The purpose of pain is to warn
you of impending injury, or
injury that has already occurred.
Neuropathic pain, injury to a
nerve, can be awful, last forever,
and be relatively unresponsive
to typical treatments. Here we
have an injury that’s really not
serving a useful purpose, not
warning you of anything, but it
persists, and your brain still thinks
this is valuable information.
—Gilbert J. Fanciullo, MD
Dartmouth-Hitchcock
Medical Center
Annual Report 2004
It was 1978, November 22.
8:40 a.m.
I was teaching at a school
in Boston. I walked up
three little steps
to open a window…
How to Read this Report
You are about to experience
how physicians and staff
consider and treat each patient
at Dartmouth-Hitchcock
Medical Center, primarily
through the telling of Holly
Field’s journey from a life of
constant pain to one of pain
management and functioning
well enough to do the things
most important to her.You will
come to better understand how
collaboration, innovation and
ongoing learning—as well as
closely listening to our patients’
experience of their conditions
and involving them as true
partners in their treatment—
are helping us to transform
medicine.
…As I turned to
loose nail on the middle
I fell very hard
I heard a terrible crack.
and took me to
I can remember lying
“Please don't let it
You will learn of Holly’s
story through the “voices” of
doctors, nurses, and researchers.
Some were directly involved
with Holly’s treatment, others
indirectly; all are actively
committed to the treatment
of pain. Additionally, we will
share the story of one of our
pediatric patients, Lauren Enos.
On the facing page, we’ve
listed the individuals involved
in these very personal stories.
By way of describing their
specific points of engagement
with Holly, they share our
process of discovery and our
ongoing reinvention of health
care.
Weinstein: As a surgeon, I want
to understand low back pain, in
particular in people who have
herniated discs, the most common
Our sincere thank you to the
Enos family. Our thanks as
well to our good friend and
colleague, Holly Field, for so
generously giving her time,
sharing her vulnerability, and
humbling us with her strength,
determination, and compassion.
reason for which surgery is
performed. Some people with a
herniated disc have a lot of pain,
Gilbert J. Fanciullo, MD, MS
and some don’t. My question
is why.
Fanciullo: We see three types of
patients in the Pain Center at
DeLeo: My area is pain research.
DHMC: acute pain patients, chronic
I work with Gil and Jim.We’re
pain patients, and cancer pain patients.
in drug development and we go
We typically treat acute pain patients
literally from basic science to
with drugs or injections.They don’t
humans; it is very translational.
have the changes that occur centrally
in the spinal cord or the brain that
occur in patients with chronic pain.
Holly has chronic low back pain. She
suffers from moderate pain almost
all the time.
2
come down, there was a
step, my heel caught, and
on my left side.
An ambulance arrived
a local hospital.
on the gurney and thinking,
be a broken hip. I’m only 39!”
—Holly Field
The Voices
Tim A. Ahles, MD: Director
Behavioral Medicine; Director,
Center of Psycho-oncology
Research, Dartmouth-Hitchcock
Medical Center
Marie Bakitas, ARNP: Adult Nurse
Practitioner, Section of Palliative
Medicine, Dartmouth-Hitchcock
Medical Center
Ira Byock, MD: Professor of
Anesthesiology and Community
and Family Medicine, Dartmouth
Medical School; Director, Section
of Palliative Medicine, Department
of Anesthesiology, DartmouthHitchcock Medical Center
Joseph P. Cravero, MD: Associate
Professor of Anesthesiology and
Pediatrics; Medical Director,
of CHaD PainFree, DartmouthHitchcock Medical Center
Joyce DeLeo, PhD: Professor of
Anesthesiology and Pharmacology;
Interim Director, Neuroscience
Center at Dartmouth, DartmouthHitchcock Medical Center
Konstantin Dragnev, MD: Assistant
Professor of Medicine, Norris
Cotton Cancer Center, Dartmouth
Medical School
Field: I had fractured my pelvis quite
Judy Enos: parent of Lauren, a
patient
badly and subsequently, a long time
Gilbert J. Fanciullo, MD, MS:
Director, Section of Pain
Medicine, Dartmouth-Hitchcock
Medical Center; Associate Professor
of Anesthesiology, Dartmouth
Medical School
later, my doctors discovered that
I also had broken several vertebrae.
What should have been a 2-3 day
hospitalization turned into almost
Holly Field: patient, volunteer,
mentor
10 weeks. There were a series
Weinstein: We built animal models
of iatrogenic complications—medical
about 20 years ago to simulate a
complications as a result of the
herniation and the associated pain,
medical care—that resulted in very
to understand why one person hurts
serious damage to my spine. One
and one person doesn’t. It’s become
and a half years later, I had back
the standard model for the world. I
surgery because my doctors couldn’t
have continued it here with Joyce;
explain why the pain was so bad.
Joseph O’Donnell, MD: Senior
Advising Dean, Director of
Community Programs, Professor
of Medicine, Dartmouth Medical
School; Chief of Oncology,
Veterans Administration Hospital
Norman Payson MD: Dartmouth
Medical School Class of 1973;
philanthropist; retired CEO of
Healthsource and Oxford
Healthcare Systems; Adjunct
Assistant Professor of Community
and Family Medicine; and member
of the DMS Board of Overseers
we’ve been very successful getting
funding to study that model and study
the pain. We’ve done some landmark
Lisa Szczepaniak, MSN, ARNP:
Adult Nurse Practitioner; Director
of Clinical Services, Section of
Palliative Medicine, DartmouthHitchcock Medical Center
work on the central spinal cord
response to critical stimuli. We’ve
been able to define pretty well the
James N. Weinstein, DO, MS:
Professor and Chairman,
Department of Orthopaedic
Surgery, Dartmouth-Hitchcock
Medical Center; Co-Director,
Clinical Trials Center, DMS;
Senior Member of the Center
for Evaluative Clinical Sciences;
Editor-in-Chief, SPINE
biological and mechanical factors
related to the production of pain.
3
Thank you, Benefactors.
While gifts of all amounts are
sincerely appreciated, we
include here the names of
donors who made gifts totaling
$1,000 or more during 2004.
DeLeo: Chronic pain patients often
say “we’ll try anything.” We want
to make sure that “anything” is based
DeLeo: Right now we don’t have
The ability to transform
medicine rests in the hearts
and minds of our dedicated
professionals and is driven
by our deep commitment to
provide our communities with
the best care possible and our
students with an education
second to none. Philanthropic
support nourishes this ability
in myriad ways including
program development, endowment, scholarships, and research
support.
on knowledge.
In calendar year 2004, more
than 15,000 donors provided
nearly $17 million in support
through gifts and grants
for Dartmouth-Hitchcock
Medical Center and
Dartmouth Medical School.
around back pain and spine surgery.
Fanciullo: There’s got to be a limit
And now we’re doing the largest
on the doses of certain drugs that we
trial in the country—eleven states—
use to treat chronic pain. If someone’s
looking at operative versus non-
25 years old with chronic low back
operative treatment.We’ve received
pain, we don’t want to give an
over $30 million in federal funding.
intravenous infusion of morphine
I think the impact here is huge.
because patients can’t go home and
many different classes of drugs to
Weinstein: What we see nationally
treat chronic pain. Opioids are all
is tremendous numbers of spine
very similar, and there are problems
surgeries that might not be as
with side effects. Our lab is trying to
successful as people would like. For
come up with agents we can use as
a long time, I think, both nationally
adjuvants together with opioids, so
and internationally, we have been at
we don’t have to use as high a dose.
the forefront of translational research
As the Medical School and
Medical Center continue
on their trajectory toward
excellence, we are fueled by
the faith and support of our
donors.We are profoundly
grateful to our friends, alumni,
and other supporters for their
continuing generosity.
live that way.
Field: Then followed a very long
period of really wretched times that
DeLeo: We have a patent for a glial
only got worse. I was given much too
modulating agent. In the nervous
much Percocet. Eventually I couldn’t
system over seventy percent of the
Fanciullo: The purpose of pain is
teach anymore, and I was absolutely
cells are glial cells, not neurons.We’re
to warn you of impending injury,
heartbroken. For all kinds of reasons
looking at the role of these glial
or injury that has already occurred.
our family began to fall to pieces
cells in chronic pain and how they
Neuropathic pain, injury to a nerve,
as a result of this awful thing. With
modulate neurons.This would be
can be awful, last forever, and be
the use of Percocet, with the pain not
an entirely new class of drug. Many
relatively unresponsive to typical
controlled and having lost my job, I
companies have contacted us, and
treatments. Here we have an injury
became more and more isolated from
we’re hoping one will buy the license
that’s really not serving a useful
all the things I knew and loved and
and develop it.
purpose, not warning you of anything,
retreated into myself, which is no way
but it persists, and your brain still
to be. No way to be at all.
thinks this is valuable information.
Changes occur in your spinal cord and
your brain that help to amplify these
signals, because now your body is
really trying to warn you that there’s
this terrible injury, that you need to
get away and be safe somewhere.
There are chemical changes, and
actual physical changes.When you
look at the cell structure you can
Holly Field
see changes that occur over time.
4
Mark Israel, MD, Director, Norris Cotton Cancer Center
Weinstein: The impact of the brain
in modulating the pain response is
critical. Pain is a perception; we have
different responses. Beliefs are really
Byock: Pain that is associated with
important. Fear is really important.
illness often carries with it a threat
Most people are afraid of what
to the intactness, the integrity of the
happened. Something’s wrong with
person. It threatens our being, our
me, am I going to be paralyzed? Our
function, our future, our sense of
environment is important, too: do
ourselves.We use the word pain in
we have a job, are we happily married,
a very general sense. Often the word
do we smoke, have other illnesses?
suffering would fit much better.
O’Donnell: In the medical curriculum
Fanciullo: Seventy-five percent of
at Dartmouth Medical School, we
people who have chronic pain suffer
have vertical integration groups: over
from a major depressive disorder
the four years of medical school, we
somewhere throughout their history;
consider what the students should
anxiety disorders are even more
learn in terms of knowledge, skills,
common.
values and attitudes about certain
subjects.We’ve done one on pain and
suffering. Pain is a physical symptom,
but suffering has an existential or
spiritual component. People worry:
what’s going to happen to me? What’s
going to happen to my children?
Suffering is actually probably much
more common than pain.
5
Abcomm, Inc.
Dr. and Mrs. William A. Abdu
John Ablondi and Sharil Morin
Accreditation Council for Graduate
Medical Education
Dr. William P. Adams
Mr. and Mrs. James R. Adler
AGS Foundation for Health in Aging
Clarence and Estelle Albaugh Trust
Todd James Albert
Mr. and Mrs. Judd H. Alexander
Dr. Raymond Alexanian
Alice Peck Day Hospital
Arthur E. Allen, Jr. and Eva Filbin
Allen Engineering, Inc.
Mr. and Mrs. William F. Allyn
William G. Allyn
Alpina Sports Corp.
Drs. Donna M. Ambrosino
and Howard D. Martin
American Board of Internal
Medicine Foundation
American Cancer Society, Inc.
American College of Healthcare
Executives
American Diabetes Association
American Society for
Clinical Oncology
AmeriCares Foundation
Amgen, Inc.
Gladyce V. Amidon
Dr. and Mrs. Steven K. Andeweg
Mr. and Mrs. Warren E. Andrews
William P. Annable
Anonymous (5)
Mr. and Mrs. Russell A. Armstrong
Arthritis Foundation MA Chapter
Arthritis Foundation NE/NY Chapter
AstraZeneca LP
Astrolabe Analytica, Inc.
Dr. and Mrs. James P. AuBuchon
Edward H. Auchincloss
Dr. Barry M. Austin
Auto-Torium
Louise R. Avery
Baldasaro Enterprises, Inc.
Evelyn T. Bancroft Trust
Mr. and Mrs. Stephen P. Barba
Mr. and Mrs. Kenneth S. Barclay
Bard, Rao & Athanas Consulting
Engineers, LLC
Gary M. Barnes and
Lorraine T. Nichols
Mr. and Mrs. Robert Alan Barr
Mr. and Mrs. Raymond J. Barrette
Mr. and Mrs. Thomas J. Bascetta
John P. Bassett (Deceased)
Nancy J. Bassett
Drs. Lavonne and Paul Batalden
Mr. and Mrs. J. Barry Baughman
Dr. and Mrs. Richard D. Baughman
Colonel (Ret.) Robert C. Baughman
Baxter Healthcare Corporation
Baystate Administrative Services, Inc.
Philip E. Beekman
Mrs. K. Reed Berkey
Best Buy
Theodora B. Betz Foundation
Mr. and Mrs. Burton M. Bickford
Dr. Alan N. Binnick
Prof. and Mrs. Robert B. Binswanger
Biogen Idec
Dorothy S. Bischoff
Dr. and Mrs. Harry C. Bishop
Dr. and Mrs. William C. Black
David J. Blackwell
Joan L. Blackwell
Christopher and Wendy Blau
The Blessing Way Foundation
Mr. and Mrs. Peter A. Bleyler
Mr. and Mrs. Foster W. Blough
Bonneville & Son, Inc.
Mrs. Murray Bornstein
Naomi T. Borwell
Boston Scientific Corporation
Estate of Paul A. Bourdon
Dr. DeRayne Boykins
Katharine S. Boynton
Mr. and Mrs. Robert Boynton
Mr. and Mrs. David H. Bradley
Philip Joseph Bradley
Dr. Mark G. Brauning
David A. Bridgham and Larissa King
Dr. Donald K. Brief
Pauline Brine
Bristol-Myers Squibb Company
Jennifer and Peter Brock
Dr. Mark J. Brodkey
Marlene Brody
Lucille W. Brooks
Dr. and Mrs. Henry P. Brown III
Dr. Irving E. Brown, Jr.
Janet H. Brown
Dr. and Mrs. Mark W. Brown
Alfred Rodgers Bruckler
The Buchanan Family Foundation
Mr. and Mrs. Richard T. Bueschel, Jr.
Mrs. Grace M. Bulkeley
Dr. and Mrs. Kenneth W. Burchard
J.E. and Z.B. Butler Foundation
Marjorie W. Butler
Mr. and Mrs. Martin Butler
Drs. Lynn F. and John R. Butterly
Mr. and Mrs. Edward E. Buttolph
Drs. James Byers
and Stephanie Chuipek
Dr. Ira Byock and Yvonne Corbeil
The Byrne Foundation
Dorothy and John Byrne, Jr.
Dr. Thomas W. Byron
C&S Wholesale Grocers, Inc.
Mr. and Mrs. Colin D. Campbell
Mr. and Mrs. Robert A. Campbell
Town of Canaan, New Hampshire
Cancer Research Foundation
of America
Mr. and Mrs. Edward J. Candee
Cannon Mountain Ski Area
The Capital Group Companies, Inc.
Dr. Patricia A. Carney
Dr. Charles B. Carpenter
Dr. Carolyn B. Carroll
Carvers For Kids
Dr. Kristin Pisacano Casale
Mr. and Mrs. Thomas J. Cassady
Chamberlain Machine, Inc.
Dr. James J. Chandler
Ruth H. Chapman
Mr. and Mrs.
William Henry H. Chapman II
Cheshire Oil Company, Inc.
Chestnut Manufacturing
International
John W. Childs
Chiron Corporation
Chittenden Bank Community Fund
Mr. and Mrs. Stephen F. Christy
Dr. Kyung H. Chung
Mr. and Mrs. Richard R. Clayton
Clear Channel Radio
Clear Channel Worldwide
Dr. and Mrs. William E. Clendenning
Cleveland Clinic Health System
Jean M. Cluett
Mr. and Mrs. Frederic S. Cluthe
The Coca-Cola Bottlers’ Foundation
Coca-Cola North America
Mr. and Mrs. Edmund S. Coffin
Alexander Cohen
Edwin C. Cohen
Dr. Jeffrey Cohen and Renee Vebell
Mr. and Mrs. Richard B. Cohen
Oscar Mandel Cohn
Oscar Mandel Cohn Charitable Trust
Dr. and Mrs. Thomas A. Colacchio
Dr. and Mrs. Lawrence S. Coleman
John and Helene Collins
DHART Helicopter
Byock: People say, “I feel hopeless. I
feel helpless.” What an incredible and
terrible predicament to be in. Often in
palliative care we focus first on the
Fanciullo: All our chronic pain
physical aspects of pain and then move
patients we treat with not only
to the personal aspects of suffering. In
injections and drugs, but behavioral
working through those, the patient
medicine, psychological approaches,
can perceive hope within what might
and physical medicine approaches, too.
have been expected to be the depths
We know that exercise makes people
of despair.That’s what makes the work
feel better. It produces release of
that our section does so incredibly
substances within our own bodies
exciting, and therapeutically the most
that relieve pain. Complementary
invigorating clinical work that I’ve
and alternative treatments such as
ever done.
acupuncture and massage therapy are
also very useful for chronic pain
Field: From the very moment that I
patients. Lying on the couch makes
met Dr. Fanciullo, I just had a sense
the pain worse; we want to get people
that things were going to be different.
active.They need very specific rou-
I have such vivid memories of the
tines and regimens that they can do
first appointment with him when in a
every day.
very firm, but nonetheless kind way
he let me know that any kind of care
in the pain unit is a contract deal.
6
Byock: People experience life, in a
sense, as a narrative. In listening to
that narrative, ingesting their narrative,
Field: The pain continues to be an
you can become a part of it.The
ever-present feature of my life. It is
Latin root of the word compassion is
never not there. But I am now able
Field: I sensed from the outset that
to struggle with, to suffer with. In
to co-teach a course for first and
this was a very formal and serious
walking this journey with them, on
second year students at the medical
arrangement. That Dr. Fanciullo
a path neither of us would choose, we
school with Joe O’Donnell called “On
was going to do everything he could
can begin to perceive opportunities
Doctoring.” The students have the
to help to make my life more
within this difficult journey. If you
experience of dealing with real live
comfortable and give me back some
look up hope in the dictionary, it says
patients from the outset. We teach
of the things in my life that I wanted
an expectation of something that is
them to do good intake histories
to be able to do. But in return I had
desirable and achievable. I use the
and learn about the basic systems.
to conform to what I said I would do
metaphor of narrative to help people
I’m the patient representative in his
in the pain contract. And if there was
to perceive that there might be a
section of the “On Doctoring” course.
ever a violation of it for any reason,
positive outcome. I might say to a
that was it. I would not be cared for.
patient, “If we were to look at your
I really found the contract reassuring.
life as a long biographical novel, and
I had no reason, or wish, to violate
we knew that we were in the last
what I said I’d do, and every reason
chapters of this novel, how might
Dartmouth Medical School
for hoping that some new kind of
this story be completed?” There are
received gifts totaling $2
care would work. And, it has. I really
chapters yet to write.
million in 2004 from The
Foundation for Treatment
can say that Dr. Fanciullo gave me
Field: In those 10 weeks in the
of Children with AIDS and
hospital in Massachusetts, right after
from John L. Steffens, a
O’Donnell: One of the big things
my fall, I received some of the worst
1963 graduate of Dartmouth
about taking care of suffering is
medical care imaginable. I began
College, to advance efforts
creating the space where the patient
taking notes, in part to keep my
in international health focus-
can tell you about it. It’s amazingly
sanity, about how awful it was. I had
ing on children with AIDS
therapeutic to tell one’s story. To be
written up some of it and wanted to
and the research into the
listened to. To be heard. Somebody
put it to use. What should a proper
causes and prevention of
said the world is not made up of
doctor-patient relationship be from
AIDS. The contributions
atoms; it’s made up of stories.
both points of view? How could I
will go toward the creation
turn negative experience to positive
of the John L. Steffens
advantage?
Endowment in International
back my life.
Health and provide
O’Donnell: About nine years ago, we
assistance for the DARDAR
were planning a new orientation for
project in Tanzania, Africa,
medical students.What I thought was,
a collaboration between
when you come to medical school,
Dartmouth Medical School
the first thing you should do is meet
and the Muhimbili Univer-
a patient. So I introduced Holly
sity College of Health
and she passed out a piece about what
Sciences in Dar es Salaam
a patient wants.
to provide treatment for
HIV-infected children and
7
their families.
Dr. Daniel W. Collison
and Joan C. Collison
Combined Jewish Philanthropies
Community Foundation
of Southeastern Michigan
Community Foundation
of Western Massachusetts
Community Partners Hotel Group LP
Computac, Inc.
Consolidated Edison Company
Dr. Mark B. Constantian
Dr. and Mrs. Milton Cooper
Mr. and Mrs. Martin F. Corcoran, Sr.
Cordis
Dr. and Mrs. Cornelius J. Cornell, Jr.
Estate of Eleanor and Norris Cotton
Pamela P. Crary
Mr. and Mrs. Stephen T. Crary
Mr. and Mrs. John C. Creasy
Cremona Fund, Inc.
Dr. and Mrs. Robert W. Crichlow
June L. Critchley
Dr. and Mrs. Jack L. Cronenwett
E. J. Cross Foundation
Dr. and Mrs. Harte C. Crow
Dr. and Mrs. John F. Crowe
Dr. John M. Crowe
Mr. and Mrs. James W. Crowell
Peter O. Crowell
CTMS, Inc.
Ann M. Cullen
Richard T. Cunniff
Mr. and Mrs.
Andrew W. Cunningham, Jr.
Mary S. Cunningham
Dr. Sandra J. Cunningham
Current Medical Directions Inc.
Drs. Jesse W. and Judith S. Currier
Mr. and Mrs. Philip R. Currier
Curves for Women
Mr. and Mrs. James E. Cushing
Cystic Fibrosis Foundation
Therapeutics, Inc.
Drs. Lawrence and Linda Dacey
Dr. and Mrs. Miguel Damien
Drs. F. William Danby
and Lynette J. Margesson
Daniell Family Foundation, Inc.
Barbara E. Daniell
Mr. and Mrs. Jere R. Daniell
Mr. and Mrs. Phidias G. Dantos
Dean Hill Motors, Inc.
Lindsay Dearborn
Dr. Forbes Delany
Delta Dental
Dr. and Mrs. Christopher P. Demas
Dr. and Mrs. Carl S. DeMatteo
Dr. W. Landon Dennison, Jr.
DePuy Orthopaedics, Inc.
DePuy Spine, Inc.
Dermatologic Laser Center
Dermatology of Cape Cod
Mr. and Mrs. Philip de Toledo
Dennis A. DeVaux
Linda DeVere
Dr. William E. Dewhirst
Mr. and Mrs. S. Whitney Dickey
Martha E. Diebold
Frances K. Dimmick
Dr. and Mrs. James A. DiNardo
Drs. Mary Beth
and James G.H. Dinulos
Cleveland H. Dodge
Foundation, Inc.
Mr. and Mrs. Richard P. Donadio
Drs. Eric D. Donnenfeld
and Marlene B. Brajer Donnenfeld
Dr. and Mrs. Richard W. Dow
Mr. and Mrs. Allan M. Doyle, Jr.
Robert T. Drape
Bruce M. Dresner
and Ilene Massarsky-Dresner
Mr. and Mrs. Richard B. Drubel
Mr. and Mrs. Richard Drummond
Payson: I was pretty sure after my
second year in college that I wanted
to go to medical school. Dartmouth
was appealing because of its culture:
O’Donnell: It’s interesting, Albert
the campus, the college, the long
Schweitzer had this philosophy of
history, the permanency of it. It was
the fellowship of those who bear
small.You got to know everybody,
the mark of pain…
and the classes were very personal; the
professors knew our names. And it was
Field: After the surgery, I was told
sophisticated medicine; the teaching
by the doctor that I had arachnoidits,
was excellent.
an inflamation and infection inside
the spinal column which occurs
Field: I’m involved with “Patients
when one gets infection in surgery.
and Partners,” which is intended to
There’s nothing to do for it. It only
provide a medical student a long-
gets worse, and I was told a long
term connection with a patient over
time ago that eventually I would be
the four years. I have also been a
wheelchair bound. Which, of course,
volunteer at the hospital in what
is not the case. To my wonder and
amounts to the role of patient
delight almost all the time, with
advocate: a Patient Resource
the medication I have, I’m able to
Volunteer in the Children’s Hospital
function for those things that really
at Dartmouth (CHaD) and on 5
matter.
West—neuroscience. I’d talk with
the patients and ask how things are
I was diagnosed in August last year
going. Very often a patient will say
with a major cancer and had to
something to a volunteer that they
stop working with the patients. With
wouldn’t dream of saying to a doctor
massive amounts of chemo it was
or nurse for fear, incorrectly, of some
just not sensible to expose myself to
sort of retribution. And I co-direct,
possible hospital infections.
with Joe, the Schweitzer Fellowship,
which provides community service
fellowships for medical students.
8
Konstantin Dragnev, MD
James N. Weinstein, DO, MS
Weinstein: I work with Jack
Wennberg at the Center for
Evaluative Clinical Sciences (CECS)
on a shared decision-making effort
that allows patients to get a more
Dragnev: I met Holly over a year
realistic understanding of the
ago when she was diagnosed with
options and what the outcomes
non-small cell lung cancer, the most
of those options are.
common type.The first time I met
her we had to talk about the finding
Payson: CECS is a national leader
and the diagnosis. She knew from the
in studying variation of practice
beginning that this is an “incurable”
patterns and outcomes.To a large
condition. Incurable but treatable. She
extent, health plans, HMOs like the
was very interested in participating
ones I’ve been involved in, are limited
in a clinical study. So she enrolled in
to what they can do or say in the
one of our protocols for patients with
marketplace. So we might, for
advanced lung cancer. She was getting
example, see a certain type of surgery
established doses of chemotherapy
that is probably marginal. But if
with the addition of a new drug. And
doctors are into doing it, and patients
this is based on research that was done
want it, it’s going to be done.Who’s
here at Dartmouth.
there to say that maybe we shouldn’t
be doing as many? I think there’s an
opportunity to drive things here,
to be a model for how health care
can be delivered better.
9
Dr. Kathleen R. Dube
Dublin Fund Inc.
Doris Duke Charitable Foundation
Dulude Family Foundation, Inc.
Jean M. Dulude
Durgin and Crowell Lumber
Company, Inc.
Mr. and Mrs. Robert S. Dustin
Dr. Diane Marie Dwyer
and Joseph G. Gall
Mae E. Eagleson
Eastman Friends
Eastman Golf Association
Eastwind Lapidary, Inc.
Alden W. Eaton
Mr. and Mrs. Robert J. Eckenrode
Edelweiss Charitable Foundation, Inc.
Dr. and Mrs. J. Robert Edwards
Dr. and Mrs. John H. Elliott
Dr. and Mrs. Robert M. Ellsworth
Mr. and Mrs. Louis B. Ely, Jr.
Engelberth Construction, Inc.
Epply Charitable Foundation
Mr. and Mrs. Harry F. Espenscheid
Estes & Gallup Builders, Inc.
Evergreen Capital Partners, LLC
Exxon Mobil Foundation
Dr. and Mrs. Charles S. Eytel
Margaret S. Fable
Mr. and Mrs. William J. Faccone, Sr.
Mr. and Mrs. Peter M. Fahey
Fahey Family Foundation
Fairfield County Community
Foundation, Inc.
Dr. and Mrs. Gilbert J. Fanciullo
Mr. and Mrs. Charles A. Farmer
Estate of Nellie Farr
Mr. and Mrs. Russell B. Faucett
Mr. (Deceased) and Mrs.
Stanley H. Feldberg
Dr. and Mrs. John E. Fenn
Mr. and Mrs. Allan R. Ferguson
Dr. and Mrs. David R. Fett
Fidelity Investments Charitable
Gift Fund
Mr. and Mrs. Daniel Field
Doris A. Fielding
Dr. Michael M. Finigan
First Colebrook Bank
Dr. and Mrs. Kenneth H. Fischbeck
Dr. Lloyd C. Fisher
Mr. and Mrs. Bernard Fishman
Fleet Bank
Fleet Services Corporation
Dr. Timothy P. Flood
Forest Pharmaceuticals, Inc.
Forex Capital Markets
Nancy and John Formella
Foundation for Digestive Health
& Nutrition
Foundation for Treatment of
Children with AIDS
Drs. Diane Louise Fountas
and Peter Jacoby
Joan P. Fowler
Dr. R. John Fox, Jr.
Stephen P. Fox
The Jane & Stephen Frank
Foundation
Dr. Judith E. Frank
Jean Frankenstein and David Breed
Fraternal Order of Eagles 3765
Fraternal Order of Eagles NH State
Grand Aerie
Mr. and Mrs. Robert L.V. French
Frey Foundation
Dr. Peter N. Friedensohn
Friends of Norris Cotton
Cancer Center
The Friends of Shannon McDermott
Mr. and Mrs. Milton Frye
Mr. and Mrs. Robert C. Fuehrer
Fujisawa Healthcare, Inc.
Mr. and Mrs. Clifford J. Fuller, Jr.
$5M LeBaron Gift Heralds Science,
Care & Innovation
Unconventional thinking—always looking around the corner
to identify the “next big thing”—is what helped make Dean
LeBaron successful in his career as an investment futurist.
His sort of thinking outside of the box also inspired him
to contribute $5 million to Dartmouth Medical School to
establish LeBaron Commons. Named to honor the memory
of LeBaron’s father, Francis E. LeBaron, DO, MD, LeBaron
Commons will connect the Robert and Naomi Borwell
Research Building on DHMC’s campus in Lebanon to future
research facilities there. The uniquely-envisioned space will
promote formal and informal collaboration, communication,
and interaction among members of the Dartmouth medical
community.
“I am especially attracted to the notion of a Commons
because that is where people will meet and exchange ideas,”
Mr. LeBaron explains. And for someone who has founded
exceedingly unusual, but highly successful companies, and
whose father was a doctor, the potential to contribute to
innovative space that hastens the transformation of scientific
Dean LeBaron, who splits his time between homes in New
discoveries into patient care holds special appeal.
Hampshire and Switzerland, may get his drive to pursue the
unknown and unconventional from his father. Dr. LeBaron
Dean LeBaron’s philosophies on business, science, and life
was regarded as a pioneer, personally and professionally. A
are rooted in heady concepts such as contrarian thinking,
1931 graduate of the Massachusetts College of Osteopathy
emergent behavior, and complexity science. But he realizes,
and a 1934 graduate of the Middlesex College of Medicine and
too, that transformational work can come from plain gestures,
Surgery, Dr. LeBaron was a self-taught researcher whose quest
like helping construct a special space to foster innovation—
for new frontiers made him a lifelong student. “I think of him
or trying an unusual medical procedure.
as continuously questing toward a better form of medicine,
meaning helping people,” recalls Dean LeBaron. “He was a
Late one night while at home in New Hampshire, he lost
general practitioner, and he enjoyed that. Additionally, he
vision in one eye. Under the care of ophthalmologist
worked in industrial medicine, on disease or accident preven-
Christopher Chapman, MD, and internist Jay Buckey, MD, he
tion, and also combined osteopathy with medical practice.”
agreed to try an experimental treatment that might temporarily
restore his vision. The procedure—which included a four-hour
period in DHMC’s hyperbaric chamber— worked as hoped
which pleased him, but the experience left him even more
impressed because of the willingness of the two doctors to
apply a unique combination of science, care, and innovation.
10
DeLeo: We’ve had a few small
American Cancer Society grants to
study cancer pain; the interaction
between chronic pain and metastasis.
If you have a chronic pain syndrome,
Weinstein: At Dartmouth we take
is the instance of metastasis greater?
primary, basic research, apply it to
Our work also interfaces with cancer
clinical practice all the way to shared
in the area of neuropathic pain. If you
decision making where patients
have a tumor that causes any type of
are actually making clinical decisions.
compression, that’s a type of neuro-
We’re helping effect change in
pathic pain. Also, chemotherapy can
national policy.
induce neuropathic pain. One
of our glial modulating agents is
Dragnev: It’s a little bit unusual for
effective in treating chemotherapy-
us to see a patient like Holly with a
induced neuropathy. We know we
lot of pain that’s not related to the
can co-administer this agent with
cancer. For her we clearly needed a
chemotherapy and see if it decreases
multidisciplinary approach: our team
the incidence of neuropathy. That
treated the cancer with an excellent
would be very exciting.
response, although no effect on her
pain; and the pain people treated her
Dragnev: Typically, what we have is a
as someone in pain not having the
patient who has cancer and has pain
cancer diagnosis.
related to their cancer, so when you
treat the cancer you treat the pain.
We have established an excellent
working relationship with the Pain
Service and the Palliative Care Service
based on these patients who have
cancer and pain that are related.
11
Fund American Companies, Inc.
Dr. Ann Furtado
Dr. Imre Gaal, Jr.
GAB Business Services, Inc.
Estate of Gay H. Gahagan
Dr. Stephen J. Galli
Mr. and Mrs. Paul B. Gardent
Dr. and Mrs. Theodore H. Gasteyer II
Dr. and Mrs. Alan B. Gazzaniga
Genentech, Inc.
General Motors Cancer Research
Foundation
Geokon, Inc.
Dr. Glenn S. Gerhard
Bennett L. Gershman
C. Michael Gibson
Gilead Sciences, Inc.
Laurie Giles
Prudence D. Gilmore
Dr. Benjamin J. Gilson
Dr. and Mrs. D. David Glass
Paul W. Glover, Jr.
Mr. and Mrs. Richard F. Gluck
GM Vehicle Sales, Servicing
& Marketing
Gertrude M. Goff
The Arnold P. Gold Foundation
Dr. James C. Gold
and Penny H. McConnel
Goldenberg, Miller, Heller
& Antognoli P.C.
William Goldman Foundation
Golf & Ski Warehouse, Inc.
Alfredo Gomez-Ruiz
Dr. Joseph S. Gonnella
Good Beginnings Inc.
Mr. and Mrs. Philip P. Goodkin
W. L. Gore & Associates
Dr. E. Ann Gormley
and Richard Wallace
Gorton Golf, Inc.
Mr. and Mrs. James F. Gosselin
Dr. and Mrs. Robert E. Gosselin
Mr. and Mrs. Thomas L. Gosselin
Mr. and Mrs. Eric E. Gottesman
Mr. and Mrs. Jack Grabosky
Mr. and Mrs. George A. Graham, Jr.
Wayne and Deborah Granquist
Dr. Barry A. Gray
Dr. Alan I. Green
and Frances S. Cohen
Helen S. Greenlee
Mr. and Mrs. Saul Greenspan
The Greenspan Foundation
David S. Greenwood
Garth H. Greimann
Mr. and Mrs. Alfred L. Griggs
Dr. and Mrs. Walter C. Griggs
Grimshaw-Gudewicz Charitable
Foundation
Estate of Beatrice B. Griswold
Daniel F. Grossman
and Dana Cook Grossman
Edna & Monroe C. Gutman
Foundation, Inc.
Edward Guyot
Estate of Marjorie N. Hahn
Mr. and Mrs. David K. Hall
Mr. and Mrs. Thomas P. Hall
Mr. and Mrs. Sheffield J. Halsey
Mr. and Mrs. Roger W. Hamblin
John Hancock Financial Services, Inc.
George D. Hano and Diane Crowley
Dr. William D. Harley
Mr. and Mrs. Jacques Harlow
Dr. Allan C. Harrington
Mr. and Mrs. Gary Harwood
Mr. and Mrs. Byron C. Hathorn, Jr.
Hawkins Delafield & Wood LLP
Dr. Hamilton R. Hayes
Warren J. Hayes
Mr. and Mrs. Byron W. Haynes
Daniel Hebert Inc.
Marian Heiskell
Mr. and Mrs. Armin B. Hemberger
Dr. and Mrs. W. Hardy Hendren III
Mr. and Mrs. Paul Hendricks
Hendricks/Felton Foundation
Prof. and Mrs. (deceased)
John W. Hennessey, Jr.
Martha Hennessey
Irene M. Hennings
Hermit Hill Charitable Lead Trust
The Carl J. Herzog Foundation, Inc.
Mr. and Mrs. John C. Heston, Jr.
Mr. and Mrs. Marshall Heuser
Daniel C. Hewes
Dr. William F. Hickey
and Lauri-Annis S. Rich
Frederick W. Hilles
and Jane E. Osgood
Hinckley, Allen & Snyder LLP
Mr. and Mrs. Mark F. Hinman
Dr. Francis H. Hinnendael
Mr. and Mrs. Harold R. Hiser, Jr.
Sandra U. Hoeh
Janice G. Hoenicke
Estate of Altha J. Holbrook
Mr. and Mrs. Romer Holleran
HP Hood, Inc.
Dr. and Mrs. Bruce J. Hookerman
Dr. Harriet D. W. Hopf
Albert L. Hopkins
and Lynne L. Zaccaria
Florence O. Hopkins Charitable
Fund, Inc.
Dr. Patricia T. Hopkins
Dr. Diane Marie Hoss
Jennifer A. Hotz
Deanna S. Howard
Mr. and Mrs. Tom P. Hoyt
Wentworth Hubbard
J.M. Huber Corporation
Mr. and Mrs. Delmar R. Hughes, Jr.
James A. Hughes
Hypertherm, Inc.
Dr. and Mrs. Richard S. Idler
IDX Information Corporation
The Impact Group
Independent Charities of America
Indiana University
Integrated Therapeutics Corporation
Dr. Thomas W. Irvine, Jr.
Irving Oil Corporation
Mr. and Mrs. T. Hale Irwin
Dr. and Mrs. Mark A. Israel
Mary E. Ives
Jane’s Trust
Janssen Pharmaceutica, Inc.
Jesse’s Restaurant, Inc.
Carol A. Johnson
Ellen Foscue Johnson
Johnson & Johnson
Johnson & Johnson Services, Inc.
Robert Wood Johnson Foundation
Dr. James R. Johnston
Albert C. Jones
Mr. and Mrs. Arthur Jones
Mr. and Mrs. A. Wilson Jones
Barbara M. Jones
Jordan & Kyra Memorial
Foundation, Inc.
Dr. Sarah A. Kahn
Dr. Bertrand P. Kaper
Dr. and Mrs. Aaron V. Kaplan
Dr. Claudia J. Kasales
Barbara S. Kaufman
Dr. Haig H. Kazazian, Jr.
Dr. William M. Keane
Mr. and Mrs. Thomas D. Kearney
Judith J. Keating
Keene Medical Products, Inc.
Dr. Victoria M. Keetay
Mr. and Mrs. Alan C. Keiller
Kelleher Construction, Inc.
Reverend and Mrs.
Preston T. Kelsey II
Mr. and Mrs. Robert P. Kelsey, Jr.
Bakitis: Because Gil Fanciullo is the
director of the Pain Center and started
the Palliative Care Center, we’ve
always been united in the department
Ahles: We’re in the second year of
of anesthesia. Gil took the leadership,
a five-year project to improve end-
offered his time and that of doctors
of-life care for patients with advanced
in the Pain Center to help get the pal-
stage cancer.The goal of the study is
liative medicine service going. It’s rare
to improve symptom management
and unique that they’re joined.
and quality of life.We’re identifying
patients at diagnosis and randomizing
Byock: Dartmouth has a long history
them either to regular care or a
of working in palliative care. I stand
nurse-based intervention. Our
on the backs of giants; people who
palliative care program sort of evolved
have been very important nationally
from that process.
and who built a foundation here at
Dartmouth. In many ways, while
Fanciullo: I was the first director of
I get a lot of the attention, I’m in
Palliative Medicine.We help people
a wonderful position of being
deal with serious medical illness.We
acknowledged as the conductor in
take care of not only the patient, but
a small orchestra of virtuosos.
also their family, addressing not only
pain, but other symptoms such as loss
of appetite, weight loss, hair loss,
emotional, spiritual, and social issues.
Lisa Szczepaniak, MSN, ARNP
12
Marie Bakitas, ARNP
Byock: We’re increasingly being asked
to see patients in surgery, neurology,
dialysis, who are struggling with
serious, but non-terminal illnesses.
Szczpeniak: We’re a very close-knit
What clinicians are telling us is that
group.The Palliative Care doctors and
it’s very helpful in fleshing out a more
nurse practitioners get along so well
patient-centered and family focused
with those in the Pain Center.We can
care plan.
pick up the phone anytime and call
and say, “Gil, we’ve done everything
Szczpeniak: On occasion, we have
we can medically managing this
gotten pediatric consults in the
patient’s pain. Can we implant a
PICU and NICU and even through
pump? Can you look at this MRI
pediatric neurology with degenerative
for us? Can we do some type of
neurologic disordered patients to help
high-tech procedure for this pain?”
with pain and symptom management.
And he’s right there.
We’ll draw on the support of Dr.
Cravero’s PainFree team if we need
assistance.
13
Mr. and Mrs. S. Leonard Kent
Dr. Carolyn L. Kerrigan
and David S. Greenwood
Dr. Richard I. Kertzner
The John and Estelle Ketterer
Foundation
F. Ray Keyser
Dr. Edward F. Kieger II
Larissa King and David A. Bridgham
Mr. and Mrs. Randle B. Kinne
The Karl Kirchgessner Foundation
Walter G. Kis
Lynn Kisselbach
Kiva Foundation
Knox Family Foundation
Komen Vermont Race For The Cure
Dr. Alan T. Kono
Dr. and Mrs. C. Everett Koop
Drs. Antoinette and Murray Korc
Dr. and Mrs. Gary Korenman
Koskoff, Koskoff & Bieder, PC
Dr. Kenneth J. Koval
and Mary Reynolds
KPMG Peat Marwick
Paul L. Kristensen and Trudi M. Brock
Robert R. Krumm
Dr. Thomas R. Kuhns
Dr. Bruce F. LaFollette
Drs. John M.
and Margaret J. Lagnese
Lakes Region Ice Racing Club
Mr. and Mrs. Brian T. Lally
Dr. Laurie A. Latchaw
Edward Connery Lathem
Estee Lauder Inc.
LaValley Building Supply, Inc
Jonathan S. Lavine
Dr. and Mrs. D. James Lawrie
Estate of Jennie Ethel Laws
Carola B. Lea
It’s amazingly therapeutic to
tell one’s story.To be listened to.
Dear Friends:
In Dartmouth-Hitchcock Medical
Center’s Annual Report for 2004,
we take you beyond the facts and
figures that document our progress.
We wanted to share with you the
privilege we have each day of
witnessing the tremendous interaction
of science, learning, and healing that
Pictured from left to right:
makes this medical center such a
Dr. Thomas Colacchio, President, Dartmouth-Hitchcock Clinic
special place. It is through the stories
James Varnum, President, Mary Hitchcock Memorial Hospital
of our patients that we understand
Dr. Stephen P. Spielberg, Dean, Dartmouth Medical School
what “multidisciplinary” teams really
are, what “patient-centered care”
The teamwork and creative thinking
We were also pleased this year to
involves, and how our core missions
that give our patients some of the best
celebrate with many of you the
of medical education, scientific
care in the world enrich the medical
opening of the new Doctors Office
research, clinical care, and community
center in other, less visible ways. In
Building, and other components of
outreach blend together seamlessly to
the face of serious financial challenges,
our Project for Progress.The new
enhance the treatment of our patients.
our physicians and staff have extended
construction that has occupied us for
their dedication and commitment
the last three years is now complete,
The story of our friend, colleague
to making important operational
and we have moved to the phase of
and patient Holly Field illustrates
improvements that translate to an
making renovations to the original
how the environment of innovation
improved financial picture. But
structure.We are delighted with the
and discovery—often taking place
we must continue to invest in the
new space which reflects the gifts
behind the scenes—leads to better
equipment, technology, facilities,
of so many of you, and we hope it
treatment and outcomes.We build that
and recruitment of faculty and staff
conveys the warmth and excitement
environment by actively engaging in
required to meet our missions and
we feel about the work we do on
learning and building on our core
the needs of our community.
your behalf—incubating new ideas,
expertise and that of our professional
conducting patient clinical trials,
colleagues.You and patients like Holly
While we ended 2003 with a flat
and transferring new findings and
have shown us how much we can
margin, we were pleased to close this
innovative treatments to direct
learn when we listen to our patients
year with a positive margin of 2.3
patient care.
tell us about their symptoms and their
percent. This positive margin is espe-
needs, and then also involve them in
cially significant when you consider
You are a critical part of our team.
decision-making about their treatment
that we provided over $16 million in
Through your interest and your
options.Your experiences with this
financial assistance to uninsured and
support—financial and otherwise—
medical center—shared with those
underinsured patients. Other uncom-
in this medical center, you make our
in training and those leading—make
pensated services—primarily the
dynamic environment of learning,
you a valuable partner in transforming
result of inadequate payments from
teaching, and healing possible. Along
medicine and medical care.
government payors (Medicare and
with the dedicated efforts of a talented
Medicaid)—amounted to $71
and committed corps of colleagues,
million, bringing DHMC's total for
we are transforming medicine.We’re
uncompensated care to an amount
delighted to have you with us on
in excess of $87 million for 2004.
the journey.
Financial Information
Operating Expenditures (000s omitted)
Dartmouth Medical School (DMS)
Dartmouth-Hitchcock (D-H)*
Veterans Affairs Medical Center (VA)
Total
2004
$180,351
$795,320
$98,823
$1,074,494
2003
$161,130
$721,556
$91,733
$974,419
Revenue Sources (000s omitted)
2004
Payment for Patient Services
from Third Parties
Federal Budgets for Veterans
Affairs Services
Funded Research
Tuition Income and Fees
Gifts, Bequests, Endowment
and Other Income
DMS
$10,499
D-H
$774,130
VA
TOTAL
$784,629
$94,123
$94,123
$4,700
$123,568
$14,421
$73,564
$118,868
$14,421
$36,140
$37,424
$179,928
$811,554
$98,823
$1,090,305
DMS
$9,606
D-H
$675,001
VA
TOTAL
$684,607
$87,546
$87,546
$4,187
$105,938
$13,704
$82,292
$91,733
$974,087
Revenue Sources (000s omitted)
2003
Payment for Patient Services
from Third Parties
Federal Budgets for Veterans
Affairs Services
Funded Research
Tuition Income and Fees
Gifts, Bequests, Endowment
and Other Income
$101,751
$13,704
$35,511
$46,781
$160,572
$721,782
2004 Dartmouth Medical Research Awards
2004 Revenue Sources
$98,823
$179,928
2.62%
2.62%
4.87%
5.42%
16.44%
5.49%
6.42%
16.44%
8.91%
$811,554
10.97%
14.50%
DMS
D-H
VA
*Dartmouth-Hitchcock represents
Mary Hitchcock Memorial Hospital
and Dartmouth-Hitchcock Clinic
combined.
6.09%
Medicine
Psychiatry
Other
Community & Family Medicine
Physiology
Microbiology
Biochemistry
Genetics
Pediatrics
Pharmacology & Toxicology
Radiology
DMS Administration
Other
10%
1%
Norris Cotton Cancer Center
11%
Surgery
Orthopaedics
Anesthesiology
17%
Pathology
Obstetrics & Gynecology
39%
22%
Operational and Patient Report
2004
2003
502,146
111,969
614,115
481,016
115,109
596,125
168,060
300,266
204,140
300,223
5,506
978,195
1,592,310
166,720
284,302
189,665
283,763
6,506
930,956
1,527,081
Dartmouth Medical School
Physician Office Visits
Psychiatry
Total
33,651
33,651
33,418
33,418
Veterans Affairs Hospital
Patients Discharged
Patient Days of Service
Average Daily Census
Operations Performed
Outpatient Visits
Same Day Procedures
Home Health Visits
Volunteer Hours
2,612
16,369
45
3,210
171,397
3,818
5,228
64,339
2,636
15,868
44
3,713
166,714
5,529
7,180
53,550
Patients Discharged
New Hampshire
Vermont
Other States
Total
11,359
9,226
880
21,465
10,860
8,776
991
20,627
Patient Days of Service
106,184
100,392
291
275
14,755
14,139
1,166
1,116
Emergency Department Visits
27,048
24,295
Volunteer Hours
54,000
51,850
1,012
5,977
638
972
5,922
605
292
329
163
83
23
890
289
325
174
88
27
903
Outpatient Visits
Northern Region
Lebanon
Other Sites
Subtotal
Southern Region
Concord Offices
Manchester Offices
Nashua Offices
Keene Offices
Other
Subtotal
Total
Average Daily Census
Operations Performed
Inpatient and Outpatient Total
Births
Employees (Full-time equivalents)
Dartmouth Medical School
Dartmouth-Hitchcock
Veterans Affairs Medical Center
Education Programs
Medical Students
Residents and Clinical Fellows
Graduate Students in Basic Medical Sciences
Other
Postdoctoral Research Fellows
Total
Community Benefits
Patients Receiving Financial Assistance
8,368
Financial Assistance
Financial Support for Medical Education
Physicians’ Uncompensated Teaching Time
Subsidies of Unique & Exceptional Services
Community Health Gifts, Subsidies & Activities
Payment in Lieu of Taxes
Total Community Benefits Value
$16,670,887
$8,058,843
$12,886,796
$4,259,906
$7,202,724
$832,292
$49,911,448
Uncompensated Medicaid
Uncompensated Medicare/CHAMPUS
Total Uncompensated Government Insurance
$27,393,421
$43,606,203
$70,999,624
$7,202,724
$832,292
$16,670,887
Financial Assistance
Financial Support for
Medical Education
Physicians’ Uncompensated
Teaching Time
Subsidies of Unique
& Exceptional Services
Community Health Gifts,
Subsidies & Activities
$4,259,906
$12,886,796
$8,058,843
Payment in Lieu of Taxes
Philanthropic Contributions
Fiscal Year 7/1/03 - 6/30/04
Total Philanthropic Contributions
$16,742,864
Current Operations
Unrestricted and Annual Funds
Restricted Funds
Total Current Operations
$1,082,634
$12,949,975
$14,032,609
Endowment
Restricted & Unrestricted Endowment
Student Aid Endowment
Research Endowment
Total Endowment
$848,537
$172,311
$361,376
$1,382,224
Plant and Equipment
Total Plant & Equipment
$339,204
Life Income Gifts
Total Life Income Gifts
$988,827
$339,204
$988,827
$1,382,224
Current Operations
Endowment
Plant and Equipment
Life Income Gifts
$14,032,609
Somebody said the world is
not made up of atoms; it’s made
up of stories.
—Joseph O’Donnell, MD
Mary Susan Leahy
City of Lebanon
The LeBaron Foundation
Dean Francis LeBaron
Mr. and Mrs. Stephen J. LeBlanc
Ledyard National Bank
Dr. T. David Lee, Jr.
Mark Lennon and Mary Mead
Mr. and Mrs. Wesley A. Leuthauser
Dr. and Mrs. Gary M. Levine
Mr. and Mrs. Samuel M. Levine
Mr. and Mrs. Lien Chu Li
Ted and Suzanne Lieser
Lightship Telecom, LLC
Marion T. Lilley
Eli Lilly and Company
Dr. and Mrs. Robert W. Liming
Charles Lindner and Jane Finlay
Agnes M. Lindsay Trust
Litchfield Middle School
Dr. and Mrs. Daniel S. Longnecker
Mr. and Mrs. Warren T. Loomis
Mr. and Mrs. Douglas M. Loudon
Dr. and Mrs. Franklin Lynch, Jr.
Dr. and Mrs. Joseph P. Lynch
Dr. John H. Lyons III
John D. & Catherine T. MacArthur
Foundation
Prof. and Mrs. Robert M. Macdonald
D. Hugh MacNamee Memorial
Trust Fund
David Mahoney
Maloney Associates
Dr. Lisabeth Maloney
and Joseph Maloney
Dr. Richard D. Mamelok
and Midori Aogaichi
Manchester Fall Charity Fest
Manchester NH Automobile
Dealers Charitable Fund
Mr. and Mrs. Stephen F. Mandel, Sr.
Carla Manley
Alix Manny
Mr. and Mrs. John R. Mapley
Estate of Dr. Philip A. Marden
Mr. and Mrs. Jeffrey A. Marshall
Mr. and Mrs. LeRoy E. Martelle, Sr.
Drs. Meredith A. Martin
and Thomas Treadwell
Michael D. Martin
W. William Martinez
Mascoma Savings Bank
Mascoma Savings Bank Foundation
Dr. and Mrs. Charles M. Maxfield
Priscilla K. Maynard
Drs. Rowland Mayor
and Stephanie Arlis-Mayor
Mr. and Mrs. Brantz Mayor
Dr. and Mrs. Robert E. McCabe, Jr.
Dr. Frances V. McCann
McCarthy Building Company Inc.
Philip H. McCaull
McDowell Foundation
Dr. Fletcher H. McDowell
Paul J. McGoldrick
Dr. and Mrs. Donald O. McIntyre
Dr. and Mrs. O. Ross McIntyre
Leo C. McKenna
Jane Kitchel McLaughlin
and Peter McLaughlin
McLaughry Associates, Inc.
Mr. and Mrs. Bruce C. McLaughry
Mr. and Mrs. Todd McPherson
Patricia A. Means
Medical Metrx Solutions
Medication Assistance Program
Medtronic, Inc.
Mellen St. Realty Trust
Drs. Vincent A.
and Natalie P. Memoli
Merck & Co., Inc.
Merck Company Foundation
Mr. and Mrs. Keniston P. Merrill
Mr. and Mrs. Peter K. Merrill
Weinstein: We’ve created this idea of
collaboration across many disciplines
as being much more powerful than
any individual, or any individual
department. I try to collaborate with
all departments, because I have to take
Weinstein: We all work together
care of you as the patient with as
in the Spine Center under one roof
much knowledge as I can bring to
to deal with this issue of pain.
bear on your problem.
Our Spine Center is unique in
this country, in the world, because
Fanciullo: The doctors in the Pain
of that understanding of these
Center work a day a week in the
interrelationships.We also have
Spine Center. It’s the one example
chiropractic treatment, physical
within the medical center where there
therapists, acupuncturists, herbal
is interdisciplinary patient care that’s
medicines, a potpourri.Why?
administered “real time.” We see a lot
Because nobody’s sure what works
of pain patients down there.
best. I like to think of Dartmouth
as a community of medicine brought
Weinstein: I brought neurosurgeons,
to bear on an individual patient.
orthopedic surgeons, anesthesiologists,
internists, nurse practitioners, pain
O’Donnell: To palliate is to cloak
doctors…I started the Spine Center
and relieve symptoms. And so people
based on the idea that multiple
have begun to pay as much attention
disciplines were necessary, that
to the quality of one’s life as the
surgery wasn’t the only answer.
quantity. It’s as important to control
the pain, or shortness of breath, or
Byock: When you get people together
fatigue or sleeplessness, the various
in these interdisciplinary clinics, the
symptoms that accompany the illness
whole is always more than the sum
as it is to take care of the illness itself.
of its parts.What comes out of this
is often a plan of care that is more
holistic and humanistic.
14
Healthy Skepticism and
Enormous Generosity
When Norman Payson, MD, graduated from Dartmouth
Medical School (DMS) in 1973—as a member of the first
graduating class of the school’s MD program—he received
more than a first-rate medical education. “I came away with
a healthy sense of skepticism about the way health care was
being delivered,” says Payson. “Among my mentors at
Dartmouth, there was a strong feeling that we could do
better, that there were ways to provide higher quality, more
affordable, and more responsive care to patients.”
It was a philosophy that would serve Payson well and help
drive him to great success, first as a practicing physician and
then as a business leader in the managed healthcare industry.
“I owe a great deal to Dartmouth,” says the New Jersey
native who came to DMS on scholarship after completing
an undergraduate degree at MIT. “It’s a very special place,
and I’m delighted to be able to give back to help others in
the same way that I was helped.”
Preparing Tomorrow’s Leaders
Dr. Payson recently gave a $2 million gift to DMS, half
of which will be used to provide scholarships for New
Hampshire students to attend DMS. The second million
Norman Payson, MD
will be used to help sponsor a select group of DMS students
who, in addition to their medical education, would like to
“So, what I hope to do with the second part of the gift is
pursue an MBA at the Tuck School of Business.
provide assistance and encouragement to those students
who are interested in playing a leading role in changing and
“Historically, there’s been a ‘disconnect’ between medical
improving how health care is delivered in this country,” he
science and what really happens in the marketplace,” Payson
says. “It’s very expensive to go to medical school or business
explains. “Physicians don’t necessarily understand the
school, and to do both is really a hardship. Given that we
marketing of health insurance, what the economics of drug
have these two great schools here—in DMS and Tuck—
development are, or how hospital economics work. Business
I want to help reduce that hardship and create a more formal
students, on the other hand, are well-groomed to understand
educational pathway for our next generation of leaders.”
markets and finance, but they don’t have the health care
background. For those who want to effect change in today’s
“I think clearly there’s an opportunity to drive things at
highly complex healthcare system, I think there’s a distinct
Dartmouth-Hitchcock Medical Center, to be a model for how
advantage in developing competencies in both disciplines.”
health care can be delivered better,” adds Payson.
15
Mr. and Mrs. John D. Merwin
Messer Hill Associates, Inc.
Milheim Foundation
Miller Trading Company
William A. Miller
Sally Mitchell
Mr. and Mrs. James P. Mithoefer
Mobil Foundation, Inc.
Dr. and Mrs. John F. Modlin
Montshire Endodontics PLLC
Benjamin Moore & Company
Elizabeth L. Moore
Dr. and Mrs. John M. Moran
Richard B. Morgan
Morgan Stanley & Company, Inc.
Dorothy W. Mori
Prof. and Mrs.
Leonard E. Morrissey, Jr.
Katherine P. Mosenthal
MSI Energy, LLC
Drs. Carolyn J. Murray
and Joseph P. Cravero
Muscular Dystrophy Association, Inc.
Dr. and Mrs. W. P. Laird Myers
Mr. and Mrs. Henry Nachman, Jr.
Mrs. Emily S. Nagle
Christopher E. Naimie
Mr. and Mrs. Cyrus H. Nathan
National Kidney Foundation
National Multiple Sclerosis Society
Cynthia S. Naylor
John R. Neal
Dr. Patsy D. Needham
Karen J. Neff
Mr. and Mrs. John T. Neises
Dr. D. Dirk Nelson
and Mary Kathryn Tellman-Nelson
Eunice P. Nelson
Mr. and Mrs. John K. Nelson
Linda L. Nelson
Mr. and Mrs. Walter B. Nelson
Dr. and Mrs. William H. Nelson
The Nemours Foundation
Nestle, Inc.
New England Ford Dealers
Association, Inc.
New England OB/GYN
Associates, Inc.
New Hampshire Center for
Cancer Medicine
New Hampshire Charitable
Foundation
New York Community Trust
NGM-Farmer Family Community
Lorraine T. Nichols
and Gary M. Barnes
Eleanor McKay Norris
Northeast Health Care Quality
Foundation
Dr. Mark R. Northfield
Dr. Christiane L. Northrup
Novartis Pharmaceuticals
Corporation
Anna B. Nugent Charitable
Lead Trust
Dr. and Mrs. William C. Nugent, Jr.
Mr. and Mrs. David C. Nutt
Dr. and Mrs. Daniel L. Ogg
Dr. and Mrs. Thomas B. Okarma
Dr. Robert M. O’Neal
On The Road to Recovery, Inc.
ONS Foundation
Oracle Corporation
Orr & Reno Professional Association
Orthoeast, Inc.
Ortho-McNeil Pharmaceutical
Orthopaedic Research
and Education Foundation
Mr. and Mrs. Kirk Oseid
Mr. and Mrs. George F. B. Owens, Jr.
Anne Page
Mr. and Mrs. Richard M. Page
Paraid
Donald W. Parsells
chemotherapy, we’re still providing
pain treatment. And this is really until
the end of life.We may not be 100
percent successful at all times, but the
patients do not die from cancer in
pain.Treatment of symptoms is not
only an integral part of the standard
management, but it is also considered
to be one of the most important
Bakitis: In palliative care, we try
things that you can do. Symptom
to treat pain within the context of
control is best managed in a multi-
the whole person.We also use the
disciplinary fashion which this
technology that’s the expertise of
institution provides. Collaborating
the people in the Pain Center. For
with the palliative care team has really
palliative care patients, their pain may
made us more aware of the different
be more total pain or suffering, pain
ways to treat the symptoms.
from emotional distress.
O’Donnell: Pain and suffering are
Field: Fear has a great deal to do
two of the most common symptoms
with intensifying pain. To the extent
that doctors will run into.When
a doctor can say, “you will have
the medical students are on their
pain, but we will do what we can
pediatrics rotation, they’re learning
to treat it,” really helps the pain to
about Joe Cravero’s PainFree program.
be less. The patient isn’t so afraid,
and is reassured to know that you
acknowledge there will be pain and
you say you will help.
Dragnev: When we talk to patients
with incurable cancer, most people
are afraid of not only dying, but dying
in pain. And so all the treatments that
we do are to preserve quality of life,
or improve it, to relieve symptoms
(specifically pain) or to prevent pain.
So even if we’re not doing any more
16
My 12-year-old daughter Lauren
has a developmental disability, autism.
Primarily it’s a communication disorder,
but there are a lot of sensory issues.
For her touch can be very offensive and
causes a lot of anxiety. She also has a
seizure disorder, which is why we need
to get periodic diagnostic testing done.
—Judy Enos
Cravero: What we do in the
The Johnson & Johnson-
PainFree Center is provide sedation
Dartmouth Community
and anesthesia for minor painful
Mental Health Program
procedures. Our thought was to create
Enos: We were doing very well
demonstrates the power of
a central location where any kid
for a while. She would actually
blending medical science,
who needs sedation comes to people
participate in the blood draws
social policy, and evidence-
who give this treatment every day.
on her own will. And then one
based practice to re-establish
It’s much more efficient and it’s safer
time she had a really bad
productive lives for some of
because the people there are doing
experience—not at Dartmouth,
the most severely mentally
this work all the time. Sedation is
at another institution. So that
ill members of our society.
done not just for pain treatment but
was the moment when we just
Thanks to ongoing generous
to immobilize, which previously we
couldn’t get her to go give
support from Johnson &
might have done by trying to just
blood. I tried many means
Johnson, the program has
pin the kid down.We’re able to get
before I found the PainFree
grown from just three sites
this work done better and it’s better
Center.
in 2001 to serving more than
patient care.
2,000 people in six states
Cravero: What we try to do in our
and the District of Columbia.
location is consider the patient and
The program helps people
the procedure and what the family
with mental illness and
milieu is.We have certified nurse
learning disabilities reclaim
anesthetists, residents, physicians, and
their lives by helping them
child-life specialists: all are critical
manage their illnesses and
parts of the team.
gain independence by
obtaining and retaining
competitive employment
17
in their communities.
The Robert Wood Johnson
Foundation, a committed
supporter of Dartmouth
Cravero: There’s nothing really
Medical School’s Center for
magical about what we’re doing.
the Evaluative Clinical
We’ve taken proven concepts in
Sciences (CECS), has award-
Bakitis: Nobody does anything here
terms of patient-centered care, and
ed $1 million in grants in
alone. Even if I’ve been in a leadership
patient participation in terms of
2004 for the Dartmouth Atlas
role in a project, it’s always a team
understanding their choices and
of Healthcare project. The
effort.You think when you first start
what they mean, and applied those
Atlas is a key research project
out in nursing school that you’re
known technologies to different
of CECS faculty, bringing
going to make a difference one patient
situations.
together research from
at a time. And early in my career here
diverse disciplines including
I realized that “it takes a village.”
Enos: They’re very respectful
of us in the PainFree clinic, and
epidemiology, economics,
and statistics to accurately
Enos: Initially, she was very
let us stay if that’s in her best
illustrate how medical
anxious about being in that
interest. And they let me be
resources are distributed and
environment. We had to give
the one to coach her and guide
used in the United States.
her an oral sedative even to
her into sitting and putting the
The Robert Wood Johnson
put the anesthesia mask on
mask on. They recognize that
Foundation has funded the
her. Kristin King, a Child Life
the parents really are a part
Atlas project since its incep-
Specialist, worked with us and
of making it successful for the
tion in 1996.
gave us the mask to take home
patient.
so we could play around with
Ira Byock, MD
it, role-play, talk about it. So
Cravero: In providing better patient
when we went up the second
care, there are benefits to the hospital
time we only needed to use the
as well. Somewhere along the line for
mask, we didn’t need to use
an institution like ours, there is that
the pre-medication.
factor of staff burnout and morale.
We found a totally unanticipated side
effect of this is that the folks who
used to have to do a lot of the
sedating and immobilizing are so
much happier now.
Enos: Each time Lauren gets
more confident, and I almost
think over time we can
probably not necessarily fully
sedate her. They were intuitive
about helping her get to where
she needed to be.
Joseph P. Cravero, MD
Payson: Dartmouth helped prepare
me for success in health care. I got a
first rate medical education, but also
a healthy sense of skepticism: that one
should be more skeptical about how
health care is delivered; that we can
do better, provide better care, be more
Cravero: I would credit our
affordable, more responsive to patients.
department’s leadership for being
There was a hearty kind of skepticism
able to entertain the idea for the
among some of the leadership that
PainFree Center, and definitely credit
I caught.
the structure of our clinic. Being
multi-specialty based, we were able to
Bakitis: In this organization it’s been
look at this in more than just terms
very easy to be involved in broader
of how it affected anesthesiology.
changes.The support comes through
That does go to the leadership of the
administration. Back in 1995, I
hospital. At the time that we proposed
worked on a project to improve
this, we weren’t sure what the bottom
post-operative pain management.
line was going to be for the program
We got a small grant and organized
itself. But if you look at what it
focus groups with patients who had
does for the medical center—and
had different types of large surgeries.
particularly for CHaD, our Children’s
From that project we were able to
Hospital at Dartmouth—you can
influence systems that improved
see that we’re able to get this work
pain management throughout the
done better and it’s better patient care.
institution.We made a card that
This is a very unusual program across
identifies appropriate drug therapy
the country.
for pain management.When all
new doctors in training come in they
get this card.We brought this into
the fabric of the institution.
19
Dr. Philip F. Parshley, Jr.
Dr. and Mrs. Bruce A. Pattee
Mr. and Mrs. Brian E. Pattison
The Payne Family Foundation
Mr. and Mrs. David B. Payne
Dr. and Mrs. Norman C. Payson
Virginia W. Peart
Pelletier Family Foundation Inc.
Mr. and Mrs. Craig E. Pelletier
Peninsula Community Foundation
The Penn Traffic Company
Faith L. Pepe
Margery B. Perlo
Mr. and Mrs. Ranson W. Perry
Estate of Frank G. Pettengill
Karl Pfister III
Pfizer Foundation
Pfizer, Inc.
Philadelphia Children’s Alliance
Dr. and Mrs. Anthony M. Pisacano
Dr. Marvin S. Platt
Dr. Fred Plum
Drs. Stephen K. Plume
and Martha Dawes McDaniel
Peter Polinski
Pollio Family Foundation, Inc.
Mr. and Mrs. Joseph L. Pollio, Jr.
Dr. and Mrs. Robert E. Porter
Mr. and Mrs. Steven B. Potter
Powell’s Greenhouse-Florist
Dr. Barry D. Pressman
Mr. and Mrs. Michael B. Prince
Procter & Gamble Company
Julia Wakefield Proctor Trust
Pro-Cut International Ltd, LLC
Prudential Foundation
Mr. and Mrs. Agnar Pytte
QLLA Charities, Inc.
Jacqueline R. Quayle
Quinn Family Foundation
Prof. and Mrs. J. Brian Quinn
Racing for a Reason
Dr. Scott C. Rackett
K. Philip Rahbany
Mr. and Mrs. Richard J. Ramsden
Dr. Lawrence G. Rand
Rapport, Meyers, Whitbeck,
Shaw & Rodenhausen, LLP
Mr. and Mrs. Thomas D. Rath
Rath, Young and Pignatelli
Doug Rathburn
Mr. and Mrs. Arthur I. Rauch
Redpath & Co. Realtors, Inc.
Mr. and Mrs. Edward L. Redpath
Mr. and Mrs. J. Rodney Reck
Mr. and Mrs. William S. Reed
Mr. and Mrs. Allan M. Reetz
Susan A. and David W. Reeves
Mr. and Mrs. Robert A. Reid
Shirley M. Reid
Riblet Foundation Trust
Mr. and Mrs. Henry J. Riblet
Mr. and Mrs. Lorrin A. Riggs
Dr. Paul D. Righi
Dr. Diane C. Riley
Mr. and Mrs. Harold C. Ripley
River Road Holdings, LLC
Dr. Andrew B. Roberts
Dr. and Mrs. David W. Roberts
Fayralyn O. Roberts
Sylvia M. Roberts-Moss
Dr. June K. Robinson
and Mr. William T. Barker
Jim Robinson
Paul Damon Rocchio
Roche Diagnostics
Mr. and Mrs. Frederick A. Roesch
Dr. Peter R. Rogol
Mr. and Mrs. Larry D. Roi
Ronald McDonald House Charities
of Eastern New England, Inc.
Dr. and Mrs. Richard W. Rooker
Dr. Joseph M. Rosen
and Stina L. Kohnke
Marc Rosenbaum
Mr. and Mrs. David A. Rosenblum
Samuel Rosenblum Foundation
Mr. and Mrs. Jay Rosenfield
Mrs. Donna C. Rossiter
Hélène K. Rothermund
and John C. Collins
Dr. and Mrs. Richard I. Rothstein
Mr. and Mrs. Daniel S. Rowell
Samuel B. Rowse
Dr. and Mrs. Frederic Rueckert
Gordon W. Russell
Drs. Stephanie Z.
and Stephen R. Ruyle
Albert J. Ryan Foundation
S & T Consultants
The Sallie Mae Fund
Sally’s Dream
Sam’s Club Foundation
Dr. and Mrs. John H. Sanders, Jr.
Carolyn H. Sands
Sanofi-Synthelabo Inc.
Schering-Plough
Pharmaceuticals, Inc.
Mr. and Mrs. Edward M. Scheu, Jr.
Dr. William R. Schillhammer, Jr.
Mr. and Mrs. Mark C. Schleicher
Michael A. Schneider
Elaine Schneiderman
Mr. and Mrs. Ronald B. Schram
Charles Schwab Corporation
Foundation
Mr. and Mrs. Robert L. Schwartz
Dr. Joseph D. Schwartzman
Dr. Berthold E. Schwarz
Mr. and Mrs. Robert T. Scott
Dr. Patricia L. Seal
Jesse Seaman
and Rose Y. Chin-Seaman
Mrs. Grace D. Seaton
Seaward Management Corporation
Mr. and Mrs. Steven G. Segal
Serono, Inc.
Drs. Alan D. Sessler
and Martha Ann Smith
Dr. John L. Seymour, Jr.
Michael S. Shannon
Jeffrey D. Shapiro and Mary T. Howell
John M. Shapiro Charitable Trust
Mr. and Mrs. Tiger Shaw
Shepley Bulfinch Richardson
and Abbot Inc.
Dr. Jeffrey S. Shiffrin
Mr. and Mrs.
Richard H. Showalter, Jr.
Mr. and Mrs. Richard S. Shreve
Katherine B. Siepmann
Mr. and Mrs. Andrew C. Sigler
John G. Silagyi
Dr. Anne M. Silas
and Robert Hawthorne
William & Edna Silverman
Charitable Fund
Mr. and Mrs. William A. Silverman
Mr. and Mrs. Charles J. Simons
Dr. and Mrs. Michael Simons
Mr. and Mrs. Carl N. Singer
SIR Foundation
Dr. and Mrs. Barry D. Smith
Eaton Smith
Dr. and Mrs. Frank Rees Smith
Mr. and Mrs. Austin L. Smithers
Elizabeth A. Solbert-Sheldon
Society for Adolescent Medicine
Society for Vascular Surgery
Southern New Hampshire
Medical Center
Arlene Spaulding
Dr. and Mrs. Steven K. Spencer
Dr. and Mrs. Peter K. Spiegel
Drs. Stephen P. and Laurel Spielberg
Mr. and Mrs. Howard W. Spiess
Mr. and Mrs. Biria D. St. John
Orson L. St. John, Jr.
Fanciullo: We typically think of pain
as a symptom; but for the patients
Byock: Because of the leadership that
we see, pain is their primary disease.
is already established at Dartmouth,
There’s a lot of discussion about
I know of no place else that is better
whether pain can be the primary
poised to engage in model building
disease, and it is.
for our nation that provides an
example of what healthy living looks
Ahles: It used to be that pain had to
like through the very end of life.
be secondary to something else, and
There’s a really unique opportunity
if you couldn’t find that something
to not merely build a state-of-the-art
else, it was all in your head. Maybe
palliative care program here, but really
you need to see a psychiatrist.We
to infuse the aspects of care that
now understand that there are a lot
are currently labeled palliative within
of people who have pain and we
mainstream health care here at
never find the cause for it, but there’s
DHMC in all specialties.
no question they have problems.
Cravero: The PainFree program has
DeLeo: Up until about twenty years
spun off the idea that if we can do
ago, no one really studied chronic pain
this for children there are probably
as an entity. It was always linked with
a lot of adults that would benefit
other diseases. It was always a second
from it.There are a number of
thought. Now we make sure that
people with Alzheimer’s disease or
we aggressively treat pain.We know
neurodevelopment problems, or
that patients don’t recover as quickly
significant anxieties who can’t handle
if they have severe pain; stress is
a lot of what we do in the hospital.
involved, the healing is compromised.
There are adults who can get through
their series of bone marrow biopsies
for their cancer treatment without
any help.Then there are other people
for whom it becomes the focus of
their life.We have the ability to
sedate these people, so they don’t
even know anything’s happening.
Field: It seems to me wonderful
and astonishing that the whole area
of pain medicine is now so greatly
expanded. People used to say little
children don’t have pain; we don’t
treat the pain in little kids. Or old
people don’t have pain; they don’t
need to be medicated.
20
Joyce DeLeo, PhD
Bakitis: Other organizations have
The Carl J. Herzog
not necessarily been as receptive
Foundation, a longtime
Bakitis: Within twenty minutes of
to the topic of pain. It’s not life
DMS benefactor, awarded
pain transmission that’s not relieved
threatening—quality of life, yes. It
the Medical School a
you start to have plastic changes of
hasn’t been at the very top of their
$250,000 grant to endow
your nervous system, even in your
list. It’s been a top priority of this
medical student scholar-
genetics. Unrelieved acute pain
organization to improve pain
ship aid through the Carl
is one of the risk factors for having
management.
J. Herzog Scholarship
Endowment Fund. The
chronic pain.
DeLeo: Pharmacogenomics—or
Herzog Foundation’s
O’Donnell: There’s a “Pain Day” for
understanding the genomics of the
support enables DMS
the medical students in their third
individual before you treat—will span
to offer financial aid to
year, since pain is something that goes
all fields, not just ours. I would say
outstanding and deserving
across all the different disciplines,
in ten years we will be able to predict
medical students, helping
from pediatrics to obstetrics to
much better what type of drug or
to ensure a diverse and
internal medicine to surgery. Holly
therapy to do before we do it,
highly qualified student
is one of the patients that comes in
instead of trial and error. It’s exciting
body that is poised to
to teach the students about pain.
to be here; I’m sure we’ll see it.
transform the future of
medicine.
21
DeLeo: At Dartmouth, it’s unique
because we’re smaller than a lot of
other places and physically closer.
We interact whether it’s at clinical
seminars or grand rounds; the
interface is very close.We can bring
things to translational research—
bench to bedside—very easily.
Dragnev: And our translational
research, is bidirectional.You can
have bench-to-bedside, but also
bedside findings that provide the
stimulus for something to be further
investigated in the laboratory.
Joseph O’Donnell, MD and Holly Field
DeLeo: I always think: the answers
are there, we just have to be smart
Dragnev: What makes the Norris
enough to figure out what those
Associates, community
Cotton Cancer Center here compre-
answers are. I tell my students, you
coordinators, and vendor
hensive is the close collaboration
have a hypothesis, but look at the data.
partners of 36 Wal-Mart
between teams working in different
What’s the data telling you? Don’t try
and Sam’s Club stores
aspects of cancer. If you’re talking
to fit the data into your hypothesis.
throughout Vermont and
about pain, this will be the close
What’s really exciting is looking at
New Hampshire, along
collaboration with people who are
things under a microscope, or animal
with matching-grant help
studying pain in the laboratory and
behavior, or a polymerase chain
from the Wal-Mart
other teams that are treating pain
reaction, and asking, what could that
Foundation, helped sup-
at the end of life.
be telling us? That’s where we’re
port the Children’s
pushing the science.That’s where
Hospital at Dartmouth
Byock: I’m working with Dr. Mark
(CHaD) this year. This
Israel and others in the Cancer
support provides CHaD
Center to integrate palliative care
Fanciullo: Holly has been in
with the flexibility to direct
within mainstream health care.There’s
remission, wonderfully, for about
funds where the need is
a new initiative that we’re calling the
six months. Most people would have
greatest and empowers
patient-centered cancer care initiative,
expected her to recur by now, if she
CHaD to pursue excellence
to begin to integrate aspects of
were going to recur. So we’re all
in pediatric research,
supportive oncology and palliative
optimistic that she’s going to do okay.
education, and patient care
care within mainstream cancer care.
programs.
22
we’ll make big leaps.
O’Donnell: When Holly was getting
sick, there was this amazing grieving
Whatever works for one patient won’t
or vulnerability among the students.
necessarily for another. No injury
They were really pulling for her,
or diagnosis is just like another.
praying for her the whole time,
But it’s just so important to listen to
worrying about her.They were just
the patient. I felt from the outset,
amazed at how this really “feisty”
believed, as I had never felt believed
person made it through.
in prior treatment. What a difference
that makes.
Dragnev: Holly has an excellent spirit
and very positive attitude toward
O’Donnell: When’s somebody’s
fighting the cancer. And with the
suffering—to be heard, and to be
treatment, she still has very good
validated—that’s an amazingly
quality of life. She is able to continue
positive thing.
to do what she likes to do and
hopefully this will be for a long while.
Field: I’m a passionate gardener. I
know I will be here next year. I have
O’Donnell: Medicine has two
done all sorts of revamping of the
traditions, one that’s logical, scientific
lily garden for next spring, and just
knowledge: language, math, precision.
planted a lot of Oriental lilies. And
But there’s another type of knowledge
my husband and I have just planted
in medicine. It’s called narrative
more bulbs, because one never has
knowledge—stories and myths. And
enough. And I love walking in our
everybody has their own sort of
woods. It’s fall, and the garden needs
chaotic narrative of illness. And it’s
to be put to bed. Though I can only
our ability to be able to listen to
do a couple of hours at a stretch,
people and connect to people that can
slowly the garden is getting ready
be therapeutic. And that’s one of the
for winter. Today’s task is going to
things Holly tries to bring: listening
be cutting the dead stalks of daylilies
to stories, and listening for stories.
that are all over the place.
Field: I’m 65 years old. I love being
old, and I like getting older. I am
absolutely determined that I am going
to “whup” the cancer that I have,
although it’s a terrible diagnosis. So
far I’m doing wonderfully. Dr. Dragnev
and Dr. Fanciullo, each in his way
is so fine in working with the patient
and listening to the patient and
responding to what the patient is
asking or saying, not just acknowledging and roaring on with their
own agenda.
23
Mr. and Mrs. Richard L. St. Pierre
Mabel Staples
State Farm Mutual Automobile
Insurance Company
Estate of Elsie E. Steel
Steffens 21st Century Foundation II
Mr. and Mrs. John L. Steffens
Drs. Stephen Stein and Emily Fine
Jeffrey Steinkamp
The Stettenheim Foundation
Mr. and Mrs. Peter R. Stettenheim
Mr. and Mrs. Bayne A. Stevenson
Mr. and Mrs. Clayton J. Stewart, Jr.
Ruth D. Stoddard
Strategic Hotel Capital, LLC
Drs. Karen Lizbeth Straus
and Randolph H. Renzi
Stryker Leibinger
Sugar River Savings Bank
Dr. Thomas J. Sullivan
Sulzberger Foundation Inc.
Mr. and Mrs. F. Maynard Sundman
Kate Sveda
Mr. and Mrs. Kurt M. Swenson
Synthes (USA)
J. T. Tai & Company Foundation
Gilbert R. Tanis
Sheila H. Tanzer
Tele Atlas North America, Inc.
John Telischak
Mrs. Carolyn C. Tenney
Teva Neuroscience, Inc.
Vijay M. Thadani
Mr. and Mrs. John M. Thatcher, Jr.
Dr. Charles A. Thayer
Third Wave Technologies
Dr. William H. Thomas
Christine E. Thornton
Dr. William T. Thorwarth, Jr.
The Tilles and Weidenthal
Foundation
Dr. Ivan M. Tomek
and Sheri J. Hancock
Mr. and Mrs. Frank N. Tomlinson
Traditional Management Co., Inc.
Trafalgar Square Publishing, Inc.
Dr. Thomas L. Treadwell
John and Evelyn Trevor Charitable
Foundation
John B. Trevor, Jr.
Amos Tuck School of Business
Mr. and Mrs. Kenneth M. Tucker
Mr. and Mrs. Clifford H. Tuttle
UCB Pharma, Inc.
The University of Tennessee
University of Vermont
and State Agricultural College
Upper Valley Community Foundation
Upper Valley Trails Alliance
Upper Valley United Way
Mr. and Mrs. Frederick B. Utley, Jr.
The V Foundation
Margaret C. Vail
Mr. and Mrs. Joaquin J. Vallarino, Jr.
Robert W. Valpey
Dr. Dirk J. Van Leeuwen
James and Lucinda Varnum
Verizon Foundation
Vermont Law School
Vermont Mutual Insurance Company
Vermont Oxford Network, Inc.
VFW Ladies Auxiliary Dept.
of New Hampshire
Dr. George H. Vogt
Vox Radio Group, LP
Wal-Mart Foundation
Dr. Lucy R. Waletzky
Dr. and Mrs. Andrew G. Wallace
Dr. and Mrs. Daniel B. Walsh
Earl C. Ward
Mr. and Mrs. Gail L. Warden
Dr. Bruce L. Warshauer
Mr. and Mrs. Allan Waters
Mr. and Mrs. Bruce M. Waters
Arthur K. Watson Charitable Trust
Dr. Frederick D. Wax
Samuel Waxman Cancer Research
Foundation
Mr. and Mrs. John H. Weaver
The Walter M. and Hannah H. Webb
Extended Family Foundation
Mr. and Mrs. Hartley D. Webster
Heidi P. Webster
Mr. and Mrs. Kenneth E. Weg
Dr. and Mrs. Daniel T. Weidenthal
Dr. and Mrs. Dudley J. Weider
Michael Weinrauch
Dr. and Mrs. James Neil Weinstein
Charles Weinstein, Jr.
Dr. Frank M. Weiser
Mr. and Mrs. Richard A. Weissmann
Mr. and Mrs. Robert J. Weissman
Wellpoint Foundation
Dr. and Mrs. John E. Wennberg
Joseph M. Wentzell
Margaret Wesbrook
Mr. and Mrs. William S. Wesson
West Family Foundation
Alfred P. West, Jr.
Elizabeth J. West
Dr. Franklin H. West
Drs. John D. West III
and Stephanie R. Lash
Mr. and Mrs. Perry L. Wheaton
David G. Wheeler
White Mountains Insurance
Group, Ltd.
Christopher White
Peter R. White
Mr. and Mrs. Maurice G. Wilkins, Jr.
Mr. and Mrs. Stanton N. Williams
Dr. Douglas E. Williamson
Dr. and Mrs. Peter D. Williamson
William Wilson
Donald Winterton
Beverly R. Wolf
Mr. and Mrs. Daniel H. Wolf
Arthur L. Wood
Mr. and Mrs. Paul F. Woodberry
Woodstock Foundation, Inc.
World Learning
President and Mrs. James Wright
Estate of Norma S. Wright
Colby A. Wyatt
Mr. and Mrs. William W. Wyman
Mr. and Mrs. John E. Xiggoros
Mr. and Mrs. Herbert Yalof
Yamanouchi Pharma America, Inc.
Mrs. Barbara S. Yatsevitch
Dr. Philip A. Yazbak
York Cross of Honour Medical
Research Foundation
Marie-Elise Young
and David E. Delucia
Mr. and Mrs. Fred A. Yunggebauer
Dr. David S. Zamierowski
Dr. Douglas P. Zipes
Dr. and Mrs. Joseph T. Zuaro
Dr. Michael Zubkoff
and Leslee A. Michaels
Mr. and Mrs.
Thomas R. Zuttermeister
Dr. and Mrs. Robert M. Zwolak
Board Members
Dartmouth-Hitchcock Medical Center
Board of Trustees
Thomas A. Colacchio, MD, ex officio
Norwich,VT
John C. Collins
Hanover, NH
Gary M. De Gasta, ex officio
Norwich,VT
Peter M. Fahey
Port Washington, NY
Alfred L. Griggs, Chair
Northampton, MA
Albert G. Mulley, Jr., MD, MPP
Boston, MA
Richard M. Page
East Orleans, MA
Alan D. Sessler, MD
Rochester, MN
Stephen P. Spielberg, MD, PhD,
ex officio
Hanover, NH
James W.Varnum, Secretary
ex officio
Etna, NH
William W.Wyman
Hanover, NH
Mary Hitchcock Memorial Hospital
and Dartmouth-Hitchcock Clinic
Board of Trustees*
Stephen P. Barba
Dixville Notch, NH
Stephen F. Christy
Lebanon, NH
Kilborn Church
Woodstock,VT
Thomas A. Colacchio, MD
DHC President
Norwich,VT
John C. Collins
DHC CEO,Treasurer, and Secretary
Hanover, NH
Philip Currier
Elkins, NH
Lawrence J. Dacey, MD
Hanover, NH
Carol J. Descoteaux, CSC, PhD
Nashua, NH
Thomas M. Dodds, MD
Hanover, NH
William H. Edwards, MD
Norwich,VT
Robert C. Fuehrer
MHMH Board Secretary
Peacham,VT
Wayne G. Granquist
Weston,VT
Alfred L. Griggs
MHMH Board Chair
Northampton, MA
Alan C. Keiller
Chapel Hill, NC
Mary Susan Leahy
MHMH Board Vice-Chair
Concord, NH
Keniston P. Merrill
Randolph,VT
Richard M. Page
East Orleans, MA
J. Brian Quinn
Hanover, NH
24
J. Rodney Reck
Simsbury, CT
Renée M. Landers, JD
Boston, MA
Carolyn H. Sands
Lebanon, NH
Albert G. Mulley, Jr., MD, MPP
(DC’70)
Boston, MA
Alan D. Sessler, MD
DHC Board Chair
Rochester, MN
Norman C. Payson, MD
Hopkinton, NH
James W.Varnum
MHMH President
Etna, NH
Peter Preuss
La Jolla, CA
William W.Wyman
Hanover, NH
Robert H.Young
Rutland,VT
a $100,000 Charitable
Gift Annuity in memory of
her late husband Ward, a
longtime supporter of
DHMC who was a patient
at DHMC until his death
from leukemia in 1996. In
addition, Mrs. Amidon
has remembered DHMC
in her estate plans with a
Barry P. Scherr, PhD, ex officio
Norwich,VT
$1 million bequest that will
eventually establish The
Stephen Spielberg, MD, PhD,
ex officio
DMS Dean
Hanover, NH
Warden C. and Gladyce V.
Amidon Hematology
Research Fund.
Robert L.Thurer, MD
Boston, MA
*Mary Hitchcock Memorial
Hospital is a member of the
Dartmouth-Hitchcock Alliance.
James W.Varnum, ex officio
Etna, NH
Veterans Affairs Medical Center
John D.West III, MD, ex officio
Bangor, ME
Gary M. De Gasta
Director
Norwich,VT
James Wright, PhD, ex officio
Hanover, NH
Arthur Sauvigne, MD
Chief of Staff
Lebanon, NH
Hanover, NH, established
Thomas B. Okarma, MD, PhD
Chair
Menlo Park, CA
Stephen P. Spielberg, MD, PhD
Dean, Dartmouth Medical School
Hanover, NH
Diana J.Weaver
Versailles, KY
Gladyce Amidon of
Martin N. Wybourne, PhD, ex officio
Hanover, NH
Dartmouth Medical School
Board of Overseers
Thomas Colacchio, MD, ex officio
Norwich,VT
Nils M.P. Daulaire, MD, MPH
White River Junction,VT
Gary M. DeGasta, ex officio
Norwich,VT
Susan G. Dentzer (DC’77)
Chevy Chase, MD
C. Everett Koop, MD, ex officio
Hanover, NH
25
Project Manager/Editor: Andrea Williams Contributing Editor: Sandra Adams
Interviews: Katharine Fisher Britton Photography: Mark Washburn
Design: Harp and Company
“That I can participate and
contribute in ways that bring me
such pleasure has everything
to do with Dartmouth-Hitchcock
Medical Center. They’ve helped
me to manage the constant pain,
thereby giving me back a
life to live fully!
What a blessed gift!”
—Holly Field
Dartmouth-Hitchcock Medical Center comprises
Dartmouth Medical School, Mary Hitchcock
Memorial Hospital, Dartmouth-Hitchcock
Clinic, and the Veterans Affairs Medical Center in
White River Junction,Vermont.
One Medical Center Drive
Lebanon, NH 03756
(603)650-5000
www.dhmc.org