Several smart young cardiologists filled the hours with a mix of fact and impression. With computerized slide presentations and laser pointers, they talked about how an ST segment's appearance indicated ischemia or injury and whether the ST segment was nonspecific. They listed the criteria for hypertrophy of each chamber and for distinguishing between supraventricular tachycardia with aberration and ventricular tachycardia. They told us how to tell pericarditis from early repolarization and how to tell artifact from reality. They were smart, efficient, and often funny. And I learned some things.

As luck would have it, the long-retired, former chairman of medicine at the institution where I trained was scheduled to speak at the end of the course. While I gathered a Danish and coffee in the interval before he spoke, I approached him. He smiled warmly, recognized me, and asked about my partner, who had also trained with him. He seemed genuinely pleased that I had made the effort. It was clear that his 80-plus years had taken their toll. I had heard he had new knees. He didn't seem as tall as I remembered, and he was very hard of hearing despite hearing aids.

Before he began his talk, he stumbled slightly, trying to maneuver the overhead projector into place, and he had trouble getting the laser pointer to work. The room was quiet and cold.

Then he looked up and started to speak. His voice was deep, but quiet, with a measured southern lilt. It commanded attention and not a little fear. He had large hands that he used sparingly but effectively. He glanced at the electrocardiogram on the screen, and you could almost see his eyes spark. I was suddenly transported back 25 years to a large conference room filled with white-coated interns and residents like myself.

He was from a different time, when the physical examination actually meant something. When almost everything you needed came from the bedside, and you didn't always need an echocardiogram or a scan. He drew the QRS, T, and ST-segment vectors on an overhead projector. He spoke of shifting axis and ruptured plaque; of the "fan," not "bundle," of conducting tissue in the left ventricle; of the course of each of the major coronary arteries; of how he would correlate the electrocardiogram changes with the anatomic changes, either from catheterization, autopsy, or the knowing production of septal infarcts in hypertrophic cardiomyopathy. And he predicted very specifically where the particular coronary artery had finally failed in its duty ... "around the junction of the first and middle thirds of the left anterior descending artery."

Often he would call residents up to the front of the room and have us draw the vectors. After our usually flawed attempts, he would lower his head and shake it sadly. "How can this be?" he'd say and sigh as he corrected our drawings.

As the next electrocardiogram went up on the screen, a doctor next to me snorted derisively, snapping me back to the present. "There he goes again with those vectors," she said with a roll of her eyes. I sensed she thought that his talk was irrelevant, perhaps quaint. We used to joke about him too, probably for similar reasons. We just couldn't keep up with him. The difference was in the respect he commanded at the time.

I went to a meeting this week and confronted my past. I saw a mentor from long ago who demanded excellence from his students and residents, as well as himself. Who never took shortcuts and who didn't speak primarily in sound bites. Who had immersed himself in the science of medicine. Over his entire career he had done the long hours of dissection and correlation and thinking. He continued to learn and write long after most of us will be alive, let alone practicing. And despite, or maybe because of, his years, he was still, by far, the smartest person in the room. A few may think medicine has passed him by, but I say it just never caught up with him.