Dr. Jeffrey Lander, Ophthalmologist, Tries Not to Make Any Mistakes

Dr. Jeff Lander

York ophthalmologist Dr. Jeffrey Lander admitted that he has a Type A personality and is a perfectionist. Born and raised in Warren, Ohio, not far from Youngstown, he went through primary school as a mediocre student. He had no direction in the small town that was dominated by steel production (he worked for a summer in one of the dangerously hot mills). But Jeff’s canny sixth-grade teacher, an imposing former basketball coach, wanted his students to excel, so he spent the entire year warning them that they needed to “hit the ground running” when they got into the seventh grade or they would surely fail. 

Dr. Lander told me he was the only kid “stupid enough” to actually believe the teacher. So he studied all summer to avoid flunking out the following year. And he found out that he was pretty okay at learning if he put his mind to it. 

He continued to do well academically through high school in the late 1960s and early 1970s. At age sixteen, his aunt asked him what he was going to do with his life. Having no clear path in view, he ventured lamely that he would, perhaps, study German or maybe go to medical school.

Part of the abandoned Warren Steel mill in Warren, Ohio
as many heavy manufacturing businesses collapsed
  (From "Architectural Afterlife")

“Jeff! Are you crazy?“ she said.

“Okay, I will go to med school,” he replied, reacting swiftly to the tone of his aunt’s stern response. (This was an example, said Dr. Lander, of his inclination to make important life decisions without a lot of conscious thought, “without thinking very hard.” Decisions that usually turn out quite well... though not always.)

There was intense competition for spots in medical school, so Dr. Lander studied his “butt off” in high school. And he did a few things in those important adolescent years of rapid brain change that (it turns out) helped prepare him for his work as an eye surgeon: he built model airplanes, liked to draw, and played the piano (where his “four limbs were doing different things at the same time”). And his church pastor (possibly agnostic, thought the perceptive student) taught Jeff critical thinking, the skill enabling one to look carefully, to see things as they are. This became a lifelong habit.

Though not a Catholic, Jeff decided to go to John Carroll University in Cleveland, since they had a good track record (about 50%) of getting people into medical school (mostly by weeding out a bunch with especially difficult courses early on). The Jesuits (“the intellectual force of the Catholic Church during the Reformation,” said Dr. Lander) strengthened Jeff's analytical bent. 

John Carroll University (From JCU)

He had “laser focus” in college and received letters of early acceptance to two medical schools on the same day: he was offered a position at the prestigious University of Washington, St. Louis, and one at the state-sponsored “free” Medical College of Ohio, three hours from home. It was a no-brainer; he stayed in Ohio.

Jeff wanted to be “the best doctor” possible. So he “did nothing but study” just to land “in the middle of the class.”   Surprisingly candid, he said that his experience in medical school “was  awful.” The academic work came easily but the clinical rotations were challenging. 

The first class of the Toledo State College of Medicine,
later named Medical College of Ohio, in 1969
 (From the University of Toledo)

No attending he worked with, he wryly noted, wrote in their review of him that, “Student Lander was one of our best medical students ever!” Yet he did manage to receive “honors” in a few of the specialties. During his psychiatry rotation, for example, he sat down with a hospitalized patient and she opened up and told him everything. The attending remarked the next day that the woman greatly enjoyed being interviewed by him. But she thought Jeff was a priest and was horrified to find out that he was only a medical student. (He had taken the time to listen to her.) 

Yes, Type A Jeff felt a lot of anxiety in medical school. And he soon realized (among other things) that the brain (his brain) doesn’t work so well without enough sleep.

Anyway, in the late 1960s and early 1970s, as his fellow students were doing their darndest to be “melllow,” to fit in with the times, Dr. Lander clearly saw himself in a different light. He was not calm or easy-going, he said; he was a hard-working serious young person with a defined goal. In time, he concluded that it was okay to be himself.

The young medical school (it was established in December 1964) had an unusual curriculum. For the first two years, they studied a single system (such as the cardiovascular system) from the basic science to the pathology and the clinical aspects before moving to another system (such as musculoskeletal) in the classroom. 

The clerkships came in the third and final year (there were no summers off).  Most other US medical schools had a four-year program, two years of basic science, then two clinical years. Dr. Lander and ten of his classmates chose to take a fourth year of (also free) training. They knew they weren’t yet prepared to be responsible for taking care of patients. 

University of Toledo (previously the Medical College of Ohio)
 (From UT)

His initial plan (in line with the school’s primary care mandate) was to go into family medicine. When the students were (early on) given the opportunity to choose to spend time with (or “shadow") a physician in the community to get a feel for things the primary slots he wanted were already filled (they worked through the alphabet from both ends and "L" was near the middle) and he was matched with an eye doctor. 

That unexpected experience put the ophthalmology bug in his head despite the fact that he had already been leaning away from family practice and toward academic internal medicine, where keen diagnostic skills and knowing “everything”  (“like Dr. House,” he said, but without the edge) were prized. 

A TV physician/role model:
The imposing and intense Dr. Gregory House with his team
(From Cinemablend)

The two-week clerkship in ophthalmology changed his mind. You see, the eye clinic visits were short, the surgeries were quick, you could take morning coffee breaks, and you didn’t have to be up all night. You didn’t have to deal with people who were actually sick. And it’s “impossible to kill somebody,” said Dr. Lander. Since the body of knowledge and the skills to be mastered were limited (though still substantial and exacting) it was an ideal career choice for a self-described seeker of perfection. 

So Jeff decided to go for it. When he and a fellow colleague were casually advised by a resident that they couldn’t possibly get an ophthalmology training position because they were just too competitive, Jeff instantly shot back: ”Just watch!”

So he spent a year preparing to get into an eye program. He matched at Geisinger (his fourth choice of 16). Before starting, he did a required year of a rotating internship (1980-1981) at Mt. Sinai in Cleveland. This was, he said, “a wonderful place.” And he saw “tons of pathology,” when he was in the inner city hospital providing care to the urban poor. (The hospital had to close in 1996 due to economic pressures.)

Dr. Lander fondly recalled a two-month block in neurology with the bow-tied Neurological Institute-trained Dr. Howard Tucker. Jeff “loved” the civilized, academic, mild-mannered, and warm-hearted neurologist. (Jewish Dr. Tucker is still teaching residents twice a week at St. Vincent’s Charity Medical Center in Cleveland. And at age 101, he still–in 2023–holds the Guinness Record as the world’s oldest practicing physician, awarded to him in 2022; he has no plans to retire.) 

Dr. Howard Tucker with his Guinness plaque
(from "The Today Show" 8/10/22)

After the busy internship year in Ohio, Jeff was off to rural northeastern Pennsylvania for his three-year residency at the rural Geisinger Medical Center in Danville. All of his attendings were competent, but they were “oddballs.” Nobody, he recalled, taught him how to refract (for eyeglasses or contacts) and there was pitifully little instruction on actually doing cataract surgery. He felt that he almost had to teach himself ophthalmology. 

(Incidentally, looking back, Jeff feels that medical school information was “so useless” and that everything he needed to know could have been taught in one year.)

Geisinger Medical Center in Danville, PA (postcard)

A break for a social-historical tidbit. Jeff said that his decision about a career in medicine (after the not-so-subtle nudging by his wise aunt)  was influenced by the popular late 1960s and 1970s TV show “Marcus Welby, M.D.” According to encyclopedia.com:

 Much of the appeal of the program surfaced in the way that Welby treated his patients. In 1965 President Lyndon B. Johnson signed the Medicare Bill, raising many questions about the degree and quality of health care offered in the United States. Americans worried that they were going to be lost in the bureaucracy of the medical system and that their health would suffer for it. Marcus Welby allayed these fears of depersonalization (as he) had an old-school work ethic and treated his patients with respect. (from https://www.encyclopedia.com/media/encyclopedias-almanacs-transcripts-and-maps/marcus-welby-md)

Anyway, after Dr. Lander finished his residency in 1984 he wanted to practice in a small town. York ophthalmologist Dr. Gordon Pratt, only 50 then, was diagnosed with a brain tumor and offered to sell his busy practice “for a song,” said Jeff. Dr. Lander wisely kept Dr. Pratt’s office staff in place, and they helped ease him into the work. And he was warmly welcomed into the small tightly-knit eye community since the doctors were “swamped.” 

There was an easy camaraderie among the local ophthalmologists as they gathered once a month at each other’s homes to talk about new developments and to get help with difficult or troublesome cases. This comforting routine of sharing continued for nearly 30 years.  Sadly, this doesn’t exist anymore, said Dr. Lander, and he feels isolated professionally.

Jeff admitted that doing exacting surgery on the eye is stressful. In fact, he still gets nervous and he said that his “stomach goes into a knot” for the first few cases of the day.

“No case is routine until it’s over,” said famed Cincinnati cataract surgeon and innovator Dr. Robert Osher. And Dr. Lander knows that. So when already-prepped patients in the OR ask him at the last minute if he’s relaxed he replies: “Definitely not!” He knows that being slightly on edge and being slightly anxious generally improves performance, the Yerkes-Dodson law, (at least it does for him). 

There is an optimal level of arousal (in yellow) for difficult tasks

He said that one of the ways he deals with stress is through a strict exercise regimen. An optometrist in Danville had introduced him to Dr. Kenneth Cooper’s program in 1987. Dr. Cooper was the Air Force physician who, in 1968, invented the term “aerobics” for the endurance exercise deemed most important for heart health. He recommended a total of 30 minutes of sustained physical activity most days of the week. Dr. Lander, a self-admitted “exercise maniac,” has unswervingly followed this advice since 1987.

Another way for Jeff to cope with the stress of performing the delicate surgeries was to continuously hone his skills, even (especially) as the highly precise procedures evolved. The first major change happened halfway through his residency. And in 1991, the technique still used now, phacoemulsification, breaking up or emulsifying the clouded lens while simultaneously sucking the broken pieces of it out of the eye and making sure the pressures within the eye remain stable, was the new standard. It had to be learned by surgeons already in busy practices, so Dr. Lander took a “weekend course.”

An ophthalmologist doing precise cataract surgery
(From AARP and getty images)

As he adapted to these changes, cautious Jeff didn't want to hurt anybody by missing something critical for a lack of medical knowledge, not simply inadequate surgical technique. So he has repeatedly tested himself with a homemade deck of question-and-answer 3x5 flash cards. (Somehow, I doubt that many other doctors–or any other doctors, for that matter–do this type of reviewing so consciously, so deliberately, so humbly.)

And so, after nearly 40 years in private solo practice, Dr. Jeff Lander would like others to benefit from his experience. He put together a detailed 50-page book on cataract surgery for residents, a book he wished he could have had, himself, while he was in training. A work complete with his own (touched-up) drawings. A how-to-do (but not DIY!) manual  that he will sell on Amazon for, say, “$19.95.”  

But taking out our worn-out lenses (over half of us will develop cataracts by age 75) and replacing them with brand new clear acrylic or silicone versions while making sure that nothing goes wrong (it very rarely does) is only one of the "three legs” of Dr. Lander’s independent practice. 

He enjoys doing general eye care (often with continuity, “like a family doctor” who likes his patients and talks easily with them), of course, does the lens replacement surgery and performs laser treatment for glaucoma, and has a good-sized optical dispensing area with an optometrist, Dr. Howard Hartzell III. He said his practice is purposely diversified, should something unexpected happen in the future. 

His tireless wife (the practice administrator) “works 70 hours a week” running things and keeping the books. His son (diagnosed with what used to be called Asperger’s) also works in the office and is well-liked by the patients. 

Dr. Lander recently cut back on his office hours (just a little bit) but he has no plans to retire (unless his wife decides she’s finished). And, in the future, he would like to have the opportunity to do some clinical teaching to pass on what he has painstakingly learned and tried to get right, to get perfect, for the past 39-plus years in York. 

Well, I thought that was the end of our doctor's story, but no, there is more:

As the post was being put together it was already mid-September; the interview with Dr. Lander was in April. The unexpectedness of life may slow the writing process, but what happens along the way is often material for another tale. And, as Jeff has said to me, sometimes a story is just so interesting the way it turns out.  We may be surprised, and find that we’ve been completely duped, we had missed the point. 

So when I texted Jeff to let him know I would be sending him a draft for review his reply provided an unanticipated twist: he had stopped doing cataract surgery in May.

You see, he had awakened from sleep one day with severe right shoulder pain. As he went to write himself a note his hand did not work. He had a compressed nerve root, a pinched nerve, in the neck. He needed urgent surgery. After that, he took two weeks off and decided it wasn’t safe to do cataract extractions anymore; he would put down his scalpel and just practice medical ophthalmology. His wife was happy with that plan. 

And a friend of his wants to put together a blues band. So Dr. Lander said that he needs to learn how to improvise on the saxophone. He thinks this is going to take a while.

The original Blues Brothers Band (before Belushi and Aykroyd)
 (Photo from "The Echo" by Pepe Botella)

By Anita Cherry 9/24/23

Dr. Mark Lavallee: Resilience (Part Two)-- Still Standing

Having fallen through the roof into the burning building onto his back and sustaining extensive burns to his knees and elbows as he tried to crawl to safety, burns that covered 10-15% of his body, and having crushed several vertebrae, Mark was hospitalized, he recollected, “for a week or two.” This was, of course, the end of his brief, but eventful, fire-fighting career. 

But he continued to run with an ambulance crew in medical school. Sometimes they were lucky enough to be enlisted to stand by during big concerts at the Hershey Arena and he recalled with boyish excitement that he then got to see Black Croes and U2 up close.

"The Philadelphia Inquirer" 8/10/92 story on the U2 rehearsal
at HersheyPark Stadium for the outside leg
of their elaborate "Zoo TV" world tour)

(If you did not read Part 1 already or forgot what happened you can view that here.)

Early on, Mark had thought seriously about becoming a pediatrician or a plastic surgeon. But while at Hershey he had a humiliating experience with a senior surgical resident; he couldn’t scrub away the supposed “dust” (the typical EDS scars) on his knuckles. He was not allowed to continue on the case. 

And as he worried that his hands might not hold up for a long surgical career, he decided on the specialty of Family Medicine. He said that he could still do small surgical procedures, he could deliver babies, and he could do inpatient and outpatient work. (For a while, consistent with his strong Catholic faith, he had toyed with the idea of doing missions for his life’s work.) 

Family Medicine Residency and Fellowship

So he traveled about forty miles south from Hershey on Route 83 in 1994 to start his three-year Family Medicine residency at the York Hospital. He said that he enjoyed the demanding “really hard” program where he learned to survive on three hours of sleep.  He found it to be especially “fun to do women’s health” and Mark admitted that this brought out his competitiveness; though he delivered a remarkable 75 babies while a resident, he had aimed for 100!  (By the way, he met his ex-wife Tara in York and they were married in 1997.) 

After he finished his residency, his deeply personal interest in the value of athletics and treating sports injuries led to a one-year fellowship in the relatively newly-established field of (non-surgical) sports medicine at Crozer-Keystone in Springfield, just outside of Philadelphia. As part of the training, the fellows covered the sad-sack Swarthmore football team (they had not won a single game in 12 years, though they had an 8-1 record in 1984), the Chester High School (where one of the athletes he was to examine was carrying a 9 mm handgun), and the Philadelphia Eagles and 76ers.

When he helped with pre-participation physicals for the Philly basketball team his simple task was to check for hernias, to ask the player to turn his head and cough.

A Different Version of  AI

When Mark routinely told a rookie on the squad that he had to check his “family jewels,” his “privates,” the young man with a heavy sterling silver bike chain dangling around his neck was suspicious. He wanted to know that the doctor had no agenda other than clearing him to play. Dr. Lavallee tried to reassure him, but it was not enough. 

Thinking that this doctor with a somewhat high-pitched voice could be bought off, the wary basketball player pulled out a wad of cash and slapped a fifty on the table. Then another. Reacting quickly (maybe too quickly), Mark quipped that he usually gets a tip after the exam. Anyway, there were no hernias. And Allen Iverson was allowed to play ball.     

Helping a Fellow Athlete

Later that year, as a competitive weightlifter (Mark said he could squat 440 pounds and bench press 290 at 150 pounds bodyweight), he was working out at the huge Springfield Sportsplex when he had another unusual encounter. 

He wanted to use the only set of 25-pound dumbbells but they were being hogged by a guy involved in a big tennis tournament at the modern facility (with ten courts). Mark asked if he could “work in” with him.  The guy wearing white pants and a white shirt said okay, and as he watched Dr. Lavallee use the weights he asked Mark if he could get some pointers. Mark complied, of course, and Peter (that was the guy’s name) was appreciative. In fact, he asked Mark if they could work out again. 

Later that evening, while watching the sports news with his wife, a tennis fan, Mark suddenly realized that the unassuming athlete he helped at the gym was, in fact, the No. 1-ranked men's tennis player in the world, Pete Sampras.

Pete Sampras stretching for a return (from Britannica)

(At his home, Dr. Lavallee proudly displays the numerous memorabilia of his sports encounters and world travels.)

Mark's fellowship program director had a relationship with the Olympics and Dr. Lavallee spent two weeks at the Colorado Springs Olympic Training Center high-performance lab doing VO2 max testing. (This may have set the stage for his later deep and prolonged involvement with the Olympic weightlifting program.) 

Olympic and Paralympic Training Center (from "visit Colorado Springs")

South Bend

Following his Primary Care Sports Medicine fellowship he looked around carefully for someplace where could use his new skills. He ended up in South Bend, Indiana. He was hired as the Director of Sports Medicine at Memorial Hospital in 1998 and Co-Director of the South Bend Notre Dame Sports Medicine Fellowship in 1999 as he managed to bring two traditionally disparate groups of physicians (surgeons and non-surgeons) together. In addition, he practiced family medicine (but without sleep-depriving obstetrics) and acted as the team physician for several high schools. 

Mark also served as a volunteer physician and consultant for the University of Notre Dame from 1998 until 2013. And as an Assistant Clinical Professor at the Indiana School of Medicine, he began his academic career. He has written a variety of chapters for sports medicine texts, presented numerous case studies at professional meetings, and published original and review articles in peer-reviewed journals. 

The Catholic University of Notre Dame (from Britannica)

He developed a special interest and expertise in the use of musculoskeletal ultrasound at the bedside and helped write the definitive guidelines for the training of fellows in this important underused diagnostic (and therapeutic) technology.  

And while in South Bend, Mark (though I cannot, for the life of me, see how he had the energy, much less the time) did even more. He began his long (and strictly volunteer) involvement with Olympic weightlifting (his first event was a minor Masters meet in Baton Rouge in 1998).  He also started his first connective tissue or Ehlers-Danlos/Marfan’s clinic. And most importantly, he and his wife adopted two boys with special needs, Thomas (with EDS and born in Thailand in 1997 and adopted at age 5) and Sean (with severe cleft palate and born in China in 2001 and adopted at age 2).

Gold medal winner Sergio Alvarez from Cuba
 at the 2011 PanAm Games in Mexico (from gettyimages) 

Injury on Labor Day 2011

Moving ahead, throughout his career in medicine, Mark has stayed in touch with those he trained. And he visited one of them, Jerrad Zimmerman (head team physician for the "Fighting Illini" football team), in Champaign, Illinois, on Labor Day 2011. As he jumped off a dock at the former fellow’s pond he felt intense pain. It was as if he was “shot in the foot.” 

He had ruptured his right Achilles tendon and he needed “major reconstructive surgery” on his ankle.  This did not deter him, however, from making the 2011 XVI Pam AM Games in Guadalajara, Mexico, on crutches for his Olympic duties as a USOPC team physician. But he has poor healing due to his fragile connective tissue, and he developed a delayed wound infection (foreshadowing the dark events to come).   

The Move Back to York

Well, after 15 productive years in the Midwest in the shadow of the Golden Dome an 11-hour drive away from family, and with a busy family of his own, and a sense of professional unease, there was a turning point. Mark and his wife decided to return to the Mid-Atlantic region to be closer to her family and his parents and two brothers. 

So in 2013, Dr. Lavallee came back to the York Hospital as Director of the York Hospital Sports Medicine Fellowship and Associate Director of the Family Medicine Residency. And he continued his unpaid work with the Olympics and tended to the Ehlers-Danlos/Marfan population.

Sadly, his very physically active and socially and spiritually involved mother, Connie, died of cancer in early 2015. (His father later remarried and Mark said that the former Barbizon model that is his stepmother still “rocks a bikini” in her 80s.)

Before proceeding further with Mark’s story, a few comments regarding resistance training, one of his areas of special expertise.

The Many Benefits of Resistance Training

According to Dr. Lavallee (2013), weightlifting (as a paradigm of resistance exercise) “improves strength, bone density, flexibility, proprioception, explosiveness, and functional movement, and these benefits carry over to almost every other sport.” And he adds that “studies demonstrate that lifelong daily physical activity confers many health benefits, including a decrease in (artery-clogging) lipids, (better) cardiovascular fitness, (improved) bone health, (better) mental health, improved glycemic control, and (lower) blood pressure.”

As a result of the physical stress or resistance exercise, muscle fibers are stimulated to increase in size and configuration and may change in type (slow twitch vs. fast twitch). And adapting to increased loading, there are changes in the supporting connective tissues and tendons. Bone growth is stimulated as well.

And the nervous system plays a role, especially early on in training, by more effectively activating the called-upon muscle groups to contract (such as the biceps when bending the elbow) while allowing opposing muscles (the triceps) to relax. This coordinates and smooths out the effort, making it more efficient. So, with resistance work, there is more muscle with more strength and more power (they are two different things), more stability, and more grace.

Prima ballerina Misty Copeland demonstrating
 strength and gracefulness (photo by Henry Leutwyler)

In addition (as if the above isn't enough), a consistent resistance training program may improve cognition and has been shown to slow the progressive decline seen in individuals with the syndrome of mild cognitive impairment, often a forerunner of Alzheimer's. Strength training releases several important hormones including the brain-derived neurotrophic factor (BDNF) that enhances the plasticity and growth of new neurons in the hippocampus, the earliest site of damage in Alzheimer’s. 

And it has been repeatedly demonstrated that regular exercise, including weightlifting, can reduce anxiety and depression and improve sleep. The list of benefits goes on and on. (Quick, everybody to the gym!)   

The Fellowship Program in York

As Dr. Lavallee ran the Sports Medicine fellowship program at WellSpan, with two fellows a year, he was on-call for Orthopedics and Family Medicine for a full year. He loved the chance to teach, and the first four or five years were “great” and he was “excited” to be involved in a “top-notch” training program. 

But (like all things) stuff began to change. As the health system extended its reach geographically, individual physicians had less and less influence on decisions about their practice. And when Mark’s plan to develop a relationship with a local university had little support from his employer the contract went to a competing health system. He was disheartened but continued to strive to provide the best training for his sports medicine fellows.

 The Scuba Incident

He still did international travel for Olympic sports (incidentally, in June 2022 he was the first non-athlete or non-coach to be inducted into the USA Weightlifting Hall of Fame) and in 2019 he was in Pattaya, Thailand (about two hours from Bangkok) for a weightlifting congress when he had yet another leg injury. 

Peaceful view of Pattaya (from Tripadvisor)

They had a day off and the weather was beautiful. Mark decided on an adventure; he would do a scuba dive to see the beautiful coral and the endangered hawkbill sea turtles, and to explore the popular HTMS Hardeep shipwreck (a Japanese steamship carrying fuel that was sunk by the British on June 1, 1945). 

Visibility in the water was excellent and the small group of experienced divers easily “penetrated” the bombed vessel that had landed on its side about 27 meters below the surface. But entering the boiler room, then encountered a scary “man-sized grouper” and turned around. By the time they carefully backed their way out of the wreck (with the help of a guide string) the sea currents had picked up. “A  monsoon rolled in,” said Dr. Lavallee. 

He was the last man to get back onto the 28-ton tour boat and as a huge wave hit the bow he was thrown. Mark ruptured his weakened right patellar tendon and dislocated his kneecap. The sea was now 15 feet lower than the dock and he was hoisted from the boat head-down on a backboard (an oddly unpleasant experience, said Mark).

He was quickly taken to a well-equipped “destination hospital” in a pickup truck. He had a CT and MRI within ninety minutes and immediately underwent the urgently-needed surgery. He was hospitalized for two days. He wasn't allowed to leave without paying the entire bill so he put the $12,000 charge on a credit card. He then took a 20-hour flight home, and used neither his FMLA for time off nor the available Disability, thereby protecting his job. And (despite severe fatigue) Mark managed to see a full roster of patients the day after his return to York, less than a week following the surgery.    

Changes at WellSpan      

During his time with WellSpan, physicians came and went. When it was deemed by his superiors that he was, perhaps, too demanding as a teacher, they had changed his role to assistant director. In addition, they had put a hold on his research (though it was self-funded) and put him on “production” instead of a salary. So when he felt that he was treated unfairly after the above surgery (he had innocently asked one of his staff if she could give him a ride home since he couldn’t drive yet, and this was an unforgivable breach of protocol ) Dr. Lavallee decided to look elsewhere for the next phase of his medical journey. 

So he took a position with the University of Pittsburgh Medical Center (UPMC) as the huge Western Pennsylvania health system moved into the local area to compete with WellSpan. As one of their regional medical directors, he initially oversaw 22 medical practices, tried to make them profitable, and worked to recruit physicians to the area (a difficult assignment, he said). After the first year, UPMC hired another physician to help out, so Mark had to manage only 11 practices and he was still able to do what he loved most; practicing non-operative sports medicine and helping patients live better with EDS.

The UPMC-Presbyterian Hospital in Pittsburgh (from UPMC)

More Leg Trouble

But the saga with his poor legs would not end with the mishap on the Gulf of Siam. On July 3, 2021, Dr. Lavallee, one of his sons, and his son’s friend were at his father's property on Cape Cod looking forward to the holiday celebration the next day. However, Mark saw the dismal forecast and decided to return to York where the weather was to be more suitable for a summer outing. He was carrying a box of Doritos to the car when he tripped and fell. He instantly knew that he had ruptured his left patellar tendon.

He needed urgent surgery once again but wanted to get this done closer to home. His son, though he was an inexperienced driver, drove the eight hours from the Cape to Harrisburg. Mark had the tendon repair the next day. 

By the third or fourth post-op day, moving around on crutches, he began to get short of breath and sweaty. He checked his pulse-ox and it was low. He worried that he might be having pulmonary emboli, dangerous blood clots to the lungs from his wounded leg.

When he was seen three days after the surgery the dressings were removed and everything seemed to be okay. But when Mark had chest pain and a falling oxygen saturation he was admitted to the York Hospital overnight. The chest CT showed no clots. But when the tech did an ultrasound behind the knee the usually stoic Dr. Lavallee “yelped” in pain. There were no thrombosed veins but something was clearly wrong. There was an infection, and when it was seen to be quickly getting worse an infectious disease specialist was called in. 

Really Serious Leg Trouble (Again)

Dr. Punitha Arunkumar’s diagnosis of the rapidly-spreading process (advancing two or three inches in 40 minutes by then) was “necrotizing fasciitis.” The attending surgeon, Thomas DiPasquale, frankly told Mark that there was a 90% chance he would lose his leg above the knee and a 20% chance that he would succumb to the feared "flesh-eating" disease. So he needed surgery immediately. (Can a person hear such frightful predictions more than once in their lives?)  

The next morning, with “huge chunks” of his leg missing, was “the most emotional time” of his entire life. He knew that if the bacteria spread to the core of the body severe widespread gangrene would occur and he could “awaken with no arms and no legs.” There were five more surgeries over eight days as more and more dead pieces of his leg were removed.  He eventually had no quadriceps tendon, no patellar tendon, and only half of a patella.

Mark asked to see the priest and he took communion, confession, and last rites “all at once.” As he prayed, he asked God what he was supposed to learn from enduring his dreadful experience. And he listened. 

A sixth surgery was done a week later, this time to place an external fixator to keep his mangled leg from falling apart. Rebuilding the leg with muscle flaps and skin grafts was next. Hyperbaric oxygen, human growth hormone, and testosterone might help to regenerate tissues, he was told, and split-thickness skin grafting would be needed. But he would have to wait a month to get to Johns Hopkins where all of this could be done. He asked for inpatient rehabilitation while waiting to go to Baltimore, but his request was denied. So Mark went home.

The Burn Unit and Beyond

His son took care of him for a few weeks, and his cousin, a widow, stayed longer as he went to Hopkins in August 2021. The eight days in the burn unit during Covid-19 were difficult as he was fighting for his life and his leg; his cousin could not visit, his son was in college, Dr. Lavallee was divorced by then, and had just decided to break up with his girlfriend, and his engineer father who lived five miles from Hopkins stayed away. He was doing this alone.

He sometimes heard the soft moaning of the other patients suffering from burns of up to 90% of their body surface (almost always eventually fatal). Patients whose average stay was 18 months. Some of whom, his nurse quietly told him, were homeless individuals who were deliberately doused with gasoline and set ablaze by gang members as a very sick prank. 

Mark needed extensive skin grafting, both using conventional surgical techniques and the proprietary ReCell system of taking his own cells, separating them, and then spraying the specific cell types that can grow new skin onto the affected area. This worked well and he left Hopkins after eight days. But he needed to finish a full ten-week course of IV antibiotics to be certain that the bacteria responsible for the terrible flesh-eating disease were completely gone. 

Though his orthopedic surgeon had told Mark that he might not be able to walk after the devastating infection and the multiple surgical attempts to save his life Dr. Lavallee had other ideas. He would use his extensive knowledge of sports medicine and strength training to rehabilitate himself. 

He did that and resumed his position with UPMC, managing practices and caring for his patients, especially those with various types of EDS and sports-related injuries.

And so Mark has continued to be able to join his family for their yearly get-togethers on Cape Cod. He surfs the waves on a boogie board, takes a bike ride, and goes on a swim (he loves the feeling of moving weightlessly through the cool water) before he cooks a nice dinner for everybody. And he enjoys being alive.

A Few Personal Thoughts

When first meeting Dr. Lavallee, you cannot avoid being struck by his scarred body with missing pieces. But you quickly feel his energy and spirit, and his need to help others, if given the chance. You sense his complete empathy and compassion for the suffering person in front of him. And that he will venture into the thorny wilderness to try to find what the patient needs. And that he’s not afraid of getting hurt as he explores the unknown. And that vulnerability and strength may coexist.

And Yet Another Major Surgery

(Shortly after the two lively and riveting interview sessions, Dr. Lavallee and several other regional UPMC managers were summarily relieved of their positions, so he’s looking to reinvent himself again. He also told me, by the way, about his long and complex surgery at UPMC Children's Hospital of Pittsburgh in early February 2023 to alleviate the cardiac failure caused by compression of his heart from the sunken-in chest wall, the severe pectus excavatum that was thought to be just a cosmetic issue when he was a youngster. And he said that he went back to the gym and the pool in no time at all after the operation. And that, with gratitude, he feels great.)

References and Readings:

1. Finoff, J., Lavallee, M., and Smith, J. "Musculoskeletal ultrasound education for sports medicine fellows: suggested/potential curriculum by the American Medical Society for Sports Medicine." British Journal of Sports Medicine 2010: 44; 1144-48.

2. Lavallee, M. and Mansfield, M. "Weightlifting training gives lifelong benefits." ACSM Health and Fitness Journal 2013: 17; 2 1-4.

3. Current, Austin. Science of Strength Training: Understand the Anatomy and Physiology to Transform Your Body. DK Publishing, New York, 2021. (A complete guide with phenomenal diagrams of each exercise, from beginner to expert.)

4. McCloud, J., Stokes, T., and Phillips, S.M., "Resistance exercise training as a primary countermeasure to age-related chronic disease." Frontiers Physiololgy 10; June 6, 2019. (Exhaustive review of lots of data eventually slightly favoring use of resistance activities over endurance training alone.) 

By Anita Cherry 8/6/23

Painting by AC

Dr. Mark Lavallee: Resilience (Part One)--Flexibility

Dr. Lavallee

His “very extroverted” and kind mother studied at the University of Massachusetts and as she started her Ph.D. in marine biology at Yale she worked with Jacques Cousteau. So there were nearly yearly family vacations to Cape Cod with frequent visits to the Woods Hole Oceanographic Institution for a while. When Mark and his younger, but much taller, brothers Brian and Paul, climbed onto the Calypso, the famous research vessel, they headed straight to the galley. 

They were looking for the “funny doughnuts,” buttery flaky French croissants. Mark recalled that Jacques, (host of popular TV documentaries in the late 1960s and early 70s on ocean life, and co-inventor of the modern SCUBA gear), was “super skinny and smelled like cigarettes.”  

His Parents and Early Life

Mark’s father, Ray Lavallee, was from Northhampton, Massachusetts, before the family moved to Upstate New York just outside of Syracuse. He was an electrical engineer with GE and a defense contractor. Among other things, he developed and patented a sensitive microphone for so-called “Towed Array” sonar surveillance devices trailed behind ships. They allowed long-range detection and tracking of (quiet) Soviet nuclear submarines during the Cold War.   

The restored 43-meter Calypso in 2016 (from the Cousteau Society)

After Mom abandoned her Ph.D. aspirations she felt a calling to teach, but then gave that up temporarily to raise her three boys. One day, she took Mark to the pediatrician for an ear infection. The doctor had just read an article about a rare hereditary disorder of connective tissue called Ehlers-Danlos syndrome (EDS). The physician quickly recognized that Mark had this genetic condition of excessive joint mobility, soft stretchy skin, easy bruising, and poor wound healing with scarring. (Though it is much more than that, since the disorder may affect almost any organ.)

Anyway, a month after his fateful diagnosis, when Mark, the future Family Physician, Sports Medicine, and recognized EDS Specialist, was in the first grade, the family moved from the Syracuse suburb of DeWitt to the U.S. Naval base in Argentia in the Canadian Province of Newfoundland. Dr. Lavallee (the name is derived from the French “the valley”) told me that it was cold in the far north on the western edge of the Sea of Labrador and there were deep piles of snow for him and his brothers to play in (but it is not nearly as snowy as Syracuse, by the way).

A current view of Argentia, Newfoundland
after the Naval base closed in 1994 (from Wikipedia)

The people in the close Christian Celtic community were welcoming and deeply religious. Mark’s mother found that the women she met during her visits to town had unusually large families. And she often returned home with stories, such as this one told by Mark with a pretty good musical Irish lilt:

“Mrs. Lavallee, how are your children? And how many did God bless you with?” asked Mrs. Smith.

“I have three beautiful sons.”

“Uh, oh, problems in the bedroom Mrs. Lavallee?”

“No. Why do you say that?” 

“Well this is Mrs. O’Conner, and she has been blessed with 21 children.” 

“How many do you have?”

“I had 18, but lost two at sea.”

Small remote fishing communities, you see, often have large families for economic and cultural reasons. This allows them to survive and maintain their unique heritage and identity. 

An Adventure/Misadventure 

Well, after school was out for the year, his mother was “up for adventure.” She took her sons and one of their friends to “a park,” said Mark. She found a 1700s abandoned fort in “disarray.” Guys like that kind of stuff, right? It would be fun, right? But something awful happened.

The boys were running around, as they will do. Mark was exploring and creeping down a wooden stairway into “a basement or dungeon” (he wasn’t sure which) when the worn tread he stepped on gave way.  His right leg fell through it. As a result of his fragile connective tissue the injury to his lower leg was devastating; from his knee to his foot, the skin and underlying tissue were simply stripped off. It was “like peeling a banana,” said Dr. Lavallee. (The official medical term for the injury is “degloving.”)

Degloving injury to the lower leg (from Ben Ward)

All young Mark saw when he looked at his poor leg was “blood and bone and muscle.” His mother put down one-year-old brother Paul, quickly applied pressure to try to stop the bleeding, and sent her five-year-old son Brian back to the parking lot to look for help.

There was a white pickup truck and two men who looked official (but probably were not, thought Mark since no government employees worked on Sundays).  Brian frantically told them what had happened. They had a stretcher (and, for some unknown reason, a shovel) and would help. They took Mark to the hospital on the naval base. When the ER doctor saw the gaping wound he knew that Mark needed specialist care. He immediately sent the family to St. Johns, the provincial capital and site of the only trauma hospital, one hundred miles away.

Gangrene

At St. John’s, Mark saw a British general surgeon. By then, a portion of the torn skin flap had already died, so he was treated as a burn patient with whirlpool sessions and wrapping. But his foot soon began to “turn colors.” It went from purple, to dark purple, to black. And it started to smell. The big white-uniformed orderly who had been caring for him, carrying him to and from his daily treatments, began to sob.  

Mark had developed gangrene. His right foot was dying. So, after about a week, he was evacuated back to Syracuse and the next day he was seen at the Upstate Medical Center. The orthopedic and plastic surgeons there had to decide whether to take his leg off from below the knee or above the knee, in order to save him.

View of Upstate Medical Center, Syracuse (from SUNY Upstate)

His usually-stoic mother cried. She told her son that he needed surgery. That he would certainly lose his leg, but that he might lose his life. So he would receive the final of the seven Catholic sacraments, Last Rites (“from Father Dave of Holy Cross Parish,” as Mark was careful to recall). The first-grader thought for a minute and then said (as he was later told) that since that meant that he would go to heaven it wouldn’t be a bad thing at all, “that’s what we believe.” He knew well the children’s bedtime prayer: “Now I lay me down to sleep…”  

But as Mark’s horribly injured leg was unbandaged the next day in preparation for surgery his foot was, miraculously, pink. The leg (and his life) would be saved. But the extensive damage would be very slow to heal. He couldn’t walk for three years and had to get around in a wheelchair until fourth grade. 

Young Mark had faith then, and he still does. (His mother sent his story to “Guideposts” and it was published). And he feels that the early and accurate diagnosis of his genetic disorder of connective tissue, knowing what he had and what he needed to deal with, helped him adapt. This was, he said, his “introduction to medicine.”

Faulty Connective Tissue

What is “connective tissue,” you ask? 

From nci.org: "Connective tissue “supports, protects, and gives structure to other tissues and organs in the body. (It) also stores fat, helps move nutrients and other substances between tissues and organs, and helps repair (tissue) damage.”  Much of it consists of fibers of collagen, the main structural (and most abundant) protein in the body. Connective tissue is what holds us together. 

And in EDS, the formation and processing, or packing, of collagen fibrils may be altered by at least 19 different mutated genes. There are 13 (or more) types of EDS. Dr. Lavallee has what is called "classical" EDS, one of the most common forms. It can be due to many specific mutations in the COL5A1 or COLA5A2 genes. 

Types of connective tissue (from quizlet.com)

By the time he was in the fifth grade, the family had moved from upstate New York to Severna Park, Maryland, near Annapolis, the site of the U.S. Naval Academy. Even by then, through his experiences with doctors and hospitals as a patient, Mark felt a calling to become a physician.

An Experience at Johns Hopkins

Johns Hopkins in Baltimore was the “only place” seeing EDS patients like him, said Mark. The field of medical genetics was being single-handedly developed by the illustrious Dr. Victor McKusick at the Moore Clinic. Disorders of connective tissue were a particular interest of his. Dr. McKusick confirmed the diagnosis of EDS and told Mark's parents that he must avoid potentially dangerous activities. 

One routine clinic day, Mark (probably in the sixth grade then) was enlisted (with the consent of his parents) to help teach the “next generation of doctors” (i.e., medical students). There was a child with Marfan’s syndrome (the tall one), one with brittle bones and a misshapen skull of osteogenesis imperfecta (the short one), and Mark, with Ehlers-Danlos (the one in the middle).

Young Mark waited behind the curtain for his turn. Just before he was to go out onto the stage in the auditorium he was asked to take his clothes off so the students could see all of his scars. He did as he was told and stood there completely naked in front of about “a hundred people.” They wanted to see Mark stretch his skin, to see his joint flexibility, to see his wounds. He just wanted to put on his underpants!  

Examples of skin lesions in EDS (from American Journal of Medical Genetics)

More about EDS

But EDS is much more than a medical curiosity to be shown to eager medical students. And different forms of the condition involve different tissues. For example, some people may have abnormal spinal curvature (scoliosis) and some have life-threatening heart valve or vascular problems (including aortic aneurysms). Many have chronic pain and disabling fatigue (as in fibromyalgia), sometimes along with troubling anxiety and depression. Disturbances of the autonomic nervous system (especially the POTS syndrome with lightheadedness and fatigue) and immune system (with so-called mast cell activation) are now recognized as common features of the hypermobility syndromes. The diagnosis of EDS may be missed if it is not thought about.

No Sports; More Time to Study

Moving on. In secondary school, Mark was a good student, of course. But his attempts to fit in socially through athletics fell flat. He said that he “ran like Jerry Lewis” and had trouble finding his sport. It turned out that he liked wrestling and was good at it, but he was injured over and over as a result of his faulty connective tissue and poor healing. Shoulder dislocations were so frequent that he learned to fix them himself.

And as he was followed at Hopkins he had punished his scarred and deformed body (his chest wall was sunken in, a condition called pectus excavatum) so much that he was told by the experts that he was “not allowed to exercise.”  He was to forego all physically strenuous activities, even gym class.

So, with an extra study hall, he had more time for books. And without afternoon sports, he had more time to eat. A typical comforting snack for the sedentary high-schooler could be two Big Macs, a large order of fries, two packs of Reese’s, and a large Coke (totaling about 2,310 calories!).  His weight climbed to 230 pounds. 

After high school, Mark attended Penn State as a pre-med student in the Honors program. By habit, he usually squeezed himself into the same seat in class. He said that one of his fellow students who typically sat next to him was a real “specimen.” This unusually pale classmate (looking “like Casper The Friendly Ghost’) was muscular, “he was ripped,” Mark said. They became friends and then roommates. Brett was “struggling with organic chemistry“ but Mark had “figured it out” so they made a pact; Mark would help Brett with classwork, and Brett would help Mark change his body (and his wounded psyche). 

Strength Training and on to Medical SChool

Mark learned that if he was careful, and used proper technique, he could avoid injury; he could do fairly intense body-building (and strength training) relatively safely. Oddly, the gym facilities on the big campus with the well-known successful football team were limited. So Brett and Mark (with a few other investors) opened a student-run 24-hour gym. They (and anybody else at University Park) could work out whenever they wanted to. It was a huge success, such that when the young entrepreneurs later sold the gym it paid for two years of their medical school!

The huge IM Building at Penn State Main Campus:
Open 9 a.m-9 p.m. (photo from PennState)

So, while at Penn State, Mark was “either studying or at the gym.”  And, at some point, he even lifted competitively.

He worked hard and he was accepted to the Hershey Medical School as a sophomore. But his father was leery about his son’s choice of career since Mark had fainted at the sight of blood (his grandmother’s, not his own) when he was home one summer during college (though it was a hot day and he had worked outside and he might have just been dehydrated, he thought).

The future Dr. Lavallee needed to test this fateful possibility. Could he practice medicine, could he be a doctor, if he had hemophobia, a morbid fear of blood?  

He decided to get his license to volunteer as an EMT at State College to test this. The plan worked; he proved to himself that he could stand the sight of blood without getting sick or passing out. When he wanted to continue running with an ambulance crew over the summer break back in Maryland there was a hitch. The rule was that you had to first qualify as a level 1 firefighter. He was game, but that didn’t really turn out so well.

Let's Try Firefighting!

He went to a fire-fighting school in Maryland between his junior and senior years at Penn State. One day, there was a single-family house fire. His job was to climb the hook and ladder to get to the roof. His partner was to use a circular saw to cut holes in the roof to ventilate vertically and prevent deadly back-draft. But they were given mistaken directions; instead of ventilating away from the fire, they were directly on top of it.

The roof caved in and Mark fell through onto the floor that was in flames. His heavy breathing tank was shoved into his spine. It was hazy, black, and “extremely hot,” maybe 600-700 degrees. And he was in terrific pain. Fortunately, the experienced fire suppression team was there within seconds, but as Mark struggled to crawl to safety Army-style on his forearms and knees his protective turnout gear melted. (Continue the story...)

Efforts to produce tactical ventilation through a roof (From cfitrainer.net)

By Anita Cherry 6/10/23

Dr. Carole Dorsch: She likes puzzles

Dr. Dorsch

Until she was two, Carole, her parents, and her father’s older brother lived together in her paternal grandmother’s neat row home on North Broadway in Baltimore, just up the road, the boulevard, from Johns Hopkins Hospital. After that, her parents bought a place “down the shore” in Essex-Middle River on an estuary of the Chesapeake Bay. It was just 12 miles from the city but seemed “so far away” to the little girl. So, Dr. Carole Dorsch and her younger sister Beatrice grew up playing on the water. 

Carole’s father, Oscar, did electrical work for Standard Oil during the Great Depression and was an aircraft inspector for the Navy during WWII. He was a bit of a pseudo-entrepreneur, said Carole, and after the War, he continued to work as an electrician and bought a number of rental properties. Her mother left high school to take a job in a factory and then worked as a beautician, running her own shop.

But her father had a “midlife crisis” when Dr. Dorsch was in the second grade; he wanted to enjoy life. So he stopped working, planted flowers, raised birds, and began careful investing in the stock market (and he was quite good at it). This was okay for a number of years, but when his first daughter decided on her own in the eighth or ninth grade that she wanted to go to college Oscar realized that he needed to do something else to make that happen. 

He liked working on his own, doing everything himself, and not delegating tasks to others. So he purchased one of the earliest franchised drive-in fast food and ice cream restaurants, a “Twin Kiss.” Carole said that her parents “toiled away” from morning to night running the place on Bel Air Road. She worked there when she could, even while in medical school. When the restaurant shuttered for the winter, the family sold Christmas trees. Later on, after Carole finished medical school in 1968, her father turned the restaurant into a liquor store (that was sold shortly before he died of cancer).

Vintage photo of Ken and Jean Witmer's drive-in walk-up "Twin Kiss"
ice cream and sandwich restaurant in Palmyra, PA

Her father had told her (and Carole choked up as she recalled this for me) that when he stood on the corner of Monument and Broadway, the location of the iconic Johns Hopkins Hospital, selling newspapers, he never had a thought that his daughter would one day graduate from there. 

Dentist or Doctor?

Anyway, Carole’s interest in science, in how things worked, in how they were put together, was a driving force for her as she was in school.  But being a doctor was not her initial plan. You see, she had “terrible teeth” and was “always at the dentist’s” and she thought she would be a dentist. (Her family doctor, it turns out, wasn’t really the best role model; he smoked  cigarettes while he examined her, even though he had part of a lung removed to treat tuberculosis!)

So she carefully carved a bar of soap into teeth and took the dental aptitude test. She was all set. Until her father, who rarely offered advice, said, “I'd rather you be a doctor than a dentist.” She listened, bought a small anatomy book, and shared her new excitement with her mother.

While attending Kenwood High School she studied piano at Peabody Preparatory. She recalled that on the way to her lessons the bus passed by Hopkins and she saw the medical students “floating around” in their short white coats. She said that “there were sheep” just east of the hospital since Dr. Manfred Mayer needed their red blood cells for his work on complement (an essential part of the body’s complex defense mechanism, the immune system, a system that sometimes betrays us, as we will see later). 

Postcard depicting the Peabody Institute in Baltimore 

On to College

At Kenwood, she had a “wonderful teacher of American history” who had gone to Hopkins. He told her that if she was thinking of all-male (until 1970) Hopkins she should consider Goucher College in Towson. She did, and Carole, the budding scientist, entered the all-women’s school as a biology major but later switched to chemistry. 

She did a lot of lab stuff at Goucher. She especially enjoyed genetics and embryology, and as a member of the Biology Club, she went down to Hopkins to listen to Dr. Victor McKusick (the “father of medical genetics”) as he gave brilliant evening sessions. And as a (promising) “Goucher girl” she was picked to work with the “wonderful” gastroenterologist Dr. Frank Iber in his lab for two summers (while also doing her part at the family’s busy restaurant).

“The story of my life,” said Carole, ”is that I ran into a lot of really nice people who helped me along the way.” (She really did.)

Anyway, as she liked the basic science and the lab work, she wavered between going to graduate school for a Ph.D. and a career in medicine. Her “prim” unmarried chemistry advisor at Goucher was also the medical school advisor and after Carole decided on medicine she was given advice for her critical upcoming interviews. 

So, for the University of Pennsylvania grilling, she wore (wait for this...) a Jackie Kennedy-style pillbox hat and pristine white gloves. The session went well but, in time, the interviewer “was concentrated on what would happen” if she got married, was she worth it?  That is, would she practice medicine for only a few years and thereby waste a valuable space that could have been filled by a man with a longer career? 

January 21, 1961 (from theprojectsworld.com)

The admissions interview at Johns Hopkins was different. Dr. Tommy Turner, the Dean, let Carole know that (somehow) Dr. Iber had already told him “very nice things” about her. For the illustrious Dr. Turner, intelligence, brainpower, was the most important criterion for admission, not who you were, or what race, religion, or sex. Carole was accepted.

While still at Goucher she did carbohydrate studies “hydrolyzing mucopolysaccharides” with Suzanne Brownlee from Duke for her senior thesis. And with that connection, and her “travel lust,” she spent the summer before medical school on the Durham campus working with Dr. Bob Wheat. She was able to get, in 1965, her first scientific publication: the one-page work titled (Dr. Dorsch had to think for just a second) “The occurrence of pyruvic acid in the capsular polysaccharide of Klebsiella rhinoscleromatis.”  (More than 30 papers in peer-review journals would follow.) 

Dr. Dorsch's first published paper

Medical School

So Carole immersed herself in medicine at Hopkins in East Baltimore from 1964 to 1968; there were nine women in her class (compared to only one or two in the classes just before and after hers). She recalled this was during the height of the civil rights movement and she was a witness to the terribly destructive riots that followed Rev. Martin Luther King Jr.'s shocking assassination by James Earl Ray on April 4, 1968, at the Lorraine Motel in Memphis. 

(Later on, when Carole was in Memphis during one of her travels, she visited the iconic motel, once faded, and since 1991 reborn as “The National Civil Rights Museum.”)  

During the rioting mayhem, and at the request of then-Governor Spiro Agnew, there were National Guardsmen with rifles stationed every twenty feet along Broadway, she said. Carole was visiting friends on Monument Street and  watched in horror as “North Avenue was in flames.”  More than 10,000 troops were deployed and over a thousand fires were set.

Fire on Gay Street in Baltimore on April 6, 1968 (from the AP)

While in medical school, she continued to “do a lot of lab stuff” with the “connective tissue” division. She worked with organic solvents and (“brand new”) antinuclear antibodies and their so-called staining patterns for diagnosis). She presented a paper at a rheumatology meeting in Cincinnati in the middle of winter (after her first plane flight). When the effort from a mere student was criticized, she received moral support from the chair of the session, Dr. Eugene Barnett, from Rochester. 

She didn’t wither and continued to do basic research. One summer she worked with chicken embryos at the Carnegie Embryology Lab and another one of her projects involved trying to isolate basophils, the hard-to-find white blood cells associated with allergies. 

The Johns Hopkins medical school class of 1968
 (Young Carole is third from the left in the front row.)

Internship and Residency 

When it was time to choose a career path, Dr. Dorsch decided on Internal Medicine. She applied to Vanderbilt, Hopkins, and a few other places for her internship and one-year residency through the new match program, intended to pair applicants to hospital positions equitably. But the department chairman at Hopkins, Dr. McGehee (“Mack”) Harvey, called Carole himself to offer her a spot (outside of the match, maybe not quite Kosher) on the prestigious Osler Service.  She couldn’t say no. 

On Osler, you worked hard, often through the night and the next day, with only one day off a week. She said that you took every tenth admission and followed 10-15 patients in the hospital at one time. There was no ICU (imagine that!) and very limited ancillary help, so you did almost everything yourself.  You learned medicine by taking care of patients day after day.  

Intern presenting a patient during Grand Rounds in Hurd Hall Hopkins (c. 1950s)  

She had not decided what to do after completing the two years at Hopkins when she “ran into” the masterful clinician, teacher, mentor, and diagnostician Dr. Philip Tumulty in the school cafeteria.  After they talked about her career, he told Carole that, since she liked to experience different things and had thought about UCLA for a third year of internal medicine training, he would gladly make a call to one of his colleagues there to facilitate that.

Los Angeles and Back to Baltimore

During a break in her studies, Dr. Dorsch had decided to take her mother to Europe for three weeks. While waiting in the old BWI airport (Friendship International), she opened a letter from UCLA. They offered her a third-year postgraduate position.  She quickly raced around the terminal to find stationery to send the reply. So she went to California.

Her first specialty rotation in the sun was rheumatology.  She quite enjoyed solving the “puzzles” of the patients who had “connective tissue diseases” or, more accurately, autoimmune disorders like lupus or rheumatoid arthritis. Dr. Barnett (who, you may recall, had come to her rescue at the meeting noted above) had moved to UCLA from Rochester by then. He saw her talent and wanted her for his program. (The specialty of rheumatology was relatively new as there was no board certification until 1971 and no accredited fellowships until 1987.) 

"Mary Betty" (ACP)

Carole liked L.A., took the fellowship, and stayed on the West Coast for a total of four years. She was lured back to Baltimore in 1974 by (the imposing) Dr. Mary Betty Stevens as Dr. Stevens took over the running of the Connective Tissue division.  (She was the first woman to head a division of medicine at Hopkins.)

(Speaking of strong women, here's an interesting tidbit later shared with me by Dr. Dorsch. After the hospital was built from the large estate left for this purpose by merchant and banker Johns Hopkins, there weren't enough funds to build the medical school. Four daughters of the original trustees offered to raise the needed money, but only if the school admitted women. And so it did, when it opened in 1893. In fact, writer Gertrude Stein, who studied psychology with William James, was in the class of 1901. But she didn't receive a degree, possibly due, in part,  to William Osler's known tendency to misogyny--nobody's perfect.)  

The expanding group of rheumatologists was based at Good Samaritan Hospital, away from the main Hopkins campus, and Dr. Dorsch was to be the lab person on the small team. Among other things, she continued her important work on autoantibodies.

Antibodies and Immunity

A few words about antibodies and immunity are needed for our review. The exceedingly complex immune system (rivaling the complexity of the nervous system) evolved to protect us from injury. To heal wounds. To repel dangerous microbial invaders. To find and eliminate cells that have mutated and might grow into widely spreading cancers. To allow us to survive long enough to reproduce. 

But sometimes things go wrong. Microbes block our defenses or even hide deep inside our cells. Cancers figure out ways to actually turn off the immune attack. And sometimes the system misfires and mistakenly rebels against our own tissues (the self) as if they are foreign (the other).  The autoantibodies so produced are the cause of many diseases. This includes, for instance,  type 1 diabetes, the commonest thyroid problems, gluten sensitivity and celiac disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and many other conditions, including the prototype autoimmune disease, systemic lupus erythematosis. Dr. Dorsch often took care of people (mostly young women, by far) who had or were suspected of having this complex autoimmune disorder. 

Lupus

Systemic lupus, by the way, was first clearly described by…(any guesses?)...none other than the aforementioned towering figure Sir William Osler, the Canadian general internist who became the father of modern American medicine. As the first physician-in-chief at Hopkins, he was the originator of bedside teaching of medical students, and the inventor of the house officer model of training.    

Osler contemplating a patient at Hopkins
(from National Library of Medicine)

So, let's take a short journey into the stuff of lupus. According to an article on Medscape, systemic lupus erythematosis is “a chronic inflammatory disease that can affect almost any organ system, although it mainly involves the skin, joints, kidneys, blood cells, and nervous system. Its presentation and course are highly variable, ranging from indolent to fulminant.” 

It may be notoriously difficult to pick up in the early stages since the symptoms may be very vague. And it can mimic other diseases, diseases that are organ-specific. So Carole, using the acquired Oslerian skills of active listening, careful observation, and meticulous examination, diagnosed and treated many patients (mostly women) that confounded the non-rheumatologist specialists. (And, thereby the saying: “If you don’t know what they have, send them to a rheumatologist.”)

In lupus, there is a loss of B-cell tolerance and recognition of self-antigens. The B cells (that we learned about early in the Covid-19 pandemic) originate in the bone marrow (hence, the “B” as opposed to "T" cells related to the thymus gland in the chest). They mature into plasma cells that produce antibodies. 

There is a slew (maybe more than 100!) of such antibodies against various cellular components (especially debris from degenerated cells) found in individuals with lupus in addition to the diagnostic double-stranded DNA antinuclear antibody. And these different antibodies may affect different tissues in different ways. 

(Antibodies directed against the NMDA glutamate receptors in the brain, for example, are involved in some of the neuropsychiatric syndromes reviewed in one of Dr. Dorsch's writings with the Hopkins group.)  

Trying to limit inflammation and damage with non-steroidal drugs and antimalarials and suppressing the immune system generally with steroids or chemotherapeutic medications were the only treatment options throughout Dr. Dorsch’s career as a physician. There were often troublesome side effects and many treatment failures. 

Targeted therapy for lupus became available in 2011 with the approval of belimumab (the first drug approved for lupus since hydroxychloroquine...in 1955!). This monoclonal antibody (“-mab”)  blocks the B-lymphocyte stimulating factor (BLyS) that increases the survival and growth of autoreactive B cells and decreases self-tolerance. It is helpful when other treatments have failed, but only to a degree.

Cartoon depicting the mechanism of belimumab (from ASCPT)

Back to Maryland for a While, Then Florida  

At Hopkins, Dr. Dorsch and her colleagues were productive, producing paper after paper while seeing patients and teaching students. But things were slowly changing (as they always do).  Carole applied for research grants to support the work, but funding was often lacking. Hopkins Rheumatology had joined up with the University of Maryland group. Dr. Harvey retired and Dr. McKusick took over as department head. The teaching became routine and uninspiring. And as Carole “did a lot of work without recognition” she looked to move on. 

One of her rheumatology friends from L.A. had a private practice in Pensacola and needed help. Dr. Dorsch liked the idea of doing her own thing, of being her own boss, and she left the Mid-Atlantic for the Florida Panhandle in 1982. She was busy, but as she had to take turns admitting general medical patients from the ER she was too busy. There were no students or residents, and she found that she sorely missed teaching. And she and her friend eventually “did not get along.” (Her father had warned her to “never to go into business with a friend.”) What would she do next?

From Florida to Pennsylvania

She was at an American College of Rheumatology meeting “somewhere” and was sitting at a bar with a colleague she knew from the joint program with the University of Maryland, Dr. J. Wolfe Blotzer. It just happened that Wolfe was looking for someone to join his practice at the York Hospital. There would be residents and students to teach, and she would do only rheumatology. It sounded better than what she was doing with her friend. So Carole came to South Central Pennsylvania in 1988 for career #3.

By the early 1990s, their private practice had grown to the point that they needed another physician. But financial constraints made it difficult to recruit someone. And the business of medicine, overall, was changing, as hospitals started acquiring practices and employing physicians. 

The York Hospital’s first hired physician was Dr. Francine Camitta, an endocrinologist and diabetologist. Dr. Dorsch was the second (she was naive and simply handed the hospital her practice). They moved Carole around a few times, but she enjoyed the patients, the teaching, and the camaraderie of fellow physicians, and she was happy for a good while.      

But nothing stays the same, and as the “medical group” of primary and specialty practices became larger and larger there were more and more rules and regulations. Office managers were put in place to make sure the dictates were followed, however arbitrary. While some managers were “wonderful,” others were not so much, and could even hurt the practice. 

In addition, the hiring of hospitalists meant that Carole and her partners would stop admitting their patients to the hospital and would focus on outpatient work. Eventually, she lost contact with other doctors and felt “lonely and isolated,” she told me. On a whim, she attended a course in Philadelphia where they talked about other things doctors could do besides seeing patients.

After Years of Practice in York, A Rewarding Teaching Career

Soon after, an ad in the local paper caught her attention: the Harrisburg Area Community College (HACC) was looking for adjunct faculty to teach science to nursing students in Lancaster. She taught her first summer class in anatomy and physiology in 2002 and kept going. She was still in practice then and as she finished in the office and ran to evening sessions twice a week during the year, she “loved it.”   

Harrisburg Area Community College, York campus (from HACC)

A HACC York campus was set up in 2005 and Dr. Carole Dorsch was hired as the first faculty member. Over time, the staff grew “tremendously.” Teaching, she said, gave her a chance to “re-learn basic biology,” to, for example, learn about cell membranes and transport systems, to learn how things work. She was “quite happy” at HACC. She taught full-time for 11 years, for a total of 14 years with the community college. When she finally left the school in 2018 it, too, had changed.

In Retirement

In her retirement, as she looked forward to more travel, Dr. Dorsch has had a battle with her own immune system. Years ago, she was found to have what’s called a monoclonal gammopathy of uncertain significance (MGUS). A clone of one of her B cells was producing a single useless immune globulin in excessive amounts. There were no symptoms, but Dr. Dorsch knew that this could turn into a more serious bone marrow disorder, multiple myeloma, a cancer of the antibody-producing plasma cells. And so it did, not too long ago. The therapy for this has been complicated by neuropathy with numbness of her feet and weakness of her legs. She is improving slowly.

Outside of medicine, Dr. Dorsch especially enjoys travel and seeing something new. She likes to read, of course, but she said that she also likes to cook and has “more cookbooks than medical books.” A recent interest is that of piecing together jigsaw puzzles. She discovered this while sitting patiently in the courthouse waiting to be called for jury duty; she was looking for something to occupy her ever-curious mind when she found a puzzle on a small table. 

And, after four varied careers in medicine, mindfully putting the pieces of the cardboard puzzle together, and finding where they fit, where they belonged, was oddly satisfying. And it mirrored exactly what she did for her patients as a specialist in complicated immunologic rheumatologic diseases. 

And it is hoped that as her plasma cell cancer (that she strongly suspects was the result of work with organic solvents years ago) is kept in check she will be able to continue her travels, either just down the road or much farther away.

References and Readings:

1. Bartels, Christie. MD, MS. "Systemic Lupus Erythematosis." Medscape Nov 11, 2022. 

2. Fineglass, E.J., Arnett, F.C., Dorsch, C.A., Zizic, T.M., and Stevens, M.B.  "Neuropsychiatric manifestations of systemic lupus erythematosis, clinical spectrum, and relationship to other feature of the disease." Medicine (Baltimore)  1976, 55: 323-339. (My husband said he relied on this article when he was a medical resident seeing patients with lupus.)

3. Richtel, Matt. An Elegant Defense: The extraordinary new science of the immune system; A tale told in four lives. Harper Collins/William Morrow, New York, 2019. (Popular story-telling account of immunity; an enjoyable easy but informative read.)

By SC

Anita Cherry 4/30/23