Albert W. Grokoest 1917-1991
By Nicholas P. Christy '51
This series, Faculty Remembered, features profiles of former faculty members at P&S. The author of the series is a 1951 P&S graduate and former professor of medicine. He is now special lecturer in medicine and writer-in-residence at P&S.
1917: born in Lincoln, N.H. 1924: parents divorced. Learned viola as a boy. 1935-39: planned to major in music at Hamilton College but urged to study chemistry. 1939-43: P&S. 1944: medicine intern at Presbyterian Hospital. 1944-46: Army service in World War II Italy. 1946-48: medicine resident at Presbyterian. 1950: Faulkner fellow in the arthritis clinic of PH. 1949-68: co-author of 10 papers on rheumatoid arthritis. 1962: book on juvenile rheumatoid arthritis. 1969: president, New York Rheumatism Association. 1950s-70s: "downtown" practice in internal medicine and rheumatology and observations and conclusions about novel approach to patient. 1976-86: chief of the arthritis clinic at Roosevelt Hospital. 1989: retired. 1990: emeritus status at Columbia after 40 years in P&S Faculty of Medicine. 1991: died of cancer of the prostate.
Grokoest. s practice and teaching cannot be understood without knowing his early life and what he later learned from his patients. The parental divorce when Albert was 7 shattered him. His mother was cold and distant. As a boy from the only divorced family in a small town he felt ostracized. His musical talent was the only way he could please his mother.
Looking back, Grokoest concluded that P&S taught him disease, not diseased patients. To speed up the process of growing up, he embarked in the 1950s on a course of Freudian psychoanalysis, pursued for many years. This, coupled with clinical revelations from his patients, gradually transformed his life and practice.
The essence: You cannot practice medicine without a healthy psyche yourself. The key to much illness, he found, is loneliness, usually due to distant, inept upbringing by remote "hands-off" parents. The link here between this conclusion and Grokoest. s own early history is, of course, obvious. He had to learn to control his own need to control-by-rescuing so he could recognize and amend such tendencies in patients. using disease as a substitute for the absence of love and friendship.
Patients supplied numerous examples of the overriding power of emotions in the pathogenesis and course of disease. A man with rheumatoid arthritis, trapped in Holland Tunnel traffic, has a panic attack; his RA abates. An 8-year-old girl with juvenile rheumatoid arthritis has enuresis. Her cold, remote parents impose harsh measures; the JRA gets worse. When the restrictions are lifted, the JRA subsides. A friendless 15-year-old boy with JRA tells Grokoest, "You can. t throw a cripple out into the street," and "my parents don. t care about me." Three young men with AIDS survive unusually long periods when they unlearn that sexual contact is the only way to express friendship. Many alcoholics turn out to be using drink as a replacement for comradeship. Once, Grokoest was able to suppress an acute flare-up of RA over the telephone.
It is easy to imagine that Grokoest. s conventional colleagues sometimes looked askance at his unorthodox beliefs and methods, regarding him as "way out" or "over the fence." Nonetheless, given his standing as a distinguished rheumatologist ("technocrat," as he put it) and internist, they did not treat him dismissively. As for medical students, Grokoest made his deepest impression upon the youngest; his influence was most potent with students. many, not all. It was less so with house staff and less still with attending physicians. This is no indictment of Grokoest. s "message," rather of growing technocratic dominance as young doctors age.
Dr. Grokoest. s special way of teaching his preceptorial groups stressed doctors. formal demeanor and unflagging awareness of their own behavior and moment-to-moment reactions to the patient. An excellent account of Grokoest. s methods was given by a former student, M.G. Luken III. 73, in the letters column of the Spring 1999 issue of P&S Journal. Most students were deeply impressed by this approach. But one tutorial group, during the third-year clinical clerkship in medicine, complained that Grokoest. s material was "inappropriate," presumably not technical enough. Grokoest. no stranger to anger. resigned as preceptor.
The other two main threads of Grokoest. s career were music and art. His maxim to students and patients: "Surround yourselves with beauty." He played viola with amateur string quartets, often including professionals. The word spread; he acquired many musicians as patients and acted as physician to the New York Philharmonic during its tours. He sponsored and financially helped young groups getting started: the Orpheus Chamber Orchestra, the Alexander String Quartet, and others.
Painters became patients. He collected widely, often buying pictures by unknown artists depicting people in distress. Grokoest used these as illustrations for patients and students. One such painting, of a skeletal, ravaged young man by the Austrian Egon Schiele (1910), was bought by Dr. Grokoest at an auction for $5,000 in 1959. He hung it in his waiting room for patients to think about. At Sotheby. s 24 years later, he sold it for $2.4 million. The famous Mark Rothko was "rescued" by Grokoest who correctly diagnosed hitherto unidentified gout. A grateful Rothko gave his doctor a valuable painting, which Grokoest bequeathed to a New Hampshire museum.
Grokoest left two enduring contributions to P&S. First is the A.W. Grokoest Scholarship for P&Sundergraduates to support studies of approach to the patient and the "mind-body connection." The other is a continuing series of family symposia for people with arthritis. These are held biannually throughout the New York metropolitan area on the same topics; they take place at local hospitals, administered by the New York chapter of the Arthritis Foundation in cooperation with several medical schools.
So Dr. Grokoest. s work goes on. He worked hard to subdue his own psychic injuries, putting them to use. Weaving together the strands of his life. technology, medicine, music, art, his psyche. he translated all this into unusual empathy with patients and students, achieving a novel, unique approach. Unconventional, unorthodox, independent, cranky, original, and "different," he never endeared himself to the medical establishment. But it can be argued that, for those who came under his tutelage, what they learned from him outweighed the ordinary curriculum by suffusing their day-to-day practice with more forbearance, more astuteness, more sophistication. more mercy.
Author. s Note:
This illustrates the unorthodoxy of his teaching and his musical leanings: To emphasize the importance of pitch in detecting heart murmurs, he had students sing. aloud. the opening bars of "Farmer in the Dell." In 1989 he auditioned to play the viola in a Mexican orchestra, which judged his playing "authoritative," about which he wrote, "In Mexico, authoritative means loud." This is a fraction of the existing material.. N.C.
The writer acknowledges the help of P&S archivists and of Roslyn Hawkins and Inge Mayer in the Department of Medicine. Ross Alfieri, president of the New York chapter of the Arthritis Foundation, and Ken Browne supplied valuable materials. Several physicians at Columbia provided useful biographical data and appraisals: Dr. Dorothy Estes, Dr. Felix E. DeMartini, and Dr. George H. McCormack, who also directed the writer to other sources. Dr. Charles L. Christian, once a colleague of Dr. Grokoest. s at Presbyterian and former head of New York. s Hospital for Special Surgery, gave a rich store of anecdotes.
"Nature. s Cure: The Art of Dr. Albert Grokoest," a 12-minute video produced by Ken Browne, is available at a cost of $15, including shipping and handling. An audio cassette recording of a 1987 radio interview is available at a cost of $8. Both can be ordered from Ken Browne Productions, 41 Union Square West, Suite 1121, New York, NY 10003. Orders can also be placed by phone (212-243-4344); fax (212-243-0381); or e-mail (email@example.com).