Excerpt published in Wisconsin Medical Journal
Lu Ann Moraski, DO

Chapter 19

Quarter Pounder with Thighs

Dennis Costakos, MD
Neonatologist
La Crosse, WI

    I was working as a patient transporter at Albert Einstein Hospital while in high school. There was one particular eye cancer, that to cure the cancer, they just remove the person’s eye—called malignant melanoma of the conjunctiva. It’s just a little cancer of your eyelid, so I became interested in using physics or chemistry to try to treat the person with that surgery—the first paper I ever wrote.
    I used an isotope, a radioactive chemical that nobody had thought of using. Hafnium 182 has a very long half life, so if a hospital purchased it, it’s a one-time purchase for the hospital’s existence. Basically, I had figured out that this isotope put out two different types of radiation, within a magnetic field. I could curve the one that I wanted to the patient’s eye and let the other one go into the wall. I wrote all the physics equations.
    I didn’t have to treat any patients. Doctors had worked out the biology of the tumor and they already knew what radiation worked. But with the current radiation techniques in the 70s, they had to use surgery. I used an electric field to give the medical team the radiation they wanted, but not the radiation that would hurt the patient.
    Of course, I put it in various science fairs, and I presented it to some of the physicians at Albert Einstein. I remember David Milstein, MD, the director of radiation or nuclear medicine reading it and saying, “No, this would not be something we would do.” He said to me three or four years later, “I held your paper. That idea now is not so far fetched.”
    Well, maybe 6-8 years later, I went back to get a recommendation for medical school. He told me everything I had foreseen in that article went on to get done. To me, it just seemed so obvious, in the sense that I was really approaching the problem as somebody who was not a physician. I was 15 or 16 years old. My interest was chemistry and physics, but I wanted to be a physician. I put at the front of the journal that I wanted to be some kind of a medical scientist. I knew where I wanted to go and what I wanted to do. 
    In those days, the science folks in physics and chemistry, and the math and biology folks, really were in different circles. The groups basically did not really talk to each other. Everybody sort of went off in their own direction. I wanted to be a physician before I was ten. My grandmother Felicia said, “If he wants to be, don’t discourage him. It’s a good profession.” After my mother’s experience with cancer, even though for a little while I was moving more toward engineering or physics, that revitalized my interest in using physics and chemistry to heal people.

Chapter 21

"DR DTOX"

Michael Miller, MD
Addiction Medicine
Madison, WI

    I had an insight one day. I was going to teach a roomful of residents and medical students and I thought, What do you want the bullet points to be? What do you want the take-home messages to be?
    I walked into this room. They’ve never seen an addiction medicine specialist in their lives; they have no idea why they were asked to come to this lecture. I sat down and said, “When you work with a patient who has alcoholism or addiction, the only thing you have to do to be successful with them is to love them. That’s what you have to do because nobody else does, and they don’t love themselves. They’re terribly ashamed, and they’re used to people in the health care system getting down on their case, making smart aleck comments, yelling at them, blaming them. They expect the health care system to treat them the way that the rest of society does, if not worse.
    “Walk in there and care about them as a person, listen to their story, be non-judgmental, and have them experience you as somebody who cares about them, even with their alcoholism or drug addiction. It will be transforming for them. I see it in my patients every day when I see them realize how I’m interacting with them. You can do the same thing. If you don’t do it, if you walk in there with an attitude, if you walk in there and make them feel worse and make them feel still more guilty, and make then feel more self-loathing, you’ll be just like the rest of ‘em.
    “And the patient will clam up and not give you accurate information. You won’t make an accurate diagnosis. You won’t have a good doctor/patient relationship. They won’t do what you ask. They won’t come back. You’ll have a treatment failure and a self-fulfilling prophecy. The first thing you need to do with these patients is to love them.”

 How did they react to that?
 
    Very respectfully, very thoughtfully. Whoa, what’s this guy saying? They also know I’m not nuts. When they hear it, they like, mull it around, but it resonates.
    I feel good about the opportunity to work with these young people. When you work in psychiatry, it’s somewhat out of the mainstream of medicine. You could be looked askance by peers. “Oh, you’re just a shrink. You don’t practice real medicine.”
    If you’re in addiction, the stigma’s worse because the common belief is; well of course, these people brought it on themselves. It’s willful misconduct—all of which are inaccurate and biased statements. But they’re part of the popular culture and popular stigma, the young doctors in training pick up from the culture we live in.
    Within addiction, there’s a caste system. Working with alcoholics, the unwell, the unemployed who are neighbors, everybody knows an alcoholic. Everybody has them in their family. We may hate alcoholics, but we know Uncle Joe and Aunt Patty are alcoholics, and we love them, so they’re okay.
 “But junkies? Oh no. Junkies are different than drunks.” If you work with drug addicts, you’re even more to the marginalized group. And if you’re a doctor working in a methadone clinic, obviously, you can’t get a job working anywhere else. “Maybe you could get a job in a prison. Maybe you’ve lost your license.”
     A doctor who works in addiction with drug addicts in a methadone clinic, which I don’t, is the most stigmatized of all! Is there something about me that likes to say, I’m up to that. I’ll be different. I don’t care what those bastards say. I’m going to go out and take care of these people and do a good job of it. I am sure that is part of it that’s drawn me to this line of work. I’m happy to be there when nobody else is willing to be in the fray.

Chapter 32

Miraculous Minds

Darold Treffert, MD
Pyschiatry
Fond du Lac, WI

    "Rainman" is not the story of Kim Peek. He inspired the movie, but it’s not his story. It is a composite of a number of savant skills in the character of Raymond Babbitt. But all the skills that you see are based on real people. The toothpick scene is real. There have been cases of that instantaneous, eidetic imagery, and the ability to immediately count how many items are on the floor, almost before they get there. Computing square roots, but not being able to tell the difference between the cost of a candy bar and a sports car, is a very real phenomenon.
    The movie is really about two conditions. One is autism, and the other is savant syndrome, which is grafted on to the autism. The spectacular abilities—memorizing the phone book, the toothpick scene and others—those are part of savant syndrome. But, “Judge Wapner— I got to see Judge Wapner” at an exact time—those are parts of autism. The point is that not all autistic people are savants and not all savants are autistic.
     Dustin Hoffman did a marvelous job of portraying autism and savant syndrome. He spent some time with autistic people. Savant syndrome is a condition in which people with autism, or some other developmental disability or central nervous system disorder, have some island of genius that stands in contrast to their overall handicap. But it can be autism. It also can be just more generalized brain damage, or it can be, we’re learning, Alzheimer’s or certain other forms of dementia. For example, people can develop skills, unearth skills that were not evident before, which is the so-called acquired savant, which itself is a fascinating area because it talks about what I call the little “Rainman” within us all. And the trick is how to tap that without having a stroke or some other kind of catastrophe.

Hear audio clips from the interviews.