The coronavirus disease 2019 (COVID-19) pandemic has necessitated drastic changes across the spectrum of health care, all of which have occurred with unprecedented rapidity. The need to accommodate change on such a large scale has required ingenuity and decisive thinking. The field of physical medicine and rehabilitation has been faced with many of these challenges. Healthcare practitioners in New York City, the epicenter of the pandemic in the United States, were among the first to encounter many of these challenges. One of the largest lessons included learning how to streamline admissions and transfer process into an acute rehabilitation hospital as part of a concerted effort to make acute care hospital beds available as quickly as possible.

During the weekly grand rounds held in the Department of Rehabilitation Medicine at Albert Einstein College of Medicine (AECOM), its chairman, Arthur S. Abramson, MD (Figure 1), would quietly roll his wheelchair to a set of short parallel bars at one side of the conference room, lock his metal long-leg braces, and pull himself up to his considerable height. For him it was part of a daily regime of standing to stretch his spastic muscles and provide weight bearing to his lower extremities that he continued even 30 years after his spinal cord injury. But for the persons who were privileged to receive their residency training under his supervision, this image of a literally and metaphorically towering figure, the personification of the triumph of will over a severe physical disability, remains indelible. Not the least of his many accomplishments during a long and distinguished career was his wisdom in recruiting an extraordinary trio of physiatrists who formed the nucleus of a department that, along with its eponymous medical school, celebrates its 60th anniversary in 2015. Arthur Abramson's phoenix-like ascent from the ashes of World War II to the heights of his profession, along with the closely related careers of physiatrists Edward F. Delagi, Heinz J. Lippman, and Matei S. Roussan, provide a glimpse into the evolution of physical medicine and rehabilitation (PM&R) during the era subsequent to that of its founding fathers, including Frank Krusen, Robert Bennett, and Howard Rusk, each of whose contributions to the genesis of the specialty have been previously documented in this journal 1-3. Another less well recognized first-generation physiatric pioneer, Karl Harpuder, also played a crucial role as mentor to these 4 physicians who made the rehabilitation medicine program at AECOM a center of clinical, academic, and research excellence from its inception. Arthur Abramson, MD. (Photograph by Ted Burrows, courtesy of the Archives, Albert Einstein College of Medicine.) In 1950, Samuel Belkin, PhD, President of Yeshiva University, a Manhattan-based institution of higher education combining Jewish and liberal arts studies, proposed that it should add a medical school. Part of the mission of this school would be to enhance the opportunity for Jewish college students to earn a medical degree at a time when quotas were significantly limiting their opportunities. Belkin and his colleagues contacted Albert Einstein, the most celebrated scientist of the 20th century and a notable humanist, with the proposition that this new medical school be named in his honor. Approaching age 75 years and nearing the end of his life, Einstein eventually agreed to the plan and was able to see the early stages of the school's development, although he did not live to see its completion (Figure 2). Having a large hospital in close proximity to the school was essential for clinical teaching, and the construction of the 898-bed Bronx Municipal Hospital Center (also known as Jacobi Hospital and later Jacobi Medical Center), adjacent to the Einstein campus, met this requirement. When AECOM opened on September 12, 1955 4, Jacobi Hospital included 4 founding clinical services: medicine, surgery, psychiatry, and rehabilitation medicine. It is a reflection of Abramson's formidable powers of persuasion that his specialty, which had only been recognized by the American Board of Medical Specialties in 1947, was included among those 3 far more widely recognized areas. For him it represented the culmination of a dramatic personal odyssey that had abruptly begun 11 years earlier on a battlefield in Belgium. Albert Einstein and the original model for the medical school named in his honor. (Courtesy of the Archives, Albert Einstein College of Medicine.) Midway through his life's journey, on December 27, 1944, during the Battle of the Bulge, a German sniper's bullet shattered Abramson's thoracic spinal cord and ended his career as a surgeon. At the age of 32 years, he was already Chief of Orthopedic Surgery for the United States Army in the European theatre, and until that pivotal moment his life had been characterized by a steady series of accomplishments. Born in Montreal in 1912, he earned his undergraduate and medical degrees at McGill University, where his extracurricular activities included membership on the wrestling team. His surgical training took place in New York City, including the Montefiore Medical Center, where he likely encountered Karl Harpuder, MD, Chief of Physical Medicine, for the first but certainly not the last time. His progress through the surgical ranks was remarkably rapid, culminating in a leadership role during the European invasion that commenced on June 6, 1944. Within 7 months of D-Day, his life nearly came to a premature end. Fortunately, he survived as a result of treatment with antibiotics and sophisticated emergency care, neither of which had been available during World War I and had resulted in 1-year mortality rates of 90% for soldiers with spinal cord injuries sustained during that earlier conflict. Facing the supreme crisis of his life, Major Abramson had to draw upon his experience as a wrestler, waging a fierce battle against dependency and despair. His coach during this struggle was none other than Karl Harpuder, who became simultaneously his doctor, mentor, and professional role model. During inpatient treatment at the Bronx Veterans Administration (VA) Medical Center, Harpuder initiated the vocational rehabilitation process by directly challenging his patient with the question, “When are you going back to work as a doctor?” The measure of how that question was answered is evident when reviewing the milestones that marked the decade following his injury. Despite having T5 paraplegia, within a span of 10 years, Arthur Abramson completed his own rehabilitation, retrained in a PM&R residency by 1948, obtained his PM&R board certification in 1949 (American Board of PM&R certificate #114), and took charge of the program at the VA where he had previously trained. Finally, in 1955, he was named Chairman of PM&R of the newly established AECOM, a position he held until his death at age 70 years. The quarter century he spent in that role was an eventful time in the development of PM&R, as the field forged its legitimate place within medicine with an interdisciplinary model of care that was as relevant for the civilian population as it had been for other injured World War II veterans. Abramson was a highly visible and prominent participant in that era of expansion as the specialty gained increased recognition. In addition to creating and leading the AECOM program, Abramson held many national positions. He was one of the founders of the American Paraplegia Society and served on the Board of Directors of the American Board of Physical Medicine and Rehabilitation (AAPM&R) from 1957 to 1968, on the President's Committee on Employment of the Physically Handicapped, and as President of the AAPMR from 1971 to 1972. Among the many honors bestowed on him were the President's Handicapped Man of the Year Award in 1955 (Figure 3) and the Gold Key Award from the American Congress of Rehabilitation Medicine (ACRM) in 1966. He delivered the ACRM John Stanley Coulter Memorial Lecture at the 1967 national meeting and the Walter J. Zeiter Memorial Lecture at the AAPMR Annual Assembly in 1975. In 1980, he became the sixth physiatrist to receive the Frank Krusen Award. Dr Abramson receiving the President's Award as Handicapped Man of the Year from Vice-President Richard Nixon in 1955. (Associated Press, courtesy of the Archives, Albert Einstein College of Medicine.) Abramson was named the first Samuel Belkin University Professor of Medicine at Yeshiva University in 1977. His numerous publications included articles and book chapters on spinal cord injury rehabilitation, spasticity management, neurogenic bladder, therapeutic exercise, phantom pain, and innovative models of patient care such as the Rehabilitation Day Hospital (which provided the equivalent of a full day of inpatient rehabilitation services without requiring hospitalization) 5 and the “Therapeutic Community” (a project fostering active patient participation in the treatment process as a means to improve the patient's perception of their social functioning—a novel idea at that time) 6. His close collaborator in these latter 2 projects was Bernard Kutner, PhD, a social scientist whose participation added a unique perspective to the clinical and academic atmosphere within the Department. Similarly innovative was his establishment of a close alliance with the School of Physical Therapy at Ithaca College beginning in 1959, a program that was coordinated by Justin Alexander, a physical therapist who also became an integral part of the Department as an educator of physiatrists and therapists. Abramson's inclusion of Kutner and Alexander illustrates his deep commitment to a truly interdisciplinary model of rehabilitation care. One of Abramson's most meaningful contributions to his profession and its literature was his championing of the rights of people with disabilities. The Bill of Rights for the Disabled, which he created together with Bernard Kutner and which appeared in the 1972 issue of the Archives of Physical Medicine and Rehabilitation 7, identified persons with disabilities as a population whose civil rights had thus far been largely overlooked by society and by the Federal government. It presented 16 resolutions addressing the health, employment, housing, architectural, transportation, income, and educational needs of people with disabilities. Historian Richard Verville comments that the Bill of Rights for the Disabled was essentially an expansion of the Civil Rights Acts of 1964 and the Voting Rights Acts of 1965 and that it cited most of the areas that were subsequently included in the National Council on Disability's Report to the President and Congress in 1988 8. The Americans with Disabilities Act, signed into law by President George H. W. Bush 2 years later, clearly reflects many of the concepts first articulated in this seminal document. Abramson proudly displayed a copy of it on his office wall for the remainder of his life. Along with his role as national advocate for disability rights, Abramson had a more personal impact on the lives of hundreds of patients with spinal cord injuries whose initial rehabilitation care took place at Jacobi Medical Center and at the Hospital of the Albert Einstein College of Medicine (now the Jack D. Weiler Hospital/Montefiore Medical Center). His interactions with these patients were unforgettable experiences for them, because he was a living demonstration that a person with paraplegia could not only be independent in self-care, wheelchair mobility, and bladder management but could drive an automobile with hand controls, work as a physician, and serve as a departmental chairman. When he made teaching rounds on the rehabilitation unit, the patients sat up taller in their wheelchairs (John F. Ditunno, Jr, MD, personal communication). Similarly, resident physicians in his training program and students from the medical school saw him as a superb role model of successful reintegration into society, the ultimate goal of the rehabilitation process. During his final years, Abramson endured a number of physical and academic hardships. He had often remarked that since his injury he never had a day totally free of pain, but now it worsened as a result of the effects of diabetes mellitus, and he ultimately required a below-knee amputation that further impaired his mobility. At the same time, as the Einstein and Montefiore clinical and residency programs were in the process of being unified, there were major threats to their continuation as a distinct department rather than being subsumed under the Department of Neurology. After 25 years as its undisputed leader, he was essentially “demoted” to the role of acting chairman, an indignity that he bitterly resented and that was still unresolved at the time of his death in 1982. It is a tribute to the professional stature of his physiatric associates, and above all to the determination of his successor, Matei Roussan, MD, that the Montefiore and Einstein PM&R Departments did not come to an end at this critical juncture in their history. One of the marks of great leaders is the high quality of the persons they select to fill key positions in their organizations. By recruiting Edward Delagi, MD, in 1954, Heinz Lippman MD, in 1955, and Matei Roussan, MD, in 1958, Abramson demonstrated shrewd and visionary leadership. Each of them broadened the range of expertise within the Department, becoming highly respected clinicians, researchers, and teachers. Any one of whom could easily have served as chairmen of other programs, but, fortunately for future trainees, they spent their entire professional careers at AECOM, providing the stability and academic credibility so essential for a fledgling department. In his choice of associates during the subsequent decade, Abramson added such illustrious colleagues as Gabriella Molnar, MD (pediatric rehabilitation), Victor Cummings, MD (amputations, prosthetics), Aldo Perotto, MD (electrodiagnosis), Samuel Levine, MD (inpatient rehabilitation), and Harold March, MD (cardiac rehabilitation); Drs Molnar and Cummings went on to receive the Distinguished Clinician Award from the AAPMR in 1989. The 4 members of Abramson's “dream team” (Abramson, Delagi, Lippman, and Roussan) shared a number of characteristics typical for the second generation of physiatrists, who, to paraphrase Sir Isaac Newton, saw further by standing on the shoulders of the first-generation giants who had established PM&R as a medical specialty in 1947. All 4 entered PM&R from other specialties rather than choosing it at the outset of their careers, and, with the exception of Delagi, they were all international medical graduates. Their shared first-generation physiatric mentor also mirrored those characteristics. Karl Harpuder, MD (1894-1974) was born in Munich, received his medical training in Germany, and emigrated to the United States in 1934, where he became the head of physical medicine at Montefiore Medical Center from that year until 1961 (Figure 4). Board certified in internal medicine, he also became one of the earliest board-certified physiatrists in 1947 (Certificate #24). His personal experience with spinal tuberculosis may have contributed to his professional transformation from internist to physiatrist. Harpuder was an editor for the American Journal of Physical Medicine, and his contributions to the specialty were recognized when he received the Gold key Award from the ACRM in 1957 9, 9 years before his most illustrious disciple was similarly honored. Karl Harpuder, MD. (Courtesy of the Archives, Montefiore Medical Center.) Although Montefiore's Physical Medicine Department was among the earliest of its kind in the United States, Harpuder actually had a 19th-century predecessor in the same institution, Simon Baruch, MD, who could be described as a proto-physiatrist, and whose family continued to be intimately involved in the development of PM&R throughout much of the 20th century. When it opened in 1884 as the Montefiore Home for Chronic Invalids, Simon Baruch was the chief of its medical staff. He had previously served as a surgeon in the Confederate army, where he performed the first documented surgical removal of a ruptured appendix. A strong advocate for the use of hydrotherapy in the treatment of medical disorders, he was in many respects a physical medicine physician 50 years before the recognition of the specialty 10. Of equal significance, he was the father of financier and philanthropist Bernard Baruch, who played a prominent and decisive role in the early history of PM&R through his close relationship with first-generation physiatrists including Krusen 1 and Rusk 3. Simon Baruch's name also endures through his endowment of the Simon Baruch Professorship in Rehabilitation and Regenerative Medicine at the College of Physicians and Surgeons, Columbia University. Born in the Bronx in 1911, Edward Delagi, MD (Figure 5) initially planned to be a neurosurgeon. He completed his residency in PM&R at the Bronx VA Hospital in 1954 under Abramson, who promptly recruited him for the new Rehabilitation Medicine Department he was forming. As Clinical Director, Delagi spent the next 3 decades at AECOM, where his gifts as a clinician, teacher, and electromyographer earned him the accolades of his professional peers and the deep affection of hundreds of residents, who particularly cherished his weekly kinesiology sessions. One mark of that affection was their renaming of the test for intrinsic hand tightness as the “Delagi Test.” Another mark of that affection was the fact that residents felt they could share professional or personal concerns with him, knowing that they would always find a sympathetic ear and wise counsel. He particularly loved making a difficult problem simple and making a topic easier to grasp (Gerald Herbison, MD, personal communication). This attribute is clearly demonstrated in the book he co-authored with Perotto and Iazetti on anatomic localization in clinical electromyography 11, which is now in its fourth edition. In 1983 his clinical and academic contributions were recognized when he received the Distinguished Clinician Award at the AAPMR annual meeting. He was a fascinating contrast to Arthur Abramson's intense and sometimes intimidating persona. Delagi was less physically imposing, modest, soft-spoken, easygoing, and optimistic, but with an equally powerful intellect. His veneration of his Chairman never flagged, and they often appeared to be unconsciously emulating the “good cop/bad cop” model. Delagi was content to remain second in command, devoting himself to patient care and teaching. Starting in 1985, he enjoyed a long and happy retirement in Florida, during which he was able to indulge his lifelong passion for fishing. He also became a dedicated golfer who soon was shooting scores in the low 80s, a measure of his innate athleticism (Loren Fishman, MD, personal communication). He died in 2004 at the age of 92 years. Edward Delagi, MD. (Courtesy of the Archives, Albert Einstein College of Medicine.) Heinz Lippman (Figure 6) was born in Germany in 1908, where he completed his medical education. Soon after the establishment of the Third Reich he moved to Italy, where he trained in and practiced internal medicine. In 1939, just 1 day before Hitler's invasion of Poland, he emigrated to England, where he briefly taught biochemistry at Oxford. He arrived in the United States the following year and worked in the vascular surgery department at Mount Sinai Hospital. Under the influence of Harpuder, he did his residency in PM&R and became board certified in 1959. Heinz Lippmann, MD. (Courtesy of the Archives, Albert Einstein College of Medicine.) When Lippman joined Abramson and Delagi at Einstein in 1955, he established and then supervised for more than 40 years a peripheral vascular disease clinic at Bronx Municipal Hospital Center. Several generations of residents learned from him the value of the semi-rigid Unna boot for treating the edema and nonhealing ulcers of chronic venous insufficiency, often with startling results in patients whose complications previously had persisted for years. A pianist of professional caliber, he maintained a close connection to music and musicians throughout his career, performed in Carnegie Hall, and played private chamber music with amateur violinist Albert Einstein 12. He also participated in the musical life of the medical school, selected the Steinway for its auditorium, conducted the student orchestra, and often acted as accompanist for student instrumentalists. In one of the articles reflecting his musical background, he questioned whether the term “overuse syndrome” among musicians was being overused itself, recommending that it be renamed the “misuse syndrome” 13. Like Delagi, Lippman received a Distinguished Clinician Award from the AAPMR (1986), but unlike him, he never completely retired, remaining an active member of the AECOM faculty despite encroaching illness until a few weeks prior to his death in 1998. He died just short of his 90th birthday. Matei Roussan, MD (Figure 7) was born in Bulgaria in 1922 and received his medical education in Paris. After emigration to the United States in 1957, he joined Abramson the following year and was his successor as Chairman of the unified Einstein and Montefiore program, renamed the Arthur S. Abramson Department of Physical Medicine and Rehabilitation in 1987. The 5 years during which he was Interim Chairman (1983 to 1987) were probably the darkest period in the Department's history, and its survival as a separate entity was very much in doubt. Roussan's greatest achievement may well be that, despite these challenges, and thanks to his tenacious advocacy, the Department survived, ultimately prevailed, and subsequently thrived. Matei Roussan, MD. (Courtesy of the Archives, Montefiore Medical Center.) His true passion was for clinical care, research, and teaching rather than for academic politics. He followed in the footsteps of Delagi and Lippman by receiving the AAPMR Distinguished Clinician Award in 1990, making him the fifth AECOM physiatrist to be so honored during the 8 years between 1983 and 1990. With his dry wit and urbane manner, which reflected his European roots, he delighted residents and students during bedside patient teaching rounds. The urodynamics laboratory, which he developed and supervised at Jacobi Medical Center, was a source of some of the earliest published data on the role of oral baclofen (Lioresal) in treating vesicosphincteric dyssynergia in patients with spinal cord injuries who had a neurogenic bladder 14. Although he worked only part time after Avital Fast, MD, succeeded him as chairman in 1994, Roussan continued seeing private patients within the department because most of them vociferously insisted on keeping him as their physiatrist. When he died at age 86 years, after a 50-year affiliation, and exactly 100 years after the birth of Heinz Lippman, it truly marked the end of a golden age for PM&R at Montefiore and AECOM. One of Arthur Abramson's favorite sayings was, “Function does not flow from the tip of a scalpel, from drugs, or from surgery; only function leads to more function.” In every aspect of his life he was the embodiment of that adage. When he was younger he wanted to be an architect, and in many ways he fulfilled this ambition despite choosing a medical career, by creating an outstanding PM&R department from the ground up; by erecting a scaffolding that ultimately grew into the Americans with Disabilities Act; and by reconstructing his own life following his spinal cord injury with such determination that it could serve as a blueprint for the rehabilitation paradigm itself. The building blocks that formed the foundation of a PM&R department that now bears his name were the persons he selected as his partners. Drs Delagi, Lippman, and Roussan were the first of a lineage that now extends to include hundreds of physiatrists throughout the United States and the world. That is his most lasting legacy. In 1973, while a resident at AECOM, I had the unique privilege of being Dr Abramson's “roommate” during the AAPMR/ACRM annual meeting in Washington, DC. During those few days, I probably learned more about disability and rehabilitation from observing him than I did from all the excellent didactic teaching programs during that entire year. Despite being in a hotel room that was not ideally wheelchair accessible, he was totally independent in all his activities, and my only “assignment” was to push his wheelchair down the seemingly endless hotel corridors, which had ultra-plush carpets that made self-propulsion exhaustingly difficult. The conversations we had during those long journeys from hotel room to conference room were a wonderful opportunity to get to know this extraordinary man in a much more personal way. I was amazed at the reserves of patience, discipline, and strength required for a person with paraplegia to carry out dressing, transfers, bathing, and bladder care. But once he had joined his colleagues, his energy, passion, and charisma swept away any thoughts of physical limitations. Wherever he was, he dominated the room with his larger-than-life personality. “Archie,” as his intimates called him (as did the residents when he was not around), was no angel. He could be aggressive, abrasive, and bitingly sarcastic. As John Ditunno recalls from his 6 months at AECOM, which he considered the high point of his training, Arthur Abramson's relationship with medical professionals outside of his closest associates could be complicated, even hostile; if he did not respect a colleague, it was obvious to everyone (John Ditunno, personal communication). However, his perspicacity in choosing his 3 longest-serving associates (Delagi, Lippman, and Roussan) was confirmed by their own strength of character, which enabled them to stand up to his without being overshadowed. Fortunately, for members of the residency program, he was a kinder, gentler teacher and mentor. Many New York City–based PM&R residents during the 1960s and 1970s had the good fortune to encounter him in more informal circumstances, during the monthly dinners and lectures held in the venerable New York Academy of Medicine. On these occasions he displayed a genial and expansive nature that made him eminently approachable. A final image I treasure is that of his car transfers at the end of the work day. After approaching the right side of his vehicle and opening the front door, he grabbed the side of the car and, with a mighty pull of his arms, seemed to literally fly out of his chair into a standing position, looking as if he was about to pull the side of the car down rather than pulling himself up. Pivoting into the front passenger seat, he reached over to fold up his wheelchair and lift it into the back seat with one arm. Wheelchairs in the 1970s were not the ultralight devices of more recent times, and the sheer strength involved in that maneuver was reminiscent of the story of Abraham Lincoln holding a heavy metal axe horizontally. It was characteristic of the man that this superbly virtuosic demonstration of power and independence boldly flaunted the safer and more customary techniques for such transfers. Drs John Ditunno, Loren Fishman, and Gerald Herbison provided personal recollections of their experiences with Drs Abramson, Delagi, Lippman, and Roussan. Dr Lippman's son, Dr Lawrence Lippman, shared memories and photographs of his father. Aurelia Minuti, AECOM archivist, and Connie Delehanty, Montefiore Medical Center archivist, gave us access to documents and photographs that greatly enhanced the content of this article. The office of the American Board of Physical Medicine and Rehabilitation provided Board certificate numbers and dates for the physiatrists profiled in this article.