Washington and Lee University
Ten years ago Tom Shepherd, the progenitor and sponsor of the eponymous Shepherd Poverty Program, visited us at Bellevue Hospital in New York City. Coincidentally, he was a classmate of mine, W&L Class of 1952. I didn't know Tom well then but over this last decade I have had at least nine occasions to silently bless him for his kindness and his utter genius at making his generosity work in a way that will pay large dividends for many years to come.
Along with Tom came the sage and kind Professor Harlan Beckley, the University on-campus driving spirit of the Shepherd Poverty Program. They wanted to be convinced that our treatment facility for heroin addicted patients passed muster. Wow, I thought, these folks are serious! To come from afar to check us out and be assured that their interns would be in a placement which would fulfill their vision was enough for me to want to give these dedicated undergraduates the experience they deserved. What I didn't expect then was the added value they provided our clinic and me. In the past, our clinic has "entertained" many medical students, residents simply passing through, and fellows in various disciplines. In large measure they were labor-intensive for us. Not this time.
Each new intern came with a toolkit of unique skills and a fervent desire to learn. But especially, they wanted to be of service. And indeed they were. They were assigned tasks as counselors-in-training. They ran groups as co-leaders. With careful supervision by Emily Howard, our director of social work, they worked with patients one-on-one. Emily grew up in Lexington by the way; her dad was Washington and Lee's bursar for many years.
I treasured the time I spent with these young men and women. I had them assist me in the clinical assessments of new patients. I taught them the rudiments of medical history taking and the physical examination with the shortcuts I had acquired over the last half century which they will discard and then learn their own. And that was, for me, a unique gratification. Almost all of these Shepherd interns planned to do just that, become physicians. Several of them are physicians already. I caught up with Dr. Lisette Casagrande '03 now in her last year of fellowship training in nephrology (diseases of the kidney) at Mt. Sinai Hospital and Medical School. She wants to super-specialize in transplant medicine. Whoa, I thought, when she was our Shepherd intern 10 years ago, she didn't know where the kidneys were exactly, and now, look at her, a trained and dedicated physician-scientist already making her mark. Nephrology, especially kidney transplantation is a field fraught with ethical issues in matters of affordability (poverty) and end-of-life decisions. Perhaps I knew from the beginning that someone as energetic, as enthusiastic and as smart as Lisette Casagrande would be doing what she is now doing.
The last intern before I retired, Andrea Hanick '10, is enrolled on scholarship in the MD/PhD program at Case Western Reserve University School of Medicine. She, like every one of the others, is marked for something special. Like the others, she brought her dedication and enthusiasm.
I believe it was with Kyle Meehan '05 that I took advantage of my long-standing professional relationship with Dr. Barbara Sampson, now associate director of the Office of Chief Medical Examiner of the City of New York. The Medical Examiner (ME) Headquarters are on the campus of the NYU School of Medicine so it was a short walk to the ME autopsy suite where on any given morning five or six autopsies were being done simultaneously. I arranged for the Shepherd interns to observe the workings of the largest medical forensics enterprise in the world. Never having seen an autopsy before, each one reported back to me, in their own words, what a transformative experience this was for them. Indeed, it was a lesson in the final common pathway of poverty, death by murder, by suicide, by traumas regularly associated with homelessness and destitution.
Stuart Hurst '07, now at the Emory University School of Medicine, was the first Shepherd intern I introduced to Dr. Ken Carr whose lab is exploring the neurobiology of addictions. Stuart saw cutting-edge research that will have, in the long term, much to do with understanding the biology of the addictive diseases. The relationship between alcoholism and drug dependency to impoverishment throughout the world is being studied in animal models. The neurobiology of craving is what addiction is all about. Stuart was so taken with the work being done in Ken's lab he stayed on for the entire morning. He returned to the clinic to continue his work with our patients with a perspective on poverty from neuroscience that will serve him well.
Each of the 10 interns, nine from W&L and one from Berea, have had a rich experience. Hamlet says in Act V, Scene 3, "The readiness is all." The eight weeks these students of poverty spent with us have increased their readiness for the rest of their lives.
Dr. Robert Maslansky is retired medical director of the Out-patient Addiction Rehabilitation Services of the NYU School of Medicine at Bellevue Hospital, a Division of Alcoholism and Addictive Diseases of the Department of Psychiatry.