician should conduct himself. I will always appreciate my time spent with Dr. Willman. Jerome Basinski, M.d. 63 Belleville, Ill.

Grand Rounds

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As I recall it was my final exam for the junior year surgery rotation, and I was assigned to Dr. Willman for my oral case presentation. Dr. Willman, chairman of the surgery department, was an inspiring but, admittedly, intimidating teacher. I had chosen to take surgery late in the year partly because surgeons were, well, all kind of intimidating to me and I wanted to get some clinical experience behind me before facing them. I presented a case to him, and he asked me about X-ray findings. I must have said the X-ray showed such and such. Dr. Willman was quick to correct me. An X-ray is interpreted as showing such and such. That, hopefully, was my only mistake. I passed phew and to this day when I hear a fellow physician say that an X-ray shows something, Im tempted to say, No, it is interpreted as showing something. But I dont say it. After all, Im not Dr. Willman. Geoffrey Kotin, M.d. 77 Oakland, Calif.

My initial interaction with Dr. Willman was at orientation for the third-year surgical rotation. He told all of us something that sticks with me to this day. After introducing himself he said, I can teach a monkey to operate. I cannot teach a monkey the necessary judgment to be a surgeon. Judgment and basic medical knowledge will be your best attributes as a surgeon. Technical expertise comes with experience. Judgment is far more difficult to learn. Each Saturday morning, we had Willman Rounds. Attendance was not mandatory, but those who chose not to participate missed the opportunity to learn from a master educator. One Saturday one of his patients crashed in the cardiovascular ICU. He led a group of 15 or so students bounding up several flights of stairs after he was stat paged. Here was a man nearing 70 trouncing a bunch of 20-somethings up the stairwell. He summoned the chief resident and opened the patients chest in the ICU. The patient survived. I marveled at his expertise, calm under fire and absolute professionalism in that moment of tremendous pressure. I have been in that situation numerous times over the years, and what I learned that day still stays with me. When under duress, the entire team looks to the leader. The entire team draws its emotion from the team leader. A calm, collected leader, even in the face of the ultimate storm, begets a calm, efficient and effective team. The leader who panics spreads that panic to the team via osmosis, and everybody, including the patient, suffers. It was the lesson of a lifetime, and Dr. Willman probably never realized he was giving it. It came naturally to him the gift of a teacher in the truest sense. Between Dr. Willman and my residency program director, Dr. William G. Cioffi, I learned all I needed to know about becoming a good surgeon attention to details, compassion and dedication to the profession. anthony F. Cutry, M.d. 95, Ph.d. Florence, S.C.

Memories of my surgical rotation as a third-year medical student under the watchful eye of Dr. Willman abound. I distinctly remember him stopping me in the hospital halls to inquire where I was going and what I was doing. When I told him I was delivering some blood samples to the lab, he curtly asked me what else I was doing. I remember this as my introduction to multi-tasking, a lesson that has served me well. I also recall my exit oral exam/interview with Dr. Willman during which he spent the first 20 minutes grilling me on constipation and laxatives. The lesson on attention to detail has likewise stayed with me for 34 years. stephen r. Phillipp M.d. 76 Fort Wayne, Ind.

the willman family has requested memorial contributions be sent to:


Saint Louis University Willman Endowed Chair One Grand Blvd., Room 319 St. Louis, MO 63103

Dr. Willman has been the most professionally perfect and spectacular physician I have known. He had a major influence on my life and career. I was a medical student when I first met Dr. Willman, and from 1971 through 1976 I was a faculty member in the cardiology division. I was lucky to get to know this man beyond those roles as well as his surgical patient. No, I didnt need cardiac surgery. It was my appendix that led to a trip to the OR. As a junior faculty on a consult rotation with Dr Willman, I mentioned that I had a peculiar abdominal discomfort in the right lower quadrant. A few questions revealed some loss of appetite and mild feeling of malaise. Soon, rounds were over, and I was escorted to his office for an exam. I think there was some blood taken, too, but this was a Friday afternoon, and I had plenty of work to catch up on before the weekend. Sunday morning at home I heard a knock on the front door and there was Dr. Willman. My home was in Olivette not that close to Webster Groves where the Willmans lived. He asked if I was well and if I thought he should re-examine my abdomen. Well, what does one say? I passed that exam but barely. So, we agreed that I would come into his office first thing in the morning. Monday, I checked in, was examined and soon was off to the OR for an appendectomy. Needless to say, I recovered and was back to consult rounds. Dr. Willman is a man I can never thank enough for my professional

ON MARCH 19

151 fourth-year Saint Louis University School of Medicine students learned where they would spend the next three-to-seven years of their residency training. They were surrounded by family and friends as they ripped open their envelopes during a ceremony at Lumen in downtown St. Louis. According to the National Resident Matching Program, which conducts Match Day programs across the country, there was plenty to celebrate. More than 94 percent of seniors nationwide who applied for residencies this year were paired with a program of their choice the highest percentage in more than three decades.

anEsthEsioloGy

heidi Brehm UMDNJ-New Jersey ty Curtis Saint Louis University School of Medicine Qiao Guo Stony Brook Teaching Hospitals (N.J.) Jason hahn Northwestern McGaw/NMH/VA (Ill.) Jason hochstrasser Saint Louis University School of Medicine Christopher houston Northwestern McGaw/NMH/ VA (Ill.) shanna ogden Texas A&M-Scott & White neel Patel University of Chicago Medical Center (Ill.) James reusch University of Missouri-Kansas City Programs sneha shah University of Maryland Medical Center rajesh singh Barnes-Jewish Hospital (Mo.) Christopher wang University of Missouri-Kansas City Programs nicole weiss Tulane University School of Medicine (La.)

Peder anderson Montana Family Medicine John armilio Research Medical Center (Mo.) alan arthur University Hospitals-Columbia (Mo.) Eric Bloemer Union Hospital (Ind.) tinarose Bosslet St. Johns Mercy Medical Center (Mo.) daniel Broadbent St. Johns Mercy Medical Center (Mo.) Eric drenkhahn University of Kentucky Medical Center ryan-niko hickman Ohio State University Medical Center Matthew hurley Southern Illinois University -Carbondale Kara Mayes St. Johns Mercy Medical Center (Mo.) henry Pelto University of Washington Affiliated Hospitals Jennifer wessels St. Johns Mercy Medical Center (Mo.)

intErnal MEdiCinE

trevor McCotter SAUSHEC-Lacklund Air Force Base (Texas) Elliot McKee Indiana University School of Medicine Ghassan Mohsen Saint Louis University School of Medicine randall Morse University of Massachusetts Medical School alexander Myers University of Tennessee College of Medicine-Memphis Justin reis SAUSHEC-Lacklund Air Force Base (Texas) lenore rengel Virginia Commonwealth University Health System nisha shetty Rush University Medical Center (Ill.) John sleesman University of Colorado School of Medicine-Denver rupinder sodhi Saint Louis University School of Medicine Elizabeth trevathan UCLA Medical Center (Calif.) Vincent woo Harbor-UCLA Medical Center (Calif.)

anusha Vasamsetti Saint Louis University School of Medicine

orthoPaEdiC surGEry

tyler Krummenacher University of Chicago Medical Center (Ill.) Kevin McCarthy University of Kansas School of Medicine-Kansas City Kevin Perry Mayo School of Graduate Medical Education (Minn.)

orthoPaEdiC surGEry RESEARCH

david nelles Wright State University Boonshoft School of Medicine (Ohio)

otolarynGoloGy

Child nEuroloGy

stephanie Merkle Washington University-St. Louis (Mo.)

dErMatoloGy

Joel Crockett Wright State University Boonshoft School of Medicine (Ohio) James Macdonald Mayo School of Graduate Medical Education (Ariz.)

EMErGEnCy MEdiCinE

thomas Belanger Barnes-Jewish Hospital (Mo.) Justin Coomes University of Louisville School of Medicine (Ky.) daniel Johnson York Hospital (Pa.) stephen Kohut St. Lukes-Bethlehem (Pa.) Ketan Patel University of Nevada Affiliated Hospitals-Las Vegas Marie Vrablik Indiana University School of Medicine

FaMily MEdiCinE
Jonathan alde UIC/Illinois Masonic Family Medicine Residency scott andelin McKay-Dee Hospital Center (Utah)

oPhthalMoloGy
Kevin Gertsch University of North Carolina Hospitals rohit Parihar Saint Louis University School of Medicine

Grand Rounds

11

Photo on facing page: alan arthur celebrates his match to University Hospitals-Columbia Family Medicine with his son, taylor. To see more photos from match day, visit

more

medschool.slu.edu/alumni/

Kashif abdullah Saint Louis University School of Medicine adrian alexander University of Tennessee College of Medicine-Memphis John allan New York-Presbyterian/Weill Cornel Medical Center Kalyan Bhoopal University of Illinois College of Medicine-Chicago Matthew Bonzelet University of Wisconsin Hospital and Clinics Melinda Chu Saint Louis University School of Medicine Janice Chyi Rush University Medical Center (Ill.) Edward Coverstone Duke University Medical Center (N.C.) arlene dawravoo Rush University Medical Center (Ill.) Matthew dopp Mayo School of Graduate Medical Education (Ariz.) Jill Grounds Boston University Medical Center (Mass.) howard hsu St. Johns Mercy Medical Center (Mo.) deema ismail University Hospitals Case Medical Center (Ohio) Michael Kidd Mayo School of Graduate Medical Education (Ariz.) adam littich University of Nebraska Affiliated Hospitals Priti Marwaha University of Illinois College of Medicine-Chicago

intErnal MEdiCinE PEDIATRICS


Elizabeth hofbauer University of Minnesota Medical School

nEuroloGy

Kamala saha St. Josephs Hospital (Ariz.)

Muhamad amine Loyola University Medical Center (Ill.) Peter anderson University Hospital-Cincinnati (Ohio) shannon higgins University of California Davis Medical Center ryan Jackson University of South Florida College of Medicine-Tampa Kumar Prasad Saint Louis University School of Medicine Jackie west-denning Louisiana State University School of Medicine-New Orleans

nEurosurGEry

PatholoGy

Joanna Kemp Saint Louis University School of Medicine anne-Marie woelbel Cleveland Clinic Foundation (Ohio)

oBstEtriCs and GynEColoGy

Mark Fierro Saint Louis University School of Medicine rebecca Grinsell NCC-Walter Reed Army Medical Center (D.C.) Catherine laska Saint Louis University School of Medicine deanna Mills Kaiser Permanente-Southern California Region april Parker Barnes-Jewish Hospital (Mo.) Jenny Pennycook Saint Louis University School of Medicine

Mary ann Bleem SAUSHEC-Brooke Army Medical Center (Texas) Erica Fan Hospital of the University of Pennsylvania James Mathews Barnes-Jewish Hospital (Mo.) Matthew Poeschl Penrose Hospital (Colo.) sarah thompson University of Kansas School of Medicine-Kansas City

dana hartnagel Wright Patterson Medical Center (Ohio) Jaya Jacob University of North Carolina Hospitals taylor Jerman University of Iowa Hospitals and Clinics luke Krispinsky Naval Medical Center (Caiif.) theresa lorkowski NCC-Walter Reed Army Medical Center (D.C.) Courtney Maguire St. Louis Childrens Hospital (Mo.) yaser namvargolian University of California -San Francisco hoang nguyen St. Louis Childrens Hospital (Mo.) Fafa nyirenda University of Tennessee College of Medicine-Memphis laura Plencner Childrens Mercy Hospital (Mo.) sunil raikar Saint Louis University School of Medicine daphne say University of California San Diego Medical Center John schweitzer Baylor College of Medicine -Houston (Texas) Monica sondhi Rush University Medical Center (Ill.) Jennifer tiehen University of Colorado School of Medicine-Denver Kevin thompkins University Hospitals-Columbia (Mo.) laura waters Saint Louis University School of Medicine

Kimberly leeman UPMC Medical Education Program (Pa.) sean lehner Medical College of Wisconsin Affiliated Hospitals robert lieberman University of Southern California Conor lowry Staten Island University Hospital (N.Y.) tod Mattis Grand Rapids Medical Education and Research Center (Mich.) Joseph Mullen Saint Louis University School of Medicine steven steer St. Lukes-Roosevelt (N.Y.) Milad yazdani Cleveland Clinic Foundation (Ohio)

radioloGy ONCOLOGY surGEry GENERAL

Pawel dyk Barnes-Jewish Hospital (Mo.)

PsyChiatry

Bonnie applewhite Barnes-Jewish Hospital (Mo.) amy dowell University of Washington Affiliated Hospitals lance Kaikati Einstein/Montefiore Medical Center (N.Y.)

PEdiatriCs

deborah ayuste Emory University School of Medicine (Ga.) Marisa Brant Childrens Hospital-Philadelphia (Pa.) Jenifer Butler Childrens Mercy Hospital (Mo.) andrea Coverstone University of North Carolina Hospitals sara Franzen University of Texas SW Medical School-Dallas donna hamacher Indiana University School of Medicine

radioloGy DIAGNOSTIC

talha allam Saint Louis University School of Medicine andrew Barina Duke University Medical Center (N.C.) Kenneth Cicuto Maine Medical Center Joshua Clayton Albert Einstein Medical Center (Pa.) ashwin hegde University of Nebraska Affiliated Hospital nishant Kumar University of Illinois College of Medicine-Chicago anthony Kuner Integris Baptist Medical Center (Okla.)

andrea Behr Albert Einstein College of Medicine (N.Y.) timothy Capps Saint Louis University School of Medicine Victor ha Hospital of St. Raphael Program (Conn.) Monica Jacobus UIC/Metro Group Hospitals (Ill.) stephen Jovonovich Oregon Health and Science University steven Mapula University of Texas SW Medical School-Dallas Cyrus orandi Saint Louis University School of Medicine Margaret riesenberg Medical College Wisconsin Affiliated Hospitals tyler rust San Antonio Military Medical Center (Texas) david ryan UIC/Metro Group Hospitals (Ill.) Peter sidor Cedars-Sinai Medical Center (Calif.) Corinne tan Indiana University School of Medicine allen tanner University of Texas Medical School-Houston timothy Vreeland SAUSHEC-Brooke Army Medical Center (Texas)

uroloGy

lindsey herrel Emory University School of Medicine (Ga.) James Mark Thomas Jefferson University (Pa.) Kevin ostrowski Oregon Health and Science University

e
The Medical cenTer library revoluTionizes journal access.

VAILABILITY
by Marie Dilg

Patrick McCarthy couldnt have picked a worse day last March to show off the librarys new digital services. A winter storm was bearing down on St. Louis. Heavy snow and fog blanketed the city. The University was on the verge of closing. Yet, to McCarthys surprise, more than 400 people braved the weather and attended the open house a sign of just how eager users were to see the digital transformation of the library and its impact on information access. Everyone assumed we were going to live in a hybrid world for a while some electronic journals, some print journals, said McCarthy, director of the Medical Center Library, but in the science field we saw that the debate was settled almost immediately in favor of electronic delivery. We didnt want to react to that. We WanTed To geT ahead

of iT.

Grand Rounds

13

His department did get ahead of it by creating a unique electronic document delivery system that is receiving national attention both for its speed and its scope. McCarthy said the system, Digital Document Delivery (D3), provides students, residents and faculty access to all journals, online, all the time. McCarthy refers to it as the library that never closes. Were in an environment thats expected to function 24 hours a day, and we have users who want access to information 24 hours a day, McCarthy said. We can offer that now.

Record Time

In the majority of cases, document access is self service. Users know the name of the journal, go on line, pull it up and download the article from the schools journal holdings. In other cases, the journal may not be licensed by SLU or the journal is too dated to be immediately available electronically. It could be on the shelves in the library, in storage on the lower level of the Learning Resources Center or located at another library. In that case, users submit an article request through ILLiad a software program on the Universitys server that automates interlibrary loan functions. The librarys document delivery staff receives the ILLiad request, locates the article and puts it into the users e-mail box.

We guarantee delivery of an article within 24 hours, but its usually more like one to two hours, McCarthy said, Weve even gotten articles to users within five minutes of their request. Its that fast. No other medical school library in the country is offering this service.
Prior to D3, users had to come to the library, look up the article, hope they had the correct change to photocopy it and settle for a less than perfect reproduction. D3 provides original quality PDF articles. Also in the past, if the journal was located at another library, it took three to five days for it to arrive by mail or fax. Mark M. Knuepfer, Ph.D., professor of pharmacological and physiological science, frequently requests articles to support his teaching and research. In a world thats so information dependent, this service is critical for any biomedical research community, Knuepfer said. Were expected to keep abreast of a body of knowledge that is increasing exponentially. Any delay in retrieving the information makes it less likely that we can assimilate the data into the context we need to learn because our challenges change daily. Its also greatly appreciated by students if they can get rapid answers to their questions.

No request is too challenging for D3 either. P.J. Koch, manager of document delivery and interlibrary loan, helped develop the system. Not long ago he received a request from a physician who needed an article on consumption from an 1888 issue of The Lancet. The article was too old to be available electronically but not too old to find in the School of Medicine journal archives. Using a state-of-the-art Minolta scanner, Koch was able to scan and get the article to the users inbox within the hour. In another example, a researcher wanted an article on health care and insurance from a 1943 issue of Time magazine. The researcher did not know the name of the article, the author or the exact issue of the weekly magazine. Even with so little to go on, Koch found the article. The researcher had what he needed within a couple of hours. Melinda Chu, a fourth-year medical student, experienced the power of the system when she was doing an away rotation in dermatology at Columbia University in New York. She requested an article from a small journal in France and received it a short time later. The other residents were really impressed at what I could get, she said. Chu also has an interest in medical history and routinely needs help finding journals from the late 19th and early 20th centuries. These are journals that no one has looked at in 100 years, and they find it for me, she said. Its pretty awesome. The library launched D3 in 2007 as a pilot program for users in the School of Public Health, the Anheuser-Busch Institute (ophthalmology and dermatology) and the medical schools OB/GYN service at St. Marys Health Center. The response was so overwhelmingly positive that the library began offering it to all schools at the Medical Center in 2008. The document delivery staff is now handling 100 to 120 requests a day. The advantage of not having to go to the library every time we need something allows us to do even more than weve been able to do in the past, said Knuepfer, who has served on the librarys advisory board since 2003. Services like this are no longer a luxury but a necessity for a competitive research institution.

On the Receiving End

The Medical Center Library also saved money by systematically reviewing its journal holdings. The library has direct electronic subscriptions to 1,000 medical journals and online access to another 35,000 in all disciplines in cooperation with SLUs Pius XII Memorial Library and the Omer Poos Law Library. The medical journals were costing the library $900,000 a year. The cost was increasing 10 percent every year, and we couldnt keep up, McCarthy said. Given our shift to an electronic environment, we calculated the cost-per-use and decided to stop buying some of the most costly, lowest-use journals and pay only for the articles requested from those journals. I compare it to iTunes. Instead of buying the entire album for $20, you buy only the song you want for 99 cents.

A new kind of space

In the first year, the library saved $300,000 with this on-demand approach. McCarthy said the library is using the savings to build a robust archive of electronic resources and the most efficient system to manage those resources.

The switch to digital information delivery has made printed journals obsolete. All of the Medical Center Librarys medical journal subscriptions moved to electronic format in 2008. The library also is moving 100,000 of its journals to an off-site facility being developed for use by all SLU campus libraries. Articles from these journals will be provided through the D3 program. The change frees up about one-third of the librarys physical space. So what does this revolutionary change mean for the Medical Center Library? What is its role when it no longer needs to be a warehouse and when users can obtain information without ever crossing its threshold? McCarthy said the library remains the centerpiece of academic life. While the Internet tends to isolate people, the library brings students and faculty together. He said the relocation of journals provides the School of Medicine with the opportunity to reconfigure and update library facilities. We get about 200,000 visitors a year, McCarthy said. Firstand second-year students are our heaviest users. They want and need interactive relationships. Residents who are on-call like to come over here for a quiet place to study. Some researchers like the feel of the paper and the smell of a book. Digital document delivery wont change that. McCarthy is hoping to renovate the library to fit what users want now. In focus groups he conducted last year, users told him they wanted a place to gather with more comfortable seating, study rooms, better work spaces, access to outlets and a business center.

Budget Savvy

Going digital has led to some unexpected financial benefits. Unlike other medical school libraries, the SOM does not charge its internal users for the document delivery service. It does, however, charge fees to qualified external users, such as independent researchers and law firms. The fees generate about $40,000 a year.

The challenge, McCarthy said, will be to bridge these more traditional library services with the new information technology the School of Medicine is committed to providing. He said the library will face this challenge with the same forward thinking it did when developing its unparalleled document delivery system.

14

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15

THE M O H S ADVAN TAGE


Helping skin cancer patients cure tumors while saving face.
Jennifer Hoffman is sitting in an exam chair flipping through her copy of This Old House. The magazine has become essential reading for the 34-year-old graphic designer from Washington, Mo. Hoffman and her husband live in a 130-year-old house that has more than its share of do-it-yourself projects. The magazines cover story focuses on vintage fixtures. Small changes big impact, the magazine promises. The same promise may be made of the surgery Hoffman is scheduled to undergo shortly. She has a basal cell carcinoma on her scalp and Scott W. Fosko, M.D., professor and chairman of the department of dermatology, will use Mohs micrographic surgery to remove it. Mohs surgery was created by general surgeon, Fredrick E. Mohs, M.D., who first described the procedure in 1941. Mohs is the optimal treatment modality for certain basal cell and squamous cell carcinomas because it provides complete tumor margin evaluation, accurate identification of tumor extension and maximal preservation of healthy tissue. Using the very precise technique, surgeons remove layers of skin sequentially and immediately examine them under the microscope until the samples indicate the skin cancer is completely removed. Tumor removal is the primary focus, with preservation of healthy tissue a significant benefit of the procedure, Fosko said. We remove only the tissue we have to. The School of Medicine has one of the busiest and fastest growing academic Mohs surgery practices in the metro St. Louis area, with surgeons performing an average of 1,200 procedures a year on the second floor of the Anheuser-Busch Institute. Mohs surgery is indicated for cancers located in high-risk areas such as the nose, ears, eyelids, lips, hairline, hands, feet and genitals where tumor behavior is less predictable, and conserving healthy tissue is critical for cosmetic or functional purposes. The outpatient procedure also is recommended for cancers that are at high risk for recurrence. With regular or traditional surgery, less than one percent of the tumor margins are actually examined, thereby increasing the chances that a tumor extension or root would be missed and left behind to regenerate. Fosko said Mohs allows for examination of 100 percent of the tumor margins, thus reducing the chance that tumor cells will be left behind. Some tumors when caught early can be small and easy to approach. While Hoffman is under local anesthesia, Fosko removes a nickel-sized piece of flesh from her scalp and maps the orientation of the excised tissue relative to its location on her head. Fosko sends the sample to Shelia Harris-Ezell, a histotechnologist who runs the Mohs lab two doors down. Within minutes, she processes tissue specimens using staining and a horizontal sectioning method to prepare slides for Fosko to interpret. If Fosko sees no additional areas of the tumor, the patient is declared clear. If more cancer cells are observed, another layer of skin is removed and examined. Each layer removed is called a stage. Due to the methodical manner in which the tissue is removed and examined, the cure rate for Mohs surgery is as high as 99 percent for certain skin cancers. Hoffman goes back to her magazine and waits for her results. Ive had Mohs surgery so many times Ive lost track, but I still get a little nervous waiting, she said. I know what to expect during the procedure, but I never how much (tissue) is involved and what the repair work will bring.

Hoffman has Gorlin syndrome, a rare genetic condition characterized by multiple and early onset basal cell carcinomas. Since being diagnosed in high school, Hoffman has had Mohs surgery more than 20 times to remove cancerous tissue from her body, mostly from the neck up. Unfortunately, the first excision today did not remove all the cancer. Fosko has to cut a little wider and a little deeper. One of Foskos patients required 17 stages before he was declared clear. Hoffman is luckier. About 30 minutes after the second stage, Judy Stecher, Foskos Mohs nurse for the last 15 years, delivers the news. Youre clear, she announces. Its all gone. They embrace. This is the best part of my job, said Stecher as she walked out of the room.

Team Approach

Sometimes tumors are more advanced and much more involved for the patient. Such a scene is playing out down the hall for Delores Stuckel of Bellville, Ill. She discovered a basal cell carcinoma on the left

actually seeing a dozen other specialists with the Saint Louis University Cancer Center whose resources benefit the patient and whose expertise adds to our understanding of skin cancer. This approach to skin cancer makes SLU a tremendous resource for patients and referring physicians, Fosko continued. I believe our program, and all of the involved physicians and surgeons, make our skin cancer program, unique and outstanding in the delivery of our patients care, Fosko said. Based on a similar model, Fosko also has organized the Multidisciplinary Melanoma Group, which consists of physicians from dermatology, dermatopathology, surgical oncology, medical oncology, pathology, radiation oncology, otolaryngology, ophthalmology, nuclear medicine and plastic surgery. We discuss and manage our skin cancer patients in a coordinated fashion every day. We come together monthly to discuss our melanoma patients and other high risk skin cancer patients, Fosko said. This multidisciplinary approach allows us to handle the most complicated cases in the region.

Expansion Plans

Roots and All

Mark M. doig, Pa-C, assists Fosko (left) as he removes cancerous tissue from Hoffmans scalp.

Fosko brought Mohs to the School of Medicine when he arrived in 1993 shortly after dermatology became a division of the department of internal medicine. In 1996, the division became a department and has not stopped expanding since. The department currently has eight full-time faculty, with two more joining this July. Fosko was the only Mohs surgeon until 2003 when he brought on a second surgeon to address the growing demand for the procedure. Fosko also established a Mohs fellowship in 2003 and currently is training his 5th fellow. Mohs surgery soon will be offered at the SLUCare facility in Des Peres. Mohs is a definite area of growth for us, he said. A majority of our patients live within a 100-mile radius of the University, but were seeing more and more patients driving four or five hours to get to us. The team approach at Saint Louis University continues to provide outstanding patient care, and it allows us to expand our teaching programs and develop research initiatives in cutaneous oncology.

side of her nose about three years ago. Her dermatologist tried scraping it off and burning it off with lasers and creams, but the carcinoma reoccurred and wrapped itself around the nerves in her skin. By the time she saw Fosko, Stuckel lost half the tissue on her nose. It took Fosko and his team eight stages to remove the cancer for good. Had the tumor been managed earlier, the patient may not have lost so much tissue. Basal cells can be very tricky to the eye and often can be resistant to what are usually effective treatments, said Fosko. Our practice focuses on these very difficult to manage skin cancers. Stuckel will have to have her nose reconstructed by plastic surgeons at SLU. Fosko said the surgeons are part of the multidisciplinary team that provides critical support for his skin cancer patients. Saint Louis University has one of the most outstanding multidisciplinary approaches to treating complicated skin cancers, Fosko said. When patients come to see me, theyre

Im fortunate to be a part of it, and Im proud of our many successes in our skin cancer program.

| Fosko
Jennifer hoffman (left) as she receives the good news from Judy stecher.

16

Grand Rounds

17

From left: Tavis Di Bisceglie and Teckman

John Tavis, Ph.D.


Professor, Department of Molecular and Microbiology Joined the School of Medicine in 1994

Poised for Discovery


Saint Louis University School of Medicine has one of the largest hepatitis C practices in the world. The practice is built on the national reputation of the liver disease scientists who are making breakthroughs in diagnosing and treating patients not only with hepatitis C but with hepatitis B, fatty liver disease, hemochromatosis and cancer. In this issue of Grand Rounds, we examine the work of three of these researchers.

Adrian Di Bisceglie, M.D.


Professor, Department of Internal Medicine | Chief of Hepatology | Co-director of the Liver Center Joined the School of Medicine in 1994

Sometimes optimism outpaces reality. In a recent study, Di Bisceglie put a promising treatment for non-responsive hepatitis C patients to the test to determine whether doctors hopes about the approach were warranted.

In the United States, about 4 million people have been infected with hepatitis C, and an estimated 10,000 to 12,000 people die from complications each year. While about half fully recover after an initial course of peginterferon and ribavirin, half do not respond to treatment. As researchers struggled to find an effective treatment for non-responders, some early studies suggested that low-dose peginterferon, known as maintenance therapy, might suppress the virus and slow liver damage. Researchers were hopeful that the approach might work, and doctors began using the treatment with patients, even as the value of the treatment remained unknown. Di Bisceglie chaired the NIH-funded, multi-center clinical trial that set out to determine whether maintenance therapy was, in fact, effective.

The results, published in the New England Journal of Medicine, were clear: maintenance therapy did not stop liver disease from progressing. This course of treatment had been adopted by a number of doctors in the U.S. and in other countries, though it had yet to be proven to work. It is clear now that practice should be stopped based on the results of this trial, Di Bisceglie said. In addition, researchers were startled by the rate of progression of liver disease. After four years, 30 percent of the patients in both the treatment and control groups had developed liver failure, liver cancer or had died. Among those with noncirrhotic fibrosis, 10 to 12 percent developed severe liver disease, also unexpected. Patients with hepatitis C in these circumstances got very ill over the course of four years, surprisingly so, Di Bisceglie said. The lesson we

learned is that once chronic hepatitis C gets to the stage of advanced fibrosis, patients can decline rapidly. The illness can be devastating, as Di Bisceglie, the former chief of the liver diseases section at the National Institutes of Health, came to appreciate even more fully during the course of the study. There were 105 patients enrolled in the study here at Saint Louis University, and I personally saw them every three months for as long as eight or nine years. Many have since died or developed cancer. It is very humbling to appreciate how bad this disease can be. With low-dose peginterferon ruled out, researchers will turn their efforts to the next area of promise: protease and polymerase inhibitors that are currently in clinical trials.

For the last decade, Tavis has been trying to get a handle on the amazing survival skills of the hepatitis C virus (HCV). Being infected with HCV can be like having a time bomb inside your body, said Tavis, one of the nations leading HCV researchers. The virus sneaks into your system through direct blood contact with an infected person. It heads to the liver and replicates itself with remarkable efficiency. The immune system tries to clear HCV, but the virus wont back down, and this standoff can go on for decades. Interferon therapy is the traditional way of treating HCV, but it works in only half of the patients. The bodys interferon responses and the virus counter-responses are like evenly matched boxers, Tavis said. Doctors had no way of knowing whether giving a patient interferon was putting him or her through an expensive and grueling therapy for naught. That is, until now. Tavis and his collaborators, Rajeev Aurora, Ph.D., and Maureen Donlin, Ph.D., found they could use a mathematical model to analyze the viral genome from hepatitis C patients and predict whether patients would respond to interferon therapy. Their method of analysis could also be useful in predicting which patients are likely to respond

to medical therapy for other life-threatening viruses. We identified patterns, which are called covariance networks, in the sequences of HCVs genes in two groups of patients those who responded to and those who resisted traditional therapy, he said. The patterns we found will enable a doctor to predict whether or not a medication will work in a patient. We also identified amino acid hubs that linked to many other amino acids, which could be valuable targets for new antiviral drugs. A chip-based assay that determines whether a patient is likely to benefit from the treatment could be designed for about $100 a sample and given to patients before a 24to 48-week course of interferon therapy is prescribed. If the test shows the treatment wont work, physicians could counsel against interferon-based therapy, avoiding tens of thousands of dollars in expenses and painful side effects for the patient, Tavis said. The side effects of the medicines to treat hepatitis C are terrible. Why put a patient through this for a year if the treatment isnt going to work anyway?

G R A N T S at a Glance
Adrian M. Di Bisceglie, M.D., professor of internal medicine and chief of hepatology, has received a $2.5 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases for the project Midwest Hepatitis B Consortium. Dale Dorsett, Ph.D., professor of biochemistry and molecular biology, has received a $1.2 million grant from the National Institute of General Medical Sciences for the project An Animal Model for Cornelia de Lange Syndrome. Oleg G. Kisselev, Ph.D., associate professor of ophthalmology, has received a $1.1 million grant from the National Institute of General Medical Sciences for the project Biophysics of Receptor/G-Protein Interactions. Leigh E. Tenkku, Ph.D., M.P.H., assistant professor of family and community medicine, has received a $1 million grant from the U.S. Department of Health and Human Services for the project Midwest Fetal Alcohol Syndrome Training Center.

Jeffrey H. Teckman, M.D.


Associate Professor, Department of Pediatrics | Department of Biochemistry and Molecular Biology Joined the School of Medicine in 2005

Teckman has spent the last 15 years exploring a genetic liver disease that some physicians mistakenly consider rare. Alpha-1 antitrypsin deficiency (Alpha-1) is underdiagnosed and underappreciated,

Teckman said. Its as common as cystic fibrosis and affects approximately the same amount of people 100,000 in the United States. But because Alpha-1 can cause a broad range of problems over a patients life span, its easy to underestimate its impact. Alpha-1 is caused by the defective production of alpha-1 antitrypsin (A1AT) in the liver. The liver makes large quantities of the protein, which it then dumps into the blood steam. Normally, A1AT serves as a protector. If a person breathes in bacteria, white blood cells release certain digestive enzymes to eradicate the germ. In patients with Alpha-1, the liver manufactures an abnormal type of the protein that is not released into the blood and instead builds up in the liver. In the absence of A1AT in the blood serum, some of the white blood cells enzymes may go unchecked and cause widespread damage in the lungs. Teckman said patients born with the deficiency can develop life-threatening liver disease as infants, some develop liver problems as

children, some develop lung diseases, such as COPD or emphysema, as adults, and some people never get sick. A key to better detection and treatment is understanding the basics of the disease. One question Teckman and his colleagues are exploring is how the protein build up damages the liver. Fifteen years ago, Teckman said they knew very little. Since then, he and his team have made significant breakthroughs. They have had two major reports featured on the cover of Hepatology, the worlds leading liver journal. As part of a nationwide NIH-funded study of children with various liver diseases, Teckman is collaborating with researchers across the country on Alpha-1 studies that could lead to more effective treatments. In addition to his research, Teckman has lobbied Congress and the NIH for increased funding for liver disease, and, for several years, he has been on the board of directors of the Alpha-1 Association. He writes much of the organizations patient education literature.

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schmidt

Living the Mission | For

two weeks last fall, Martin Schmidt, M.D. (86), woke early each morning and trudged up a steep hillside to see children in a poor village in western Kenya. He worked eight to 10 hours a day in a stuffy tent with limited supplies and endless medical problems. He suspected many of the children had HIV. Many more were orphans who lost their parents to AIDS. He helped those he could and shed tears for those he could not. When he left, he had one thought: I wish I had done this sooner. This mission trip was the most rewarding professional experience of my life, Schmidt said. If

I had gone 25 years earlier I think my perspective on whats really important would have matured sooner. Its not how big your house is or how expensive your car is its family and friends and community. Everyone knows these things but we dont live by them. Kenyans live by them. They are uncluttered. Schmidt, a private practice pediatrician in St. Louis, went to Kenya with Project Helping Hands, a non-profit group based in Oregon that has been providing health care in Third World countries since 1994. He was encouraged to go by two nurses in his office who had worked with Project Helping Hands previously. He also was inspired to take

the journey after hearing a grand rounds presentation at Cardinal Glennon Childrens Medical Center given by Mark Kline, M.D., president of Baylor College of Medicines International Pediatric AIDS Initiative. The statistics were unsettling, recalled Schmidt. West Central Kenya has the highest rate of HIV/ AIDS in the country about 23 percent of adults are infected. Many succumb to the disease, leaving behind their children. It is estimated Kenya has more than a million orphans. In preparation for his trip to Oyugis, Schmidt spent several months collecting vitamins, childrens ibuprofen and antibiotics from any pharmaceutical representative who came through his door. I saw a little girl who was suffering from malaria, and we didnt have any malaria drugs because the political

unrest in the country cut off supplies, he said. I was only able to give her mother Motrin to fight the fever, but she was so grateful, we both ended up crying. While this was Schmidts first mission, it wont be his last. Helping Hands has received land to build a permanent clinic in the village. The agency hopes to get the clinic up and running but then leave it in the hands of the community. Schmidt said physicians and residents from nearby medical and nursing schools would staff it. Self-sufficiency is what drew me to this organization, Schmidt said. I didnt want to go and just put a Band-Aid on the problem. I want to be a part of something that is creating a lasting impact. Schmidt hopes to bring his three children with him on one of his next missions.

In Memoriam
Thomas Aceto Jr., M.D.

Alumni Receptions April 28 May 3 May 5 May 14 May 18 June 15-17 Aug. 2 Oct. 22-24 May 30 June 2-3 June 2-4 June 5-6 June 12-13 June 13 June 26-28 American Academy of Neurology - Seattle Pediatric Academic Societies - Baltimore American College of Obstetricians and Gynecologists - Chicago School of Medicine Precommencement American Psychiatric Association - San Francisco New Resident Orientation White Coat Ceremony Medical School Reunion CME programs Acute Stroke & Cerebrovascular Intervention The 20th Annual SLU Summer Geriatric Institute: The Building Blocks of Geriatrics Dubai Spine Masters II: Advances in Deformity Management - Dubai New Techniques in Colorectal Laparoscopic Surgery The Latest Techniques in Foot and Ankle Surgery Annual Alumni/Residents Day Cosmetic Blepharoplasty (pt. 1) and Introduction to Face Lift (pt. 2)

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former chair of pediatrics and former pediatrician-in-chief at SSM Cardinal Glennon Childrens Medical Center, died in January. He was 79. Dr. Aceto chaired pediatrics from 1980-1990, a time marked by tremendous growth. His contributions include expanding the departments full-time faculty and launching developmental pediatrics at Cardinal Glennon. The Knights of Columbus Developmental Center, which opened in 1982, continues to treat children with conditions such as mental retardation, neuorological disorders, learning disabilities and autism. Dr. Aceto also was known for his extensive research on growth hormone replacement, which led to better understanding of the physiology of growth and therapy of those children with growth disorders. Dr. Aceto is survived by his wife, Arne, and by two daughters, both of whom are doctors.

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For information on the CME programs, please call the SLU School of Medicine continuing medical education office at 314-977-7401. See updates and details about Practical Anatomy Workshop programs at pa.slu.edu. For any other events, please contact the Alumni Relations Office at 314-977-8335.
Bernard Fehlman, M.D. (51) William Sullivan, M.D. (51) Valle Willman, M.D. (51) Robert Burns, M.D. (52) Gilbert Maestas, M.D. (52) F. Ritter, M.D. (52) Eugene Tucker, M.D. (52) Donald Belknap, M.D. (53) William Doubek, M.D. (53) Thomas Cook, M.D. (54) Neil Gallagher, M.D. (54) Charles Gariety, M.D. (54) Benjamin Kozikowski, M.D. (55) Kenneth Walter, M.D. (56) Joseph Russell, M.D. (57) Theodore Baiz, M.D. (58) William Tierney, M.D. (60) Donald Maraist, M.D. (62) John Phillips, M.D. (62) Michael Burghardt, M.D. (64) William Holm, M.D. (65) James Ottolini, M.D. (65) John King, M.D. (68) Fredric Suser, M.D. (73) Michael Cunningham, M.D. (78) Gregory Mantych, M.D. (82) Douglas Pohl, M.D. (83)

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He truly was at the forefront of plastic surgery for his time and on the cutting edge of such diverse areas such as cleft lip repair, head and neck surgery for cancer and hand surgery, said Robert Johnson, M.D., chair of the department of surgery. Dr. Paletta was a founding member of both the Plastic Surgery Research Council and the American Society of Surgery of the Hand. Dr. Paletta is survived by his wife of nearly 25 years, Mary Howard Paletta and eight children, including his son Francis Paletta Jr. 77 and Christian Paletta, M.D., who is director of plastic and reconstructive surgery at SLU.

In Memoriam
Amedeo Losito, M.D. (38) Cecil Baker, M.D. (42) Arthur Howard, M.D. (43) John OConnor, M.D. (43) Charles Oliphant, M.D. (43) Joseph Robinson, M.D. (43) Ernst Wallen, M.D. (43) James Kilduff, M.D. (45) George Schejbal, M.D. (45) Jack Barrett, M.D. (46) Frank Dzurik, M.D. (46) Edward Kessler, M.D. (46) Joseph Kolp, M.D. (46) Gregor Sido, M.D. (46) Edmund Massullo, M.D. (47) Raymond Murphy, M.D. (47) Michael Healy, M.D. (48) Peter Mathieu, M.D. (48) Daniel Radecki, M.D. (49) Peter Regan, M.D. (49) Richard Saunders, M.D. (49) John Walterscheid, M.D. (49) James Donahoe, M.D. (50) Harold Schwarz, M.D. (50)

Francis X. Paletta, Sr., M.D.


an internationally recognized physician who directed the division of plastic and reconstructive surgery for 35 years, died in February. He was 93. Dr. Paletta joined the faculty of the department of surgery at the SOM in 1950 and formed the residency program in 1954. In 1956, he started the Midwests first cleft palate team at Cardinal Glennon. He served as chief of the division of plastic surgery until his retirement in 1985.

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Scenes from Reunion 08 LEFT Thomas J. Olsen,

M.D. (79), president of the alumni association, with 2008 Alumni Merit Award Recipient Edward A. Chow, M.D. (63), and Philip O. Alderson, M.D., dean and vice president of health sciences. Chow was recognized for establishing the Chinese Community Health Care Association, an HMO that ensures health services are more accessible to the Chinese community of San Francisco. ABovE Members of the Class of 1988.

Make Plans For Reunion Weekend 09 Oct. 22-24

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PROFILE OF PHILANTHROPY
The summer after his first year of medical school, Robert Christopher, M.D. (59), contracted polio three months before the polio vaccine came on the market. He took a year off to rehabilitate and returned to medical school paralyzed from the waist down, walking on crutches. Unsure whether Christopher could handle the rigors of medical school, the dean sent him to Robert M. OBrien, M.D., chairman of the department of orthopaedic surgery for an exam. With Christopher still sitting in his office, OBrien called the dean and said: The polio paralyzed his legs, not his brain. I dont see a single reason he cant make it through medical school. With that, Christopher became the first person with a physical disability to be admitted to the School of Medicine. This was way before the Americans with Disabilities Act, Christopher said. She was right. When I walked into an exam room and saw a patient with a spinal cord injury or a paraplegic who was down in the dumps, I could honestly say, I know how you feel. Ive been through this. When youre standing in front of them on crutches and youre telling them youre going to help them get through this, I think it carries a lot more weight. After completing his residency, Christopher spent four years on the faculty at the University of Michigan Medical School. From there he went to the University of Tennessee College of Medicine in Memphis, where he stayed for 33 years. In 2001, he retired from his position as professor and chief of the division of rehabilitation medicine. Christopher now lives in Vero Beach, Fla., where he and his wife, Doreen, are active in the local St. Vincent De Paul Society, providing food and financial assistance to low-income families. He also gives generously of his time to several organizations that work with people with disabilities, such as the Cerebral Palsy Foundation and the Arthritis Foundation. Christopher also gives generously to the School of Medicine and has done so since graduation. I couldnt give much in the beginning, but I felt it was important to give something, he said. State schools can get federal support, but private schools cant draw on those resources. Support for private schools has to come from alumni. Im eternally grateful for the faith the school showed in me, and I think its only right that I return the favor.

They didnt have to take me back, but they did. And every single professor did everything possible to make sure I had the same experiences as the other guys.
After graduation Christopher specialized in physical medicine and rehabilitation. When I got polio I spent five months in the hospital, he said. One of my doctors said I should think about rehabilitative medicine because I would have a natural affinity for my patients.

T O L E A R N M O R E about giving opportunities and tax benefits that may be associated with your gift,
contact the office of development at the School of Medicine at (314) 977-8303 or msalsic1@slu.edu.