P&S Journal: Fall 1996, Vol.16, No.3
Alumni Profile: Abbie Ingalls Knowlton: A Doctor's Doctor
By Peter Wortsman
Abbie Ingalls Knowlton'42
|For more than half a century, Abbie Ingalls Knowlton'42 has relished the courage and conundrums of the human species and committed her life to the care and study of what ails it.|
Asked what medicine has meant to her, her soft voice falters at first before finding the right words, accented ever so slightly by the hint of a Virginia drawl: "It's an enormous privilege!"
Her medical career at P&S began on a winter morning in 1937, when, as a prospective student on her way to be interviewed by the late Charles Flood'28, she emerged from the subway and peered up at the towering specter of the old Presbyterian Hospital, leaning so far back she dropped her hat, and thought: "Oh my, this is a very big place!" Clearly impressed by the candidate's credentials, though unaccustomed at the time to women in medicine, Dr. Flood gave an enthusiastic thumbs up. She was one of six women admitted that year.
She welcomed the intellectual challenge of P&S, the clinical rigors of studying under Drs. Atchley and Loeb and went on to do her house staff training at Presbyterian, the first woman to be appointed chief resident in medicine. She subsequently joined the P&S faculty, pioneering clinical research in endocrinology, shepherding numerous chronically ill patients through decades of devoted care, and teaching generations of students and house staff how to listen. Adored by her patients, revered by her students, admired by her peers for the quality of her care and the depth of her caring, this soft-spoken petite woman, once daunted by the sheer magnitude of the medical center, has come to embody its heart and soul.
A Sister's Childhood Illness Marks a Medical Mind
| Medicine first piqued her interest in early childhood in the course of witnessing her older sister's serious illness with osteomyelitis and complete recovery under the care of an able physician. "We were both given dolls at the time and named them after doctors," she recalls, her sister's for the surgeon who made her well, and hers no doubt for the internist she hoped one day to become.|
Child's play turned serious in her teens, when she tagged along after the family doctor and volunteered in various capacities, taking blood counts and urine samples and scanning X-rays at the local hospital. The dean of her college, Bryn Mawr, recommended her to the P&S Admissions Committee as "one of the two outstanding undergraduates in science in this graduating class" and "one of the very best medical candidates we have had."
| At P&S, she came under the influence of Dr. Robert Loeb and followed him into the then-nascent field of endocrinology, focusing her clinical research interests on adrenal disorders. Dr. Knowlton co-authored (along with Drs. Charles Ragan and Charles Plotz) an important paper on Cushing's disease and specialized in the management of patients with Addison's disease with a knowledge that has been described as "encyclopedic." |
America's entry into World War II drew faculty and staff overseas for active duty. Despite a tradition of gender-based exclusion, Dr. Knowlton's outstanding qualifications made her the logical candidate for chief residency in medicine. In 1947, she was named instructor in medicine and has subsequently risen to the rank of clinical professor.
The introduction of glucocorticoids in the early 50s revolutionized the care of individuals with Addison's disease and other endocrine disorders, in many cases turning lives around.
Dr. Knowlton and her colleagues helped fine-tune and tailor the administration of glucocorticoids to the needs of patients.
A Legend in the Quality of Patient Care
The quality of her patient care is legendary. In the words of longtime colleague Nicholas Christy'51, "She surrounds her patients with careful attention but manages to do this without being obtrusive." Selected by her peers as president of the Presbyterian Hospital Practitioners Society and honored as Practitioner of the Year, she also has received the Arnold Gold Foundation Award given to a distinguished physician "who has demonstrated compassionate and devoted patient care and who has served as a humanistic role model for students and young physicians." This honor found its fitting complement more recently when another colleague, Dr. Edward B. Schlesinger, the Stookey Professor Emeritus of Neurological Surgery, set the financial wheels in motion to endow an annual prize in Dr. Knowlton's name to be awarded to a third-year student who best exemplifies her high standard of care.
"The basic business of the physician is the one-to-one relationship with the patient, and no government regulation or HMO constraints can change that," she adamantly maintains. To Abbie Knowlton, there are few things more satisfying than the human dimension of that extraordinary partnership and trust.
She fondly remembers the brave woman with Gaucher's disease, bedridden and in chronic pain, whose case she followed for many years. Merely listening with obvious concern proved a lifeline, emboldening the patient to battle for life and make the most of her difficult condition.
And there was the obese diabetic Dr. Knowlton repeatedly and unsuccessfully urged to lose weight. Finally, Dr. Knowlton faced her with the statement: "Your diet is a limited one on which you should be losing weight. I have to think you're not following it." The patient was incensed: "Indeed I am! I eat my diet every day-and then I eat my dinner!"
She won the confidence of another difficult patient, coaxing him to take his medication with talk of betting at the track, which proved a living metaphor for his betting on himself.
Teaching by Example Is Her Remedy of Choice
Today Dr. Knowlton worries that, with all the constraints on the doctor-patient relationship from managed care and government restrictions, doctors have less time to really get to know the patient. Teaching by example is her remedy of choice. She has coached scores of first-year students in the art of interviewing the patient and taught second-year physical diagnosis in the Atchley-Loeb tradition.
|She has orchestrated the weekly Clinical Pathological Conferences (better known as CPCs) that have become legendary over the years. Selecting diagnostic puzzles from among the current cases, reviewing charts, collating, summarizing relevant data, inviting specialists, radiologists, and pathologists to discuss each case-the result often proves an unforgettable learning experience for all parties concerned. "At P&S, we call her Dr. CPC!" says Andrew Frantz'55, professor of medicine and chairman of the admissions committee, on which Dr. Knowlton serves, interviewing prospective students and house staff.|
So what is the secret of great teaching? "First off, you've got to want to teach, of course," she laughs, acknowledging a wide variety of effective modes and styles, from the flamboyant lecture to the solid well-organized presentation.
How would she characterize her own pedagogical method? "Strictly bedside, in the Loeb tradition! Taking patient histories, moreover, is still one of the great pleasures in medicine," Dr. Knowlton adds, plucking an apt simile from her extra-medical life. "It's like fishing," she says, "you cast and then you reel in a little, giving them just enough line to run with so they feel that they've expressed themselves, and then of course for those who run on forever you reel them in a little tighter!"
There's an irrepressible twinkle of joy in her eye as she speaks of patient care. As she readily affirms, "I can't think of any way I would rather have spent this last half century."
Colleague and research collaborator Leslie Baer'63, associate professor of medicine, calls her "the consummate physician, a scientist who brings her abundant humanity to bench and bedside." One quality that makes her such a fine teacher and role model, he believes, is the fact that she has "always stayed open and never stopped learning."
Long before the quandaries faced by women in the workplace entered the popular consciousness, Dr. Knowlton managed to balance the joys and responsibilities of family and medical life, while raising a son and daughter with the staunch support of her husband, the distinguished psychiatrist and past president of the American Psychoanalytic Society, Kenneth Calder'44. She was married previously to another P&S-trained psychiatrist, Peter Knowlton'43.
A Leader in Rallying Alumni Support
For years, she has added to her busy schedule service to P&S and its Alumni Association. "I firmly believe that the only thing that can save this world is education," she insists. To that end, she has long invested a considerable amount of time and energy to help rally the ranks, notably while president of the Alumni Association, as co-chair of her class since 1978, and as chair of the P&S Annual Fund since 1983. Under her leadership, the fund rose from $558,220 to almost $7 million this past year.
Sobered some years back by the diagnosis of metastatic ovarian cancer, she has not allowed illness to crimp her style or dampen her enthusiasm. Teaching, caring, interviewing prospective candidates, leading the alumni, Dr. Abbie Ingalls Knowlton continues to set the pace at P&S. In the words of Dean Herbert Pardes, "Abbie applies the best in herself as physician, educator, and human being to help bring out the best in us all."