Dr. Joe B

Joe B. LaRussa, MD, is in private practice of pediatric allergy and immunology in Birmingham. He received the MD degree from the UAB School of Medicine in 1990, followed by a pediatric residency at UAB and a fellowship in allergy and immunology at the University of Virginia.

DrJamesPittman Patch

I first met Dean Pittman when I was applying to medical school. I went to his office, blue blazer, tie, all ready with the “yes, sirs,” and “no, sirs.” He was the quintessential dean: steely blue eyes, glasses, balding, white goatee, bow tie, and long, white, starched lab coat with name embroidered, and pens in the pocket.

He looked over my transcript, paused, cleaned his glasses, rubbed his chin, and grunted a few times. Then he finally said, “It looks like you had a well-rounded experience up on that mountain.”

“Yes, sir,” I admitted.

“Well, I’ll tell you what. You need to take biochemistry, microbiology, Anatomy and physiology.”

“Oh, yes, I can do that.”

“You need to make all A’s, too.”

“Oh, yes, sir, I can do that.”

“You need to bring your MCAT scores up, and you need to get a research job.”

“Oh, yes, sir.”

I had my marching orders. And just to one-up him. I worked in the ER at UAB on Sunday afternoons.

Dean Pittman8 28 13From left, Joe LaRussa, Jim Pittman, Wayne Finley and Scotty McCallum, 2013The next time I saw Dean Pittman was at the end of my first year of medical school. Those of you who know Volker Hall can picture the auditorium where classes are held. The rooms have those small windows on the doors. One day we could see Dean Pittman pacing back and forth in front of the door. Like a shark, waiting. We knew someone was in trouble. But who? I had a plan. Since I was one of God-given small stature, I figured I would position myself behind two of the bigger guys in the class and sneak outside. After walking out the door I thought I was free, when I felt this tap on my shoulder. It was Dean Pittman. He said “Follow me.”

Dean Pittman could walk fast, and it seemed they had added four more blocks to UAB that year. I was dragging behind heart pounding, HR 160, diaphoretic. All I could think is, “I’m going to lost my white coat, I’m going to lose my white coat.” We got down to the hospital; Dean Pittman never took the elevators; he flew up six flights of stairs. We stood outside of a patient’s room and he began quickly speaking in what at the time sounded like a foreign language.

Chief Complaint: Swollen neck

HPI: This is a 43 YOBF who presents with a 2 yr. history of swelling on the right side of her neck. The mass is nontender.

She has had some fatigue, no fever. No other assoc symptoms.

No alleviating factors.

PMH: Allergies, NKDA, Medications: BC powder – prn

Surgeries – none

FH: Denies thyroid dz. SH/Environmental History, ROS.

P.E.: Vital signs, HR 89, BP 140/90, O2 sat 98% Temp 98.6

Gen: WDWN no acute distress, HEENT – TMs clear and pearly, conjunctiva clear, EOMI, PERRL, Turbinate not swollen, Oral cavity-tonsils=2, Neck: 3X3 cm mass left of midline. CV-RR

MGR, Lungs: CTA, ABD: BS, HSM, Skin clear, Neuro . . .

A/P (1) Thyroid goiter

We then went in and examined the patient. It was the first time I heard a SOAP note.

Dr. LaRussa with Dean Pittman Sept 2012 IMG 5489The author with Jim Pittman, 2012I was in awe. I though Dean Pittman must be the smartest person I’d ever met. He knows all that information and on all these patients in the hospital. I guess that is why he was the Dean. This was my first exposure to how doctors communicate and discuss medical information about a patient. Many of us today can remember those days, whether as a pediatric intern, doing your first LP, or a surgery resident doing your first incision. How often did we hear “See one, do one, teach one”?

We walked down the hall. I was eager to see who was in the next room: A pneumonia, chest pain, diabetes? Unfortunately, we did not stop. We walked down the hall, turned the corner and Dean Pittman stopped, pointed down the hall, and said “You have a lot to learn. Head back to Volker Hall.” I turned back toward the patient rooms thinking my facial expression could convince him … just one more patient. It did not work.

After a chief resident year, we moved to Charlottesville for fellowship, and then returned to Birmingham. We would run into Dr. Connie and Dean Pittman at the Alys Stephens Center going to the symphony. Busy with medicine and young children, time passes. About a year and a half before he died, though, a fellow in my clinic asked me about an article. Like most physicians, and in spite of Google and PubMed, I went to my trusty file cabinet. As I was going through the files, my eye caught a file with a tab that said “TRH.” I’m not sure why, but I pulled it out, and thought I would look through it after work.

The TRH Society was supported by an endowment by Hall Thompson and was named for the physician Tinsley Randolph Harrison. A group of third and fourth year medical students met twice a month in the Center for Advanced Medical Studies for dinner with a small group of faculty members. Following dinner, a student presented a paper. Dean Pittman was my sponsor and I gave a presentation on the painting “Medical Giants of Alabama,” commissioned by Dr. Pittman in 1982 and painted by Marshall Bouldin III. My presentation was in the file.

The file prompted me to visit Dean Pittman. The slides from the presentation were Kodak projector slides, so I had the put on a CD and went to see him. He had suffered several strokes since I had last seen him. We talked about William Crawford Gorgas and Marion Sims, two of the subjects in the painting, and before I left I asked him if he wanted me to come again. He said he would like that. So from then on we visited every two weeks on Saturdays at 2 pm. We covered Hippocrates, Galen, Harvey, Pasteur, Lister, the discoverer of penicillin, Alexander Fleming, Thomas Aquinas, St. Augustine, the New York Yankees and their 27 World Series championships, Babe Ruth, Lou Gehrig, Mickey Mantle, Yogi Berra, Joltin’ Joe DiMaggio, Marilyn Monroe and the list went on and on.

At a particular session, we were talking about the discovery of DNA, and the scientists Watson and Crick. DNA, mRNA, tRNA, amino acids, proteins. Dean Pittman said, “You’re a smart fella.” I told him, “I’m not sure about that; I have a lot to learn.” So many years ago, I knew how much there was for me to learn, and he was the teacher. Now he was at his kitchen table, in his comfortable flannel shirt and slippers, no bowtie, not torturing medical students, not grilling residents. If not being taught, which he was not, he was being reminded of all the things he had long known.

So that day, I realized it is more about a person’s willingness to teach than about their being smart. It was Tinsley Harrison who said, “Learning is more a matter of the heart than the brain,” and he acted accordingly.

In August 2013, Dean Pittman was moved to St. Martin’s in the Pines. I visited a few days later. The nurses would come in one by one, and I could tell they were very frustrated. Apparently one nurse would come and say, “Dr. Pittman, what kind of doctor are you? Dean Pittman would look at the nurse and not say anything. The next nurse would come in and say, “Dr. Pittman, what kind of doctor are you?” and again, the same answer … or non-answer. Then they asked me. Being loyal to Dean Pittman, I looked at him and, not sure why he was playing this game, went along with it and said, “Well you know he was dean of the UAB School of Medicine for 19 years. That’s pretty good, you know!”

 M98 15P 0002 PittmanJANow I knew that he and Dr. Connie were both endocrinologists and that he had particular expertise in the thyroid. The physical therapist came in and then the speech therapist came in, the nutritionist came in, and with all, the same outcome. Finally, one day, after two weeks of this, I went by and visited and there was one nurse who was really determined to find out what kind of doctor he was. So when I passed her in the hall, she stopped me and said, “Dr. LaRussa, I know what kind of doctor Dr. Pittman is.” I said, “What happened?” The nurse said, “Well, I just looked him right in the eye and asked him, ‘Dr. Pittman, what kind of doctor are you??’”

“Well, what did he say?”

“He looked me right in the eye and said, “A damn good one.”

Knowing Dean Pittman, he would want this story to have a happy ending. You see, Dean Pittman had high standards; he put the bar way up there. It is up to us, because if we teach what he taught us, and then if those young doctors teach the others, in a sense, Dean Pittman will still be teaching. It is perpetual, everlasting.

Grand Rounds is a part of the medical process, where attending physicians, fellows, residents, interns, and medical students are all together in an auditorium while a professor discusses his or her area of expertise. There is also a time when a case is presented and the other subspecialties all join in to solve the case. It is a great medical learning environment where these attendings pass down their way of thinking and their knowledge. One day, I visited Dean Pittman with Dr. Wayne Finley and Dr. Scotty McCallum, MD. They reminisced about Grand Rounds with Tinsley Harrison, MD and Champ Lyons, MD, which Dr. Finley described as “a lively, spirited duel, but Tinsley Harrison usually won. Sorry, surgeons.” But then Dr. McCallum was quick to say, “The pathologists always had the final word.”

At the end of each visit, I would shake Dean Pittman’s hand, put my hand on his shoulder and say, “See you at Grand Rounds this week.” He would look at me and say, “Sure.” Both of us knew it was not likely to happen. But it became a ritual, and it made it easier to end our time together.

If I could tell Dean Pittman two things, they would be these:

First, I would to express my gratitude and thank him for giving me the opportunity to be a physician.

And second would be, “I’ll see you at Grand Rounds, Dean Pittman. But the next time will be the biggest Grand Rounds of all, His Grand Rounds. And if I could ask one more favor of you, Dean Pittman, it would be if you could save me a seat to Galen, Harvey, or Pasteur, maybe even Lister. And maybe after lunch, we could swing by and visit Tinsley Harrison.”

About Dr. Pittman

 A93 04 0599 Pittman

Born: April 12, 1927, Orlando, Fla.

B.S., Davidson College: 1948

M.D., Harvard Medical School: 1952

Internship, Massachusetts General Hospital: 1952-54

Clinical Associate, National Institutes of Health: 1954-56

Married Constance Shen, MD: February 19, 1955

Internal Medicine Resident, UAB, 1956; Chief Resident, 1957-58

Joined UAB faculty: 1959

Director, UAB Division of Endocrinology, Diabetes, and Metabolism: 1962-71

Dean of Medicine: 1973-92

Died January 12, 2014, Birmingham, Ala.