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Mystery Briefcase from last episode of Homicide Mystery Briefcase from last episode of Homicide

Homicide’s Final Episode: The Mystery of the Battered Briefcase

When NBC’s Baltimore-based, gritty city-cop show Homicide: Life on the Street ended and all the props went up for sale, longtime fan Howard Edwards was there. As he rummaged through the varied detritus the producers had collected from around the city for six years’ worth of hourlong episodes, his eye fell on a single battered brown briefcase. Inside, he came upon a pile of documents, all carrying the Johns Hopkins letterhead.

Edwards knew his wife Kay would be interested—she’s a senior administrative assistant to the dean—so he purchased the briefcase and brought it home. Most of the papers, the Edwardses discovered, pertained to the School of Medicine’s offices of Admissions and Student Affairs. All dated back to the mid-1970s. There were student evaluations and memos from the promotions committee. And there was correspondence with members of the admissions committee, practically all of it signed by David Knox, a now semiretired Hopkins ophthalmologist who was dean of admissions from 1976 to 1979.

The Edwardses postulated that the briefcase had been stolen years ago from someone in the admissions office. When the police apprehended the thief, they must have impounded the briefcase and deposited it in their cluttered evidence room, where it sat unopened until the producers of Homicide came by looking for authentic police-station leftovers to use as props.

“I’ll be right over,” said Knox when told of the find. He inspected the grotty brown case with its broken locks and busted hinges. Disdainfully, he eyed the ballpoint pen, its barrel embellished with a 1970s-style psychedelic design. He thumbed through the neatly typed onion skin carbons. “This is not my briefcase,” Knox proclaimed, “and it never would have been my briefcase.” A likely suspect, he said, would be Gerald Gotterer, who had been an associate dean in the Office of Student Affairs from 1970 to 1978.

“No,” said a perplexed Gotterer, reached at his office at Vanderbilt University, where he’s now senior associate dean for faculty and academic affairs, “I was never robbed in Baltimore. I’m afraid that rings no bells.” Why not check with the Office of Admissions to find out how they typically dispose of old papers.

“The only way we release files is by boxing them and sending them to archives,” David Trabilsy, assistant dean for admissions, said with certainty. “After five years, they’re burned.” Only one person, he added, could solve this mystery—Lorinda McColgan. “If she doesn’t know the answer, no one will.”

“Well, I do remember a time when papers were taken in an uncovered container to the incinerator to be burned, and lots blew all over the street,” said McColgan, an assistant in the Admissions Office from 1967 to 1986, now at the University of Maryland. “The next day we got calls from people all over the Hospital who had found our papers. My hunch is that someone picked up these documents on Broadway.”

But clearly, that mishap doesn’t account for exactly how the tattered briefcase with its strange contents migrated from Hopkins and wound up, some 25 years later, as a prop on Homicide. For now, at least, the case of the case remains unsolved, written in red on the unforgettable white board that concluded Homicide’s every episode.

-- Anne Bennett Swingle

It's Harvard and US

for the 10th consecutive year, the School of Medicine is one of the top two ranked medical schools in the nation, according to U.S. News & World Report’s annual rankings. Only Harvard outscored Hopkins. Rounding out the top five schools are Penn, Washington University and Columbia.

And in another ranking, for the eighth year in a row, Johns Hopkins is the top earner among medical schools for National Institutes of Health biomedical research funding, garnering $255 million in competitive grants in fiscal year 1999. University of Pennsylvania was number two at $238 million. Rounding out the top five medical schools in the NIH-funding category were Washington University, UCSF and Yale.

Ogling Celebrities: From Fergie to Stevie

Glittering Fergie
Sweeping into the Billings Board Room, her New York handlers in tow, Sarah Ferguson, duchess of York, extended a bejeweled hand to the ogling physicians waiting to greet her. Here from Weight Watchers, Fergie presented a grant to a program that teaches residents how to mange obese patients.

Public figures like Fergie come through the Hospital with such regularity that the limos and the media trucks parked in the Broadway circle are just part of the scenery. For the physicians who meet and treat them, though, a little star power can go a long way to gaining exposure to their work. Consorting with royalty certainly didn’t hurt Jeanne Clark, for instance, the senior clinical fellow in the Division of General Internal Medicine who received Fergie’s award. Though the total amount of the grant wasn’t huge, she says it lent a higher profile to her effort to make obesity prevention part of the medical school curriculum. “If it hadn’t been for Sarah, no one would have known about it.”

And yet in these days of fast-breaking news, a visit from a celebrity can mean more exposure than anyone bargained for.

The bejeweled Fergie, here on behalf of Weight Watchers.

Tipper’s Operation
Even though endocrine specialist Robert Udelsman does about 300 neck operations a year, when Tipper Gore arrived to have him remove a thyroid nodule just after Christmas, he felt a tad nervous. The operation, a thyroid lobectomy, is risky because it endangers the delicate nerves to the vocal chords, and postoperative bleeding can obstruct the airway.

Tipper’s nodule turned out to be benign, and Udelsman’s surgery went like clockwork—to be on the safe side, he spent the night in the Hospital—but dealing with the press proved more complicated. Because Gore had asked for privacy, Udelsman couldn’t say a word until the results were in. That didn’t stop endocrine surgeons from all over the United States from going on the airwaves to comment on the nature of his thyroid surgery. Udelsman finally had his national say, after all the pathology tests were in, and he had good news to report. He immediately found his office swamped with calls from thyroid patients around the country wanting to have “Tipper’s operation.”

With it all, the experience was a positive one. “People learned about thyroid nodules and the standard treatment, and it was good press for the whole institution,” Udelsman says. Also, he had a long late-night chat with the vice president who stayed over in the luxe Marburg Pavilion.

But the next day the patient, wanting to talk privately with her physician, chided her hovering husband: “Al, get out of here!” Says Udelsman: “It’s the first time a vice president has ever been kicked out of a room for me.”

No Wonder
Sometimes celebrities cause a ruckus without even showing up. Months after Stevie Wonder visited the Wilmer office of ophthalmologist Mark Humayun to learn more about the retinal microchip implant, a rumor leaked out that the blind soul singer was himself a candidate for the chip. When Humayun’s unsuspecting secretary arrived at work after the story broke, more than 250 e-mails had flooded her account. Soon she was racking up nearly 300 calls a day.

The resulting intense interest in the eye chip from the media impelled Humayun to join an impromptu press briefing to explain the technology and dispel misconceptions. Though there was no news, and no Wonder (who’s an unlikely candidate for the eye chip in the first place, since he’s been blind from birth), that didn’t stop MSNBC from broadcasting the briefing live, or the Washington Post from running a Page One story, or the likes of Barbara Walters and Katie Couric from snapping up interviews with the Hopkins ophthalmologist.

-- ABS

All Treatments Considered

when the British Medical Society asked the American College of Physicians to come up with an editor for the first U.S. edition of its popular evidence-based medical handbook, the APS turned to Johns Hopkins, knowing the medical center was expert in this particular method of evaluating medical treatment. The editing job fell to internist John Flynn, who’s now completed the job.

Even though the compendium has been published for several decades by The British Medical Journal and is used extensively by physicians in the United Kingdom and Canada, evidenced-based medicine isn’t a foreign concept. The Journal of the American Medical Association ran a series of articles on the subject, and physicians Neil Powe, Eric Bass and Steven Goodman founded an Evidence-based Practice Center at the School of Medicine a few years ago. Yet, in the United States, evidence- based medicine has been slow to emerge from under the shadow of the more traditional method for determining how to treat various medical conditions: using a panel of national experts to establish standard treatment guidelines. The difference in the two methods is that the medical guidelines model recommends a specific treatment, while evidence-based medicine leaves it up to the physician to decide which treatment best fits a particular patient.

Flynn with the book

Flynn with the book.

Flynn worked with 60 faculty specialists here to review the handbook and make changes to fit U.S. medical standards. To offer practice situations like those clinicians encounter every day, they start with questions: which treatments improve outcomes in treating acute myocardial infarction, for instance, or what are the short- and long-range effects of using specific drugs to treat stable, chronic obstructive pulmonary disease? The editors then summarize the best evidence—mainly from randomized, double-blind, controlled clinical trials—to answer the questions.

The American revisions have altered treatments for certain illnesses; some blood-clotting agents used in Great Britain, for instance, haven’t been approved by the U.S. Food and Drug Administration and were left out. In treating HIV infection, whole sections were dropped, since therapy in the United States for HIV is more advanced than in the United Kingdom.

At first glance, the handbook looks like a Readers Digest condensed medical manual. But that’s exactly what the editors/publishers wanted: a concise, practical guide to provide busy clinicians with the best care options for a variety of diseases.

“We’ve never had an anthology like this in American medicine,” Flynn says.

-- Patrick Gilbert

Proof that Med School Doesn't Stifle Flair

The online journal Chrysalis (http://omie.med.jhmi.edu/chrysalis) features a dazzling potpourri of work by Hopkins medical students that is at once scholarly and creative. In addition to academic essays and research papers, there’s also fiction, poetry, photography and original artwork. Not to be missed in the 1999 issue: a first-person account of volunteering in a children’s hospital in Haiti and essays on polio and on the Dalkon Shield. Poems, photographs, watercolors and, especially, a traditional Indian dance choreographed by a fourth-year student and all rendered in digital video.

Chrysalis grew out of the School of Medicine’s Physicians and Society course after first-year course director Jean Ogborn, wowed by her students’ writing, began mulling over how she could give it more exposure. Supported by a minigrant from the University, she turned loose fourth-year students Melissa Sparrow and Charles Tuchinda to set up the site with the help of campus experts.

In designing the site, Art as Applied to Medicine faculty and students settled on a pressed leather cover and deckle-edged parchment look like something an explorer might have carried in the 19th century. Chrysalis debuted at the end of 1999 and will be published once a year.

The R.N. Degree Takes on Glitter as the Nursing Shortage Hits Home

for anyone who’s ever spent time in the cramped waiting areas and treatment rooms in the old Hopkins Oncology Center, the new Harry and Jeanette Weinberg Building dedicated in October spelled one word: R-E-L-I-E-F. Garnished with a lobby that holds a half-dozen palm trees, the new facility offers five stories and 500,000 square feet of gorgeous surroundings for treating some of the Hospital’s sickest patients, plus ample room for the latest out- and inpatient cancer-fighting technology.

And yet there are problems. With the nation in the grip of a nursing shortage, Hopkins simply hasn’t had enough nurses to staff all the services in this and several other buildings. To assure that patients have good nursing care, some specialties have had to postpone admissions or even close beds. The predicament has pushed Hopkins Hospital into its first-time-ever nurse recruitment campaign, complete with radio and newspaper ads.

Meanwhile, retention efforts moved into high gear, starting with a landmark survey asking nurses to state the pros and cons of their jobs. Veteran nurses pulled no punches. While ecstatic about Hopkins’ level of care, they were blunt about the need for higher wages, lighter workloads and improved scheduling and staffing. Hospital administrators responded with uncharacteristic swiftness. Within weeks they’d unveiled sweeping pay increases bringing the nursing salary scale here into the top 10 percent of metropolitan Baltimore hospitals and were looking at ways to up-grade the benefits package. A successful hiring campaign should help ease workloads.

Health care experts blame the nationwide nursing shortage on a variety of factors: With salaries for nurses low and topping out quickly in comparison to demands of the job, fewer young people are attracted to the field. Nationally, the average age of registered nurses stands at 45. A majority of nurses also appear to be shunning hospital jobs for the more agreeable scheduling of health maintenance programs, home health care and doctors’ offices.

With salaries for nurses low and topping out quickly in comparison to demands of the job, fewer young people are attracted to the field.

Karen Haller, the Hospital’s vice president for nursing, says she and many of her colleagues find themselves expending all their time and energy these days just on recruiting new nurses and retaining experienced ones. Physicians like Benjamin Carson, director of Pediatric Neurosurgery, meanwhile have climbed on a soapbox to preach the need to stem the shortage.

Cardiac surgeon Scott R. Stuart explains specifically: “Surgeries get put off because we can’t utilize all of our beds.” Stuart worries that this shortage, unlike others in the past, may take years to right itself because of declining enrollments in nursing schools. “My own take is that an entire generation has moved away from nursing because it saw the profession as one with little growth potential.”

Department of Neurology chief John Griffin, M.D., calls the dearth of qualified inpatient nurses “the single dominant thing on my radar screen,” and he has set up a committee of physicians to help Haller deal with the problem. For Griffin, the crisis has hit at a time when the neurosciences are at the top of their game. “We’ve put a full court press on trying to respond to this issue,” he says. “The bottom line is that the institution as a whole has been uniquely successful in developing new procedures, but the basis on which everything rests is the availability of inpatient nursing.”

-- Melody Simmons

In Search of a Better Mouse House

to basic scientists the mouse is almighty. Our animal cousins, it appears, resemble us in certain fundamental genetic aspects far more than anybody ever suspected, so by analyzing the bodily systems of mice, researchers can understand better how some human diseases work.

Take molecular geneticist Jeremy Nathans, who’s done groundbreaking work on disorders that destroy vision. He’s using a line of mice that have had certain DNA sequences removed in the laboratory (they’re referred to as “knockout” mice) to rule out genetic possibilities in the development of the hereditary blinding disorder retinitis pigmentosa. To complete this study as well as several others he’s working on, Nathans needs some 2,000 mice housed in exact conditions. And he’s only one of hundreds of Hopkins scientists who rely on these rodents for their laboratory investigations.

For researchers then, the fact that the School of Medicine has limited capacity to house mice is no small problem. At the moment, there are 21 mouse facilities holding a total of 35,000 mice scattered throughout campus. And while that may seem like a lot of squeaking, it no longer comes close to filling researchers’ needs. Baylor University’s Genetics Institute, for instance, is currently doubling its mouse-housing capacity to 360,000.

As Hopkins lays out plans for a new research facility on the corner of Broadway and Madison—groundbreaking is June 12—one subcommittee is devoting itself exclusively to the mouse-house problem. A national expert on the subject from a Yonkers, N.Y.-based firm brought in to consult with the committee recommended that Hopkins build a $30 million, 64,000-square-foot animal facility. The consultant pointed out that while that figure might seem high, the medical school would recoup its investment by being able to close all but three existing mouse facilities and substantially reduce the per diem costs scientists now pay to house their mice. The recommended animal complex would take up two of the Broadway research building’s eight floors.

Howard Hughes investigator David Valle calls the proposal right on target. While acknowledging that the facility will be costly, he stresses that it will pay off by boosting Hopkins’ research capability as well as its ability to recruit and retain faculty.

-- Patrick Gilbert

The Dean/CEO Contemplates His Job

three-plus years after stepping into the top job for Johns Hopkins Medicine, Dean/CEO Edward Miller said the biggest change that’s taken place in his work schedule is that he now spends at least 30 percent of his time on fund raising, “telling prospective donors why new medical and research buildings are important and how they can make a difference.” Another 30 percent goes to working on government issues and public policy. “We have a lot at stake right now both in Annapolis and Washington,” Miller says.

Dean/CEO Edward Miller, M.D.
Dean/CEO Edward Miller, M.D.

The rest of his time, the dean says, goes to all the other things that cross his desk—recruiting department chairs, finding new ways to make life less hectic for clinical faculty, dealing with Hospital issues, making sure Hopkins maintains its position in the health care marketplace, etc. Asked to state his philosophy about staffing his administration, Miller responded: “You put the best people around you, and then stand out of their way.”

-- Patrick Gilbert