A PA alumna serves those who served

Amanda Turner Magee helps wounded veterans of Iraq and Afghanistan in their recovery.

How many alumni of the Physician Associate Program receive visits at work from U.S. senators, the secretary of defense and President George W. Bush?

For Amanda Turner Magee, PA-C, M.M.Sc. ’03, it’s a frequent occurrence at Walter Reed Army Medical Center, where she is a physician assistant for inpatient amputee and blast injury care in the Physical Medicine/Rehabilitation Department. She’s part of a team that cares for injured soldiers returning from Iraq and Afghanistan. This team includes physiatrists, surgeons, physician assistants, physical and occupational therapists, nurses, prosthetists, social workers and psychologists.

“The workings of military medicine and the logistics that go into treating combat-injured soldiers are new things I’m learning,” said Magee, who previously worked in an emergency room in Pennsylvania and was a physical therapy tech before coming to Yale. As a large teaching facility, however, Reed resembles the “big academic hospitals I rotated through at Yale.” But in her current job, “… we are often in the public eye.”

Politicians, military leaders and celebrities often visit the soldiers at Walter Reed. “The president comes every few months, sometimes completely unannounced,” Magee discovered. “One particular visit was announced because he was presenting Purple Hearts, some to patients I had treated. I was selected to attend the ceremony and the informal gathering where he spoke individually with the recipients and other patients. A few weeks later, the White House sent me a photo of the president, my patient, the patient’s wife and myself. It was a lovely surprise.”

Her department averages 15 to 25 inpatients, flown by MedEvac twice a week from a hospital in Germany to nearby Andrews Air Force Base. Most patients have been involved in some type of blast. “An amputee patient not requiring ICU support is usually admitted to our service about a week from his or her injury date. They have multiple medical issues, including infections, orthopedic injuries and often severe pain syndromes,” said Magee. “We provide general medical care, including treating infections and blood clots, preand post-operative care, pain management and wound care. … We initiate their rehab process, including educating the patient and family, and oversee their progress in therapy to establish their long-term rehab plans.” Patients’ co-morbidities often include vision loss; brain or spinal cord injury; fractures; severe nerve or vascular injury; and post-traumatic stress disorder.

“Most of our patients adjust remarkably well. They have great support here in PT, OT and prosthetics, surrounded by soldiers who are the same age with similar injuries,” Magee said. “When they’re well enough to leave their rooms and become more involved in rehab, they improve psychologically, feeling they’re part of a group again, and seeing progress.”

On their first extended breaks at home, patients suddenly face the reality of civilian life as an amputee. “We try to anticipate [the physical and often emotional difficulties they will face after discharge], and help send patients home with a plan—such as a job or college enrollment—so ideally, after months of rehab, they know what they’ll be doing if they’re getting out of the military,” said Magee.

Initially, a series of articles in the Washington Post in February that outlined neglect and deficiencies in treatment of outpatients at Walter Reed didn’t affect Magee’s team. “I truly feel that patients get very good care here. We have a comprehensive amputee rehab program which focuses on returning patients to their highest possible level of functioning. Some go on to complete marathons, skydive and return to active duty service,” Magee said. Since the media attention to difficulties at Walter Reed and the resignations of key officials, however, a recent hospital-wide emphasis on administrative issues keeps her busier than ever. “We’re following new policies when they become outpatients. We’re doing a better job of tracking them after discharge and making sure that patients [continue to] get mental health support, too.”

Mary L. Warner, M.M.Sc., PA, assistant dean and program director of the Physician Associate Program at Yale, remembered Turner standing out during clinical training. “She demonstrated excellent relationships with patients and staff, which has likely been crucial in her work at Walter Reed. I am sure the patients benefit from the breadth of her knowledge base and true enthusiasm for providing outstanding health care.”

Her experiences have created deep bonds between Magee and her patients. Magee senses that she’s “becoming committed to veterans’ health care. I’d like to stay in it—it is a privilege to be involved in people’s lives at a time like this, to be able to help them. The patients are wonderful and it’s very rewarding.”

—Carol Milano

An American doctor finds home on opposite sides of the Pacific Ocean

Alice Shepard Cary, M.D. ’45, HS ’47, recalls sitting on a tatami mat made of woven straw, her legs tucked neatly beneath her, in the home of a patient in Kyoto, Japan, in the early 1950s. As the light softly filtered in through the translucent washi-paper walls, she steadied her hand as she prepared to insert a needle attached to a pneumothorax machine between the ribs of the young woman lying on a futon. Careful not to puncture the girl’s lung, Cary injected air between the lung and chest wall until she felt confident that she had collapsed the cavity in the young woman’s lung, praying that she was saving the girl from a fatal case of tuberculosis.

Cary treated several patients with tuberculosis during 48 years as a medical missionary in Kyoto. Before streptomycin reached this corner of the world in the mid-1950s, the common treatment for tuberculous cavities was to collapse the infected lung in order to “rest” it so lesions could heal, or to remove it surgically—often using only local anesthetic. Like her parents and grandparents before her, Cary’s lifelong passion has been to heal the sick and care for others in accord with her Protestant faith.

Born in June 1920, Cary spent her first 14 years in Turkey, where her father, Lorrin A. Shepard, M.D., a surgeon and 1914 Yale College graduate, was director of the American Hospital in Istanbul. Cary came to the United States in 1934 to attend high school in Massachusetts and went on to premed studies at Wellesley College.

During this time, Cupid’s arrow struck. The object of her affection was Otis Cary, her brother’s handsome roommate at Deerfield Academy. Born in Kyoto, Otis was also the child and grandchild of missionaries. When World War II began, Otis left Amherst College to join the Navy and was assigned to a POW camp at Pearl Harbor, where, because of his fluency in Japanese and his affable nature, he became the executive officer of interrogation. Alice and Otis were married in December 1944.

Alice, meanwhile, was one of three women among 56 men in the Yale School of Medicine’s Class of 1945. Her memories of the time are nothing but fond. She is quick to point out that she experienced no discrimination because of her gender from either the professors or her male classmates. “The few professors who used sarcasm as a teaching tool were just as sarcastic to the men as to the women,” she says.

After the war Otis returned to Amherst, then began graduate studies in history at Yale. Alice, meanwhile, was an intern and assistant resident at New Haven Hospital. In 1947 the couple settled in Japan, where Otis had been sent by Amherst College to teach American studies at Doshisha University in Kyoto. Alice began working in the student health center. The two lived in Amherst House, a small on-campus dormitory where they bridged Western and Eastern cultures for the next four decades.

The early years in Japan were difficult, as Alice struggled with the language and tried to turn dehydrated potatoes, eggs and Spam into appetizing meals. In 1957 she joined the Kyoto Baptist Hospital, where she saw outpatients, roughly half of them Japanese and half foreigners. Despite being a Western doctor in Asia, she had little difficulty caring for patients and says she never received negative reactions from her Japanese patients.

“During the early years there were many requests for medications not yet available in Japan,” she said. “I could, and did, order them from the United States, but had only limited funds, so had to disappoint most patients.” She also worked part time treating outpatients in the Louis Pasteur Institute and raised four children, three of whom have Japanese spouses.

Alice retired from the hospital in 1993 and returned to the United States in 1996 with Otis, who was beginning to suffer from Alzheimer’s disease. Otis died from pneumonia in April 2006. Alice, who lives in Oakland, Calif., returns to Japan at least once a year to visit two of her children still living there. She has served on the board of the East Bay Chapter of the United Nations Association of America, an organization that strives to support the principles of the U.N. by educating and mobilizing Americans. “I want to back the U.N. because, like me, it tries to have its eyes on the whole world, and I would like the United States to know more about and be more concerned with the welfare of the rest of our planet.” She also manages to visit with her Yale roommate, Louise Burr Albulet, once or twice a year.

Alice says that her lifelong goal has been to “love the world and everyone in it—even difficult patients and relatives. I’ve not been totally successful.” But then again, she says, “A worthy goal is always just beyond one’s reach.”

—Kara A. Nyberg


			Originally published in Yale Medicine, Autumn 2007. Copyright © 2007 Yale University School of Medicine. All rights reserved.