Hooked on Rheum with Max I. Hamburger, MD
When I was 12 years old, I had already made the decision to become a doctor, so that was where it started. What followed was a combination of family illness and a fascination with the immune system.
When I was in eighth grade, my father became ill and was hospitalized for many weeks. He was fatigued, losing weight, muscles rapidly wasting away, with white blood cell counts off the charts. His doctors could not figure out what was wrong. Eventually, they determined that he had rheumatoid arthritis. Although he was rheumatoid-factor negative, he had risk factors we now know: Multiple packs a day smoker and periodontal disease.
I watched him go from a vigorous, healthy man in his early 40s to someone who was, for a time, completely disabled, the worst 10% decile. The disease moved through him like Sherman to the sea. Within a few years, he ruptured the extensor tendons in both of his hands, and his knees and hips were end stage. The family lived through that while I was in high school and college. He ended up parked on prednisone as his mainstay for the rest of his life. This was before methotrexate. Eventually, after hip replacements, he returned to work, but every day was a major struggle. He died of lymphoma at 70.
When I got to medical school, I had no plan to go into rheumatology or any other subspecialty. I never articulated to myself that I would focus on the disease that stole away my father’s health — the father who could toss a ball back and forth, teach me sports — and our family’s economy. After my first year at Albert Einstein College of Medicine, I was offered $800 to work in a rheumatology lab for the summer. I was a poor medical student and that was a lot of money.
Fortunately for me, it was the laboratory of Dr. Peter Barland. Peter was a compassionate, knowledgeable and caring doctor, a very nice man with a sense of humor. Working with him, I came to gain a much broader and deeper understanding of immunology and rheumatology.
Looking at lines of immune precipitation in ouchterlony plates, that first summer transitioned into my spending much of my last year of medical school working in Peter’s lab on antibodies to extractable nuclear antigen, using samples provided us by Eng Tan. I was excited to participate in rheumatology rounds, listen to the interchange between the remarkable minds in the rheumatology division, and watch the interplay between rheumatology, renal and dermatology. The seeds were sown.
I asked Peter to care for my father. There was not much we could do for patients with RA, but Peter would see my father every 3 months, measure the range of motion in his joints and do blood work. My father remained badly, badly damaged by the disease.
I moved on to Bellevue Medical Center for my internship and residency. The chief resident was also to become a rheumatologist, Dr. Peter Gorevic. Peter gave me the chance to spend time back in Dr. Barland’s lab during my elective time as a resident, and I found myself even more interested in autoimmune disease and rheumatology.
We published several papers on mixed connective tissue disease, and that helped me secure a position as a clinical associate at the NIH. For a time, I had considered a position as a fellow in radiology at Montefiore, an excellent program, but Peter convinced me otherwise. He simply said, “Nope. You have to take care of patients.”
Happily, rheumatology enabled me to be an amateur radiologist. And so much better, by the early 1980s we awoke to the remarkable capabilities of methotrexate, and the 1990s brought us the biologics transformation of the subspecialty and outcomes for our patients.
Both Peter Barland and Peter Gorevic were role models, people I admired, mentors, and both went on to be leaders as rheumatologists. I found much in how they pursued the profession that I took on in my own way.
My father had been a union organizer, and that surely seeded my interest in organizing with the subspecialty. All this is how it came to be that I evolved into becoming a rheumatologist. If a person loves what they do, is it work or is it fun? I’m doing everything now to ensure that as long as my body, brain and partners allow, the years to come on the other side of 75 will continue to be as rewarding as the last.
Max I. Hamburger, MD
Founder and executive chairman
United Rheumatology
Managing partner< br />
Rheumatology Associates of Long Island