Physician MEDSTAR WASHINGTON HOSPITAL CENTER
News for Medical Staff, Residents, Fellows and Alumni
vol. 18, no. 3
Resident Match Day
Bringing the Best
and Brightest to
of Medicine Program
Director Sal Pindiprolu, MD
are 2011-2012 Chief Residents
Ruta Dubinskaite, MD;
Vikramjit Mukherjee, MD and
Mohamed Azzam Aljaabari, MD
4 Cover story 6 Orthopaedic/plastic surgery 12 Cardio-Oncology program 14 Olympic ideal
CHIEF MEDICAL OFFICER NEWS
Our Focus on Patient Safety ACOG Conference in Saudi Arabia:
Demonstrates Shift in Culture Reflections on a Trip to a Different Culture
by Janis M. Orlowski, MD, MACP
Our hard work is paying off: the culture of “Perfection is not attainable. The stark difference in culture was evident as soon as her plane
patient safety is improving at MedStar Washington Hospital Center. landed. She was traveling with ACOG President James Breeden,
The results of the 2012 survey on our patient safety culture found
But if we chase perfection, MD. “We were met by a representative from the National Guard
Health Affairs. They handed me a box with a black robe and
that compared to the 2010 survey, the overall perception of safety abaya (scarf) to cover myself.”
has increased. Also up from the last survey: we can catch excellence.” “Before last year,” she continues, “I wouldn’t have even been able
I frequency of events reported —Vince Lombardi to go to this conference, because women weren’t allowed to stay
I manager expectations and actions promoting safety in hotels alone without a family member. The first day I went to
breakfast, and sat down with other conference members. The
I continuous improvement in organizational learning waiter came up and said, ‘Sorry, this is a man-only table.’ So I
The umbrella survey last December investigated the overall quality
went to the little coffee shop in the hotel and had breakfast by
I teamwork within units of our educational programs. Surveyors also determined whether
myself. Even in the lectures, men sit on one side and women on
we provide proper processes for and assistance to our residents and
openness of communication the other.”
I fellows, and took a look at how we run meetings, our policies and
procedures, the structure of the GME office, our educational
I feedback and communication about errors Once Dr. Iglesia adopted the “When in Rome…” attitude, she
materials and teaching, our support for residents and fellows when
says she began to immerse herself in the conference, where
I non-punitive response to errors they become stressed, how the Designated Institutional Official
cultural differences translated into medical problems she could
operates and even the sleeping and other on-site arrangements we
staffing address. “About half of the Ob/Gyns are women,” she says. “They
I have for our program. Cheryl Iglesia, MD, at the ACOG conference with Saudi Ob/Gyn were eager to learn, because sexual dysfunction among women is
management support for patient safety Hafiza Turkistani, MD pervasive and often ignored. For instance, vaginal tightening is
I Please accept my personal and professional thanks for everyone
involved with GME: our program directors, the GME staff, all of popular after childbearing years, and any discussion of domestic
I teamwork across hospital units violence is taboo. It’s also assumed that older women aren’t going
you who work with our residents. Your help in teaching the next
I handoffs and transitions generation of physicians has incredible significance for the future of Cheryl Iglesia, MD, FACOG, says her to remarry, so there is no need for vaginal estrogen or anything
like that. There often are very complicated pregnancies, because
health care in America. mother taught her never to talk politics, religion or sex in public.
the average number of babies is five, but 16 is not unusual. Some
I’m very pleased to report that for the overall patient safety grade, To this year’s graduates, I hope you know that you have received an women may have as many as six Caesarean births.”
two thirds of the respondents said their work area or unit in the She had no choice but to disobey, when she found herself
education second to none. We have watched you mature into skilled
hospital should be rated excellent or very good. Thirty percent said seated beside a garrulous Palestinian physician at an American
clinicians, ready to take on private practice, a fellowship or employed Dr. Iglesia was peppered with all kinds of questions during the
it was acceptable, and only a small percentage said it was poor or Congress of Obstetricians and Gynecologists (ACOG)
status. Whether you stay in the area or go elsewhere in the world, workshops, and then began receiving emails with more
failing. The majority of respondents work in medical, surgical or conference in Riyadh, Saudi Arabia in January. “Suddenly I
please stay in touch with us. questions.
intensive care units, with 79 percent reporting direct interaction or found myself talking about all three,” she says. “Sex seemed
contact with patients. A final thought from a famous doctor, Dr. Seuss, from Oh, the Places the lesser evil, so I tried to stick with that.”
You’ll Go!: Outside of the conference, Dr. Iglesia was able to enjoy the city.
The intent of the survey is to compare ourselves to our previous Even that topic had its caveats when Dr. Iglesia discovered that in “Our hosts were all very gracious, and took us out to an event
survey, to see if we are making progress in the system of safety, as “You have brains in your head. Muslim countries, the word “vagina” is politically incorrect to say every night,” she says. “I particularly enjoyed the Saudi history
perceived by our medical staff and associates. in public. “Many women don’t have a word for that body part,” museum, where I discovered much about Islam that I didn’t
You have feet in your shoes. know. We also were invited to dinner at the home of the chair of
she says. “It’s a wonder I wasn’t arrested.”
Patient safety is one of the key elements cited by our Board of You can steer yourself any direction you choose. the department, where we had a traditional meal.”
Directors as an important indicator that we are providing the best While at the conference, she gave lectures on prolapse surgery,
patient first care for our patients and their families. Thank you for You're on your own. incontinence and sexual dysfunction, and attended several Dr. Iglesia reports her week-long experience taught her several
your continuing efforts in expanding and extending our patient workshops. lessons. While she was initially taken aback by the cultural
safety culture. And you know what you know. differences, she believes we’re much the same. “Family is very
S And YOU are the one who'll decide where to go.” Dr. Iglesia, director, Female Pelvic Medicine and Reconstructive
Surgery, has been on mission trips to several countries, but this
important. And all politics aside, our humanity is similar; we
strive for the same things in our jobs and in our families. And
For the second consecutive time, our Graduate Medical Education Congratulations and best wishes to all of our graduates. I was her first experience in a Muslim country. “Not only are there although there are wars and sanctions and religious
(GME) program has received a full five-year accreditation from the geographical and ethnic differences,” she says, “there is the misunderstandings, I think we are more alike than we are
Accreditation Council for Graduate Medical Education. This full religious one. It was definitely a culture shock.” different.” I
accreditation is quite unusual, and demonstrates that we have a Janis M. Orlowski, MD, MACP, is senior vice president, Medical Affairs,
strong, vibrant program with excellence throughout all of its and Chief Medical Officer. Contact her at firstname.lastname@example.org or
2 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012 3
COVER STORY F E AT U R E
Resident Match Day from cover
On March 16, more than 16 thousand medical school
seniors waited for the results of the 2012 Resident Match Day. The
University School of Medicine. The number of graduating medical
students will continue to increase each year, reaching the targeted 30
Eight Residents + South American
day brought the highest match rate in 30 years, with 95.1 percent
of allopathic medical school seniors placed in first-year U.S.
percent increase by 2017.
Currently, residents have the advantage in the selection process,
Beach Getaway = Vacation
residencies by the National Resident Matching Program (NRMP). because there are fewer applicants for a set number of residency
A total of 1,763 students at osteopathic schools also were matched
by William Yi, MD, PGY3 Surgery Resident
positions. But as the number of medical student graduates grows,
with open slots. residency programs will have the selection advantage. Each
residency program mounts its own placement effort, culling through
“The match went very well,” says Jen Remington, MHSA, director,
scores of applicants to determine which residents it prefers.
Medical Education. “We filled all our available slots, and the
majority of the new residents ranked high on our match list.
Lately, to escape the rigors of work,
A lot of residency programs compare academically, Padmore says. explore new lands and expand our horizons,
Seventy-eight newly matched residents begin at the Hospital Center "If candidates are interested in 10 programs that look similar eight mutual friends from various connections
in late June.” academically, they look at other things on which to base their agreed when Emergency Medicine resident
decision. They look at how a program is structured to provide Dana Kindermann, MD, said, “Let’s go to
The Hospital Center has more than 300 residency positions in
work/life balance, options and availability for research or other Cartagena, Colombia for a vacation.”
a range of specialties, explains the hospital’s Designated
electives, and the ability to engage in the local community."
Institutional Official for Graduate Medical Education, Janis M. Besides Dr. Kindermann, joining me from
Orlowski, MD, MACP. Padmore describes another trend she is seeing: “Residents are MedStar Washington Hospital Center were
becoming more tech-savvy. They want to know where hospitals are Emily Siegel, MD, Emergency Medicine, and
“Seven of our residency programs participate in the match—
with Electronic Medical Records (EMR), wireless hot spots, and if Alex Zubowicz, MD, Surgery. Other
Emergency Medicine, Internal Medicine (preliminary and
the iPad® or other handheld devices are used. They have grown up residents represented internal medicine,
categorical), Surgery (preliminary and categorical), Obstetrics &
with technology and are accustomed to it. It makes a difference to family medicine and anesthesiology, and
Gynecology, Dermatology, Internal Medicine/Dermatology and
them in how they navigate the workday.” came from Mt. Sinai, UCSF and Johns
integrated Vascular Surgery,” says Dr. Orlowski, who is also senior
vice president of Medical Affairs and Chief Medical Officer. “Other Hopkins. We all wanted to visit an
GME programs—Podiatric Surgery, Ophthalmology, combined off-the-beaten-path destination that was
How the Match Works warm and would allow for both relaxation
programs with other hospitals and fellowships—go through
different match processes.” Candidates submit a standard electronic application to the NRMP as well as adventure.
with demographic information and educational background, an
Some 600 applicants submitted electronic applications to the essay about what kind of residency they are seeking and why they are Located on the Caribbean coast of Colombia,
Dermatology program, and about 45 came in for interviews. The interested in that area. Cartagena is a traditional colonial shipping
program has two categorical positions and two combined Internal city evolving into a popular South American
Medicine/Dermatology positions. This year, all four positions were I Candidates take the U.S. Medical Licensing Exam to determine if beachside getaway. Jutting skyward from the
filled by candidates who ranked in the program’s top six choices. they are ready to begin a residency program. waterfront sands are countless skyscrapers all
built within the last decade, as tourism in the
“We routinely get our top choices,” says Alan Moshell, MD, I Candidates select residency programs they are interested in, area has exploded. Behind lies the old city,
Dermatology residency program director. “Dermatology is one of and NRMP sends those programs to the candidate’s electronic built of stone and retaining the small narrow Residents leaving the Totumo mud pit, ready to be scrubbed off by local women.
the more competitive specialties, and we continue to place application. passageway streets of a time gone by. In the
residents who have done very well in medical school and distance, with its cannons still pointing including playing basketball with locals, mud is apparently great for your skin.
standardized testing. Getting our top choices is a reflection of the I Programs select and interview candidates, often conducting skywards, looms the Castillo de San Felipe de kite-surfing and going on long runs
individual interviews, panel interviews and hospital tours. throughout the city. The entire group went While in Cartagena, we didn’t make any
strength of our program.” Barajas, the greatest fort built by the Spanish decisions based upon our experiences in
in any of their colonies. out to dinner most nights, to sample the
The Hospital Center/MedStar Georgetown University Hospital I Programs rank candidates they wish to place. seafood and to grab drinks at local bars, or sit medicine; we really tried to act as tourists.
Emergency Medicine program received about 1,000 applications The redefinition is apparent in the people of and watch dancers in the streets. Although we tried not to talk about
I Candidates rank the residency programs they most prefer.
for 10 slots. About 150 came for interviews, and 135 of those the city as well. Wealthy Colombian women medicine, the topic couldn’t be avoided.
were ranked. I A computer matches residents with programs, taking into strut the sidewalks wearing Prada heels, We spent a great deal of our time exploring We discussed at length about how practices
account the candidates’ preferences and programs’ preferences, interrupted every four steps or so by beggars. the architecture and life of the old city, but also are different between our respective
“We did very well, placing some of the top candidates who applied,” until all positions are filled. Grasping at calves, asking for a small gift of took time to see other sights. An hour-long institutions. We all left realizing that while
says Jeffrey Love, MD, residency program director for Emergency money or water to help them survive the ferry ride from the city sets you on the beaches the poor are far worse off than the poor in
Medicine. “We offer rotations at two different hospitals with very Then came the “scramble,” where unplaced candidates contacted oppressive Caribbean heat, the poor receive of Rosario Islands, where you can have a pina the United States, in Colombia they know
different patient populations, so that’s a big draw. We also emphasize hospitals that still had openings, and ask for consideration. This little sympathy. colada for $1 and a beer for 50 cents. Our how to better cope with it.
critical care rotations.” year, the scramble was replaced with the Supplemental Offer and group slept in hammocks on the beach for $7,
Acceptance Program (SOAP). Developed in collaboration with the Despite the wealth disparity, people in and fell asleep after a night of trading stories It was a vacation, but the experience shed
Association of American Medical Colleges (AAMC), SOAP was Colombia seem genuinely appreciative of with backpackers from Australia. light on how one’s attitude is so important to
New Electronic Process designed to streamline the scramble process, by automating it. what they have. A Friday night of the experience of life. Even illnesses, though
entertainment in Cartagena can be a One “can’t miss” attraction of Cartagena is debilitating physically, don’t have to be so,
This year’s match had a change: an electronic process paired NRMP publishes electronic lists of programs with open residency the mud pit volcano of Totumo. Jump inside mentally or emotionally. My trip
unmatched residents with open slots. gathering at one of the many town squares
positions; unmatched students applied electronically for these for an impromptu salsa concert. a small crater at the top, and you land in a re-emphasized how important it is to help
In 2012, there were a few more applicants than in 2011. "This positions. Program directors ranked applicants and NRMP tub of gray that allows you to float and all patients’ outlook on life and inner
correlates with increased class sizes in medical schools," explains tendered offers to applicants in eight rounds. Applicants had to To explore Cartagena, we broke up into experience something akin to weightlessness, experience, to help them through the
Jamie Padmore, MHSA, vice president for Academic Affairs, make a decision within two hours of receiving an offer. I smaller groups. We all stayed at the same which has something to do with your experience of being sick. I
MedStar Health, and associate dean for GME at Georgetown —Catherine Avery house, but some did more active things, buoyancy in the mud. An added benefit, the
4 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012 MAY/JUNE 2012 | PHYSICIAN | MEDSTAR WASHINGTON HOSPITAL CENTER 5
F E AT U R E
Putting the Pieces Back Together
Takes the Whole Team
James DeBritz, MD Robert Golden, MD Praful Ramineni, MD Anthony Shiflett, DO James Street III, MD
hospitals would go straight to amputation after seeing the open start healing. We also had to set his humerus, so he could use his arm Wherever he thought he was, he knew he wanted out, and had to be
wounds and bones sticking out.” during his rehab.” restrained because he kept trying to pull out his tubes, get up and
Dr. Ramineni says, “In terms of the injuries I could address, there
was a big area exposed with a lot of dead tissues. A day after the His wife Katie, an equestrian U.S. Park Police Officer, had gone to the
First Priority initial surgery, I did a formal wash-out, and moved part of his calf accident scene and was transported with him by helicopter to the
When the visible trauma is as severe as in Officer Fowler’s case, Dr. muscle to cover a portion of the wound. We replaced some exposed Hospital Center. “He was conscious and talking to me,” she recalls,
Shiflett says he expects to find equally severe injuries in the chest or areas of unhealthy tissue and tendon with artificial substances a few “but after the initial surgery, he became combative. I had to keep
abdomen. “The extremities could wait. My first priority was ruling days later. One of these substances, Integra™, is revolutionizing a lot telling him he wasn’t in command. I knew what he was thinking.”
out injuries to vital organs,” he says. “Officer Fowler’s helmet, which of plastic surgery. It’s a material your own cells will grow into, made
split in half, probably saved his life. He was confused and agitated, of bovine and shark, backed with a layer of silicone. Within a couple Dr. Shiflett says, “We normally don’t allow family in the trauma bay
which made me highly suspicious of a head injury. A CT scan of weeks, it becomes like normal skin tissue. You remove the silicone, while we’re doing an initial assessment. But she was really helpful in
showed no head injury, but did reveal a splenic injury.” and do a normal skin graft.” keeping him calm, so we let her stay.”
“We were walking a tightrope,” continues Dr. Shiflett. “He’d lost a lot
of blood, but we didn’t know if it was from his extremities or spleen.” The Recovery
He inserted a DPA catheter into Officer Fowler’s abdomen to aspirate “I’d Never Had an Accident”
fluid, while Orthopaedic Trauma surgeons Robert Golden, MD, and Officer Fowler recalls very little of those two weeks. He doesn’t A month after the accident, Officer Fowler was released to MedStar
James DeBritz, MD, focused on his broken bones. Had Officer Fowler remember being hit by the minivan on I-395 that crushed the sidecar National Rehabilitation Hospital, where he began intense physical
experienced a hypotensive episode during surgery, Dr. Shiflett would therapy. Several surgeries followed back at the Hospital Center, to
have returned to the OR to apply suction to the catheter. help close the open wounds and the non-union tibia fracture.
“If I encountered blood at that time, I would have taken out his “When the bone comes out of the skin,” Dr. DeBritz explains, “it
spleen. The catheter was left in place during the surgery. This is not basically loses its blood supply. Blood flow needs to be re-established,
common, but it did provide a window for us into his abdomen. The and the tibia, which has poor soft-tissue coverage anyway, has a
idea to do this came from my partner, Trauma surgeon James Street,” higher rate than other bones of not healing. While his other wounds
he explains. had healed, this one had not. Last fall, we performed synostosis, a
posterior lateral bone graft with a separate incision on the back of
The orthopaedic surgeons began cleaning the wounds and realigning the tibia, to add bone graft between the tibia and fibula to try to get
The his left leg and arm, using external devices. Dr. Ramineni was called in the two bones to heal together. We took the bone from the inside of
patient had a broken leg. to assess the open wounds and the muscle below, and used Vacuum his right femur, using a very innovative technique called reamer
Assisted Closure® dressings to temporarily close the wounds. irrigator aspirator bone graft.”
More specifically, a fractured femur and tibial plateau, as well as
open, multiple fractures of the tibia, fibula and calcaneus. There was Dr. Golden says, “Once Officer Fowler was stabilized, we could start Dr. DeBritz still regularly sees Officer Fowler. He says, “He’s doing
also a left humerus fracture, a broken finger, a concussion and the definitive treatment for the fractures.” great and at a desk job at the Park Police. If I had known then where
damage to the spleen. we would be today with his progress, I would have been ecstatic: no
infection, healed humerus, femur, calcaneous, finger, a tibia well on
MedStar Washington Hospital Center trauma surgeon Anthony Partnership of Orthopaedic Surgery its way to healing, and soft tissue coverage. Does he have some
Shiflett, DO, and his team had to move fast when they received word and Plastic Surgery symptoms? Yes, he has some knee and foot pain. That will get better
in March 2011 that a victim of a motorcycle accident—a Code
During the next two weeks, Officer Fowler underwent several with time. He’s going to be completely functional again, and back
Yellow trauma—was headed for the hospital. Dr. Shiflett recalls,
surgeries. Dr. DeBritz says, “We inserted an intramedullary titanium where he wants to be, on his motorcycle.”
“When I first looked at him, I wasn’t asking myself whether we could
save his leg. I was asking whether we could save his life.” rod through the middle of the tibia fractures, the longer of the two Dr. DeBritz adds, “So many things can go wrong with an injury like
bones in the lower leg, to hold it up as it healed. The challenge with this. He was lucky we have the team here able to care for injuries
A year later, David Fowler is walking with a cane, and as he continues Officer Fowler’s injuries was the periarticular break at the joint line like his. Equally important is support from his family and
to recuperate with intense physical therapy, he plans to return to his of the tibia. That had to be treated differently than the segmental employer. His wife has been next to him the whole time, his
career as a motorcycle police officer in the Special Forces branch of open fractures in the femur and tibia. In addition, he also had open
of the motorcycle into his leg, and sent him flying across two lanes of colleagues have been very supportive and he has a great attitude.
the U.S. Park Police. wounds on his foot, he broke his calcaneous and had tendon
traffic. A member of the motor unit for 19 years, Officer Fowler He has everything to maximize his chances of having a good
ruptures.” outcome. A big part of the healing process is his dedication to
Officer Fowler’s amazing outcome would be unlikely at a hospital became a motorcycle instructor in 1995. “I’d never had an accident,” he
without a 24/7 trauma team. Praful Ramineni, MD, is a plastic “It was a game of prioritizing and staging,” Dr. DeBritz continues. says. “I always told my students, if ever I did, it would be a big one.” therapy and terrific family support.” I
surgeon who specializes in soft tissue trauma, and was part of the “We had to plan the surgeries so we didn’t compromise his recovery, —Norma Babington
“For about 10 days, I kept dreaming I was either scuba diving trying
team saving Officer Fowler’s life. He believes, “A lot of other but balance that with the need to move quickly, to allow his tissues to to find my wife, or on a mission on Air Force One,” he says.
6 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012 MAY/JUNE 2012 | PHYSICIAN | MEDSTAR WASHINGTON HOSPITAL CENTER 7
F E AT U R E
“A Walking Miracle”
5,000 Miles from Home, Sample direct phone numbers of the neurologist and cardiologist
on call. “I wasn’t having any part of an answering service, not when
the Hospital Center physicians
instant access to the images.
my friend could not see,” Dr. Sample says.
But Life-Saving Care from the Team A subsequent workup included a transesophageal echocardiogram
Drs. Aulisi and Benson
determined from the MRI that her
(TEE) and an MRI, both of which yielded troublesome details. strokes were small and did not require the
The TEE showed a tumor (a myxoma) on her heart. The MRI clot-busting tPA (tissue Plasminogen
showed McCabe had experienced two small strokes, likely caused Activator). Dr. Satler asked to review the echo; cardiologist Zuyue
by blood clots on the surface of the myxoma or fragments released Wang, MD, confirmed the diagnosis. McCabe was cleared to fly home.
from the tumor.
Drs. Corso, Panza and Satler recommended that she get on the next
With that information in hand, Dr. Sample marshaled the talents of available flight to Washington to have the myxoma removed at the
Hospital Center physicians Edward Aulisi, MD, chair, Neurosurgery; Hospital Center. With encouragement from Sue Eckert, RN, chief
Richard Benson, MD, associate director, Stroke Center; Paul Corso, nursing officer, McCabe made the decision to come home.
MD, chief, Cardiac Surgery; Julio Panza, MD, director, Cardiology;
and Lowell Satler, MD, director, Interventional Cardiology. It was When she arrived directly from the airport to the Hospital Center
close to midnight on the East Coast, and “not one of these physicians the next day, her care team was well-prepared. Following a series of
was on call,” says Dr. Sample. “My phone was burning up. We were tests, including a catheterization by Dr. Satler, and a follow-up TEE
texting and calling so much, my phone was actually hot.” by Dr. Wang, McCabe was scheduled for surgery the following day
with Dr. Corso.
The team on the East Coast needed to see McCabe’s test results,
quickly. Dr. Benson asked the Straub Clinic & Hospital team to upload Dr. Corso excised the myxoma, which was deep and required repair
the images to a secure cloud available through Vigilant Medical, giving of the septal wall. “Pat was extremely lucky. She will have a full
recovery and should have no recurrence,” says Dr. Corso. “Her case
demonstrated the kind of talent and commitment that exists here.
I am truly proud of being part of a team that takes care of our own.
Dr. Sample was untiring in making arrangements from almost
5,000 miles away. I would hope all patients could get this service,
Surrounding Pat McCabe, RN, are team lead physicians Richard Benson, MD; George Sample, MD but I don’t think it can happen without someone like George
and Paul Corso, MD
directing the symphony. ”
McCabe recuperated on 4NW, under the watchful care of her nurse
Sometimes, you’re in the right place at the right time, for a minute to catch my breath,” she recalls. “I told him to go in and
colleagues. “I was so very well cared for,” she says. “The nurses there
with exactly the right people by your side. I would join him later.”
knew me as a nurse who did mock codes on their units, but they
Edward Aulisi, MD Julio Panza, MD
Later never came. As Dr. Sample prepared to stand in for her, he treated me as a patient, and did not assume I knew about sternal
Sometimes, the improbable and perfect coalescence of compassion, precautions, post-op care and stroke care.”
technology, advocacy, altruism and coincidence results in just the turned to pulmonologists Christian Woods, MD, and Matthew
right outcome, for just the right reason. Schreiber, MD, who were there to support the team, and asked
them to investigate. When Dr. Woods returned without her, Dr. Three months after the abrupt upheaval in her life, McCabe was
Sample knew something was wrong. back to work on her unit, and participating on performance
Last fall, MedStar Washington Hospital Center nurse Patricia improvement committees.
McCabe, who has spent most of her 20 years on 2G, the medical
intensive care unit, was the centerpiece of a medical emergency that McCabe, resting on a chair outside the conference hall, had been
approached by a nurse at the hotel’s first aid center, and was “If it hadn’t been for all the doctors being with me the entire time in
can best be described as “you can’t make up this stuff.” Hawaii and here in Washington, I don’t know what would have
persuaded to lie down. By the time Dr. Sample arrived after the
presentation, she was having trouble seeing. happened,” she adds.
In Honolulu, Hawaii to present a clinical
paper with George Sample, MD, director, “Pat’s situation was very serious,” says Dr. Benson. “She is a walking
surgical intensive care unit, at the “Even though Pat said she was feeling better, I took cues from the Lowell Satler, MD Matthew Schreiber, MD
first aid nurse, who did not feel right about something,” says Dr. miracle.” I
annual meeting of the American —Annamarie DeCarlo
College of Chest Physicians, McCabe Sample. “I held up my fingers and asked Pat if she could see them.
was on her way to the She said no. I said, ‘We’re going to the hospital.’”
conference room when she
began to feel dizzy. After a cab ride to Straub Clinic & Hospital, the series of remarkable
events began. They were greeted by an emergency department nurse,
“I was walking with who had been apprised of the situation by the first aid nurse at the
Dr. Sample to set up convention center, who happened to be his wife.
and I told him I The ED nurse played a pivotal role in getting McCabe the right care
wanted to sit down quickly, bypassing the on-call consulting service and giving Dr.
Zuyue Wang, MD Christian Woods, MD Sue Eckert, RN
8 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012 MAY/JUNE 2012 | PHYSICIAN | MEDSTAR WASHINGTON HOSPITAL CENTER 9
in part to the advanced stage and grade of disease at the time of the including one day in the ICU.
Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: operation. Combined with the procedure’s magnitude,
cytoreduction-HIPEC fell out of favor with all but the most Pancreatic cancer—which recurs in
Promise for Certain Colorectal, Ovarian, Pancreatic Cancers dedicated specialists whose work led to continuing improvements in
both the procedure and outcomes.
approximately 90 percent of patients post-
surgery— is another potential application.
Through a Hospital Center clinical trial,
“Today, we know that skill with electroevaporative surgical started in 2009, Dr. Sugarbaker and his
techniques and a thorough knowledge of the distribution patterns of team want to determine if cytoreductive
Cytoreductive surgery plus From its advent in the 1980s as a therapy for rare and peritoneal carcinomatosis— in addition to patient selection and
earlier intervention—are essential for the best outcomes,” Dr.
surgery and intraperitoneal chemotherapy
can improve that prognosis.
previously fatal peritoneal carcinomatosis, cytoreductive surgery
HIPEC: How it with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is now
emerging as a potential front-line treatment for cases of incurable
Sugarbaker says. “Advances in powerful chemotherapies and the use
of neoadjuvant therapies are also contributing to the procedure’s
David Perry, MD
Eligible patients first undergo a Whipple
procedure and a hot gemcitabine wash.
Works colorectal and other gastrointestinal cancers, as well.
The procedure—a single surgical event
combining debulking with intraoperative
Cytoreduction-HIPEC is now commonly recognized as the
standard of care for peritoneal metastases of limited extent of
That is followed by six additional cycles, also heated, administered on
an outpatient basis through an intraoperative port.
Ten patients have enrolled in the study so far, including Jay Pringle
disease. For patients with peritoneal mesothelioma, Dr. Sugarbaker
Cytoreductive surgery plus HIPEC, an arduous and heated local chemotherapy—was long from Cleveland.
and other cytoreduction-HIPEC specialists report five-year survival
aggressive procedure, is most effective when the viewed by many physicians as a last resort.
rates of 60 percent. “My odds were not stellar to begin with,” he says. “With the standard
patient is young, in relatively good health and in the But continuing refinements to the
early history of disease, so metastases are limited. At technique, patient eligibility—and, most Currently, specialists at approximately 115 major medical centers operation and systemic chemotherapy, if I lived one year, good; two
importantly, improved outcomes—are nationwide use the combined therapy for a variety of peritoneal years would be great. But the combined cytoreduction-HIPEC
that point, Dr. Sugarbaker says, the likelihood of
changing that mindset, gaining advocates primary cancers, with other applications emerging. approach showed foresight, out-of-the-box thinking, and made
both a cure and improved quality of life are greatest.
among patients and physicians alike. That’s sense to me. I decided to take the chance.”
Before the combined procedure, the primary good news for the 20 percent of
malignancy must be resected using the least invasive gastrointestinal cancer patients for whom
New Frontiers Dr. Sugarbaker already has several pancreatic cancer patients,
Paul H. Sugarbaker, MD pre-dating the trial, who have reached the four-year-out mark,
surgical technique, to reduce the chance of traditional therapies will fail, leaving them While peritoneal primary malignancies are relatively rare—
appendiceal cancers are diagnosed in about 2,000 people in the and hopes Pringle will be one of them.
peritoneal seeding through tumor rupture or surgical with a grim prognosis, according to a pioneer in the field, Paul H.
trauma. The peritoneal metastases, however, should Sugarbaker, MD, FACS, FRCS, director, MedStar Washington United States each year; peritoneal mesotheliomas arise in even
be left intact for the peritoneal surface oncology Hospital Center’s Program in Peritoneal Surface Malignancy. fewer, around 1,000—cytoreductive surgery with HIPEC is showing
promise in three more common arenas: colorectal, ovarian and Looking Ahead
team. Initial surgery is most often followed by a pulse “These are the patients who stand to benefit the most,” says Dr. pancreatic cancers. While it’s too early to predict the ultimate outcome for either patient,
of systemic chemotherapy—usually FOLFOX—and Sugarbaker, who has performed approximately 1,700 cytoreductive- results so far are promising. Jim Heim is back home and at work
then a month of rest and recuperation. HIPEC procedures. “In nearly every study conducted here and Colorectal cancer affects nearly 150,000 nationwide each year, with a again. Jay Pringle travels to the Hospital Center once a week for three
abroad, the combined therapy doubled or even tripled the median high mortality rate. Death is often caused by microscopic residual weeks for a chemotherapy drip directly into his abdomen.
At that point, cytoreduction plus HIPEC is employed
survival rates for this population, as compared to systemic disease from peritoneal seeding, perforated cancer, positive
to deal with the remaining metastases. The oncology peritoneal cytology, tumor spill during surgery, or ovarian or other
chemotherapy alone. More impressively, about one-third of the Dr. Sugarbaker knows, however, that there are many more patients
surgeon first removes all visible evidence of disease adjacent organ involvement. Dr. Sugarbaker, who has performed with a range of abdominal cancers who could benefit from the
patients treated are still alive at the five-year mark.”
using electroevaporative surgery—which involves cytoreductive surgery-HIPEC on about 250 colon cancer patients, procedure if it were more widely accepted and available. Toward that
high voltage from an electrosurgical generator, a A randomized trial in the Netherlands, five multi-institutional estimates that 10 percent of all primary colorectal patients may be end, he is hosting the Hospital Center’s first-ever training course on
pure cut mode and a ball electrosurgical tip—versus studies and a number of phase II studies, including some at the candidates for the combined procedure. cytoreduction plus HIPEC to inform physicians of its use and
traditional scissor and knife dissection, to prevent Hospital Center, indicate that peritoneal metastases can be benefits. To be held on June 21 and 22 (see page 17), the event will be
unnecessary blood loss. The high voltage “adequately treated with cytoreduction-HIPEC, allowing Jim Heim of southern Maryland was one of a combination of lecture and labs, and carries two CMEs.
electrosurgery also creates a margin of heat necrosis practitioners to come up with prognostic indicators which give us them. At 46, with a history of ulcerative
that is devoid of viable tumor cells and less likely to about a 40 percent cure rate,” he adds. colitis, he was diagnosed with colon cancer Through such professional education and clinical trials, Dr.
develop recurrence. and referred to Thomas Stahl, MD, director, Sugarbaker hopes to convince more physicians of the combined
The key to achieving the best outcomes lies in more stringent patient Colon & Rectal Surgery at the Hospital procedure’s value. But he acknowledges that gaining broad
Surgery is followed by 90 minutes of HIPEC lavage, as selection criteria and earlier referral for earlier intervention. Center. During surgery, Dr. Stahl discovered acceptance has been a rocky road.
the surgeon manipulates the organs to assure that the tumor had perforated the colon,
causing peritoneal seeding. As a result, he “Even today—30 years after the introduction of cytoreduction-
uniform drug distribution. This route of delivery
confined the surgery to removing the large HIPEC—patients are often not referred to us until after they have
allows for higher doses than systemic chemotherapy An Evolving Technology undergone at least one surgery plus one to two years of systemic
while minimizing systemic exposure, reducing some intestine and tumor, recommending further
In the 1980s, Dr. Sugarbaker was part of the team of scientists and treatment with chemotherapy and then the chemotherapy,” he says. “By that time, they are even more debilitated
of chemotherapy’s side effects. Heat is thought to Thomas Stahl, MD
pharmacologists at NIH that developed the cytoreductive-HIPEC cytoreductive-HIPEC combination. by disease, and sometimes their previous treatments, making it
soften the tumors, making them easier to penetrate, combined approach, first applied against appendiceal cancer and difficult to derive the best results from the combined procedure.”
while increasing the potency of the toxins. peritoneal mesotheliomas. History indicated that neither resection “It was a huge shock,” Heim recalls. “Dr. Stahl said it looked like a
nor systemic chemotherapy alone could effect a cure, primarily due firecracker had gone off in my abdomen. I had never heard of The proof, however, lies with the hundreds of other cytoreduction-
Before suture, a shunt or in-dwelling catheter is HIPEC patients who are alive and well today, and newer ones, like
to microscopic seeding of cancer cells throughout the peritoneum. cytoreductive surgery and HIPEC before, but I did my research and
positioned for subsequent intraperitoneal Jay Pringle, who seek the procedure when their options are slim.
Researchers theorized that the combination of cytoreductive surgery realized my options were fairly limited.”
chemotherapy, post-surgery, as needed.
and lavage with intraoperative chemotherapy, applied directly in the “I have faith this was the right decision for me,” Pringle concludes.
site and heated to optimize cancer cell toxicity, may be more To first reduce the number of nodules, Heim underwent four
Cytoreduction-HIPEC can take 12 hours or more; “Plus, I have the chance to help others which appeals to the teacher
effective. cycles of systemic chemotherapy with Hospital Center medical
however, patients with less disease can often be oncologist David Perry, MD, which brought the total down by in me.” I
completed in half that time. Their experience with both cancers proved them right; however, in nearly 100 percent. Heim then had cytoreductive surgery and —Leslie Whitlinger
practice, the procedure often led to only modest improvements, due HIPEC with Dr. Sugarbaker, followed by 11 days of hospitalization,
10 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012 MAY/JUNE 2012 | PHYSICIAN | MEDSTAR WASHINGTON HOSPITAL CENTER 11
Area’s First Cardio-Oncology Program
Collaborative Approach To Prevention & Treatment of
Cardiovascular Effects from Cancer Treatment Agreeing is Sandra Swain, MD,
medical director of Washington
Goals of the MedStar Heart Institute
Cancer Institute. “We treat a large
MedStar Heart Institute’s Cardio-Oncology Program
is the first of its kind in the region, bringing together the collective
Those drugs most associated with heart damage include
anthracyclines, long a front-line treatment for breast cancer, and
number of cancer patients, and are
seeing an increase in cardiovascular
problems in recent years, due to the
expertise of nationally respected cardiovascular specialists and
medical oncologists, to tackle a growing phenomenon among
surviving cancer patients: cardiotoxicity.
newer molecular therapies, including Herceptin®. Anthracyclines
cause cell death, and their potential to promote permanent heart
damage, even many years after the treatment, has long been known.
new drugs we are using. The new
program provides a tremendous
added-value to patient care. It
The newer tumor-targeted drugs, like Herceptin, have shown to cause creates a framework for
The Cardio-Oncology program is a win-win for oncologists and damage through different mechanisms and often earlier in the collaboration with MedStar Heart
cardiologists, and most importantly, their patients. It allows patients treatment process, particularly when used in conjunction with Institute cardiologists, in which to I Ensure better outcomes of patients with cancer and
to successfully complete the most effective cancer treatment, while anthracyclines. Sandra Swain, MD monitor cancer patients who are cardiac issues
being monitored to prevent heart issues. being treated with these newer and
“Herceptin has proven to be a very effective treatment for a subset of
The emergence of many new and more effective targeted therapies.” I Provide earlier detection of cardiac toxic side effects of
patients with breast cancer,” Dr. Barac says. “It functions by inhibiting
effective cancer treatment modalities the HER2 protein, which is overexpressed in breast tumors. But we cancer treatments
“We don’t want to wait until patients have irreversible heart disease,
has saved millions of lives in the last have discovered that the molecular signaling pathways the drug or until decades after cancer treatment, when damage has led to the
two decades—but has also brought blocks are important to the survival of heart cells,” she explains. I Prevent or reduce further cardiac damage — and, when
development of heart failure,” Dr. Barac adds. “Thanks to referrals
unanticipated adverse effects. possible, reverse it
from medical oncologists, we can assess patients for their level of risk.
“Cardiovascular toxicity can be one For patients at high risk, we can intervene and modify cancer
of the complications of cancer I Monitor patients with potential cardiac issues who are
Emerging Field treatment to prevent damage from occurring, or prevent progression
treatment,” says Ana Barac, MD, of heart disease. Or, we can treat patients with medications, such as receiving cancer treatments
director of the Heart Institute’s For a majority of patients facing cancer, the benefit of anti-cancer
drugs outweighs the risk of cardiac events. “Our goal is to carefully ACE inhibitors and beta-blockers, to limit cardiovascular problems
Cardio-Oncology program. “There during and after cancer therapy.” I Better understand cardiac issues in patients with cancer
has been mounting evidence that assess the risk of cardiotoxicity, and to assure close surveillance, by participating in research studies
some traditional chemotherapy in particularly for high risk patients. Our program and others elsewhere In many instances, there are no formal guidelines for diagnosis and
Ana Barac, MD use for decades, as well as some novel across the country are taking a collaborative approach to care. treatment of cardiotoxicities, Dr. Barac says. But cardiology and I Eliminate cardiac disease as a barrier to effective cancer
targeted cancer therapies, can cause Oncologists and cardiologists work together to prevent cardiac damage, oncology specialty societies are taking notice; the field is growing
monitor patients’ cardiovascular health during treatment, and provide therapy
cardiovascular events,” Dr. Barac explains. “These problems can arise internationally, and the number of articles published in the last few
during or shortly after treatment, or years into survivorship.” long-term follow-up cardiac care for survivors,” explains Dr. Barac. years has grown exponentially.
Cardiac MRIs and echocardiography, with novel measures including
echo-strain imaging, are important imaging tools that the Cardio-
Figure 1: Figure 2: Oncology program is employing to assess a patient’s level of risk for
cardiac incidents. “We can also test for novel biomarkers in the
blood—the presence of enzymes that can signal risk for heart
innovative program such as ours
damage,” she adds.
Figure 1: provides the best care, and allows us
Echo-strain to best use resources to tackle
imaging, for early uncommon presentations of illnesses.
Creating Treatment Protocols An integrated system also helps
cardiac issues The program will also help to build a database to better understand promote collaboration across
cardiotoxicity, and better identify patients at risk, as well as track specialties, and access to the most
them over the long term. It is seeking funding for a proposed study to sophisticated technology. All of this
investigate novel imaging and biomarker techniques as predictors of has multiple benefits for patients.”
cardiotoxicity, in an urban population of cancer patients with high
Advance cardiac The rallying cry for early intervention
prevalence of cardiovascular risk factors.
MRI to determine and increased communication between
oncology “Large clinical trials of new cancer treatments haven’t focused on this Stuart Seides, MD oncologists and cardiologists is
treatment plans special population,” Dr. Barac explains. “We need to better growing, Dr. Seides notes. “We now
understand how to assess the risks and benefits of cancer treatment know the importance of balancing the goal of cancer therapy to
options for these patients, so that they can make more informed maximize survival with the concurrent objective of minimizing
decisions. We want to create an effective tool for cardiac risk cardiac damage—and that’s the program’s ultimate goal.” I
stratification of cancer patients—and ultimately, to develop new —Emily Turk
“The advantage of being part the MedStar Health system is having For a consultation or referral, please call 202-877-4227 or
access to a large population of patients,” says Stuart Seides, MD, Cardio-Oncology@medstar.net.
physician executive director of MedStar Heart Institute. “An
12 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012 MAY/JUNE 2012 | PHYSICIAN | MEDSTAR WASHINGTON HOSPITAL CENTER 13
F E AT U R E
Living the Olympic Ideal
“I could think of no better way
to give something back to swimming It wasn’t; he fell and broke his arm. Nowhere is that sentiment better evidenced, he says, than with the
professional dancers he works with, including groups such as The
“With the cast, I couldn’t get into water,” Dr. Johnson says. “I did Washington Ballet, American Ballet Theatre and touring companies
than to study orthopaedics and be everything else I could think of to stay in shape, while also hoping I’d that perform at The John F. Kennedy Center for the Performing Arts,
be a fast healer.” Warner Theatre and The National Theatre.
part of this new discipline.” Cleared to swim in time for the Trials, Dr. Johnson scored enough “Dancers are the finest professional athletes around,” he says. “Their
points to grab the final spot on the 38-member team. Given the regimen for warming up is the paradigm for all athletes. They have a
strength of the U.S. swimmers that year, he couldn’t help but feel need to perform, do well and strive for excellence. It’s right there on
confident about his chances of winning some gold medals. the surface, as it is with all other athletes.”
But what Dr. Johnson “won” in Mexico City was a case of dysentery Dr. Johnson adds that an injury can be as much of a life-changing
that sapped both his weight and energy. event for an aspiring 17-year-old Olympian as it is for the weekend
Though he recovered in time to swim the preliminaries of the 800M runner or tennis player.
relay, his coach felt the team needed to be at its best against equally “Treating the injury is where I apply my medical skill,” he says.
potent East Germany. He replaced Dr. Johnson with a teammate “But I also try to keep them focused on cross-training and other
named Mark Spitz, who would go on to capture a then-record seven exercises, and keeping the ‘motor’ running while they wait for the
More than 30 years after making the U.S. Olympic golds in Munich four years later.
Swimming Team, Orthopaedic Surgeon David Johnson, injury to heal.”
MD, uses the lessons of that experience to help patients Sure enough, the U.S. team powered its way to the top of the podium. Though he no longer pursues medals, Dr. Johnson is as active as his
pursue their own “personal bests.” And though he could only cheer on his teammates, Dr. Johnson says demanding professional schedule permits. He swims casually, and
the experience was its own reward. races in events, such as the annual 4.4-miler beneath the Chesapeake
Of the more than 10,000 athletes expected to compete in the London
Olympic Games this summer, only a handful will earn medals. But “I was always a student first,” he says. “Swimming just broke up the Bay Bridge; he plays platform tennis and golf with his wife and he
the Games are much more than a matter of winning and losing. They monotony of all those hours in the library.” takes in the occasional hike. But his favorite activity in recent years
are the culmination of each athlete’s journey of training, has been kayaking the Potomac River and other areas around the
determination, and, sometimes, sheer luck that makes it possible to And if luck wasn’t always on his side, timing was. Dr. Johnson’s Chesapeake Bay.
represent his or her country on sport’s most prestigious stage. competitive career coincided with the emergence of sports medicine
as a medical specialty. “Each summer during several weekends, I’ll paddle from Mt. Vernon
It’s an experience that Dr. Johnson knows quite well. to Point of Rocks and back,” he says. “There are places where the
David Johnson, MD, swimming at the 1968 Olympic Games
“I could think of no better way to give something back to swimming water is still very clear. And it’s a thrill to see a bald eagle or an osprey
A competitive swimmer in high school and college, Dr. Johnson than to study orthopaedics and be part of this new discipline,” he says, swoop in and grab a fish right in front of me.”
earned a spot on the 1968 U.S. Olympic Swimming Team, which It was at age 16 that Dr. Johnson’s athleticism finally surfaced. Thanks adding that much has changed since those early days, when teams
captured more than two dozen medals in Mexico City. He stayed close to the encouragement of friends and impromptu backstroke lessons often relied on the experience and sometimes, “folk wisdom” of That a former Olympian manages to stay active is hardly surprising.
to competitive athletics after completing his medical training, serving at a public pool from a former Egyptian Olympic team member, he trainers and coaches. But Dr. Johnson stresses that kind of lifestyle offers a wealth of
as team doctor for swimming and other sports. And as the U.S. “skate won his age group at the Delaware State Championships. The more physical and mental benefits.
doc” at the 1980 Winter Olympics in Lake Placid, he had a front-row strokes he mastered, the more events he won. That led to a spot on “We’ve learned a great deal about human performance and injuries,
and what can be done to both treat and prevent them,” he says. “It’s “There are so many opportunities to stay active in the Washington
seat for speed skater Eric Heiden’s record five gold medals, and the the varsity swimming team at Yale, and selection to several national area,” he says, “and when you do that, you push back your physical age
hockey team’s thrilling “Miracle on Ice” win over the Soviet Union. teams that competed overseas. also become routine to have trained physicians and physical therapists
involved at all levels, even high school and younger.” and actually stay younger from a biological standpoint.”
Not bad for someone who failed his first swimming class at age 4. As the summer of 1968 arrived, Dr. Johnson came home from college And that goes for anyone regardless of age and ability, he adds. “You
expecting to step up his conditioning before the Olympic Trials in Dr. Johnson also understands the mental side of sports,
“And for the longest time, I didn’t have much talent in other sports particularly the “desperation” athletes feel when they’ve been don’t have to be an Olympic athlete to be athletic.” I
August. He figured test-riding a new bicycle for his mother would be
either,” Dr. Johnson says with a laugh. a good start. sidelined by an injury. —Jim Parsons
14 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012 MAY/JUNE 2012 | PHYSICIAN | MEDSTAR WASHINGTON HOSPITAL CENTER 15
NEWS & NOTES D E PA R T M E N T O F C O N T I N U I N G M E D I C A L E D U C AT I O N A N D Q U A L I T Y T R A I N I N G
Upcoming CME Conferences
Please visit http://cme.whcenter.org for updated conference information or call 202-877-3200.
Doctors’ CME Transcripts
REGULARLY SCHEDULED SERIES—AMA PRA Category 1 Credit(s)™
Conference Monthly, 4th Tuesday, 7 p.m. Conference Orthopaedic Oncology
Weekly, Tuesday, 7 a.m. Various locations Twice Monthly, Wednesday, 8 a.m. Preoperative Conference
The Department of Continuing Room G-200 2 AMA PRA Category 1 Credit ™ Various locations Weekly, Thursday, 7:30 a.m.
Medical Education is excited to 1 AMA PRA Category 1 Credit ™ 202-877-8080 1 AMA PRA Category 1 Credit ™ Siegel Auditorium
announce that you can now 202-877-7504 202-877-3154 1.5 AMA PRA Category 1 Credit ™
download, print or e-mail your ENDOCRINOLOGY 202-877-8098
CME transcript. CARDIOLOGY/ Endocrine Grand Rounds NEUROSURGERY
Physicians enjoyed two days of celebration CARDIOVASCULAR Weekly, Tuesday, 8 a.m. Neurosurgery Conference PHYSICAL MEDICINE
Visit http://cme.whcenter.org 4NW Conference Room &
for Doctors’ Days in March. Eric Skolnick, and click on “View Your CME
Cardiac Catheterization Weekly, Tuesday, 7:30 a.m. AND REHABILITATION
Conference & Lecture Series MedStar Georgetown University CTEC Board Room NRH Medical Grand Rounds
MD, Anesthesiology, loaded his plate with Transcript” for complete Weekly, Wednesday, 7:30 a.m. Warwick Evans Conference Rm 1 AMA PRA Category 1 Credit ™ Weekly, Friday, noon
instructions. 1 AMA PRA Category 1 Credit ™
the day’s delicacies. Reginald Robinson, MD, CTEC Conference Theater 202-877-5026 NRH Auditorium
1 AMA PRA Category 1 Credit ™ 202-877-9137 1 AMA PRA Category 1 Credit ™
Cardiology, was happy to receive his MedStar 202-877-8220 202-877-1657
Washington Hospital Center umbrella. MEDICINE GYNECOLOGY OB/GYN
UPCOMING CONTINUING Cardiac Surgery Grand Rounds GI Case Conference
Enjoying lunch were Benjamin Lee, MD, MEDICAL EDUCATION Weekly, Tuesday, 7:15 a.m.
Grand Rounds SURGERY
Monthly Weekly, Thursday, 8 a.m. Burn Center Lunch and Learn
Cardiology; Marc Schlosberg, MD, Neurology; CONFERENCES
CTEC Conference Theater Various Restaurant Locations True Auditorium Monthly, Second Thursday, noon
1.25 AMA PRA Category 1 Credit ™ 2 AMA PRA Category 1 Credit ™
John Aseff, MD, Physical Medicine & 202-801-0905
202-829-0170 Morbidity & Mortality 1 AMA PRA Category 1 Credit ™
Rehabilitation; Robert Bunning, MD, JUNE 21-22, 2012 Weekly, Thursday, 9:30 a.m. 202-877-6662
Cardiology Grand Rounds Medicine Grand Rounds
Rheumatology and Rafael Convit, MD, Workshop on the Management
Weekly, Tuesday, 12:30 p.m.
5B–3 Conference Room
of Peritoneal Metastases Weekly, Wednesday, 12:30 p.m. Center for Vascular Surgery
Plastic Surgery. Paul H. Sugarbaker, MD –
CTEC Conference Theater True Auditorium Journal Club Conference and M&M
1 AMA PRA Category 1 Credit ™ 1 AMA PRA Category 1 Credit ™ Monthly, 1st Thursday, 9:30 a.m.
Activity Director Weekly, Thursday 7:30 a.m.
MedStar Washington Hospital 5B–3 Conference Room G-213 Conference Room
Center, Washington, D.C. 2 AMA PRA Category 1 Credit ™
Echocardiography Conference Perinatal High Risk Multidis-
Weekly, Thursday, 7:45 a.m. MULTIDISCIPLINARY 202-877-8050
MedStar Health Research ciplinary Conference
SEPTEMBER 21, 2012 CTEC Conference Theater
Weekly, Tuesday, 8a.m. General Surgery Orange
1.25 AMA PRA Category 1 Credit ™ Institute Grand Rounds
Controversies in Cardiac 5B-3 Conference Room & Green Team Teaching
202-877-6264 Monthly, 3rd Friday, noon
Arrhythmias 2012 CTEC Conference Theater 1 AMA PRA Category 1 Credit ™ Conference & Lecture Series
Edward V. Platia, MD – 1 AMA PRA Category 1 Credit ™ per session Weekly, Thursday, 8 a.m.
Activity Director Electrophysiology Core 202-877-9663
202-877-7164 General Surgery Conference
Cosmos Club, Washington, D.C. Room
Weekly, Tuesday, 7 a.m.
Multidisciplinary Breast ONCOLOGY 2 AMA PRA Category 1 Credit ™
Authors’ Day Congratulations to OCTOBER 4-5, 2012
Dilemmas in Cardiovascular
1 AMA PRA Category 1 Credit ™
Weekly, Wednesday, 7:30 a.m.
Siegel Auditorium Twice Monthly, 2nd & 4th Friday, Hepatobiliary Case
Dr. Swain Julio A. Panza, MD –
1 AMA PRA Category 1 Credit ™
Surgical Classroom – Room G-270
Monthly, 3rd Friday, 8 a.m.
1.5 AMA PRA Category 1 Credit ™ G-213C Conference Room
Capital Hilton, Washington, D.C. Weekly, Wednesday, 4 p.m.
Multidisciplinary Head 1.5 AMA PRA Category 1 Credit ™
This year’s Authors’ Day, Sandra Swain, MD, 1st & 3rd Wednesdays: 202-877-3908
VA Dept. of Medicine and Neck Tumor Board
held during National medical director, NOVEMBER 2, 2012 Conference Room (4th Fl.) Conference Oncology Grand Rounds
Colorectal Colloquium: Surgical Weekly, Thursday, 4 p.m. Highly Reliable
Library Week, Washington Cancer Institute 2nd & 4th Wednesdays: Weekly, Friday, noon
Surgical Team Training
Management of Pelvic Floor Cath Lab Conference Rm (5th Fl.) Room C1-119 Siegel Auditorium
celebrated 250 at MedStar Washington Disorders, Rectal Cancer and 1 AMA PRA Category 1 Credit ™ 1 AMA PRA Category 1 Credit ™ 1 AMA PRA Category 1 Credit ™ Monthly, First Tuesday, 7 a.m.
Inflammatory Bowel Disease 202-877-9403 or 202-877-6718 True Auditorium
published physicians. Hospital Center, is 202-877-6363 202-877-2505
1 AMA PRA Category 1 Credit ™
James F. FitzGerald, MD –
The physicians wrote beginning her term as Activity Director Multidisciplinary Sarcoma Thoracic Oncology 202-877-0290
317 articles in 170 MedStar Washington Hospital Conference
President of the American Center, Washington, D.C.
Dermatology Grand Rounds Twice Monthly, Tuesday, 7:30 a.m. Weekly, Thursday, 7:30 a.m. Surgery Grand Rounds
journals, and the group Twice Monthly, Thursday, 8 a.m. Siegel Auditorium Pathology Conference and M&M
Society of Clinical Oncology. MedStar Washington Hospital 1.5 AMA PRA Category 1 Credit ™ Weekly, Tuesday, 8 a.m.
included five journal DECEMBER 7, 2012 Center & Georgetown University
For the past year, Dr. Swain 202-877-8098 1 AMA PRA Category 1 Credit ™ True Auditorium
editors-in-chief, three Thyroid Disorders: Hospital
202-877-6567 1 AMA PRA Category 1 Credit ™
served as President-Elect; Recent Clinical Advances 2 AMA PRA Category 1 Credit ™ 202-877-5133
books with senior Kenneth Burman, MD – 202-877-6654 NEONATOLOGY
she has also held leadership Visiting Lecturer Series in ORTHOPAEDIC SURGERY
editors and six chapters Activity Director
written by physicians in
roles on the ASCO Board of MedStar Washington Hospital EMERGENCY MEDICINE
Twice Monthly, 1st & 2nd Grand Rounds
Directors and The ASCO Center, Washington, D.C. Emergency Department Thursday, 12:30 p.m.
five additional books. Grand Rounds 5B–3 Conference Room
Weekly, Monday, 7:30 a.m.
Cancer Foundation, and Weekly, Thursday, 9 a.m.
3 NW Conference Room
1.5 AMA PRA Category 1 Credit ™
served as Chair of the True Auditorium & MedStar Morbidity & Mortality 202-877-6664
Georgetown University Warwick Monthly, 3rd Thursday,
Lynn McKinley-Grant, MD, Dermatology, presents the web-based application
Cancer Education and Evans Conference Room 12:30 p.m.
of Visual DX, Essential Dermatology in Pigmented Skin. She was the senior ed- Nominating Committees. 4 AMA PRA Category 1 Credit ™ 5B–3 Conference Room
202-877-8080 1 AMA PRA Category 1 Credit ™
itor of the book version.
16 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012 MAY/JUNE 2012 | PHYSICIAN | MEDSTAR WASHINGTON HOSPITAL CENTER 17
CHIEF FELLDENT SPOTLIGHT
Meena Shah, MD Lisa Jacobson, MD
Cardiology Emergency Medicine
be, community medicine. Prior to practice preventative medicine, including for A little known fact about Lisa Jacobson, MD: She
medical school, she believed she could hypertension and diabetes. The training had tremendous stage fright as a child. This may come as a surprise to
meet that interest through pediatrics encompasses all of it, and at different points her colleagues in the Department of Emergency Medicine at MedStar
and preventative medicine. In part, in one’s career you could actually focus on Washington Hospital Center, given Dr. Jacobson’s willingness to
that was shaped by her time as an different parts of the specialty.” assume starring roles during simulation trainings with her residents.
undergraduate and public health
major at The Johns Hopkins During her time as a chief fellow, Dr. Shah “I had horrible stage fright growing up,” she admits. “But I have
University in Baltimore. Dr. Shah went has especially loved working with George enjoyed these roles more than I ever thought I would. Sometimes it’s
on to receive a master’s in that field Ruiz, MD, director, Heart Failure Clinic fun to jump on stage and pick a character you’ve probably seen in the
from Boston University, followed by “Having the opportunity to work closely hospital, and then really ham it up,” she laughs.
her medical school and residency at with advanced heart failure patients has
been one of the most enjoyable experiences Her true passion around teaching lies within this burgeoning realm of
the University of Maryland. medical simulation. “It takes teaching out of the critical setting, into a
throughout the fellowship,” she notes.
“When I got to medical school, I setting that models the critical setting as much as possible, while
realized that I really liked working “Working with my co-chief, Dr. Sameer providing a safe training environment for residents, medical students
with an adult population and in Jamal, to represent a group of 18 has been and even for providers who can work on new skills, deficiency areas,
internal medicine, specifically critical great, because we can advocate for the or new techniques related to patient safety,” says Dr. Jacobson. It
care,” says Dr. Shah. “It was a 180- fellows and for what we think is most presents opportunities to debrief a situation, where you might not
degree switch.” important in the curriculum, and what we normally have that luxury, as well as practice through repetition.
think could help the overall educational
When Dr. Shah completes her experience.” That experience, combined with Dr. Jacobson says she’s played almost every role imaginable in
fellowship this summer, she’ll return the incredible hands-on learning that the simulations: distraught family member or patient, the curriculum
to the small community in St. Mary’s patient population of the Hospital Center creator and course instructor. At the national level, Dr. Jacobson and For Dr. Jacobson, a bonus of working at the Hospital Center is her
County where she grew up. Dr. Shah provides, made for an amazing fellowship her team have run simwars, a high-fidelity simulation competition. ability to interact with residents. “It keeps me, as a practitioner, up to
will join her father’s cardiology experience, says Dr. Shah. They have been recruited to begin doing simulation trainings for other date, and forces me to make sure I’m providing them with the best
practice, also working alongside her specialties, including Anesthesiology, Pediatrics and Gynecology. education I can give them,” she says. “It’s so great to be challenged, to
elder brother. “It’s where it all began Dr. Shah tries to find some time with her discuss the art of medicine versus the science of medicine. It’s also
husband, who has been endlessly supportive Growing up, Dr. Jacobson may not have envisioned acting in her beneficial to see their varying styles, and adjust what you’re doing
for me,” Dr. Shah says. “It’s a very future, but she always knew there would be medicine. “I always
small town that has been very good to of her career, when she’s not at the Hospital every day based on who you’re working with. You’re learning from
Center. Timing, however, is tricky: he is in enjoyed the science side of things and looking into ‘why’ things were them as much as they are from you.”
my family. You know everyone, you’re
Meena Shah, MD, entered taking care of a community, there’s such a the first year of a gastroenterology happening,” she recalls. As an undergraduate at the University of
Wisconsin-Madison, she majored in environmental studies and Dr. Jacobson notes that she has a serious travel bug, which she tries to
medical school planning to become a sense of community.” fellowship at MedStar Georgetown
pediatrician, like her mother. She finished University Hospital, so schedules conflict. completed her degree in three years. When it came time to decide indulge whenever the opportunity arises. Her work on the national
medical school planning to become a For Dr. Shah, an obvious perk within her “We find time on a day-by-day basis,” she what to do next, she knew medical school would be a certainty, but front with simulation trainings has taken her around the country, but
cardiologist, like her father. But Dr. Shah, future job is getting to work with her laughs. took advantage of that year she’d earned back to experience she also enjoys leaving the country for vacation when she can find the
who is now a chief fellow in Cardiology at brother. “He has been an incredible mentor something different. Dr. Jacobson packed her bags and moved east to time. Dr. Jacobson recently returned from a 10-day trip to Thailand.
MedStar Washington Hospital Center, throughout my entire educational Their favorite hobby together is cooking. Washington, D.C., where she joined Physicians for Social
“We are both Indian, so we cook a lot of Responsibility as an intern, focusing on environmental policy. “We packed it all in. The country was far more developed than I
assures us that her mom bore no hard experience,” says Dr. Shah. Eight years her would have imagined,” she notes. “I was really impressed by their
feelings when the daughter decided to senior, Dr. Shah’s brother also attended Indian food, but we try to hit up a little bit
of everything,” she says. “I lived the intern life that all the kids working on the Hill live. infrastructure.” Although she says what impressed her most was the
switch to her dad’s specialty. Despite the Hopkins as an undergraduate and the Definitely not the life I live now as a District resident,” she laughs. food: “It was so amazing to wander up to a street vendor and enjoy a
family lineage and windows into both University of Maryland School of Medicine. Who’s the better cook? “We do very well dish more than you ever would in America.” I
specialties she received growing up, Dr. together,” she says diplomatically. I Dr. Jacobson returned to University of Wisconsin-Madison for — Maggie Master
Shah’s path was formed by her own “My brother has always been critical for me medical school, and completed her residency at Mount Sinai Medical
throughout my education, and to transition — Maggie Master
experiences in medical school, not by her Center in New York.
parents nor her brother, also a cardiologist. to a role where he’s going to be a colleague
and mentor is very exciting,” she says of her Of life in the Emergency Department, Dr. Jacobson says she thrives
“My parents are quite supportive of me family’s practice. “My parents are thrilled on the diversity of her everyday experience, along with the
making my own decision about medicine,” that we’ll be working side by side.” tremendous sense of team that is fostered in the ED among nurses,
says Dr. Shah, who notes that for her, the doctors and technicians. “There are definitely days when we feel like
decision came down to an evolution of For Dr. Shah, Cardiology is a perfect fit. “It our heads are spinning, and other days when we don’t look like it
interest during medical school. Dr. Shah’s contains such a wide spectrum of so many does on TV,” she says.
primary passion had been, and continues to facets of medicine: It’s critical care, yes, but
there’s also a wide spectrum where you can
18 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012 MAY/JUNE 2012 | PHYSICIAN | MEDSTAR WASHINGTON HOSPITAL CENTER 19
110 Irving Street, NW
Washington, DC 20010
M ED S TAR W ASHINGTON H OSPITAL C ENTER
C O N TA C T I N F O R M AT I O N
James S. Jelinek, MD, FACR
PHYSICIAN’S PERSPECTIVE Editor • 202-877-6088
Margo Smith, MD, FACP
Associate Editor • 202-877-7164
From the Desk of… Margo.A.Smith@MedStar.net
Ziad Deeb, MD Managing Editor • 202-877-8530
MedStar Washington Hospital Center Physician is
an informative bi-monthly publication for all the members of the
Hospital Center Medical and Dental Staff. It is a forum to report
In the Department of Otolaryngology, Our clinic for treatment of voice and news of interest to the medical staff, introduce new providers and
proﬁle current ones, exchange ideas and opinions about subjects
we have three full-time and three part-time swallowing disorders is headed by Nazaneen of interest and controversy, and recognize the professional and
Grant, MD, who is fellowship-trained in this personal accomplishments of our practitioners. Its overall goal is to
otolaryngologists, in addition to active help foster and celebrate a sense of community among the broad
private attendings. Our work involves area. In conjunction with the Speech diversity of the Hospital Center physician membership. The
newsletter is published by the editorial services division of Public
collaboration with other medical specialties. Pathology department, we provide state-of- Affairs for the Ofﬁce of Medical Affairs.
Here at MedStar Washington Hospital the-art medical and surgical management of MISSION—MedStar Washington Hospital Center is dedicated
disorders that affect the larynx and voice. to delivering exceptional patient ﬁrst health care. We provide the
Center, we are fortunate to have highly region with the highest quality and latest medical advances
specialized colleagues using advanced Our section of facial plastic and
through excellence in patient care, education and research.
technologies, which enables us to offer MedStar Washington Hospital Center, a private, not-for-proﬁt
reconstructive surgery is headed by Michael hospital, does not discriminate on grounds of race, religion, color,
state-of-the-art treatment modalities. Reilly, MD. He performs both facial cosmetic gender, physical handicap, national origin or sexual preference.
Visit the hospital’s Web page at www.WHCenter.org.
Under the leadership of Stanley Chia, MD, procedures, as well as complex head and
associate chair, Otolaryngology, we are neck reconstructions, including John Sullivan, President, MedStar Washington Hospital Center
utilizing the daVinci® Surgical System to microvascular free flaps. Dennis R. Wraase, Chairman of the Board
MedStar Washington Hospital Center
treat select head and neck tumors. We The hospital has one of the oldest Hearing & Kenneth A. Samet, FACHE, President and CEO, MedStar Health
perform more head and neck procedures Speech departments in the area, directed by
with this technology than any other hospital Teri Wilson-Bridges, MA, MHA, CCC-A. James Jelinek, MD, FACR Editorial Board Members
in the greater Washington, D.C. area. This Editor John Buek, MD • Jeffrey
Neurotology is headed by Dennis Fitzgerald, Dubin, MD • Zayd Eldadah,
system allows our surgeons to operate with MD, who treats diseases of the ear, dizziness, Margo Smith, MD, FACP MD, PhD • Philip Fidler, MD
greater precision and control in order to Associate Editor
and balance. • Cheryl Iglesia, MD •
minimize the risk associated with more Mark Smith, MD, FACEP Sunny Jhamnani, MD •
We work closely with the division of Editor Emeritus Karen M. Johnson, MD •
extensive traditional surgeries. Geoffrey Kaung, MD •
Interventional Radiology, whose members Marge Kumaki Robert Lowery, MD •
In conjunction with the Department of visualize and embolize vascular tumors in Managing Editor Adedamola Omogbehin, MD
Neurosurgery, otolaryngologists now the head and neck prior to resection, to help • Stephen Peterson, MD •
Graphic Design Micheal Pistole, MD •
perform image-guided endoscopic skull- limit blood loss during surgery. Jen Remington • George
base surgery. These procedures achieve Micheal Pistole, MD Ruiz, MD • Marc Schlosberg,
As technologies continue to advance, we will President, MD • Sarah Shao, MD •
improved cosmetic and functional results Medical & Dental Staff
continue to offer patients the best treatment Douglas Snyder, MD •
with overall faster recovery times. •Lindsey White, MD •
options available. We welcome your referrals Janis M. Orlowski, MD, MACP William Yi, MD
and promise continuing communications Senior Vice President,
We are one of the few centers in the nation Medical Affairs Contributing Writers
to have a weekly outpatient clinic for the with you about your patients. I and Chief Medical Ofﬁcer Catherine Avery • Norma
treatment of obstructive sleep apnea. This Babington • Annamarie
Vice President, Public Affairs DeCarlo • Maggie Master •
unique service is run in conjunction with Ziad Deeb, MD, is chairman, Otolaryngology. and Marketing Jim Parsons • Emily Turk •
Oral and Maxillofacial surgeons. He can be reached at email@example.com Leslie Whitlinger
20 MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012