My commitment to “medical humanities” (at least consciously, and using that name) began slowly indeed in 1975 when I applied successfully for a one-month fellowship supported by the National Endowment for the Humanities (NEH).  Their motive, not told up front but as I came to understand it later, was to persuade or perhaps indoctrinate a core of relatively young faculty from colleges of nursing and medicine to return home from a special one-month “seminar” and attempt to begin instructional effort in the newly incarnated discipline of medical ethics, which dated perhaps to approximately 1970.   In 1975 the news was full of the sad and perplexing saga of Karen Anne Quinlan, and how advances in medicine and related technology were causing problems and forcing decisions never before faced in human history. 

     My summer fellowship proved to be a fine experience.  I lived with my family plus fourteen other assorted professionals and some of their family members in dormitory rooms of Williams College in Williamstown, MA.  We students met in classrooms of the college.  We studied under the tutelage of Prof. William May, a pioneer in the young medical ethics movement, who was at that time the head of the Dept. of Religious Studies at Indiana University.  The NEH program included about five other such groups scattered around the country, each restricted to 15 registrants and led by a leader in the young field such as Prof. May.  We received daily reading assignments of historical and philosophical essays, short works of literature (short stories, poems, drama), and joined in spirited discussions that were sparked by our readings and relevant personal experiences.  Registrants in my group were women and men who represented many medical and nursing disciplines.  Prof.  May was a polymath of the humanities, a friendly, benevolent and inspiring leader.

     Because I was then working half-time as part of  the Dean’s staff at UI and had much freedom and flexibility, I accepted an invitation in 1978 from Dr. George Baker, at that time Associate Dean for Student Affairs and Curriculum, to teach an experimental offering called “Medical Humanities.”  He had assembled a group of volunteer faculty members to offer analogous courses in topics little-touched in the “new curriculum” that had begun a few years earlier, such as “Nutrition“, or “Death and Dying” (a hot topic just then because of publicity about Ms. Quinlan as well as the popular book of that title by Elizabeth Kubler-Ross, and a successful Broadway production of the play “Whose Life Is It, Anyway?”)  These elective courses were offered to M2 students in the fall semester, which was the “lightest” semester in that four-year curriculum.  Students who chose one of those courses would receive two semester-hours of academic credit (only pass-fail grading) and were subscribed in total by about a third of the sophomore class. 

     The initial course in 1978,  organized around the concept of “medical humanities,” I continued to teach annually.  The experience soon led to a delightful and important contact with Professor David Morris of the UI Department of English.  We developed a course in 1979 based on the  reading and discussion of literary works.  I would not have considered myself adequate to teach a course in literature, but after team-teaching three times with him, I felt willing to fly alone when he left the UI .  That was because I gradually realized that I wasn’t being a “literature teacher,” but knew enough about literature, its forms and history, to be able to choose appropriate works and use them as departures for discussion of topics in medical ethics, professionalism, doctor-patient communication, etc.

MEDICAL ETHICS

     My original course in medical humanities with eight students proved exhilarating--to me, at least--but was far too eclectic in scope and reach, which led me to trim it the next year mainly to topics in “medical ethics.” In 1986 I enlisted as a co-teacher Leah Ingraham, a Ph.D. research scientist working in the Dept. of Internal Medicine, who was well-informed and willing to join me in this voluntary instructional effort that was more formally identified as an ethics course.  She and I repeated the course the next year.  At about that point Dean John Eckstein concluded that UI needed to join the evolving band-wagon of recognition that new doctors needed some sort of academic preparation to help them address the kinds of ethical dilemmas that were beginning to appear with frequency.  As he put it, “I think it’s time we should have a REAL ethicist,” which I didn’t consider demeaning since I had never pretended to have significant credentials, either academic or experiential, and had thought from the beginning that a REAL ethicist was needed for instruction of students, residents, fellows, and faculty.  An unstated purpose, perhaps, was to make available a resource that might offer guidance for UI Hospital physicians and administrators in formulating relevant policies and providing consultative services.

     After his epiphany Dr. Eckstein appointed a search committee.  His major helper at that time, Associate Dean Carol Aschenbrenner, and I were co-chairpersons.  Much of the committee labor came my way, for which I felt, then and now, highly rewarded through the successful recruitment in 1988 of Robert Weir, Ph. D., then a Professor of Philosophy at Oklahoma State University.  His preparation for such a role included ordination as a Methodist minister plus a Princeton Ph.D. in religious ethics under the guidance of the eminent Paul Ramsey.  It is worth noting that there were then no academic programs existing to produce “medical ethicists” and many of the pioneers were of the clergy. While at the Stillwater campus of OSU, Robert made many visits to the clinical facilities of the University of Oklahoma’s medical school campus at Oklahoma City to absorb the feel of the clinical environment and actual problems faced by patients, families, and health care staff.  In addition, he spent a three-month post-doctoral fellowship in clinical ethics at the University of Tennessee’s health-sciences campus in Memphis. After his arrival at UI, Robert and I realized that elective coursework for a small number of already-interested-or-curious students would be inadequate for future needs.  By then many hospitals had established ethics committees to help develop institutional policies and to be available for consultative help when requested by those who might be facing ethically difficult decisions.  Media at the time were eagerly carrying stories about such conundrums and how they were being addressed, or ignored, in the exceedingly real world of health care.  Medical educators began attempts to help their students at all levels understand what processes and persons could help them reach suitable decisions for action.

     Experience proved, however, that such changes were not usually adopted rapidly or easily.  But by happy good fortune, the initial proposal for an addition of a required lecture-plus-small-group-discussion type of course for the sophomore curriculum sailed through the education committee, the medical council, and received faculty approval at a regular faculty meeting.  This occurred at a time when the general mood in the medical educational world--as reflected in the press and the programs at the annual meetings of the Association of American Medical Colleges--was that contemporary medical schools employed curricula seriously over-burdened with lectures,  reading assignments, and much memorizing that needed drastic trimming. Prof. Weir and I felt much gratified that at UI the need for instruction in medical ethics was recognized as a greater need--let the generic trimming occur elsewhere.  Establishing an ethics committee in the structure of UIHC was a different story: many department heads and other faculty members seemed fearful that such a committee would promulgate and enforce rules that would require staff physicians to yield their traditional parental prerogatives to non-clinicians who would dictate clinical decisions in any disputed situation.  Much time plus many discussions and examples were needed to lower those fears to a more accurate assessment of the constructive aid to be had from improved policies and the availability of a support mechanism to assist anyone coping with difficult problems. Several years were needed, in fact, to establish an actual ethics consultation service, however, which received approval only in 2013 and was yet on the planning boards at this writing.

     After Prof. Weir structured the ethics course to include 18-20 groups of seven to eight students along with two faculty resource persons, I served as a volunteer in that capacity for several years.  I much enjoyed that involvement and what I learned from the students and my fellow faculty volunteers. I also felt cheered at the number of faculty from various disciplines that showed interest and willingness.  Prof. Weir subsequently recruited new regular faculty to the Program with major responsibilities for ethics instruction.

     The present name, Program in Medical Ethics and Humanities, had its origin in my request to Dr. Eckstein in about 1985 or 1986.  At that time I  prepared a small grant proposal (its purpose and the agency involved not now remembered)  that involved instructional support in some aspects of medical humanities.  I thought the request would be improved if it appeared that the effort would be housed in an institutional unit with a name that might resonate more productively than “Office of Continuing Medical Education.”  Dr. Eckstein agreed that I might use the name “The Program in Medical Humanities.” The grant application proved unsuccessful but the name of the program persisted.  Soon after, Prof. Weir, replacing me as program director, asked that the name be changed to “Program in Biomedical Ethics and Medical Humanities” to indicate more specifically the primary function was to concern “ethics.”

     As I learned more about “Medical Humanities,” its compass and effect on educational programs in other medical schools, I realized that the name included the connections (academic and otherwise) of medical work and scholarship to the disciplines of law, religion, sociology/anthropology, psychology, literature, politics, economics, history , languages, technology, the arts--essentially anything.  It’s a daunting list and a daunting arena of study.  Certainly any one medical school would have to make limited choices of topics and faculty.

HISTORY OF MEDICINE

     In 1982 a retired endocrinologist from the faculty at the U of Oklahoma with a strong background in medical history arrived on the Iowa City scene.  He was Dr. Palmer Howard, an acquaintance of Dr. Robert Rakel, then head of our recently established Department of Family Practice.  Dr. Rakel, having a devoted interest in medical history, had organized in about 1972 an extra-curricular interest group called the History of Medicine Society, an organization that still exists, presenting several speakers annually, plus the annual History of Medicine Society banquet with a speaker of eminence.  The visits of those dignitaries shortly became sponsored by the Dean’s office and were named the Palmer Howard Lecture.  When Dr. Rakel left the UI faculty, Dr. Howard assumed the tasks involved in maintaining the History of Medicine Society for the next several years. As a Clinical Professor of Family Practice, he engaged in vigorous lobbying for the UI and/or the College of Medicine to hire a trained medical historian for teaching and research.  That effort finally succeeded, based on a formula that such a person would be chosen through the UI Dept. of History, with qualifications, responsibilities, salary, tenure, etc. to be determined solely by the Dept. of History.  The salary was to be provided in equal parts by the Dept. of History and the College of Medicine.  The first year’s wage ($30,000.) was provided by a personal gift of $15,000. from Dr. Howard and the remainder with my agreement to come from accumulated program earnings in the Office of Continuing Medical Education.  After that year the funds would come in equal parts from the College of Liberal Arts, through the Dept. of History, plus the College of Medicine (no longer the Office of CME, but I neither knew nor know whence.)

     The person recruited to that new faculty post in 1989 was Susan Lawrence, Ph.D., whose “half-time” obligation to the College of Medicine was to teach annually an elective survey course in medical history, aimed at medical students but open to any other UI registrants, or auditors, and to take over from Dr. Howard the operation of the History of Medicine Society.  (Dr. Howard died in 1990; Prof. Lawrence left UI in 2007; UI has not had a formally trained medical historian since, although I understand that one is now being recruited by the Dept. of History, perhaps without involvement of the College of Medicine.)  After Prof. Lawrence’s departure the operation of the History of Medicine Society was left in the care of whichever librarian was then the curator of the John Martin Rare Book Room at the Hardin Library.  Those persons were, in sequence, Richard Eimas, Edward Holtum, and now Donna Hirst.  That person has also served as coordinator for the History of Medicine Essay Contest, supported,  I surmise, from the bequest left to UI by Dr. John Martin, whose personal magnificent collection of rare and important medical volumes comprise the bulk and fame of the fine collection now constituting the John Martin Rare Book Room.  Although the number of submissions has remained small, I have for several recent years accepted the invitation to serve as a judge, along with others, to choose the winning essay.  (I understand that some colleges of medicine have independent departments of medical history.)

WRITING AND LITERATURE

     Another operating component of the medical humanities proved to be my personal arena of interest and activity.  It began sometime in the  1980’s when I proposed the beginning of a “Creative Writing Contest for Medical Students.”  With my anonymous effort plus a small amount of prize money from my Office of CME funds, I arranged with the editor of “Vital Signs,” the medical student newspaper, to operate that contest.  I did not feel qualified to serve as judge but was able to obtain the excellent help of Prof. David Hamilton of the Dept. of English at UI, who was the editor of “The Iowa Review,” a prestigious literary publication from the Dept. of English.  After some six years of the contest, with gradually declining enthusiasm and advertising, plus the poor quality of printing and proof-reading by succeeding student editors of Vital Signs,  I assumed the logistics, advertising, printing and prizes for that contest, which Prof. Hamilton kindly continued to judge until his retirement.

     During that period I functioned as a primary mentor/advisor for Ms. Carol Ann Bowman, at one time a high school English teacher at Iowa City West High School, and then a new Ph.D. candidate in the UI Graduate College.  She also worked part-time in the Office of CME. Her individually-designed scholarly component was supervised by faculty members in English, Theatre, and Religion.  I served also as her counselor regarding medical elements of her study and dissertation that centered on the problem of alcoholism--she had had prior experience serving as an alcoholism counselor.  When she completed her work for the Ph.D., the first (and only one so far) in Medical Humanities at the UI, she moved to the Chicago area and obtained a part-time teaching appointment in medical humanities at the osteopathic college in Lisle, IL.  Her Ph.D. was awarded in May, 1992.  Soon after, however, she began to have symptoms that proved due to lung cancer which she battled with all the intellectual, psychological and spiritual forces she could muster--but without success.  She died the following spring. 

     In honor of her work and aspirations, and the friendship my wife and I  had developed with Carol, we made a gift to the UI Foundation in her memory, designed for ongoing support of what would henceforth be named the Carol A. Bowman Creative Writing Contest for Medical Students.  The publication of its results under that aegis began in 1994.

     At some point it seemed necessary to formulate a statement of purpose (perhaps a justification?) for conducting the Carol A. Bowman contest.  Here is my statement, still being used in the contest’s advertising appeal:  “The purpose of the Carol A. Bowman Creative Writing Contest is to encourage medical students to reflect on their new experiences in the world of medicine, to encourage the process and discipline of putting words on paper effectively, and to enjoy the satisfactions of creative effort.” 

     In 2002, after my own retirement in June, 1997, the College established a writing program to foster collegiate activity in writing, broadly conceived.  The first director hired by the College was Margaret LeMay, recently graduated from the poetry section of the UI Writer’s Workshop.  I felt delighted at that development and was pleased to turn over the Carol A. Bowman contest to Ms. LeMay.  Fortunately, e-mail communication had become possible by that time and the contest’s winning items could be published online, which saved much effort and money in printing and distributing the excellent winning submissions.  Coinciding with  Prof. Hamilton’s retirement, Ms. LeMay assembled annual panels of appropriate judges.  Her interest in recognizing and promoting the value of effective communication and its inherent creative merit led her to evolve a symposium.  I understand it to have been the first of its kind, even though many colleges of medicine either had or were developing efforts to promote student creative writing and to help students, as future doctors, appreciate the role of patient “stories” in guiding diagnostic and therapeutic maneuvers.  That “First Annual” symposium proved highly successful, with registrants from all over the country, and it has fulfilled the implicit promise of becoming an annual event.  The seventh annual conference in April, 2013, attracted 191 registrants.  Ms. LeMay’s successor in 2010, Jason Lewis--also a graduate of the UI writer’s Workshop--continued the event beginning with the fourth, and he also initiated an online creative writing journal open to submissions nationally.

     My own interest in fostering writing skill had been augmented earlier by my initiating some elective courses stimulated by a Ford Foundation grant awarded to the UI Writer’s Workshop.  That Foundation apparently thought that the writing skills of mature leaders was especially bad in the worlds of business, law, and medicine.  An idea evolved by Jack Leggett, then director of the UI Writer’s Workshop, was to utilize some of their students to teach writing courses in the UI Colleges of Business, Law, and Medicine.  My CME experience as a conference-arranger led to my involvement in offering a non-credit, evening course, meeting weekly for a semester, that I advertised to medical students, residents and faculty.  The teacher in our case was Ms. Michelle Herman, who did a fine job with a mixed-bag of a limited 15 students of varying age and experience who were willing to “workshop” their material.  The class was so successful that I arranged for it to be repeated for four more iterations until Ms. Herman graduated and the grant funds ran out.  The analogous courses failed almost immediately--in the College of Business, which made fiction-writing a REQUIRED course for its MBA students (!!) and in the College of Law, which made its experience elective, but killed it in my opinion by making it a credit-only opportunity that included a grade (A to F) entered on one’s record. 

     My satisfaction with our college’s effort (and my appreciation of its impact on my own writing as an enrollee during one semester) led me to generate a series of more brief workshops aimed at improved writing.  They were conducted by Barbara Yerkes, Ph.D., a UI alumna who then worked part-time in the office of the Dean of the College of Liberal Arts and taught in the Rhetoric Program.  I functioned in those sessions as an auxiliary teacher, but almost all the real effort and benefit came from her leadership.  I had a good time along the way and learned a lot in the nine iterations of those workshops.

     As my interest in medical humanities grew I found myself reading widely in diverse lay and professional sources--large amounts of thought-provoking items related to medical topics.  They appeared as essays (for information, analysis or persuasion), poems, fiction, photos, graphs, even cartoons.  I began to clip, cut, paste and copy these items and felt they could be useful in spreading and stretching my growing enthusiasms.  Beginning in 1987 and ending at my retirement I produced packets of such miscellaneous items, about seven times per academic year, each with a brief introduction.  A message to students and faculty each autumn invited them to tell me if they wished to receive these items that I named “Thought Bundles.”  I also sent the first bundle of the year to all entering freshmen, hoping to attract their interest to such an array of topics which avoided the scientific component of medical life unless at an intersection with issues that lay within medical humanities. And there were many such issues.  My mailing list usually had about 100 “subscribers.”  (I managed to assuage my own conscience in respect to certain copyright violations I may have perpetrated by thinking of these readers as if they were classroom students.)  I requested feedback and suggestions from my readers, and those that responded were highly appreciative.  That was comforting, of course, but I realized such assessments lacked rigor.  My introduction to the final Thought Bundle ended with this farewell: “I hope these Bundles have made a difference to you and have helped mold you into the broadly interested, deeply involved and caring person that I believe every physician should be.”

      After some of those experiences, plus reading about two other formats, I devised a new CME offering.  The first format, and source of the name “reading retreat,” was devised by Dr. Grey Diamond, founder of a new University of Missouri School of Medicine in Kansas City, that employed reading-and-discussions of current cardiologic articles.  The second was developed by a surgeon in Melbourne, Australia, who published a note in the New England Journal of Medicine describing his course for medical students who would read in class short excerpts he chose from fine literature and follow that with his guided discussion.  My first effort of the sort used a mix of medical journal articles plus literary excerpts.  I decided after one successful attempt of such a weekend retreat for practicing physicians that there was no need to use medical articles as “bait” and also that short excerpts seemed less effective and less satisfying than short works in diverse forms that could be read in their entirety.  Once deciding to use complete, relatively short works, I invited physicians to such reading retreat weekends in an assortment of pleasant locales, mainly in eastern Iowa, and then settled into a pattern of holding them at Eagle Ridge Inn near Galena, IL. From the beginning I urged doctors who registered to bring their wives to the discussion session at no additional fee (most often nurses, teachers and social workers) whose insights added greatly to the quality and epiphanies of the discussions.  Each year I set forth a different set of readings. There were almost 40 such weekend events over the next 20 years, plus nine annual sessions during the several years after my retirement--simply because my wife, Ellen, and I had always enjoyed those sessions so much and felt they were valuable, an opinion almost universally shared in the evaluations submitted by the registrants.  (During those years the language in my invitational mailings changed from urging attendance with “wife” to “spouse” to “significant other” to “guest,” mirroring great changes in society through those years.)

INTERDISCIPLINARY TEAM-TEACHING

     Team-teaching in the context of a vigorous university environment was an effort I had come to experience, value and enjoy.  Earlier, when I could arrange my schedule suitably I had sat as an auditor through a semester of third-semester Spanish, then one that broadly surveyed poetry, then an introductory course in linguistics--all of them providing much intellectual stimulation and residue.  I was delighted later to accept invitations to co-teach a course for undergraduate students with Richard Lloyd-Jones, head of the English department, then another with Wallace Chappell, director of Hancher Auditorium, and another with Prof. Bill Carroll of Cornell College: “The Ancient Roots of Science and Medicine“--these in addition to the courses taught with David Morris and my participating in our ethics course’s small-group discussions.  These personal adventures in interdisciplinary effort were augmented by service on MANY faculty committees of the UI and the College of Medicine (e.g., UI Faculty Council, UI Faculty Senate, first director of the UI Foreign Language Council, an elected committee to write the Manual of Procedure for the College of Medicine…) and also by serving as the “outside member” on many Ph.D. committees (three in hospital administration; three in English; one in religious studies; one in science education; one in music; and one in interdisciplinary study {Carol Bowman’s arena}.)  In each of those graduate committees, my editing of the dissertation and participation in the defense settings added much to my education.  My activities in CME administration also fostered my own professional medical education by keeping me in touch with topics and advances in all clinical departments of the College.

     This abbreviated review of the interdisciplinary activities that I so thoroughly enjoyed, plus those Reading Retreat experiences led to another happy team-teaching venture that invigorated me in the fall semester of the eleven years preceding my retirement:  a mix of sophomore medical students plus law students. Law students had had the opportunity for several years to enroll in a course taught by my friend Prof. Alan Widiss, whose course “Law and Lawyers in Literature,” was essentially the same sort of course I had been offering to medical students and employing in the Reading Retreats with practitioners.  Our mix of students from medicine and law, and occasional graduate students from nursing, English or journalism, was apparently a most unusual phenomenon in professional education, and proved a joy for Alan and me.  Another offshoot of this type of session was a noon-discussion session, Literature and Medicine, that I led for several years at the annual meetings of the American Academy of Dermatology.

SCHOLARSHIP

     The customary prizes or praises awarded in academic life during recent decades have resulted from research and scholarly publication, rather than from service to teaching and institutional vigor.  I have some  personal complaints about this, perhaps because my own interests have focused more on such “service,”   My own resume’ contains a smattering of publications in the arena of medical humanities, some pre-dating my formal slide into that arena. These miscellaneous items, if categorized, might fall into groups such as philosophical, historical, critical, literature-related, humanities-advocacy, or some form of educational work. They appeared as articles, book reviews, letters, book chapters, fiction, and 236 monthly essays published in the Journal of the Iowa Medical Society that might today be called a blog.   If decisions about tenure or promotion depended on those diverse entries alone, I’m not certain I’d be granted tenure, since many were small, not peer-reviewed and certainly ephemeral.  But fortunately, as the Program in Medical Ethics and Humanities began its period of formal growth, Prof. Weir and other colleagues produced work more worthy of commendation. 

     One substantial effort of mine, which I regret died a stillbirth, was my joining with him to revise and substantially update a new edition of his anthology “Death and Dying in Literature,” a valuable contribution to Literature and Medicine, published by Columbia University Press in 1980. We gave the update the title, “Death, Dying and Afterwards: Human Mortality in Literature.”  I still view our collective effort--writing, editing, and selecting--to have been a major personal milestone and pleasure. Although the editors at Johns Hopkins Press were pleased with the manuscript, the issue of paying royalties for the selected inclusions and the red tape that was involved proved insurmountable. The benefits of the effort accrue, potentially, only to his children and mine, who have the only copies.

CONCLUSION

     During the twenty-two years I served as Associate Dean for Continuing Medical Education I accumulated a substantial backlog of financial profit in the Office’s account, largely from the successful presentations of the annual Refresher Course for the Family Physician and the Reading Retreats.  Before I left the Dean’s staff in 1991 Dr. Eckstein very kindly suggested that those funds eventually be used to kick-off a campaign in conjunction with the UI Foundation to provide for a chair in my name.  In due time that idea and effort proved successful and the Richard M. Caplan Chair in Biomedical Ethics and Medical Humanities was announced at my retirement dinner in 1997.  I feel greatly honored by that distinction, which had evolved out of my growth into an entirely unanticipated addition to my ongoing life in Dermatology and Continuing Education.

     My vision of medicine (at least regarding its future) must remain fuzzy to anyone who might read this, except for divining that I have always felt that the practice of medicine is not simply a matter of applying scientific principles and knowledge to patient care, but involves “the art” as well.  That nebulous term includes for me a broad sense of people and the world, and much of that arena is encompassed in the wide notion of medical humanities.

     In this biographically-oriented synopsis concerning the beginnings of The Program in Medical Ethics and Humanities I have told the story in a non-linear structure, since the various elements kept overlapping, to say nothing of the overlap with the professional life I was leading in Dermatology and as the Associate Dean for Continuing Medical Education which together earned my wage. Those years that I served as a half-time member of the Dean’s staff (1969-1991) within my total of 36 years until retirement in 1997--and even a little more after that--were busy, fulfilling, and, I am pleased to think, contributed something of importance in the longer sweep of collegiate history.   

Richard M. Caplan, M.D.
May-June, 2013