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					        Physician               MEDSTAR WASHINGTON HOSPITAL CENTER
                                  News for Medical Staff, Residents, Fellows and Alumni
                                                                                          May/June 2012
                                                                                           vol. 18, no. 3




Resident Match Day
Bringing the Best
and Brightest to
MedStar
Washington
Hospital Center




Surrounding Department
of Medicine Program
Director Sal Pindiprolu, MD
are 2011-2012 Chief Residents
Ruta Dubinskaite, MD;
Vikramjit Mukherjee, MD and
Mohamed Azzam Aljaabari, MD




Inside…
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
                                                                                                                                                                                                                                                                                     —Norma Babington
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 janis.m.orlowski@medstar.net or
components.                                                             202-877-5284.


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
                                                                                                                                                                                                                                            take charge.
                                                                                                                                                             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.
                                                our presentation,
                                                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
NEWS




                                                                                                                                                   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
                                                                                                                                                   evolving effectiveness.”
                                                                                                                                                                                                                                 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
NEWS




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
                                                                                                                                                                                                                                                 Cardio-Oncology
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
                                                                                                                                                                                                                                                 Program
                                                                           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.
     detection of
                                                                                                                                                               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.”
     Figure 2:
                                                                                                                                                               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
                                                                                                                                                               preventive strategies.”
                                                                                                                                                               “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
                                                                                                                                                                Are Now
                                                                                                                                                             Available Online
                                                                                                                                                                                              ANESTHESIOLOGY
                                                                                                                                                                                              Anesthesiology Clinical
                                                                                                                                                                                                                              REGULARLY SCHEDULED SERIES—AMA PRA Category 1 Credit(s)™

                                                                                                                                                                                                                                 Emergency Department
                                                                                                                                                                                                                                 Journal Club
                                                                                                                                                                                                                                                                     NEUROLOGY
                                                                                                                                                                                                                                                                     Cerebrovascular Case
                                                                                                                                                                                                                                                                                                        ORTHOPAEDIC
                                                                                                                                                                                                                                                                                                        ONCOLOGY


     Day
                                                                                                                                                                                              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
                                                                                                                                                                                                                                                                     OBSTETRICS/
     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
                                                                                                                                                                                                                                                                                                        4B-45
                                                                                                                                                                                                                                 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.
                                                                                                                                                                                              202-877-8220                       202-877-6749
                                                                                                                                                        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
                                                                                                                                                                                              Curriculum Conference
                                                                                                                                                        Cosmos Club, Washington, D.C.                                                                                                                   Room
                                                                                                                                                                                              Weekly, Tuesday, 7 a.m.
                                                                                                                                                                                                                                 Multidisciplinary Breast            ONCOLOGY                           2 AMA PRA Category 1 Credit ™
                                                                                                                                                                                              Room 5B3
Authors’ Day                                                                    Congratulations to                                                      OCTOBER 4-5, 2012
                                                                                                                                                        Dilemmas in Cardiovascular
                                                                                                                                                                                              1 AMA PRA Category 1 Credit ™
                                                                                                                                                                                              202-877-3951
                                                                                                                                                                                                                                 Cancer Conference
                                                                                                                                                                                                                                 Weekly, Wednesday, 7:30 a.m.
                                                                                                                                                                                                                                                                     Gastrointestinal Oncology
                                                                                                                                                                                                                                                                     Case Presentations
                                                                                                                                                                                                                                                                                                        202-877-9849

                                                                                                                                                                                                                                 Siegel Auditorium                   Twice Monthly, 2nd & 4th Friday,   Hepatobiliary Case
                                                                                                                                                        Disease
                                                                                Dr. Swain                                                               Julio A. Panza, MD –
                                                                                                                                                        Activity Director
                                                                                                                                                                                              Electrophysiology Weekly
                                                                                                                                                                                              Conference
                                                                                                                                                                                                                                 1 AMA PRA Category 1 Credit ™
                                                                                                                                                                                                                                 202-877-3914
                                                                                                                                                                                                                                                                     8 a.m.
                                                                                                                                                                                                                                                                     Surgical Classroom – Room G-270
                                                                                                                                                                                                                                                                                                        Presentations
                                                                                                                                                                                                                                                                                                        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
                                                                                                                                                                                                                                                                                                        202-877-4599
                                                                                                                                                                                              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
                                                                                                                                                                                              DERMATOLOGY                        Conference
                                              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
                                                                                                                                                                                                                                                                     Room/Siegel Auditorium
                                                                                                                 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
                                                                                                                                                                                                                                 Perinatal Pediatrics
                                              written by physicians in
                                                                                                                 roles on the ASCO Board of             MedStar Washington Hospital           EMERGENCY MEDICINE
                                                                                                                                                                                                                                                                     Orthopaedic Surgery
                                                                                                                                                                                                                                 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.
                                                                                                                                                                                                                                 202-877-6527




16                                                                                    MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012   MAY/JUNE 2012 | PHYSICIAN | MEDSTAR WASHINGTON HOSPITAL CENTER                                                                                                                     17
      RESIOW
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
                                                                                                                                                 Non-Profit
                                                                                                                                                 Organization
                                                                                                                                                 U.S. Postage
                                                                                                                                                 PAID
                                                                                                                                                 MedStar Washington
                                                                                                                                                 Hospital Center
110 Irving Street, NW
Washington, DC 20010




                                                                                   Physician
                                                                                                  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
                                                                                                                  James.S.Jelinek@MedStar.net
                                                                                                                Margo Smith, MD, FACP
                                                                                                               Associate Editor • 202-877-7164
From the Desk of…                                                                                               Margo.A.Smith@MedStar.net
                                                                                                                        Marge Kumaki
Ziad Deeb, MD                                                                                                  Managing Editor • 202-877-8530
                                                                                                                Marge.Kumaki@MedStar.net
Chairman, Otolaryngology
                                                                                                     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 •
                                                                                                             Marlo Russell
                                                                                                            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
                                                                                                              David White
                                                                                                      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 ziad.e.deeb@medstar.net                                                Leslie Whitlinger


20                                                                                          MEDSTAR WASHINGTON HOSPITAL CENTER | PHYSICIAN | MAY/JUNE 2012

				
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