Suddenly, it struck him. Ten years before, Nyhan, professor of pediatrics at UCSD and former chairman of the department, was at the same hospital when he was shown a child with a swollen abdomen. Doctors didn't know what was wrong with him, but Nyhan, an astute clinician known for his encyclopedic knowledge, did. "This child has to be operated on right away," he told the boy's doctor, who performed the surgery to find that the child had a ruptured appendix.

Now, years later, the boy was returning with his father to give thanks to the man who saved his life. "The child was grateful and wanted to say so," Nyhan recalled.

Two years ago, University City High School student Joel Smith had his batting average boosted fifty points - the hard way - thanks to a complex surgical procedure at the hands of Dr. Reid Abrams, chief of hand and microvascular surgery at UCSD. Twelve years ago, Smith, during a skateboarding accident, bent back two major bones, the radius and ulna, in his left forearm so severely that he couldn't rotate his wrist to turn his palm upwards. It didn't stop him, however, from playing baseball although he had some difficulty fielding ground balls and swinging a bat.

After Abrams cut both bones and realigned them to give them better rotation, (using two plates and thirteen screws to hold them together), Smith was able to turn his wrist 50 to 65 percent more than he was before and not only boost his average to .445; this season he decided to try batting left-handed, something he could never do before.

"That's why I went into this. It's incredibly rewarding to have an outcome alter one's life significantly," said Abrams, who performs between 600 to 700 hand surgeries a year to help relieve disabling effects associated with rheumatoid arthritis and other crippling diseases. Abrams, who has replaced bones and reattached limbs, is also an associate professor of clinical orthopedics at the School of Medicine.

Like Nyhan and Hansbrough, Abrams typifies what makes UCSD special. We call it "medicine in action."

What began twenty-eight years ago primarily as a research center has evolved into a unique combination of experimentation and clinical care. More than a center of learning, more than a research center, more than a school of medicine, UCSD is people like Abrams, Nyhan, and Hansbrough - and dozens of others - whose insights, dedication, compassion, and understanding have touched thousands of lives and placed this institution on the cutting edge of medical discovery and first in patient care.

For almost three decades, UCSD School of Medicine and Medical Center's bench to bedside approach to medicine has made it a nationally recognized center for health care, biomedical research, and medical education while consistently ranking among the nation's leading hospitals in a variety of specialty areas. Its faculty of physicians and scientists continues to serve the community by spearheading research, caring for a large patient population, and providing many unique regional services, such as the burn center, the Shiley Eye Center, and the UCSD Cancer Center, to San Diego and surrounding communities.

From cancer to chicken pox, heart failure to headaches, clinical trials are a way of life at UCSD, where some 400 physicians and researchers regularly engage in research involving thousands of participants. But UCSD School of Medicine's research programs reach far beyond campus laboratories and into the heart of the San Diego community.

One of the longer running projects, the Rancho Bernardo Heart and Chronic Disease Study, for example, continues to yield new knowledge about age-related diseases, including Alzheimer's. Under the direction of Dr. Elizabeth Barrett-Connor, an internationally known authority on hormones and their effect on health and disease, three-fourths of the adults in this, the nation's first planned community, have been surveyed for more than twenty-five years; 80 percent of the participants who started with the project are still involved in the study.

Dr. Patrick Lyden, UCSD neurologist and part of the staff of the Veterans Affairs Medical Center, is another researcher widely known for his clinical studies. In 1996, the FDA approved the administration of tissue plasminogen activator, or TPA, the enzyme that dissolves arterial blood clots. The approval came after a nationwide study, which included pioneer research by Lyden. As he continues his research on TPA, Lyden is also focusing on whether new blood thinners work better than aspirin or coumadin in preventing recurring strokes.

Research is definitely a strength of UCSD. And the strength of that research is in molecular medicine, according to Dr. John F. Alksne, former dean of the UCSD School of Medicine. Nyhan, for one, has been tracking rare inherited metabolic disorders in children and diagnosing methods of treatment for three decades. His discovery of a rare genetic disorder caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase, or HPRT, resulted in a disease, Lesch-Nyhan Syndrome, being named after him and an associate.

In addition, the name of Flossie Wong-Staal has become synonymous with AIDS research. While working at the National Cancer Institute in 1984 with Robert Gallo, one of the discoverers of HIV, Dr. Wong-Staal was the first to clone the virus and work out its molecular structure. A professor of medicine and biology at UCSD today, she heads her own lab, where she concentrates on finding a cure and a vaccine for HIV infection.

After investing heavily in the gene therapy program, UCSD began partnering with the Boehringer Mannheim Corporation to create a molecular medicine service center on campus. "We look forward to pioneering therapies in some of the currently untreatable diseases like arthritis, Alzheimer's and cancer. Our school is very well positioned to do that," said Alksne.

The school has long been astride the twenty-first century because of its innovative programs, including PCASSO. That's not a misspelling of the artist's name but an acronym for Patient-Centered Access to Secured Systems On-line, a program that enables providers and patients to view medical data securely anywhere on the Internet. Run by Dr. Daniel Masys, associate clinical professor of medicine and director of biomedical informatics, the program uses multiple layers of encryption to scramble information so it can be viewed only by the intended recipient.

As for informatics, the field of information as applied to health care and medicine, other projects are already taking shape. One, for example, will soon enable scientists to take tens of thousands of data points on genes and sift through them on computer to establish common patterns. While the focus in the past has been on basic research, the school today sees itself fulfilling a unique role in the community. Of all local hospitals, UCSD Medical Center continues to carry the bulk of indigent care - 50 percent of all patient activity. At the same time, these patients are a key component to the teaching system and serve as a ready resource for doctors in training.

UCSD is also the only comprehensive organ transplant center south of Los Angeles providing heart, lung, kidney, liver, pancreas, and combined organ transplants. More than 1,300 kidney transplants have been performed at the medical center since the inception of the program in 1968 and at least two dozen liver transplants are performed each year.

Dr. Lewis Judd, chairman of the school's psychiatry department and former director of the National Institutes of Health, once said: "The ecology of an academic medical center is a delicate one."

It is a balance easily desired but not so easily achieved.

But at UCSD, it is a way of life.