Today, September 10, Alexandria and I climbed into the historic tower at Johns Hopkins. We made our way up the narrow stairs, looked out over Baltimore, and spent time in a place where the history of medicine is built into the walls. Later, I visited with Natalie at the Johns Hopkins Bloomberg School of Public Health. It was a day of family, colleagues and perspective—on the eve of the 25th anniversary of September 11.
The surgeon behind the Dome
And, as I learned many years ago and relearned today, there is a story that brings it all together.
The building beneath that Dome bears the name of John Shaw Billings, a Union Army surgeon during the Civil War who later helped shape the Johns Hopkins Hospital.
Billings had seen what war could do to the human body. He had also seen how the organization of care could compound that damage. Hopkins’ own history describes his concern about inadequate nutrition and what he regarded as the excessive use of amputation and surgical bullet removal, which he believed could lead to more infection.
For those of us who spend our lives working in limb preservation, that is a striking connection across the years: a surgeon asking whether an intervention was helping the person in front of him, and whether better care could prevent additional loss.
After the war, Billings helped turn those concerns into plans for a hospital that would care for patients, teach physicians and advance knowledge.
Residents resided. The bedside became the classroom.
Then came William Osler.
Osler helped make the wards into classrooms. Students learned by taking histories, examining patients and following their care. Clinical learning brought them into direct contact with the people they hoped to help.
Young physicians actually resided in the hospital’s administration building. Hopkins also preserves a wonderful piece of architectural lore: its walking tour says it is rumored that the circular hallways beneath the Dome gave rise to the expression “making the rounds.” That is a story to enjoy as lore, rather than a settled origin of the term.
Residents resided. Rounds went around. And medicine increasingly revolved around the patient.
Looking out from the tower with Alexandria, and later visiting Natalie at Bloomberg, I kept thinking about how those ways of caring are carried forward. At the bedside, we attend to one person. In public health, we ask how to build conditions in which more people can remain well. Limb preservation needs both.
What we are trying to preserve
Standing there today, I couldn’t help thinking about the arc from Billings to Osler to the work so many of us do now in limb preservation.
Our job is to make preventable loss less inevitable: to recognize risk earlier, restore circulation when possible, treat infection, protect tissue and help people keep moving.
Amputation can be necessary and lifesaving. The purpose of limb preservation is thoughtful care centered on the person, including rehabilitation and support when amputation is the best path.
What we hope to preserve is a foot, a leg, mobility, independence—and ultimately those precious hospital-free, activity-rich, dignity-filled days that matter far more than any procedural metric.
On the eve of September 11
Tomorrow marks 25 years since September 11, 2001.
That anniversary carries enormous memories of violence, loss, sacrifice, courage and service. Walking through a place devoted for more than a century to caring for the sick, I found myself thinking about the work that follows a wound.
Healing.
The work of showing up. Listening. Learning. Caring for the person whose life has been interrupted, and for the people who love them.
One patient. One wound. One limb. One bedside at a time.
Special thanks to wound-care nurse Linda Hensley for organizing our Dome tour, and to Drs. Ron Sherman, Chris Abularrage and Caitlin Hicks for generously showing me around and for their mentorship of Alexandria as well as countless other women and men. I am grateful to have shared this day with Alexandria and Natalie. The view from the tower was extraordinary. The responsibility we carry back down to the bedside is what stays with me.
We cannot always prevent the wound. But we can devote ourselves to what comes next in helping folks move through the world a little better.
References
- Johns Hopkins Medicine. About John Billings.
- Johns Hopkins Medicine. The Founding Physicians: William Osler.
- Johns Hopkins Bloomberg School of Public Health. Walking Tour (Billings Building and rounds lore).
- Johns Hopkins Gazette. A Room with a View of History (2001).
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