Rheumatology à Deux: Dorothy Wortmann and Robert Wortmann

They met in a medical school biochemistry class in which the professor arranged the students alphabetically, so that Woodward sat next to Wortmann. In the beginning, their teamwork as study partners earned them excellent grades. But when romance distracted them, they had to study apart. By the second year of medical school Dorothy Woodward and Robert Wortmann were married. That was 42 years ago.

"In college, she was chemistry major and I was biology major. So she did the experiments and I cleaned up afterward. I still do the dishes after meals," according to Dr. Robert Wortmann, who explained that his dish duty originated from a bet over a ski race. "I lost a bet wagering ‘dishes for the year’ when we were in a ski race 35 years ago. She won and has refused a rematch."

Photos courtesy Dr. Dorothy Wortmann

Asked to reflect back on his greatest achievement to date, Dr. Robert Wortmann said: "My part in our balancing family and career. We have been married for more than 42 years, we raised two sons who continue make us very proud, and, overall, we have had very satisfying careers. I won’t say it has been easy, but I will say it has been rewarding." Despite that still-lamented ski match, the Wortmanns seem to have had a marriage that has been far more collaborative than competitive, even as they moved several times before arriving in Hanover, New Hampshire, where Robert Wortmann is professor of medicine at Dartmouth and Dorothy Wortmann is a pediatric rheumatologist on the faculty.

Each Wortmann arrived at medical school through a different process. For Robert, becoming a physician may have been a matter of medicine being the family business. "Other than playing professional football, which would have been a goal if I had been bigger, faster, stronger and had any talent (I did play football at Carleton [College, Northfield, Minn.]), I guess I never really considered any alternative to medical school. I don’t think I knew very much about other occupations or professions. My father was a physician and most of our family friends were physicians’ families. Also, I was pretty comfortable in the hospital environment. As I was growing up, my father was in a solo ob.gyn. practice. That meant if I was with him, and he got called to the hospital, I would have to go with him. In those days, they would page doctors at baseball games and come find them in movie theaters. My father used an answering service that he would call hourly whenever he was away from a phone. During the daytime, I usually got to go into the pathology department and always got to see some organs or look at slides. Other times, I would hang out in the doctors’ lounge."

For Dorothy, getting on the road to medical school took imagination, the support of her grandmother, and the enthusiasm of her undergraduate advisers. "I had always expected to go to nursing school. My grandmother, who was my college scholarship, wanted me to get a BA, so I went to Mount Holyoke [College, South Hadley, Mass.], and then my advisers in college encouraged me to go to medical school. My sister was in college and my brother was in graduate school. My father had not planned on sending his daughters to graduate school. He said I could apply for scholarships back East or come to K.U. Medical School, in Kansas City." So the University of Kansas it was, for them both.

After graduation, Robert Wortmann recalled: "We were in one of the first years of the ‘couples match’ for residencies and ended up at the University of Michigan, Ann Arbor, me in medicine and she in pediatrics." Then his obligatory military service reared its head and the couple set off for Korea. If the call had come 5 months earlier, his tour would have been as a medical officer in Vietnam.

From 1973-1974, he served as a general medical officer for the U.S. Army in what was to be the last MASH (mobile army surgical hospital) in Korea. Together, that medical staff of two surgeons, one internist, one anesthesiologist, and 10 nurses cared for 12 helicopter pilots and about 90 enlisted men assigned with them to Camp Mosier, which included the 43rd MASH unit. They also cared for civilians, including residents of a nearby leper colony, as time allowed. Dr. Robert Wortmann’s duties were broad and included "doing sick call and seeing inpatients. I was also No. 3 surgeon, the radiologist, the lab officer, the blood bank officer, the rabies control officer, the VD control officer, the person in charge of doing physical exams on Korean women who were going to marry GIs, and the nuclear holocaust control officer."

Although pregnant with their son, Jon, Dorothy also went to Korea. Conditions were harsh, and the Army made no accommodations for this military wife, even though she came in handy as a pediatrician at the underserved hospital in Seoul. With Robert stationed in "north of the tank wall in a tactical zone at the MASH hospital," he had no car and she could not live on the base there. Instead, she lived in an apartment in Seoul without a car. There was an oil shortage that winter and all water had to be boiled before drinking. Until their son was born, he would visit her in Seoul on weekends when he was free, and she would visit the base on weekends when he was on duty. "The 2½ of us slept in a single bed in a Quonset hut," she recalled in an interview.

The first season of the television show "M*A*S*H" aired the year before Robert arrived in Korea. While he was there, the show’s coproducers visited his MASH unit searching for ideas for the series, which had become wildly popular despite their expectations. "The show was based on a book. They had used up all the material from the book, and they needed fodder for future shows. They did everything we did and interviewed everyone individually. Thus, I can recognize something in every episode beginning in year 3 that was based on our reality. My name was used as a character in one episode [spelled Wortman]. In another episode, they were collecting money for a pool to bet on when Colonel Potter would become a grandfather. At the time of their visit, there was just such a pool at our hospital for when Jon would be born," Robert recalled.

Once Robert was discharged from the U.S. Army, the two doctors moved to Ann Arbor, where Robert was chief resident in internal medicine. Considering how difficult it can be for two physicians to juggle a growing family around their training, the Wortmanns have made it look almost easy. Robert did his rheumatology fellowship from 1977-1979 at Michigan while Dorothy finished her pediatrics residency there, followed by her pediatric rheumatology fellowship at the same institution.

At the time Dorothy was in her fellowship, pediatric rheumatology was not a recognized subspecialty. "I did not do any research, and I was not sure I would be offered academic positions, but I have been fortunate in each of the places we have lived," she noted.

Over the years, the Wortmanns have been at the Medical College of Wisconsin in Milwaukee, where Robert eventually became professor of medicine in the division of rheumatology while Dorothy was on the faculty of the pediatrics department. From there, they moved to East Carolina University, Greenville, where Robert was professor and chairman of the department of medicine. Onward they went to the University of Oklahoma, Tulsa, where Robert was professor and C.S. Lewis Jr. Chair of Internal Medicine. And finally, they went to Dartmouth University, Hanover, N. H., where he is professor of medicine.

His colleague at Dartmouth, Dr. Christopher M. Burns, noted in an interview that: "Bob and Dottie have worked at a number of institutions over the years. Although it’s true that most of their moves were driven by Bob’s career, it’s also true that no matter where she went, Dottie had a big impact. She actually established pediatric rheumatology in Wisconsin, and dramatically improved the pediatric rheumatology programs at all the institutions she’s traveled to with Bob."

Dorothy’s area of particular expertise as a pediatric rheumatologist has been Kawasaki syndrome, a disease she first encountered as a resident: "As senior pediatric residents, we each had to do a Clinical Pathology Conference. Mine was a 3-year-old child who had been admitted for diarrhea and dehydration and who died in the waiting room while waiting for the car to be brought around on discharge. Fortunately, a medical student had taken a very detailed history, and I had read a recent article from Hawaii about a new disease reported in Japan now being seen in Hawaii. That child had Kawasaki syndrome. The cardiac sequelae were just being recognized. As rheumatology fellows at Michigan, we saw these children because it is a vasculitis. When we moved to Milwaukee, there was an outbreak with 20 children in the hospital over a several-week period. In fact, if I remember correctly, there were 13 children in the hospital at one time. This was very unusual. It was reported to the CDC and investigated. I then followed these and subsequent children with one of our cardiologists in a total of about 150 children. This was a large clinical experience at that time and led to those papers."

The stars had to align in a very precise pattern for Robert to become a rheumatologist. First, because his training was interrupted by military service, he had time to reconsider his choice of general internal medicine. Then, he was struck by how sad the general internists he met all seemed, which gave Robert another reason to rethink that specialty. Robert felt strongly that he should experience work in a research lab so he would not later regret never having done it. Going into general internal medicine would have meant no time in a research lab. Finally, Dorothy was given a pediatric rheumatology fellowship position at the University of Michigan where he would do a rheumatology fellowship. Dr. William N. Kelley asked him "what I thought of rheumatology. It turns out Dr. Irving Fox, a rheumatologist on the faculty, had just received a new grant with a post doc position. So after interviewing, it was decided that I would do 1 year of research as a rheumatology fellow.

"... I did struggle in the lab at first but found I really like rheumatology. So in April, I met with Irv and requested a second year of fellowship and told him I wanted to become an academic rheumatologist, but with a clinical, not research, position. Only 2 weeks later, I was sitting in a small library with graph paper and three different colored pencils plotting the results of an experiment (we did not have computers then). The red line went up and the blue line went down and that was my "eureka moment." Those results told me the definite answer to a question we were asking and told me what the next step was. I experienced what others had told me about, about what it is like when you know something for the first time, even if it is trivial, and you are the only one in the world to know it. But I was hooked on research. It was definitely an acquired taste," Dr. Wortmann said.

When asked to identify the largest changes in rheumatology since he was certified in 1979, Dr. Robert Wortmann cited a long list: "We have gone from salicylates and gold to methotrexate and biologics for rheumatoid arthritis. Because of these advances and earlier diagnosis, we hardly ever see crippling disease and patients in wheelchairs. I don’t know if trainees today ever see patients with swan neck or boutonniere deformities of their hands.

"The life expectancy of knee replacements has improved from 5 to 25 years (thank goodness)! Wegener’s granulomatosis has gone from a universally and rapidly fatal disease to very treatable one, and scleroderma renal crisis is almost unheard of. Fibromyalgia has become epidemic. The percentage of adults in this country with hyperuricemia has risen from 5% to 21.4% with a proportionate increase in the number of patients with gout, now 8.3 million. One of my interests is metabolic myopathies. In 1979, only 4 had been described; now we know of more than 25. The "Primer on the Rheumatic Diseases" has quadrupled in size."

Over the course of her career, Dr. Dorothy Wortmann has seen her specialty blossom: "Pediatric rheumatology was in its infancy as I started. There were not many of us, we had few medications, and there were little if any data on which to base treatment. We didn’t have a textbook until 1992 with the "Textbook of Pediatric Rheumatology," which is now in its sixth edition. At about the same time, we were a recognized as a subspecialty in pediatrics and the first Pediatric Rheumatology Board exam was given. The Pediatric Collaborative Study Group was first and now we have CARRA and PRINTO as well. We have objective outcome measures, data on which to base our decision for treatment and an array of more effective medications."

They met in a medical school biochemistry class in which the professor arranged the students alphabetically, so that Woodward sat next to Wortmann. In the beginning, their teamwork as study partners earned them excellent grades. But when romance distracted them, they had to study apart. By the second year of medical school Dorothy Woodward and Robert Wortmann were married. That was 42 years ago.

"In college, she was chemistry major and I was biology major. So she did the experiments and I cleaned up afterward. I still do the dishes after meals," according to Dr. Robert Wortmann, who explained that his dish duty originated from a bet over a ski race. "I lost a bet wagering ‘dishes for the year’ when we were in a ski race 35 years ago. She won and has refused a rematch."

Photos courtesy Dr. Dorothy Wortmann

Asked to reflect back on his greatest achievement to date, Dr. Robert Wortmann said: "My part in our balancing family and career. We have been married for more than 42 years, we raised two sons who continue make us very proud, and, overall, we have had very satisfying careers. I won’t say it has been easy, but I will say it has been rewarding." Despite that still-lamented ski match, the Wortmanns seem to have had a marriage that has been far more collaborative than competitive, even as they moved several times before arriving in Hanover, New Hampshire, where Robert Wortmann is professor of medicine at Dartmouth and Dorothy Wortmann is a pediatric rheumatologist on the faculty.

Each Wortmann arrived at medical school through a different process. For Robert, becoming a physician may have been a matter of medicine being the family business. "Other than playing professional football, which would have been a goal if I had been bigger, faster, stronger and had any talent (I did play football at Carleton [College, Northfield, Minn.]), I guess I never really considered any alternative to medical school. I don’t think I knew very much about other occupations or professions. My father was a physician and most of our family friends were physicians’ families. Also, I was pretty comfortable in the hospital environment. As I was growing up, my father was in a solo ob.gyn. practice. That meant if I was with him, and he got called to the hospital, I would have to go with him. In those days, they would page doctors at baseball games and come find them in movie theaters. My father used an answering service that he would call hourly whenever he was away from a phone. During the daytime, I usually got to go into the pathology department and always got to see some organs or look at slides. Other times, I would hang out in the doctors’ lounge."

For Dorothy, getting on the road to medical school took imagination, the support of her grandmother, and the enthusiasm of her undergraduate advisers. "I had always expected to go to nursing school. My grandmother, who was my college scholarship, wanted me to get a BA, so I went to Mount Holyoke [College, South Hadley, Mass.], and then my advisers in college encouraged me to go to medical school. My sister was in college and my brother was in graduate school. My father had not planned on sending his daughters to graduate school. He said I could apply for scholarships back East or come to K.U. Medical School, in Kansas City." So the University of Kansas it was, for them both.

After graduation, Robert Wortmann recalled: "We were in one of the first years of the ‘couples match’ for residencies and ended up at the University of Michigan, Ann Arbor, me in medicine and she in pediatrics." Then his obligatory military service reared its head and the couple set off for Korea. If the call had come 5 months earlier, his tour would have been as a medical officer in Vietnam.

From 1973-1974, he served as a general medical officer for the U.S. Army in what was to be the last MASH (mobile army surgical hospital) in Korea. Together, that medical staff of two surgeons, one internist, one anesthesiologist, and 10 nurses cared for 12 helicopter pilots and about 90 enlisted men assigned with them to Camp Mosier, which included the 43rd MASH unit. They also cared for civilians, including residents of a nearby leper colony, as time allowed. Dr. Robert Wortmann’s duties were broad and included "doing sick call and seeing inpatients. I was also No. 3 surgeon, the radiologist, the lab officer, the blood bank officer, the rabies control officer, the VD control officer, the person in charge of doing physical exams on Korean women who were going to marry GIs, and the nuclear holocaust control officer."

Although pregnant with their son, Jon, Dorothy also went to Korea. Conditions were harsh, and the Army made no accommodations for this military wife, even though she came in handy as a pediatrician at the underserved hospital in Seoul. With Robert stationed in "north of the tank wall in a tactical zone at the MASH hospital," he had no car and she could not live on the base there. Instead, she lived in an apartment in Seoul without a car. There was an oil shortage that winter and all water had to be boiled before drinking. Until their son was born, he would visit her in Seoul on weekends when he was free, and she would visit the base on weekends when he was on duty. "The 2½ of us slept in a single bed in a Quonset hut," she recalled in an interview.

The first season of the television show "M*A*S*H" aired the year before Robert arrived in Korea. While he was there, the show’s coproducers visited his MASH unit searching for ideas for the series, which had become wildly popular despite their expectations. "The show was based on a book. They had used up all the material from the book, and they needed fodder for future shows. They did everything we did and interviewed everyone individually. Thus, I can recognize something in every episode beginning in year 3 that was based on our reality. My name was used as a character in one episode [spelled Wortman]. In another episode, they were collecting money for a pool to bet on when Colonel Potter would become a grandfather. At the time of their visit, there was just such a pool at our hospital for when Jon would be born," Robert recalled.

Once Robert was discharged from the U.S. Army, the two doctors moved to Ann Arbor, where Robert was chief resident in internal medicine. Considering how difficult it can be for two physicians to juggle a growing family around their training, the Wortmanns have made it look almost easy. Robert did his rheumatology fellowship from 1977-1979 at Michigan while Dorothy finished her pediatrics residency there, followed by her pediatric rheumatology fellowship at the same institution.

At the time Dorothy was in her fellowship, pediatric rheumatology was not a recognized subspecialty. "I did not do any research, and I was not sure I would be offered academic positions, but I have been fortunate in each of the places we have lived," she noted.

Over the years, the Wortmanns have been at the Medical College of Wisconsin in Milwaukee, where Robert eventually became professor of medicine in the division of rheumatology while Dorothy was on the faculty of the pediatrics department. From there, they moved to East Carolina University, Greenville, where Robert was professor and chairman of the department of medicine. Onward they went to the University of Oklahoma, Tulsa, where Robert was professor and C.S. Lewis Jr. Chair of Internal Medicine. And finally, they went to Dartmouth University, Hanover, N. H., where he is professor of medicine.

His colleague at Dartmouth, Dr. Christopher M. Burns, noted in an interview that: "Bob and Dottie have worked at a number of institutions over the years. Although it’s true that most of their moves were driven by Bob’s career, it’s also true that no matter where she went, Dottie had a big impact. She actually established pediatric rheumatology in Wisconsin, and dramatically improved the pediatric rheumatology programs at all the institutions she’s traveled to with Bob."

Dorothy’s area of particular expertise as a pediatric rheumatologist has been Kawasaki syndrome, a disease she first encountered as a resident: "As senior pediatric residents, we each had to do a Clinical Pathology Conference. Mine was a 3-year-old child who had been admitted for diarrhea and dehydration and who died in the waiting room while waiting for the car to be brought around on discharge. Fortunately, a medical student had taken a very detailed history, and I had read a recent article from Hawaii about a new disease reported in Japan now being seen in Hawaii. That child had Kawasaki syndrome. The cardiac sequelae were just being recognized. As rheumatology fellows at Michigan, we saw these children because it is a vasculitis. When we moved to Milwaukee, there was an outbreak with 20 children in the hospital over a several-week period. In fact, if I remember correctly, there were 13 children in the hospital at one time. This was very unusual. It was reported to the CDC and investigated. I then followed these and subsequent children with one of our cardiologists in a total of about 150 children. This was a large clinical experience at that time and led to those papers."

The stars had to align in a very precise pattern for Robert to become a rheumatologist. First, because his training was interrupted by military service, he had time to reconsider his choice of general internal medicine. Then, he was struck by how sad the general internists he met all seemed, which gave Robert another reason to rethink that specialty. Robert felt strongly that he should experience work in a research lab so he would not later regret never having done it. Going into general internal medicine would have meant no time in a research lab. Finally, Dorothy was given a pediatric rheumatology fellowship position at the University of Michigan where he would do a rheumatology fellowship. Dr. William N. Kelley asked him "what I thought of rheumatology. It turns out Dr. Irving Fox, a rheumatologist on the faculty, had just received a new grant with a post doc position. So after interviewing, it was decided that I would do 1 year of research as a rheumatology fellow.

"... I did struggle in the lab at first but found I really like rheumatology. So in April, I met with Irv and requested a second year of fellowship and told him I wanted to become an academic rheumatologist, but with a clinical, not research, position. Only 2 weeks later, I was sitting in a small library with graph paper and three different colored pencils plotting the results of an experiment (we did not have computers then). The red line went up and the blue line went down and that was my "eureka moment." Those results told me the definite answer to a question we were asking and told me what the next step was. I experienced what others had told me about, about what it is like when you know something for the first time, even if it is trivial, and you are the only one in the world to know it. But I was hooked on research. It was definitely an acquired taste," Dr. Wortmann said.

When asked to identify the largest changes in rheumatology since he was certified in 1979, Dr. Robert Wortmann cited a long list: "We have gone from salicylates and gold to methotrexate and biologics for rheumatoid arthritis. Because of these advances and earlier diagnosis, we hardly ever see crippling disease and patients in wheelchairs. I don’t know if trainees today ever see patients with swan neck or boutonniere deformities of their hands.

"The life expectancy of knee replacements has improved from 5 to 25 years (thank goodness)! Wegener’s granulomatosis has gone from a universally and rapidly fatal disease to very treatable one, and scleroderma renal crisis is almost unheard of. Fibromyalgia has become epidemic. The percentage of adults in this country with hyperuricemia has risen from 5% to 21.4% with a proportionate increase in the number of patients with gout, now 8.3 million. One of my interests is metabolic myopathies. In 1979, only 4 had been described; now we know of more than 25. The "Primer on the Rheumatic Diseases" has quadrupled in size."

Over the course of her career, Dr. Dorothy Wortmann has seen her specialty blossom: "Pediatric rheumatology was in its infancy as I started. There were not many of us, we had few medications, and there were little if any data on which to base treatment. We didn’t have a textbook until 1992 with the "Textbook of Pediatric Rheumatology," which is now in its sixth edition. At about the same time, we were a recognized as a subspecialty in pediatrics and the first Pediatric Rheumatology Board exam was given. The Pediatric Collaborative Study Group was first and now we have CARRA and PRINTO as well. We have objective outcome measures, data on which to base our decision for treatment and an array of more effective medications."

They met in a medical school biochemistry class in which the professor arranged the students alphabetically, so that Woodward sat next to Wortmann. In the beginning, their teamwork as study partners earned them excellent grades. But when romance distracted them, they had to study apart. By the second year of medical school Dorothy Woodward and Robert Wortmann were married. That was 42 years ago.

"In college, she was chemistry major and I was biology major. So she did the experiments and I cleaned up afterward. I still do the dishes after meals," according to Dr. Robert Wortmann, who explained that his dish duty originated from a bet over a ski race. "I lost a bet wagering ‘dishes for the year’ when we were in a ski race 35 years ago. She won and has refused a rematch."

Photos courtesy Dr. Dorothy Wortmann

Asked to reflect back on his greatest achievement to date, Dr. Robert Wortmann said: "My part in our balancing family and career. We have been married for more than 42 years, we raised two sons who continue make us very proud, and, overall, we have had very satisfying careers. I won’t say it has been easy, but I will say it has been rewarding." Despite that still-lamented ski match, the Wortmanns seem to have had a marriage that has been far more collaborative than competitive, even as they moved several times before arriving in Hanover, New Hampshire, where Robert Wortmann is professor of medicine at Dartmouth and Dorothy Wortmann is a pediatric rheumatologist on the faculty.

Each Wortmann arrived at medical school through a different process. For Robert, becoming a physician may have been a matter of medicine being the family business. "Other than playing professional football, which would have been a goal if I had been bigger, faster, stronger and had any talent (I did play football at Carleton [College, Northfield, Minn.]), I guess I never really considered any alternative to medical school. I don’t think I knew very much about other occupations or professions. My father was a physician and most of our family friends were physicians’ families. Also, I was pretty comfortable in the hospital environment. As I was growing up, my father was in a solo ob.gyn. practice. That meant if I was with him, and he got called to the hospital, I would have to go with him. In those days, they would page doctors at baseball games and come find them in movie theaters. My father used an answering service that he would call hourly whenever he was away from a phone. During the daytime, I usually got to go into the pathology department and always got to see some organs or look at slides. Other times, I would hang out in the doctors’ lounge."

For Dorothy, getting on the road to medical school took imagination, the support of her grandmother, and the enthusiasm of her undergraduate advisers. "I had always expected to go to nursing school. My grandmother, who was my college scholarship, wanted me to get a BA, so I went to Mount Holyoke [College, South Hadley, Mass.], and then my advisers in college encouraged me to go to medical school. My sister was in college and my brother was in graduate school. My father had not planned on sending his daughters to graduate school. He said I could apply for scholarships back East or come to K.U. Medical School, in Kansas City." So the University of Kansas it was, for them both.

After graduation, Robert Wortmann recalled: "We were in one of the first years of the ‘couples match’ for residencies and ended up at the University of Michigan, Ann Arbor, me in medicine and she in pediatrics." Then his obligatory military service reared its head and the couple set off for Korea. If the call had come 5 months earlier, his tour would have been as a medical officer in Vietnam.

From 1973-1974, he served as a general medical officer for the U.S. Army in what was to be the last MASH (mobile army surgical hospital) in Korea. Together, that medical staff of two surgeons, one internist, one anesthesiologist, and 10 nurses cared for 12 helicopter pilots and about 90 enlisted men assigned with them to Camp Mosier, which included the 43rd MASH unit. They also cared for civilians, including residents of a nearby leper colony, as time allowed. Dr. Robert Wortmann’s duties were broad and included "doing sick call and seeing inpatients. I was also No. 3 surgeon, the radiologist, the lab officer, the blood bank officer, the rabies control officer, the VD control officer, the person in charge of doing physical exams on Korean women who were going to marry GIs, and the nuclear holocaust control officer."

Although pregnant with their son, Jon, Dorothy also went to Korea. Conditions were harsh, and the Army made no accommodations for this military wife, even though she came in handy as a pediatrician at the underserved hospital in Seoul. With Robert stationed in "north of the tank wall in a tactical zone at the MASH hospital," he had no car and she could not live on the base there. Instead, she lived in an apartment in Seoul without a car. There was an oil shortage that winter and all water had to be boiled before drinking. Until their son was born, he would visit her in Seoul on weekends when he was free, and she would visit the base on weekends when he was on duty. "The 2½ of us slept in a single bed in a Quonset hut," she recalled in an interview.

The first season of the television show "M*A*S*H" aired the year before Robert arrived in Korea. While he was there, the show’s coproducers visited his MASH unit searching for ideas for the series, which had become wildly popular despite their expectations. "The show was based on a book. They had used up all the material from the book, and they needed fodder for future shows. They did everything we did and interviewed everyone individually. Thus, I can recognize something in every episode beginning in year 3 that was based on our reality. My name was used as a character in one episode [spelled Wortman]. In another episode, they were collecting money for a pool to bet on when Colonel Potter would become a grandfather. At the time of their visit, there was just such a pool at our hospital for when Jon would be born," Robert recalled.

Once Robert was discharged from the U.S. Army, the two doctors moved to Ann Arbor, where Robert was chief resident in internal medicine. Considering how difficult it can be for two physicians to juggle a growing family around their training, the Wortmanns have made it look almost easy. Robert did his rheumatology fellowship from 1977-1979 at Michigan while Dorothy finished her pediatrics residency there, followed by her pediatric rheumatology fellowship at the same institution.

At the time Dorothy was in her fellowship, pediatric rheumatology was not a recognized subspecialty. "I did not do any research, and I was not sure I would be offered academic positions, but I have been fortunate in each of the places we have lived," she noted.

Over the years, the Wortmanns have been at the Medical College of Wisconsin in Milwaukee, where Robert eventually became professor of medicine in the division of rheumatology while Dorothy was on the faculty of the pediatrics department. From there, they moved to East Carolina University, Greenville, where Robert was professor and chairman of the department of medicine. Onward they went to the University of Oklahoma, Tulsa, where Robert was professor and C.S. Lewis Jr. Chair of Internal Medicine. And finally, they went to Dartmouth University, Hanover, N. H., where he is professor of medicine.

His colleague at Dartmouth, Dr. Christopher M. Burns, noted in an interview that: "Bob and Dottie have worked at a number of institutions over the years. Although it’s true that most of their moves were driven by Bob’s career, it’s also true that no matter where she went, Dottie had a big impact. She actually established pediatric rheumatology in Wisconsin, and dramatically improved the pediatric rheumatology programs at all the institutions she’s traveled to with Bob."

Dorothy’s area of particular expertise as a pediatric rheumatologist has been Kawasaki syndrome, a disease she first encountered as a resident: "As senior pediatric residents, we each had to do a Clinical Pathology Conference. Mine was a 3-year-old child who had been admitted for diarrhea and dehydration and who died in the waiting room while waiting for the car to be brought around on discharge. Fortunately, a medical student had taken a very detailed history, and I had read a recent article from Hawaii about a new disease reported in Japan now being seen in Hawaii. That child had Kawasaki syndrome. The cardiac sequelae were just being recognized. As rheumatology fellows at Michigan, we saw these children because it is a vasculitis. When we moved to Milwaukee, there was an outbreak with 20 children in the hospital over a several-week period. In fact, if I remember correctly, there were 13 children in the hospital at one time. This was very unusual. It was reported to the CDC and investigated. I then followed these and subsequent children with one of our cardiologists in a total of about 150 children. This was a large clinical experience at that time and led to those papers."

The stars had to align in a very precise pattern for Robert to become a rheumatologist. First, because his training was interrupted by military service, he had time to reconsider his choice of general internal medicine. Then, he was struck by how sad the general internists he met all seemed, which gave Robert another reason to rethink that specialty. Robert felt strongly that he should experience work in a research lab so he would not later regret never having done it. Going into general internal medicine would have meant no time in a research lab. Finally, Dorothy was given a pediatric rheumatology fellowship position at the University of Michigan where he would do a rheumatology fellowship. Dr. William N. Kelley asked him "what I thought of rheumatology. It turns out Dr. Irving Fox, a rheumatologist on the faculty, had just received a new grant with a post doc position. So after interviewing, it was decided that I would do 1 year of research as a rheumatology fellow.

"... I did struggle in the lab at first but found I really like rheumatology. So in April, I met with Irv and requested a second year of fellowship and told him I wanted to become an academic rheumatologist, but with a clinical, not research, position. Only 2 weeks later, I was sitting in a small library with graph paper and three different colored pencils plotting the results of an experiment (we did not have computers then). The red line went up and the blue line went down and that was my "eureka moment." Those results told me the definite answer to a question we were asking and told me what the next step was. I experienced what others had told me about, about what it is like when you know something for the first time, even if it is trivial, and you are the only one in the world to know it. But I was hooked on research. It was definitely an acquired taste," Dr. Wortmann said.

When asked to identify the largest changes in rheumatology since he was certified in 1979, Dr. Robert Wortmann cited a long list: "We have gone from salicylates and gold to methotrexate and biologics for rheumatoid arthritis. Because of these advances and earlier diagnosis, we hardly ever see crippling disease and patients in wheelchairs. I don’t know if trainees today ever see patients with swan neck or boutonniere deformities of their hands.

"The life expectancy of knee replacements has improved from 5 to 25 years (thank goodness)! Wegener’s granulomatosis has gone from a universally and rapidly fatal disease to very treatable one, and scleroderma renal crisis is almost unheard of. Fibromyalgia has become epidemic. The percentage of adults in this country with hyperuricemia has risen from 5% to 21.4% with a proportionate increase in the number of patients with gout, now 8.3 million. One of my interests is metabolic myopathies. In 1979, only 4 had been described; now we know of more than 25. The "Primer on the Rheumatic Diseases" has quadrupled in size."

Over the course of her career, Dr. Dorothy Wortmann has seen her specialty blossom: "Pediatric rheumatology was in its infancy as I started. There were not many of us, we had few medications, and there were little if any data on which to base treatment. We didn’t have a textbook until 1992 with the "Textbook of Pediatric Rheumatology," which is now in its sixth edition. At about the same time, we were a recognized as a subspecialty in pediatrics and the first Pediatric Rheumatology Board exam was given. The Pediatric Collaborative Study Group was first and now we have CARRA and PRINTO as well. We have objective outcome measures, data on which to base our decision for treatment and an array of more effective medications."