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5 June 1998 Vol. I, No. 32 Feature Article Metcalf Cup and Prize winner Sharon Levine A passion for teaching and compassion for her patients by Brian Fitzgerald "I thought Victor was going to die from kidney failure," recalls Sharon Levine from behind her desk, which is decorated with flowers -- congratulatory presents for receiving the 1998 Metcalf Cup and Prize, the highest teaching honor awarded by Boston University. She doesn't stay seated for long. On a recent morning, Levine, director of BUSM's Geriatric Fellowship Program, has little time to enjoy the bouquets and cards. Indeed, her office -- and classroom -- is often the apartment of an elderly person. She is about to visit one of her favorite patients: 103-year-old Victor Juba. Accompanied by medical residents Steve Morganstern and Tim Murphy, Levine gets in her car and heads to Dorchester for a house call. Driving down Blue Hill Avenue, the associate clinical professor of medicine remembers Juba's jubilance at his 100th birthday party three years ago. However, 11 months later, Levine thought that she was going to lose not only her patient, but a good friend. "He had acute renal failure," she says. "His blood tests and X-rays were fine. The problem turned out to be an adverse reaction to antibiotics. He's fine now. His kidneys have almost recovered. We're visiting him because he's got a pain in his ear." Sharon Levine, on a house call in Dorchester, talks to 103-year-old Victor Juba. Levine is director of BUSM's Geriatric Fellowship Program. Photo by Kalman Zabarsky Medical students are often skeptical about leaving high-technology clinics to visit patients at home. Doesn't the house call, complete with black bag, exist only in old movies? On the surface, the concept seems like a throwback. But for a housebound patient, a visit from the doctor is preferable. Since 1949, every fourth-year BUSM student has a four-week geriatric services rotation, seeing four to five patients a day. Levine points out that seeing firsthand how patients live can provide valuable insight -- and enable doctors and residents to make more accurate diagnoses and treatment plans. "You get to use your judgment skills in addition to your scientific knowledge," she says. "When you're in the person's home, the balance of the doctor-patient relationship changes. You ask, 'May I sit down?' 'Would you mind lifting up your shirt?' It creates a more egalitarian, more personal situation, difficult to get in a hospital." In class, Levine has been known to project slides of patients' homes and have students look for medical clues: which of the prescriptions is the patient really taking? Is she answering her mail? Are the steep steps in the doorway preventing her from making appointments? She also trains students to spot signs of elder abuse and neglect. There is certainly no evidence of mistreatment in Juba's well-kept home. The native of Trinidad and Tobago is blind and nearly deaf (Levine has to shout questions in his right ear), but he is clearly happy and loved. "Every day I have with my father is a treasure," says his 70-year-old daughter, Marjorie Iniss. "When does your ear hurt?" asks Levine. "When I yawn," answers Juba. An ear exam reveals nothing out of the ordinary, so the probable cause of his pain is TMJ syndrome, an inflammation of the jaw's temporomandibular joint. "How would you treat this?" she asks Murphy, a third-year resident. "A little Tylenol," he replies. Murphy is co