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Worcester Medicine
Editorial
Substance Abuse
Managing Pain at the End of Life As I See It Science Corner Legal Consult Financial Advice for
Physicians History of Medicine Off Call In Memoriam Society Snippets President's Message “Quality” is a most misunderstood term. The term “quality” is derived from the Latin ”qualitas,” which means characteristic. To assure excellence in a product or service, the early quality engineers standardized various qualities (characteristics) of that product or service. They were so good at their job that ”quality” became equated with “excellence.” The current spate of insurance forays into quality engineering ignores the precepts of the original engineers. When you find yourself subjected to “quality improvement,” ask yourself, “Which quality is being standardized?” Then ask yourself, “Will standardizing that characteristic provide a better product or service?” For example, Blue Cross has subjected us to a Cultural Competency Exam. What characteristic has been standardized by the 2 hours or more spent working through that exercise? Putting aside all the problems of the inappropriateness of insurers administering an academic test, the lack of reimbursement for our time, and the lack of testing of the measuring tool, I wonder how this exercise improves the excellence of health care delivery. What was their measure of success? As another example, controlling our prescribing practices with prior authorizations does not improve care. We asked some members about prior authorizations: how much time did you and your staff spend? How many were rejected? What proportion of those rejected was reasonable? 24 answered that they had spent 10 minutes to 7 hours and that the lion’s share passed through (One commented that with “…enough time all would pass.”). Only a handful of rejections seemed reasonable to the respondents. Where the insurance industry fails in quality engineering our medical society can shine. We can choose far better qualities to standardize. For example, we could standardize our information systems for recording immunizations. We could spend a little time now to assess our current sad state of affairs, implement a system, and then test how much better the new system worked. While there is an enormous amount of work involved in implementing and designing such a system, I suspect you, our members, would be more willing to waste two hours in pursuit of that goal than two hours on a Cultural Competency exam. In the coming months we will be looking for some adventuresome souls who might join us as lab rats while we test existing measures (e.g., prior authorization) and develop new measures (e.g., office information networks). We will also look for your ideas and comments. Your focus on our patients’ health will surely provide more appropriate quality improvement than do our insurers. Editorial: Pain Management
Issue Chronic pain often results from conditions that are difficult to diagnose and treat, or take a long time to treat. The pain itself is frequently managed separately from the underlying condition and requires a multi-disciplinary approach to treatment. Unfortunately, many practitioners are not adequately trained in the therapy for relief of intense chronic pain. Even worse, the members of some state medical boards are also unaware of the treatment needed and when they review physicians all they see is overuse of controlled substances. This led us to focus on pain management as a theme. As the articles came in, it became clear that this was going to be a large, complicated subject. Therefore, we decided to split the topic into two issues, allowing us to have longer articles to discuss what is new in this area and give it adequate coverage. Also in this issue, we continue our History of Medicine series by John Massarelli as it has been a popular addition to the publication.. To continue in this direction we added a history article on the Irish in Worcester. I would invite other ethnic groups to write similar articles for publication. Before writing, please contact us to discuss the details, length and content. Why
is Pain Management so Challenging? In the world of clinical medicine, there is perhaps nothing more challenging for a patient or physician than managing pain. Balancing the commitment to compassionately relieve suffering without causing harm can be a confusing mixture of imperfect science, fear and miscommunication. While clinicians are always interested in doing the best for their patients, concerns about a history of addiction, “drug-seeking” behaviors and the potential for drug diversion weigh heavily on their minds. Even their vocabulary can be unclear and inconsistent when trying to communicate with colleagues as well as patients about these issues. What do we need to know to allow for appropriate pain relief while preventing misuse and abuse of pain medications? Pain is common. Pain is the number one reason that people seek medical attention. 45% of persons in the United States will visit a doctor for pain at some point in their lives. In addition, approximately 75 million people live in “serious pain” and nearly 50 million are partially or totally disabled by pain1. According to Dr. Carver from the American College of Physicians (ACP) Online Medicine, “Both acute and chronic pain are significant drivers of increased utilization of health care resources. Persons with chronic pain are five times as likely as those without chronic pain to use health care services.” Pain is individual. The very nature of pain defined as "…an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”2 makes evaluation and treatment complicated and sets pain apart from other objective and more easily measurable complaints. Pain evaluation takes time. In addition to being a significant issue alone, pain is also a prominent feature of a number of complex, chronic illnesses. Cancer, HIV\AIDS, arthritis, and sickle cell anemia are just a few of the medical conditions that require complex disease management in addition to the management of pain. Pain medications carry risk of misuse, abuse or diversion. “Misuse” is a common phenomenon related to (1) misunderstanding the appropriate way to use pain medication or (2) using more medication in response to under-treatment of pain. Misuse does not constitute “abuse” and patients should not be labeled abusers. “Abuse” is the use of medication for non-therapeutic purpose or purposes other than those for which it was prescribed. “Diversion” is a legal term that describes the illegal procurement of prescription pain medication intended for someone else or other illegal practices to obtain prescription drugs. All physicians have legal and regulatory obligation to prevent diversion and abuse of prescription pain medications. What are the facts about misuse, abuse, and diversion of pain medications? Abuse is uncommon. Abuse of prescription pain medication is uncommon among the general patient population. Most patients who are prescribed opioids for pain do not abuse these medications or become addicted. While the National Institute on Drug Abuse (NIDA) reports that more research is needed on the factors that predispose patients to addiction, they clearly endorse the fact that the risk of addiction is minimal in most cases, especially when patients are treated on a short term basis. 3 Risk of abuse is individual. The most reliable known risk factor for predicting abuse or addiction to pain medication is a history of addiction. This neurobehavioral syndrome has genetic and environmental factors and is manifested by compulsive use of a substance despite harm. Addiction should not be confused with the phenomenon of physical dependence, an expected consequence of legitimate long term use of pain medication. Physical dependence defined as the presence of tolerance and withdrawal can be seen with cessation of either legitimate or illegitimate pain medication use. Addiction is not a contraindication to prescribing pain medication, but it will require a much more structured, individualized monitoring and follow-up treatment plan. Intervention in misuse, abuse, diversion and addiction takes time. Based on an assessment of a patient’s inappropriate use of medication, a clinician should determine whether the behaviors represent misuse, repeated misuse, likely abuse, or exacerbation of an underlying addiction. Interventions have been described for each category of inappropriate use4 and physicians are legally and ethically responsible for intervening in the setting of problems with prescription pain medications. How can clinicians and patients work together to improve pain relief and prevent misuse and abuse of pain medications? Patients:
Clinicians:
In summary, the Massachusetts Board of Registration in Medicine recognizes the role that fear of legal and regulatory sanctions may play in the problem of under-treatment of pain by physicians and has developed clear policy to alleviate physician uncertainty. The Board has clearly stated that “…inappropriate treatment of pain includes non-treatment, under-treatment, over-treatment, and the continued use of ineffective treatments”5” and has provided detailed guidelines for evaluation of a physician’s treatment of pain with controlled substances. Good pain treatment based on a thorough knowledge base applied in a fair and consistent manner with sound clinical judgment that has been meticulously documented is the best way to ensure compassionate relief of suffering and prevent abuse of prescription pain medications. Mary A. Valliere, MD is Assistant Professor of Medicine at UMass Medical School, Chief of the Division of Palliative Medicine at UMMMC is certified in Hospice & Palliative Medicine and Addiction Medicine. References:
Managing
Pain at the End of Life For many people, no fear is greater than the prospect of pain at the end of life ~ for some, it is worse than the fear of death itself. This fact was illustrated in a statewide survey conducted throughout MA in 2005 by the Massachusetts End of Life Commission and AARP of Massachusetts. In that survey, eight out of ten respondents said they were fearful of dying painfully, while only 40% said they were afraid of dying.1 Despite this widespread concern, pain at the end of life is frequently under-managed or not managed at all. Two important national studies 2,3 have shown significant deficiencies in the management of pain for dying persons as reported by family members. Similarly in Worcester, the SODIUM study 4 revealed that 20% of patients for whom pain management was important as reported by next of kin were inadequately treated for pain as they were dying. What accounts for this wide disparity between the needs of patients and the care provided to them at this most vulnerable time? Why is pain under-treated at the end of life? For a variety of reasons, pain management at the end of life can be especially challenging. The reasons have to do with cultural, legal, and professional factors related to patients and families, institutions, and health care providers. Among physicians in particular, a lack of formal training in the treatment of pain, discomfort in addressing end of life issues in general, and specific concerns related to the prescribing of opioids all may contribute to poor pain management practices. Moreover, successful treatment of pain may be challenged by multiple and complex clinical, social and spiritual issues occurring at the end of life, including the presence of other concomitant symptoms. Lack of attention to fear, anxiety, depression, and unresolved spiritual concerns may contribute to an increase in pain intensity, and the failure to attend to them can lead to devastating consequences for dying patients and their families. A closer look at barriers among physicians While some of the obstacles to good pain management among physicians may be grounded in the fear of potential legal ramifications for prescribing large doses of narcotics, others are related to an incomplete understanding of the properties of opioids and their effects, which has particular relevance for dying patients. Concerns about addiction: Many physicians fear that patients will become addicted to opioids and are reluctant to prescribe them for this reason. Studies have shown, however, that about 4% of patients become addicted4. Because the overwhelming majority of patients do not become addicted, this concern should not be an overriding one. In the unlikely event that true addiction should develop, there are resources that provide guidance in how to manage pain effectively in such patients (see article on addiction in this issue). Fear of hastening death: Physicians as well as nurses and family members often have grave concerns about administering large doses of opioids, fearing that they will hasten death. While a large dose of a narcotic given to an opiate-naive person can cause respiratory arrest, increasing the dose incrementally allows the patient to build tolerance to respiratory depressant effects, thus providing a safer transition to more effective and higher dosing.6; this should be explained to family members who may withhold larger doses of medication at home during the final stages for fear of administering an overdose. Lack of skill in managing pain: The basics of pain management are infrequently taught in medical schools, yet pain is a symptom that often causes patients to seek medical attention. As illness progresses pain may escalate, and good pain assessment (and re-assessment) and other skills are crucial for successful pain management. Additional competencies include:
In addition, examination of personal attitudes toward pain may help to uncover biases that could potentially interfere with successful pain management practices. Suggestions for improving the management of pain for patients There are many resources and options for accessing good information to assist the practicing physician in pain treatment at the end of life. For more information go to www.betterending.org. Consider the following:
Christine McCluskey, RN, a former hospice nurse and administrator, is the Executive Director of Better Ending Partnership, a community coalition to improve end of life care in Central Massachusetts. References:
As I See It: Dying – A
Physician’s Answer During a “Death and Dying “discussion in a high school’s bioethics class, a student queried, “As a physician, how do you feel about your own death?” What an appropriate and thought-provoking question. How does the “doctor” in me deal with my own mortality? How would I envision my own dying? I feel bittersweet about my death, yet I plan to die well. Death is a natural and unique event for each person, but I know that I will have only one opportunity to try to do it right. First of all, I feel my death should be a celebration of my living. Secondly, I imagine that I will experience the varied emotions that dying usually evokes in my patients. There will be my anticipatory grieving of leaving loved ones and knowing all my life dreams may not be a reality. There will be the fear of being dependent. There will be the fear that my body, mind, and soul might suffer. And perhaps most difficult will be seeing the quiet reflections of sorrow in my friends’ faces. I envision that the last month of my life might present some challenges. I might need 24-hour care. My physical symptoms might progressively and acutely get worse. I hope that I would be moved to the VNA Care Network & Hospice’s Rose Monahan Hospice Home. My death bed would see me looking out at the sunset over Coes Pond. My pain and dyspnea could be controlled with medications, either sublingually or, if needed, intravenously. I would be surrounded by the support, care, and empathy of the hospice team. I would find comfort in knowing that the hospice bereavement coordinator would console my family as they mourn in the months after my death. Part of me would still will want to be immortal, yet I would be at peace. This vision of my own dying, though, begins long before the last month of my life. If my physicians would not be surprised to read my obituary in the next six months, I hope that they would request hospice services. National Hospice and Palliative Care Organization (NHPCO) estimates that only 36% of all deaths in 2006 were under hospice care. NPHCO also relates in 2006 that only 44.1% of patients admitted to hospice had cancer; this leaves 55.9% for non cancer diagnosis including heart disease, debility unspecified, dementia, and lung disease. I am not sure what disease I would want to choose for myself ~ I think debility unspecified from being 109! In 2006, the average length of service for hospice patients was 59 days, yet the more accurate median length of service declined from 26 days in 2005 to 20.6 days in 2006. In my own story, I would be a hospice patient for seven months, and I would live alone at home for the first six months. In 2006, NPHCO National Data Set revealed 74.1% of hospice care is in what the patient calls home, including nursing homes (22.5%) and assisted living (4.6%). During this time, the hospice nurses would continue treatment for symptoms of reversible disease as well as aggressive management of the consequences of my irreversible disease. Hospice pastoral care, volunteers, and social workers would counsel me and my family. And yes, I lived longer than the six months and yet remained eligible due to my continued decline amid disease progression. In March 2007, a study published in the Journal of Pain and Symptom Management reported that hospice care may actually prolong the lives of some terminally ill patients. In the study, 4,493 terminally ill patients with either CHF or cancer of the breast, colon, lung, pancreas or prostate were selected and compared for difference in survival periods for those who received hospice care and those who did not. The mean survival was 29 days longer for hospice patients. As Medical Director of VNA Care Network & Hospice I have the honor of caring for the dying. Each day, these patients and families teach me about the art of dying. Thus, they help me answer the question of my mortality. I know discussing death and hospice with our patients is difficult. I invite you to answer the student’s question ~ this exercise added to my perspective. I encourage you to visit the Rose Monahan Hospice Home in Worcester. It is a special dwelling that will inspire your work. To arrange a visit or for any questions concerning hospice care, email me at bmeade@vnacarenetwork.org. Bernadette V. Meade is Medical Director of VNA Care Network& Hospice Science Corner: Gene
Therapy for Chronic Pain Chronic pain is often intractable to available pharmacotherapy. Opioid analgesics are effective for the treatment of moderate to severe pain chronic pain; however, their use is associated with several adverse effects, including the risk of addiction. Utilizing routes of administration that allow for drug distribution to areas rich in opioid receptors ~ such as in the spinal cord ~ may limit adverse effects while producing significant analgesia. The intrathecal administration of these agents has been shown to be more effective than systemic use1 but requires the use of an implantable pump and catheter, thereby increasing the risk of infection and other complications. Gene therapy, an experimental technique that involves the administration of genes instead of medication for the treatment of certain diseases, may be the future of chronic pain management. Researchers at the Department of Medicine and Neuroscience at the Mount Sinai School of Medicine have developed a therapeutic gene called prepro-β-endorphin (ppβEP) that was designed to induce secretion of the endogenous opioid β-endorphin. Previously, ppβEP demonstrated the ability to produce analgesia in a rat model for up to 2 weeks after administration.2 The authors concluded that the analgesic effect of ppβEP was short lived because the vector used to administer the gene was rapidly neutralized by the immune system. With new vector technology available, researchers have once again evaluated the efficacy of ppβEP in a rat chronic neuropathic pain model and have found that a single injection of intrathecal administration of ppβEP produced significant reversal of exaggerated pain responses (i.e. allodynia). This response occurred within 15 to 30 days and lasted for ≥ 3 months and was found to be reversible with the administration of naloxone.3 There are several barriers to overcome before gene therapy can be considered a viable option for patients suffering from various chronic pain syndromes. First, use of this gene has yet to be tested in humans. Second, the ppβEP gene has demonstrated efficacy in neuropathic pain models only and its benefit in other pain disorders is unknown. Third, long-term efficacy of the ppβEP gene and the safety of the vector used are also unknown. However, this exciting advancement in neuroscience may change the goal of therapy for chronic pain from reducing pain to a level that is tolerable for the patient to instead complete elimination of pain. Michele Matthews is Assistant Professor in the Department of Pharmacy Practice at the Massachusetts College of Pharmacy and Health Sciences in Worcester, MA. Email: michele.matthews@mcphs.edu References:
Legal Consult: New
Interpretations in the Physician-Patient Relationship! A physician presc This decision has some troubling impli The difficulties surrounding this apparent expansion of
physicians’ potential liability are underscored by the fact that only two
justices concurred with the opinion written by Justice I For instance, the court’s opinion co Even one of the concurring justices desc Other justices questioned whether the court’s decision
necessarily creates such conflicts. Chief Justice Dissenting Justice Cordy noted that prior Massachusetts Justice Cordy contended this new decision would act to
undermine that “strong policy,” noting “[a] nuanced communi As these re Financial
Advice for Physicians: Avoiding Common Investing Errors Can Produce
Long-Term Dividends In many ways, how you invest is more important than where you invest. If you invest in more than a handful of stocks, bonds or mutual funds, you are bound to have some winners and some losers ~ and today’s winners may be tomorrow’s losers. Over time, if you invest carefully, the winners should outweigh the losers and help you achieve your financial goals. How you invest, though, can either produce long-term dividends or cost you plenty. Investors frequently do the wrong thing. They sell the stocks they should keep and keep the stocks they should sell. They run up credit card debt and pay high interest rates while they’re getting low returns on their investments. They invest in the market when prices are high and bail out when prices are low. Knowing what not to do is, for most investors, the first step toward improving long-term investment performance. So what are some of the most common investment mistakes? 1. Gambling instead of investing. Some investors try to “time” the market, buying stocks when they think prices are going to rise and selling when they think prices are going to fall. That’s a quick way to go broke. The world’s best, most seasoned professionals cannot accurately time the market with any consistency. Neither can you. Other investors act on hunches, half-truths and tips from their Uncle Raymond, who heard from a friend of a friend whose neighbor is a broker that Acme PCs is introducing new computers for pets and that’s going to open a new market and send the company’s stock soaring. Ask yourself, “If Uncle Raymond knows so much, why isn’t he rich?” 2. Not diversifying sufficiently. You may recall hearing about employees of Enron losing all of their retirement savings when the company went broke. Financial fraud, bad business decisions, market changes, new regulations, increased competition, lawsuits and many other factors can cause a business to suffer a reversal of fortune. If all of your money is invested in that company’s stock, you will suffer when the company does. If, conversely, only a small amount of your money is invested in a company whose stock implodes, you will barely notice the loss. Investing in many different stocks is not enough, either. At the least, your portfolio should be diversified to include stocks, bonds and cash equivalents such as money market funds. Your stock and bond holdings should also be diversified. Stock investments, for example, may be in large-cap, mid-cap and small-cap stocks, value and growth stocks, and domestic and international stocks. Mutual funds provide added diversification because the average mutual fund typically is invested in many stocks or bonds at any given time. 3. Not owning stocks. Some people refuse to invest in stocks because they think they are too risky. Not investing in stocks can be much riskier, because your portfolio will not be properly diversified. Past performance is no guarantee of future returns, but historically stocks have provided the best long-term returns of any investment. 4. Failing to plan. Wealth doesn’t come naturally. You have to plan for it. Start by identifying your financial goals. How much do you need to save for retirement? How many children do you have (or expect to have) and do you expect to pay for their college education? In addition to identifying your financial goals, you’ll need to determine what it will cost to achieve them. Based on your investments, and what you plan to save in the future, what rate of return will you need to achieve your goals? Adjust your investments over time based on your changing needs and financial status. It is best to project conservatively. Having more money than you need during retirement is better than not having enough. 5. Investing short-term. It takes time for investments to grow in value. Investment professionals typically advise that investors have at least a five to seven year time frame when they invest in stocks, based on the assumption that it may take that long for the stock market to run through a typical cycle during which the market goes up and down. Building wealth is a long-term process that requires patience and discipline. Because of the cost of trading, investing short-term is also expensive. 6. Failing to invest regularly. Unless you invest a set amount regularly, you will likely put off investing altogether. You’ll find some other use for your money. You’ll wait until next year, then the year after that, then the year after that. Then you won’t have enough to live off of when you want to retire. Saving a set amount every week or every month can help you achieve your financial goals and is also a smart way to invest. Let’s say you invest $100 a month into Up and Down Technology stock. This month, the price is $20 a share, so your $100 buys five shares. Next month, the price rises to $25 a share, so your $100 buys only four shares. Note that you are buying more when the price is low and less when the price is high. This practice is called “dollar cost averaging.” Dollar cost averaging requires continuous investment in securities, regardless of fluctuating prices. Investors should consider their ability to continue to make purchases through periods of high and low price levels. Dollar cost averaging does not ensure a profit and does not protect against loss. 7. Failing to take advantage of tax-advantaged investing. Employees today can invest more than ever in tax-advantaged retirement plans, such as 401(k) plans, which allow taxpayers to defer paying taxes until retirement. They can also invest in IRAs, which are tax-deferred, or Roth IRAs, which allow investments to grow on a tax-free basis. Parents can also save for their children’s college education on a tax-advantaged basis. Contributions to Section 529 plans, for example, are made with after-tax dollars, but any growth in investment values is tax-free. Tax-advantaged investment allows more of your money to work for you because there is no taxation until withdrawals are made. Investors should take advantage of the opportunity to the extent that they can. 8. Buying “hot” stocks. “Hot” stocks can be found anywhere ~ in financial newsletters and on television, in your e-mail and in your fax machine. However, by the time you read them, they may no longer be “hot.” The market reacts to information. If a company is expected to perform exceptionally well or particularly poorly, its stock price will adjust accordingly before you hear about it. 9. Not cutting your losses. It’s good to invest long-term, but that doesn’t mean holding onto a bad investment indefinitely. If an investment turns out to have been ill advised, sell it and move on. It is more difficult to recover your losses than it is to protect your money. For example, if a stock declines in value by 50%, it will have to double in value just for you to break even. Don’t wait to recover your loses before selling. You may never recover. 10. Failing to seek professional help. If you don’t invest for a living, you are probably not aware of everything happening in the market that is affecting your investments. You are likely unaware of,failed drug tests, recalled automobiles, class-action lawsuits, changes in money managers, and the various other factors that can affect the value of your investments. Letting a professional handle your investments and help you plan your finances may save you a lot of money long-term. Over time, investors are likely to make many mistakes, no matter how careful they are. Perhaps the worst mistake they can make, though, is not learning from other people’s mistakes. Ruth R. Petty, MSFS is a Senior Financial Consultant with Centinel Financial Group, LLC, John Hancock Financial Network, 16 Laurel Ave., Wellesley Hills, MA 02481 and can be reached at 781-446-5031 or rrpetty@jhnetwork.com. Insurance products offered through John Hancock Life Insurance Company, Boston, MA 02117. Registered Representative/Securities and Investment Advisory Services offered through Signator Investors, Inc., Member NASD, SIPC, a Registered Investment Advisor. The information presented is for informational purposes only. It is not intended to replace the need for independent tax, accounting, or legal review. Individuals are advised to seek the counsel of such licensed professionals to review their personal situation.
History of Medicine: A Medical
School for Worcester Last July, a column in the Worcester Sunday Telegram with the headline “How Worcester Won Battle for Med School” told the story in a well-written, accurate fashion. But it didn’t include the drama of the balloting process which secured the site for the Heart of the Commonwealth. After World War II, the rise in population (the “baby boom”) and the growth of health insurance resulted in an increased demand for medical services. In response, the General Court of Massachusetts established the University of Massachusetts Medical School in October 1962. Its location would be decided by the university’s trustees in conjunction with the dean whom the trustees selected. The school would be a boon for the chosen area, promising first hundreds of construction jobs then thousands of staff jobs once the bricks-and-mortar phase was over, as well as homes for affluent doctors and other professional personnel. Proposed candidates for the site included Cape Cod, Boston, the North Shore, Worcester, Springfield, Amherst (where the UMass campus was), and it seems the home of every politician in the state. The decision came down to Boston, a Boston suburb, Worcester, Springfield, and Amherst. Voting for the site took place on Friday, June 11, 1965. A majority of the 22 votes was required for the selection; in the absence of a majority, the last-place finisher would be eliminated and another vote taken. Springfield, Boston, and the Boston suburb were eliminated on the first three votes, the last two places probably because of the tacit disapproval of the three established medical schools in the Boston area that didn’t see the need for another “colleague” (the academic word for “competitor”). This left Worcester and Amherst. On the fourth round the vote dramatically split at eleven apiece. A fifth vote would be necessary. One of the two trustees from Worcester, General Maginnis, was later quoted as saying the following: “There was this fellow on the board I didn’t know. We chatted before the final vote. I said to him, ‘You’re going to vote for Amherst, of course.’ And he said, ’I hate like hell to vote for it.’ Then he described his displeasure with the university over some personal matter. So I took him aside and said, ‘Now’s your chance to get even!’ On the fifth ballot the result was Worcester 12 and Amherst 10. It was as simple as that.”
Off Call: The Irish in Worcester The Irish first came to Worcester in 1826 to build the Blackstone Canal. Many were skilled laborers who had worked on the Erie Canal in New York. They were called “wide backs” for the obvious reason that they moved 2.5 yards of earth per hour for 10 to 12 hours a day with shovel and pick. An Irishman named Tobias Boland supervised the construction of the 46.5 mile canal, which started at Thomas Street in Worcester and ended in Providence and later was called the “Seaport of Narragansett Bay.” While working on the canal, these men set up camp on the east side of Worcester in the Shrewsbury Street section and called it “The Meadows” or “Pine Meadows.” The locals called it “Shanty Town.” The Irish workers were not allowed in Worcester without a pass. They could not even bury their dead in Worcester and had to take them by barge to Rhode Island. When the canal was completed, many of these laborers stayed in Worcester. By late 1830s, 500-600 Irish canalers had established a small community in Worcester’s east side. Three additional Irish settlement areas followed. The next settlement, called “Scalpintown,” was created in the 1840s on the east side of the canal. Here, Christ Church, the first Catholic church, was built in 1834, replaced in 1846 by St. John’s Church on Temple Street. East Worcester was an extension of Scalpintown and was located downtown near the railroad yards. The Island ~ or “Green Island” ~ ran along Millbury and Harding Streets. It was called The Island because the canal intersected several small streams and separated the area from the rest of the city. Two new neighborhoods emerged in the mid 1800s ~ the North End, obviously on the north side of the city, was also called Messenger Hill or Fairmont Hill, and the South End, where my father’s family came from, was an extension of The Island along Cambridge Street. Churches were important social as well as religious centers for the Irish in Worcester. Each Irish district was served by a Catholic church: Immaculate Conception - North End, St. Anne’s - East Side, St. John’s - The Island, and Sacred Heart - South Worcester. Father John Power established a small hospital at St. Anne’s parish in the 1860s because the impoverished sick members of his parish had nowhere else to go. Monsignor Thomas Griffin, an immigrant from County Cork and pastor at St. John’s church, was instrumental in the founding of St. Vincent’s Hospital in the 1890s. Two thirds of the trustees were Irish and the Sisters of Providence provided most of the nursing staff. St. Vincent’s was known for treating all ethnic and religious backgrounds the same. The second wave of Irish came to Worcester because of an Gorta Mor ~ “The Great Hunger.” The famine in Ireland is estimated to have caused 1 million deaths due to malnutrition and disease. It also caused over a million people to immigrate to the United States. By 1870, there were 8,589 Irish in the city, one fifth of Worcester’s 41,000 people. These Irish immigrants, coming from an agrarian society, were not skilled like the first wave nor accustomed to working in industry. Worcester had become primarily a center for the heavy industries of wire, iron and machinery. By 1890, Worcester was the thirteenth largest manufacturing city in America and many of the Irish worked in those factories that would in fact accept Irish workers. Patriotism was shown by the Irish in the Civil War as well as in wars to follow. Two Worcester Irish received the Congressional Medal of Honor during the Civil War. Sergeant William Plunkett ~ who lost both arms saving the colors at Fredericksburg ~ and Captain Thomas O’Neill, for his service at Cold Harbor. During World War II, two more Worcester Irish received the Medal of Honor: John V. Powers, a Holy Cross graduate and Marine whose life was lost during fighting in the Pacific (a statue of him was erected on the right side of City Hall), and Father Joseph T. O’Callahan, who taught at Holy Cross and was acknowledged for his actions as a chaplain aboard the aircraft carrier U.S.S. Franklin. The Irish faced significant prejudice from groups like the Know-Nothings in the 1850s and the Klu Klux Klan, who met in Mechanics Hall in 1920s. Politics became a way to help the Irish move forward and by 1885 over 2,800 Irish-born males became citizens and voters. Phillip J. O’Connell, a second-generation Irish-American, became the first Irish mayor in 1901 (he was later appointed a judge in 1915). By the turn of the century, many Irish attended the College of the Holy Cross. Francis J. McGrath, City Manager in 1951, graduated from Holy Cross and went on to guide the city for many years. Phillip K. Kenny “The Cobra” O’Donnell received the Distinguished Service Cross and became Robert Kennedy’s best friend. He would later become Chief of Staff for Presidents John F. Kennedy and Lyndon Johnson. He also worked with Robert Kennedy until the Senator’s death. The movie Thirteen Days was based on Worcester’s own Kenneth O’Donnell. Irish women in Worcester made great strides in entering the professional ranks and by 1910 over half of the teachers in the Worcester Public Schools were second-generation Irish women. One of these women, Mary O’Callaghan, after teaching for ten years in Worcester, went on to medical school and became one of the most respected physicians in the city. This tradition is carried on today by the likes of Mary Hawthorne, an Irish-American physician. Martin A. Lynch is a CMR Senior Therapeutic Consultant with Pfizer, Inc. He can be reached at Doolinboy@yahoo.com. References:
In Memoriam: WDMS Remembers its Colleagues James M. Morrison, MD With the exception of time away from Worcester to study medicine and service in the military, Dr. James M. Morrison was a lifelong resident of the city of his birth. A member of the Medical Staffs of St. Vincent and Fairlawn Hospitals, he practiced primary care Internal Medicine for 52 years, retiring in 2001. He exemplified the type of physician everyone proclaims we need more of, but presently too few elect to become. He loved Worcester, and Worcester loved him. He was educated at St. John’s High School and the College of the Holy Cross before entering St. Louis University School of Medicine. Early in his career, before the specialty of addictionology existed, he extended himself to patients suffering from alcoholism and advocated for the creation of an inpatient treatment facility at St. Vincent Hospital. It became a haven for the treatment of acute withdrawal and guidance for recovery. Dr. Morrison was a Charter Member of the American Medical Society of Alcoholism and Drug Addiction and served as Chairman of the State Committee on Alcoholism and Addiction. His compassion and empathy for afflicted individuals led him to serve on the Massachusetts Medical Society’s Impaired Physicians’ Committee, the forerunner of the Physicians’ Health Service, now recognized as a national model. In 1954, he co-founded the St. Vincent Hospital Alcoholic Clinic and founded Faith House, a half-way house for women addicted to alcohol and drugs. Midway in his career, Dr. Morrison moved his office into his home across the street from Worcester State College. The plantings and grooming of the grounds ~ designed and maintained by his late wife Dorcas, a talented landscape and flower designer ~ complimented the neighborhood. For many years, Dr. Morrison served as the Director of Health Services at Worcester State College, and the school demonstrated its appreciation by presenting him with the Good Samaritan Award and the Alumni Association honored him at the Annual Scholarship Tea in 2005. Dr. Morrison was an excellent athlete. He was a four-sport letterman at St. John’s High School and was inducted in the school’s Hall of Fame. In 1990, he received the Distinguished Alumnus Award from St. John’s. He played golf in college and throughout his adult life. Characteristically Jim would boast about others but was always very modest about himself and his athletic prowess. His interest in sports found its way to the professional boxing arena, where he served on behalf of the Massachusetts Boxing Commission over-seeing pugilist safety. Jim Morrison was an active member of the Worcester District Medical Society and unofficially is thought to be one of its most loyal meeting attendees. Jim was quiet but always very attentive and most fair and kind when offering opinions. He was a member of the American Medical Association and the Massachusetts Medical Society. In 1997, he received the Volunteer Physician of the Year award from the MMS. If the world were comprised of people like Jim Morrison, the entire Defense Budget could be directed to medical research and humanitarian relief. Five children, four grandchildren, two great grandchildren, and a most grateful greater Worcester community survives Dr. James Morrison. By Leonard Morse Dr. Norio Higano Dr. Norio Higano died June 16, 2007, at his home in Westborough. He was 86 years old. He was my teacher, colleague, and friend for over 40 years. He was born in Seattle, Washington, and graduated from the University of Washington in 1943 magna cum laude. He received his M.D. degree from the St. Louis University School of Medicine in 1945. He was very fortunate to have escaped the craze of being sent into one of the detention camps created for Japanese Americans during World War II. He excelled academically and was elected to both Phi Beta Kappa and Alpha Omega Alpha honor societies. Following a straight medical internship at Maimonides Hospital in Brooklyn, NY, he moved to Boston (Cambridge) for his medical residency at Mount Auburn Hospital. He then completed a research fellowship at Harvard University. In 1952, he came to Memorial Hospital as the Director of the Hospital Research Laboratory. He was a born teacher, full of knowledge that he loved to share with the housestaff and his peers. His fastidiousness was exemplified by his meticulous physical examinations. He surprised young residents with the correct diagnosis derived from history and physical examination much before the laboratory results returned with the answer. His enthusiasm to master clinical problems stimulated many house officers to become endocrinologists. I remember with pleasure the house officer parties that he and his wife Dorothy put on for the interns and residents. It is hard to believe that the “little people” present at the party (daughters Celestia and Priscilla and son Stuart) have grown and become substantial adults with children. Norio loved to drive fast and there are a goodly number of residents who can attest to that fact because he took many of us to the Atlantic City “young turks meetings.” He was proud to own a German car ~ a Hansa ~ that, unfortunately, turned out to be a dud. Norio introduced the nuclear medicine era to the Memorial Hospital by way of applying radioactive iodine in the diagnosis and management of thyroid disorders. As the years passed, we covered for one another. We all learned from him about how to address certain clinical problems, but most of all he strengthened our belief that patients always come first. By Guenter L. Spanknebel, MD Society Snippets: The Guenter L. Spanknebel, MD Medical Education Grant The Worcester District Medical Society was presented with a $10,000 Medical Education Grant from The Health Foundation of Central Massachusetts in honor of Guenter L. Spanknebel, MD, upon his retirement from service as a founding Director of the Foundation. Dr. Spanknebel served on the board since the Foundation's inception in 1999 and with other retiring director's oversaw the Foundation's assets of about $65 million and awarded grants to agencies and projects dedicated to improving the health of Central Massachusetts residents, especially those considered particularly vulnerable. |