Translating the Immune System
words by Barbara Hurley / photograph by Pete Byron
Kathleen Haines, a top doc in pediatric rheumatology, is called upon, more often than not,
to tell parents that their child has an incurable disease. Yet she remains a determined optimist, even after 25 years in practice.
he statistics are surprising. There are seven different kinds of juvenile arthritis. One in 1,000 children has a rheumatic issue. More than 300,000 children have idiopathic arthritis. But Haines’ outlook springs from what she sees as the essence of a pediatric practice – hope.
“During my clinical rotation,” she explains, “I liked pediatrics more than I anticipated. I felt at home. With children there was usually huge potential to help and hope for their future that was often lacking in dealing with older patients.”
Juvenile rheumatoid arthritis, which makes up the bulk of her practice, may be incurable, Haines reports, but as a chronic disease, it is being managed better than ever with the many new drugs that have been made available since 2000.
Initially, pediatrics had been at the bottom of her list. In fact, Haines had decided on “anything but,” perhaps because, as the oldest girl of six siblings in a Long Island, New York, family she had done more than her share of babysitting. She was the first generation of her family to go to college and was, typical of the time, encouraged to prepare for a “female” career as a nurse or a teacher. She had taken business courses in high school, but fell in love with biology. But for every career she considered – and her first choice had been dietetics – she had to answer her family’s question: So, what are you going to do with it?
Haines commuted to Hunter College in New York City, where it was her lab partner who talked to her about medical school and how to pay for it. She was a senior in college with all the prerequisites for medical school and would graduate Phi Beta Kappa. But since loans, even for education, were not part of her family’s philosophy, Haines worked as a lab technician for a year after college and was then admitted to Albert Einstein College of Medicine’s three-year program in 1972.
It was a grueling course of year-round study. Einstein was a relatively young medical school, not rigid at a time when many other medical schools had gender quotas, according to Haines. Its student body was 25 percent female and included many older students as well. However, Haines found the lack of mentors or role models who were women “really tough.” The few female mentors had been among the first wave of women in medicine. “They were not the warm and nurturing types,” she explains. “Perhaps for them it was much tougher to get into medicine so warm and nurturing was not an option.” And all her supervisors were men.
After graduation Haines did a clinical and research fellowship at Cornell and then a research fellowship at New York University. In 1983 she became an NYU faculty member and continued research in the adult rheumatology division while seeing patients in the pediatric rheumatology clinic. There was no official pediatric rheumatology program then. In fact, the first board certification in the field was not until 1992, but the first officially accredited program not until the late ’90s. This created a professional “catch 22,” since one of the pre-qualifiers to take the boards was affiliation with an accredited program. Fortunately, Haines met the other requirements and was one of the first to pass the boards. She is proud of her #28 and is board certified in pediatrics, allergy/immunology and rheumatology.
“Rheumatology and allergy are mirror images,” she explains. “Allergy involves outside agents that provoke abnormal immune responses; rheumatology looks for internal agents that do the damage.” She believes that her basic research led to a good understanding of the disease and her subsequent involvement in clinical research. One of the reasons she went to Hackensack University Medical Center in 2002 was its large patient base and potential for more clinical studies. She is a reverse commuter from her home in New York City, where she still maintains a small private practice.
Haines believes that one of the things that make her a top doc is her ability to deal with parents. “I came into medicine when there was not so great an understanding of the intricacies of the immune system,” she adds. “Today we understand it is very complicated. I recognize the need to explain and the parents’ need to understand.”
She also came into medicine during the “old days,” as she calls a more difficult time for women in medicine. “There was much pressure on female house staff members not to get pregnant,” she remembers. “These days, no one thinks about it.”
Now, she believes, there is a different attitude in medicine in general. She recalls an admissions interview for medical school — by a man, of course — who asked what a future husband would think about her practicing medicine and how she would handle having children. Always the optimist, she explains: “I never believed there is only one man for each woman. I was determined to share my life with someone who would understand.” And she has. Haines has been married for 33 years to a physician who concentrated on research and rarely saw patients. “Besides, he cooks dinner,” Haines says. “He saw me and decided I looked like I needed to be fed.”
As if to underscore the importance of a female role model — so lacking in Haines’ first years in medicine — their daughter, a recent graduate of Duke, is applying to medical school after shadowing her mother at Hackensack. Her interests: the brain and neurology. If all goes as planned, she will start medical school in 2009 and find that more than 50 percent of her classmates are women. So much for the “old days.”