My father, Aaron Mankowski (center), as a Polish army officer. 1928.

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L'esprit de l'escalier (Treppenwitz)

Once upon a time in N.Y.C., chess clubs were frequently located on the second floor, up some stairs (treppen in German) from street level. Having concluded play and in the process of descending the stairs, one might be struck by the thought that a different strategy might have produced a better outcome. That is known as wit of the stairs in English, l'esprit de l'escalier (the spirit of the staircase) in French and, simply, treppenwitz (the wisdom of the stairs) in German . It always occurs after the end of action and consists of after-thoughts, second thoughts and regrets. Here are some of mine after having published A Journey of Hope.

Miscellaneous Tidbits
With respect to a medical school course called "Laboratory Diagnosis" (see page 172),Dr. Charles Rath wrote: "Oscar, on page 113 you mention that in the Fall of 1958 when you entered Georgetown Medical School, the class size was 125. Not long afterwards the class size was increased to over 200, which made it more difficult to know all the students in the class. I recall that teaching the course in Laboratory Diagnosis was more enjoyable with the smaller class size, and I remember you and your brother John during that period.
    The course we taught was based on my participation in 1948 in a similar course for Harvard Medical Students that was revised while I was in training at the Peter Bent Brigham Hospital in Boston. At Georgetown, we were able to take advantage of the many talented investigators at NIH (National Institutes of Health) who were delighted to have the opportunity to teach. " "

A little medical school scene from Dr. Rath's Laboratory Diagnosis course:
Anonymous nervous 2nd-year medical student to Dr. Rath: "Dr. Rath, I am psychologically undone by your exam today! Given my anxious state of mind, do I need to answer the questions in order?"
    Dr. Rath, with a straight face, to said student: "You do in order to obtain a passing grade in my course, Laboratory Diagnosis!" 2

About La Salle D. Lefall, M.D. (see page 136):
In the fall of 1974, it was my pleasure to participate in a program on airway obstruction sponsored by the the Medical Society of the District of Columbia (MSDC) and chaired by Dr. Lefall at the MSDC annual meeting held that year at the Greenbrier resort, in White Sulphur Springs, West Virginia. I was enormously impressed by his talent and manner.

About platelets (see page 187, note 27):
Platelets, often referred to as blood cells, are not cells in the true sense of the word. They do not have a nucleus. They are tiny cytoplasmic fragments of the largest cells in the bone marrow, the megakaryocytes. Each megakaryocyte breaks up into about 10,000 platelets.
    These blood particles, which look like microscopic, colorless, disk-shaped specks, are found in large numbers in the blood and play an important part in the clotting process and bleeding disorders.

About Walter C. Hess, Ph. D. (pages 114—116):
Generations of Georgetown medical students were exposed to "Hess put-downs " which went something like this:
    "The recommendations of your college professors are not objective in the least and are not worth a damn in my book!3 I never pay attention to them. They are as valid as what your parents say about you!"
     "Be aware that your patients will get well not because of you, but in spite of you! Don't be smug about your clinical skills!"
    "Also know that you will get the same diseases as your patients! You will not be shielded because you are a doctor."
    And the ultimate put-down, one that was dreaded by everyone, "John Doe, I am getting peeved at you! "

About "Hyperparathyroidism (See 167—169):
A key point deserves to be reinforced about this disease. Parathyroid hormone (PTH) is turned off under normal conditions by an increased level of blood calcium. This is the so-called physiological feedback mechanism. In the disease state, a parathyroid adenoma (benign growth) continues to autonomously produce PTH. There is loss of feedback inhibition despite the elevated blood calcium level.

About summer vacations (See page 236):
Although we usually went to Longport, New Jersey for our summer vacations, occasionally we went to Bermuda for family vacations which included the girls and mother. One summer, we stayed at the sumptuous Southampton Princess Hotel up on a picturesque hill overlooking the lovely Bermuda pink-beaches.
    During a leisurely after-dinner stroll in the expansive grounds of the hotel, we stopped to admire an out-of-the-ordinary scenic panoramic ocean view. Mother spontaneously exclaimed: "We must be in Paradise!"

Errata (a few remaining ones)
Page 47: In the paragraph beginning with " Jacques Doriot, a French politician . . ." toward the bottom of the page, the name of his party "Party Popular Français " should read "Parti populaire français. " A minor error or more likely a mix up of English and French in a senior moment!
Page 175: L'Auberge chez François is located in Great Falls, Virginia. It was called Chez François in its earlier life on Connecticut Avenue, near The White House. I feel better after this bit of clarification.
Page 182: "Mount Sinai Temple" should read: "Temple Sinai." I should have known better! Mea Culpa!
Page 287: In the Bibliography of the book, I neglected to note that Joseph GIere, M.D. edited the 1962 Grand Rounds, the yearbook of The Georgetown University School of Medicine

1. Personal communication from Charles E. Rath, M,D., February 2006.
2. Personal communication from Eugene P. Libre, M.D., February, 2006.
3. There were those who said Hess himself was the Admission Committee.
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