Lynchburg, Virginia, United States
– Proverbs 4:5
|Photograph of the author (right) and Dr. Pellegrino (left). Courtesy of the author.|
One day in the spring of 1985, I remember jogging past the Kennedy Institute of Ethics at Georgetown University, wondering what went on in there. It was a gorgeous afternoon, dogwoods and cherry blossoms in bloom. Students sprawled on the campus lawns. I was a medical intern at the time, learning from attendings and residents how to handle acute problems like asthma, pneumonia, and congestive heart failure at Georgetown University Hospital. There was little instruction on how to approach the ethical dilemmas I frequently encountered. Dressed in sweatpants and a tee shirt after a long night on call, I decided to turn around and knock on the door.
A sharply dressed woman greeted me.
“May I help you?” she asked cheerfully.
“Yes,” I said. “I’m Dean Gianakos, a medical intern at the hospital. I knocked on the door to find out what goes on in here.”
“Very nice to meet you. I’m Marti Patchell. Please, come in!”
Before getting too far along with my questions, Marti ushered me into Dr. Edmund Pellegrino’s office. Unbeknownst to me, Dr. Pellegrino was one of the most distinguished medical ethicists in the world. He was also a physician, philosopher, educator, scientist, and a man of strong, Catholic faith.
Dressed in a blue blazer, gray trousers, and a striped tie, Dr. Pellegrino firmly shook my hand and offered me a chair. At five feet, ten inches I towered over him with my slight frame. I observed his broad shoulders and solid build and later learned he had been a boxer. I quickly gazed around the room: floor-to-ceiling books, and a handful of neatly arranged journals on a coffee table before us.
Although I had many questions for him, he was more interested in what I was doing.
“Dean, what patients are on your service? Tell me about their illnesses. What are you learning? What ethical dilemmas are you facing at the hospital? Tell me about your Greek heritage.”
After a long discussion, I finally got around to asking him the question that prompted me to knock on his door.
“Dr. Pellegrino, I’m curious, why are you located here on this side of the campus, instead of in the University Hospital where we really need you?”
That question was the beginning of a wonderful collaboration and mentorship. We came up with the idea of holding ethics rounds for internal medicine residents, rounds that continued for many years after I left Georgetown to pursue fellowship training.
Toward the end of the conversation, I told him about my interest in medicine and literature and how I was intrigued by the physician-writer William Carlos Williams; specifically, how he managed a busy medical practice in Rutherford, New Jersey and found time to write poetry and wonderful stories.
Dr. Pellegrino leaned over and picked up a journal on the coffee table.
“Are you familiar with The Pharos?” he asked, showing me the cover.
I was not. He went on to tell me about the journal (he served on The Pharos editorial board for many years).
“Articles on the history of medicine, literature, poetry, and the philosophy of medicine—you’ll find them in here.”
I am thankful to him for introducing me to the field of medical humanities.
After residency, I kept in touch with Dr. Pellegrino. In 1996 I invited him to speak to our medical staff in Virginia. There were years when I would drive up to Washington D.C. to join him for lunch. We would talk about subjects on which he often wrote and lectured: the covenantal nature of the patient-physician relationship; the virtues of the good physician; and the many problems created by the business of medicine.1 He brought my attention to the fictional Dr. Rieux, an exemplar of the virtuous physician:
“The most authentic humanist in that very great novel The Plague, by Camus, was Rieux the physician. He possessed the modesty to resist self-justification. He was a symbol against the moral indifference of the citizens of Oran who allowed the plague to take possession of their fellows while they pursue their possessions and pleasures. If we can educate humanists like Rieux, medicine may help treat not only the personal plague of disease but the pestilence of moral indifference that seems, like a cultural plague, silently to have possessed our spirits.”2
I have been intending to write this essay about Dr. Pellegrino for several years. Now that I have put pen to paper, I realize the timing is not coincidental. It is the end of April 2020, and I am thinking about the courageous healthcare workers risking their lives every day to fight coronavirus. Dr. Pellegrino would have been so proud of the medical profession for stepping up to the moral challenge of COVID-19. I am thinking the “pestilence of moral indifference” that Pellegrino wrote about in 1979 is diminishing. Finally, I am thinking that I am sixty-four, the same age as Dr. Pellegrino when we first met on that beautiful spring day at Georgetown.
There are many seasons in a physician’s life. As Rita Charon notes, “The doctor, too, grows up: the exhilaration and terror of internship give way to the confidence and heroism of the full stride of one’s profession, which in turn may give way to the resignation and modesty that can mark the older physician’s practice.”3 I have passed my stride, and no longer practice clinical medicine. Like Dr. Pellegrino in 1985, I am in a later stage of my career—an administrative season. As a medical educator, I still turn to his work for guidance. Preparing for an upcoming talk on leading interprofessional teams, I recently found one of his editorials from 1966 that precisely defines a problem which persists today:
“Problems in medical care are due in part to a remarkable divergence of professional goals and educational objectives among the groups of individuals who are all earnestly devoted to a common purpose—the care of the ill person. Further obstacles are a striking lack of communication and coordinated efforts in moving toward that common purpose. The patient is only too often lost in the confusion and struggle over roles, prerogatives, and leadership of the health team.”4
When I return to the Georgetown campus, I make a point of walking by the Kennedy Institute of Ethics, if only to reminisce about that beautiful afternoon and my knock on the door over thirty-five years ago. His mentorship and encouragement played a vital role in my professional life, and I am forever grateful. In the final seasons of my career, I strive to do what Dr. Pellegrino did for me: encourage and mentor the next generation of clinicians and medical leaders.
In the 1990s, Georgetown University honored Dr. Pellegrino by establishing the Edmund D. Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center. Dr. Pellegrino was the Center’s Founding Director. He died in 2013. He would have been 100 years old on June 13, 2020. After his death, the Annual Pellegrino Symposium was established to honor the man and his work, particularly his reflections on the philosophy of medicine and the primacy of the patient-physician relationship.
Marti Patchell was Dr. Pellegrino’s administrative assistant for many years. She is an amazing administrator and person and we remain wonderful friends. She told me recently that the Center faculty, when perplexed by an ethical issue, often quip: “WWPS” (“What Would Pellegrino Say?”).
- Pellegrino, ED, Thomasma, DC. The Virtues in Medical Practice. Oxford: Oxford University Press, 1993.
- Pellegrino, E. Humanism and the Physician. Knoxville: The University of Tennessee Press, 1979, 230.
- Charon, R. Communication Between Older Patients and Their Physicians: The Seasons of the Patient-Physician Relationship. Clinics in Geriatric Medicine 2000;16(1):37.
- Pellegrino, E. The Physician and the Nurse. Annals of Internal Medicine 1966;64(5):1140.
DEAN GIANAKOS, MD, FACP, is Director of Medical Education at Centra Health in Central Virginia. He is a current member of Centra’s Physician Wellness Committee. As a general internist and former faculty member at Lynchburg Family Medicine Residency, he has taught family medicine residents and medical students for over twenty-five years. He is board certified in Internal Medicine. Dr. Gianakos frequently writes and lectures on the patient-physician relationship, emotional intelligence, and the medical humanities. He serves on the editorial board of the medical humanities journal, The Pharos.