P&S Journal: Spring 1994, Vol.14, No.2
Caregivers Learn to Care for Themselves
By Jody Godfrey Melzer
"If we don't care for medical students while they are at Columbia, by helping them help each other, how can they be expected to care for others as doctors?" That sentiment led to the formation of the AIMS (Assistance to Impaired Medical Students) program in 1985.
"There is a prejudice that works against health professionals-a belief that knowledge is virtue-and this tends to perpetuate the myth that doctors don't have human problems," says Dr. Mark Gerald, assistant clinical professor of psychiatry and faculty chairman for AIMS. An estimated 10 percent of doctors are impaired at some point in their careers.
AIMS provides a resource for medical students to seek assistance for themselves or others with problems that may diminish their ability to fulfill daily responsibilities. Chemical dependency, substance abuse, alcoholism, abusive relationships, eating disorders, and other impulse-related problems are examples.
The AIMS council, comprised of nine faculty members and nine student representatives (two representatives elected from each class and one M.D./Ph.D. representative), is coordinated by Father Daniel Morrissey, assistant clinical professor of public health, who lives in Bard Hall. P&S was the second school to form an AIMS program, which also serves dental and nursing students and students in occupational and physical therapy programs.
The greatest challenge to the AIMS process is getting people to overcome the fear of reprisal. Confronting a problem, even someone else's problem, is difficult, and solutions are complicated. "Some students criticize AIMS because they feel it is not their job to 'police' their peers," says Susie Robb'96, an AIMS class representative, "but when we become doctors, we will have to look out for our colleagues because their impairment can endanger patients."
"Taking that first step is very difficult, but being able to intervene early moves the person closer to a more productive future," says Dr. Gerald. The welfare of P&S students motivates AIMS representatives, who have developed a track record for handling problems discreetly to make AIMS more accessible.
Counter to common assumptions about AIMS, the group doesn't make diagnoses, report findings, or provide treatment. Rather, AIMS is responsive and exists to provide an unbiased opinion about gray areas of conduct. Not intended to compete with other resources, such as student health services, AIMS is a sounding board.
When a problem is identified, the AIMS group may recommend a professional evaluation. Most of the specialists recommended are not affiliated with the university so the student can be offered privacy and confidentiality. Although AIMS representatives may follow up to ensure an evaluation appointment is kept, they do not receive results of the evaluation or any treatment that follows.
"The AIMS program focuses on students' lives now, while the nature of medical education prepares them for their future lives as doctors," says Father Morrissey. "AIMS tries to be the Golden Rule in practice, 'Do unto others as you would have them do unto you.' If we don't take care of them now, how can they learn to be caring doctors?"
By Nicholas P. Christy'51
Yale "Eli" Kneeland taught physical diagnosis for 20 years until he retired in 1967.
That bald sentence conveys nothing of the special influence he exerted on students and on the atmosphere of the place. Imagine P&S in the late 1940s: World War II had just ended. Euphoria abounded. The USA was on top of the world. Columbia occupied a firm place at the top of American medicine. Manhattan was easy to live in. The streets were safe; you could ride the subway at any hour. Within the walls of the Medical Center the emotional atmosphere was grave. A greater distance between students and faculty prevailed then than now. Medicine was taken as an immensely serious business. Most of our teachers were dour. Most of us admired Columbia but few of us loved it, a sharp difference from the friendlier climate of today.
Imagine encountering Professor Kneeland then, a senior member of a luminous faculty, presiding over a major course that would introduce us for the first time to real live patients. But here was a man actually willing to show us he had a sense of humor. He was tall, sturdy, and moved slowly-the rheumatoid arthritis that plagued the last 20 years of his life had already begun to limit his activity by 1949-and with dignity. He favored brown tweed suits, usually with a waistcoat, and striped shirts with high collars, giving him an old-fashioned look. To the perpetually intimidated medical student he appeared aristocratic and aloof. Brief acquaintance disabused us of the notion that he was the remote figure he seemed. We soon saw that kindness, good humor, and unfailingly delicate attention to the feelings of others radiated from him continually.
In an early lecture he spoke to us of the need for doctors to be frank with their patients. "But by frankness," he said, "I do not mean you should say to a frightened man, 'My dear sir, you have irremediable cancer, and if you are still alive three months from now, I'LL EAT MY SHIRT!'" In a formal lecture, this line, delivered with force and with Kneeland's impeccable timing, made us roar with laughter. More, by its intentional outrageousness and its plain statement of what not to say at the bedside, his joke sent an essential message, etched into our memories forever. His background, education, and broad humanistic interests fitted him perfectly for the roles he would play at P&S: conscientious, dedicated teacher; purveyor of old-fashioned, indestructible values; model of the technically expert, invariably kindly physician. Born in Rumson, N.J., he attended private schools, where he excelled. At Yale, he mastered Greek and Latin and endured the primitive teaching of chemistry there in the 1920s: Students had to repeat, after the professor, a litany of the chemical elements ("N-A-natrium, K-kalium...").Overcoming such anachronisms, he was elected to Phi Beta Kappa and graduated, intending to pursue literary studies. Made to see that his true calling was medicine, he entered P&S despite "a technical deficiency in physics" that required, to circumvent the educational rules of New York State, the intercession of P&S's dean and Columbia's president. Their confidence in him was justified: He graduated in 1926, second in his class, a member of AOA.
After a Presbyterian internship, he joined the Department of Medicine, which he was to adorn for 40 years, attaining the rank of full professor in 1958 and forging a brilliant research career, at first with the famous virologist A.R. Dochez. Kneeland and K.C. Mills were the first to establish that the causative agent of the common cold was a filtrable virus. Among 40 major contributions to laboratory and clinical studies of viral disease, Kneeland showed that "viral" (Mycoplasma) pneumonia could be cured by tetracyclines. He delighted in telling how he presented these seminal, exciting findings before the august Association of American Physicians in 1949. Unhappily, the program included Philip Hench's announcement of the first use of cortisone in rheumatoid arthritis. This totally eclipsed Kneeland's paper, but, typically, he made a funny story of it.
From the 1940s on, at Columbia, in New York, and in the country, he became recognized as an authority in infectious diseases, widely sought as a consultant. During his 1942-45 World War service with Presbyterian's Second General Army Hospital, based in Oxford, England, he was appointed senior consultant in infectious diseases for the entire European theater of operations with the rank of colonel. He was twice awarded the Bronze Star for outstanding work in care of the wounded and in preventing the spread of typhus among civilian populations.
Upon discharge from the Army, Dr. Kneeland resumed his teaching duties, taking on the complex task of managing the course in physical diagnosis, which was taught all over the city-at Presbyterian, Bellevue, and Goldwater hospitals. He regularly made rounds in general medicine and in infectious disease. His presentations at team rounds were masterpieces of clarity, order, and scholarship, memorable for his sure feeling for the right word and the pungent phrase, leavened by a delicious humor all the more winning because it was never at anyone's expense. Students, sensing his grace, his "easy, modest elegance," and his "great warmth," dedicated the P&S yearbook to him a record number of four times.
Member of all the important medical and scientific societies, bibliophile, editor with Robert Loeb of a classic textbook of physical diagnosis, trustee of the American University of Beirut, president of the Century Association, and sportsman, Eli Kneeland faithfully kept on teaching-even after arthritis put an end to the sports he loved and forced him to conduct classes from a wheelchair-until his retirement. He never complained. His manner was bright to the end. He remained a comfort to his patients, a delight to his students and friends, a gallant example to everyone. More than anyone else, Eli taught us we could enjoy medicine. He inducted us into medicine's magic circle and, when we arrived there, he made us feel at home.