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« April 2014 »

REMEMBRANCE: Nathan Schnaper, MD

Author: S. Michael Plaut, Ph.D.
Publication Year: 2011

 Sixty years ago, the Department of Psychiatry was founded at the University of Maryland School of Medicine. Dr. Nathan Schnaper was one of the first psychiatrists to join Dr. Jacob Finesinger, the department’s first chair, remaining there for his entire career. Although he retired in 1996, he continued to attend in the cancer center on a part-time basis until about two months before his death on August 23, 2010 at the age of 92. He had been the longest living member of the faculty in the medical school.

Born in Baltimore, Dr. Schnaper graduated from the Polytechnic Institute in 1936 and received a BS degree at Washington College in Chestertown, Maryland in 1940. He taught science for one year at Patterson Park High School before enlisting in the U.S. Army during World War II. He served in the Pacific Theater with the 118th General Hospital of Johns Hopkins University as the NCO-in-charge of laboratory until his discharge in 1945. He returned to Baltimore and enrolled at the University of Maryland School of Medicine, graduating with honors in 1949. He did a rotating internship with the U.S. Public Health Service Hospital in Baltimore and received residency training in psychiatry at the Sheppard and Enoch Pratt Hospital from 1950 to 1953, when he joined the faculty of the fledgling Department of Psychiatry.
Dr. Finesinger believed that Psychiatry should collaborate with other departments in the medical school and Dr. Schnaper was assigned to Surgery. He soon realized that physicians often had difficulty facing the possibility of death in their patients. This eventually led him to a long career working with patients who were critically ill or severely injured. In 1972, he was named chief of the Maryland Institute for Emergency Medicine psychiatric branch and, in 1976, became chief of psychosocial services at what is now known as the Marlene and Stewart Greenebaum Cancer Center (UMGCC), a position he held for the rest of his career.
In 2003, Dr. Schnaper published his memoirs under the title, “I Pay You to Listen, Not Talk.” The title of that book alone tells us a lot about him – his humorous, often self-effacing nature; his willingness to learn from his patients. He was also forced to learn from an illness of his own about 45 years earlier, as he described in the book.
"Nate was an icon and a father figure to all who worked at the cancer center. He was the perfect combination of friend, adviser, and institutional memory,” said Dr. Kevin Cullen, director of the cancer center. “He was universally loved." 
He appeared each day wearing his signature bow tie, white coat, red socks, and a warm, engaging smile. The door to his office was peppered with cartoons. There are physicians who remember to this day the jokes he told during his Freshman Psychiatry lectures, many of them slightly off color, but designed to make a point about the material he was presenting. His love of teaching and mentoring led to the establishment of the Dr. Nathan Schnaper Summer Scholars Program at the cancer center.
Dr. Schnaper cared deeply about others – his patients, most of whom were critically ill, his colleagues and other healthcare providers on the service, his students, those to whom he reported, and even Rover, his pet parakeet, for whom he gave up smoking- cold turkey. 
He was committed to understanding the process of dying and to helping his patients and their families face death in their own way, in their own time. He could be direct in his advice when that was needed, and his patients loved and admired him for it. He understood the uniqueness of every one of his patients, both in their personalities and their coping styles. 
Leslie Wareheim, a St. Louis social worker who did her internship on the cancer center in the early 80’s, reflected on her memories of Dr. Schnaper. “I could not adopt his approach to patients as my own,” she wrote, “it was uniquely Nate's! But I do think I learned a sort of ‘honest fearlessness’ from him in working with patients. Time is short! Don't beat around the bush if there is work to be done and the patient is ready to do it!”
“It was tough love, his brand, and he got right down to the problem,” said Dr. Stephen C. Schimpff, clinical professor of medicine, in the Baltimore Sun obituary for Dr. Schnaper (August 26, 2010). “But his approach was a very practical one, an approach that helped patients cope with their illnesses, their anxieties, the threat of death, and indeed with their death.”
Dr. Schimpff, former director of UMGCC and CEO of the University of Maryland Medical Center, added that his old friend and colleague was never one to mince words. “He cut through all the crap and would tell them, ‘This is what you're going to have to do. Life is tough. You may not make it. What's important is what you do with the time you have left.’ He was direct and very effective. The patients loved him.” 
Patients weren't the only ones whose lives were touched by Dr. Schnaper, said Dr. Schimpff. “He also helped residents and oncology fellows cope with the issues of an intense training program, and also with their insecurities of entering a field where success is often measured in reducing pain and suffering rather than cure.”
Margaret Frazier is assistant to Dr. Cullen and has worked at UMGCC for over 20 years. She recalls that, “Nate was known for visiting not just the patients but sick employees and their family members as well. Every day he went out of his way to help or care for someone, somewhere. It was his life -- his reason to live. He had a unique ability to make each person feel that they were his ‘best friend.’  His capacity for caring seemed limitless to me. I will never stop missing him.”
Dr. Schnaper was a devoted, talented, caring physician, a friend and role model to many of us, and a true Mensch.



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