University of Maryland Medical Center – Baltimore Magazine

The City That Cures: Baltimore’s Countless Contributions to Modern Medicine

Aaron Hope — Wed, 04 Dec 2024 18:00:28 +0000

Health & Wellness

The City That Cures

From the automatic defibrillator to the first public medical school in the United States, we celebrate the countless contributions Baltimore has made to modern medicine.

By Jane Marion and Christianna McCausland

Illustrations by Alicia Corman

November 2024

hen Harford County-born John Archer graduated from the inaugural class of Philadelphia’s medical school (which later became the University of Pennsylvania School of Medicine) on June 21, 1768, he became the first person in the 13 Colonies to earn a diploma from a medical college. That distinction was purely by dint of his last name—diplomas were given out in alphabetical order. Regardless, it was a red-letter day for the entire graduating class.

From the minutes written by the Board of Trustees it was declared: “This day may be considered as the Birthday of medical honors in America.”

After graduation, Archer returned home to practice in Bel Air. But back then medicine was hardly the prestigious occupation it is today. Even with his medical degree, Archer practiced what many would now consider folk medicine. Reportedly making his rounds on horses slung with saddlebags packed with medical equipment, he favored early practices like bleeding a patient to rid the body of bad spirits and treating smallbox with purging. A popular saying coined by Colonial historian William Smith was that “quacks abound like locusts in Egypt,” and it was just as likely that doctors would maim—or even murder—their patients than heal them. In fact, staying home was often considered safer than heading to the hospital.

In 1799, the Medical & Chirurgical Faculty of Maryland (now MedChi, The Maryland State Medical Society) was founded by a group of concerned physicians “to prevent the citizens [of Maryland] from risking their lives in the hands of ignorant practitioners or pretenders to the healing art.”

From these humble beginnings, The College of Medicine of Maryland (later the University of Maryland School of Medicine) was founded in 1807. It was the nation’s first public medical school and helped Baltimore establish itself as not only a medical town, but a place that would lay the foundation for the future of modern medicine. Into this burgeoning era of medical professionalism hospitals came, went, and even merged. In 1874, six Sisters of Mercy came to Baltimore to take charge of the Baltimore City Hospital health dispensary, a merger between the College of Physicians and Surgeons and the Washington Medical College. The hospital was renamed Mercy Hospital in 1909 and became the Mercy Medical Center we know today in 1988.

When The Johns Hopkins Hospital opened in 1893, it pushed the frontier further, helping to establish and improve standards for the profession and ensuring that all doctors were properly trained. William Osler, one of Johns Hopkins School of Medicine’s “Big Four” founding professors, invented Grand Rounds in 1889, giving students the opportunity to tag along with seasoned physicians as they performed their hospital rounds. And standards of care, including the idea of formal medical residency for specialty training, was instituted and is now the norm in most training hospitals.

The seed of this story was planted when we received a pitch about the history of Medstar Union Memorial’s Curtis National Hand Center, the largest hand center in the world—sending us on a quest to identify other advancements and achievements. It turns out there are more medical milestones in our city and surrounding counties than we could count.

We studied historical timeline walls at The Johns Hopkins Hospital. We visited the rare book library at MedChi and the Gibson Museum at Sheppard Pratt. We held the first surgical rubber glove at The Johns Hopkins Hospital (now embedded in plexiglass) and paged through Samuel Mudd’s dissertation on dysentery at the University of Maryland. (If your history is rusty, Mudd was the one given a life sentence for aiding John Wilkes Booth after the assassination of Abraham Lincoln.) We made a field trip to the oldest continuously operating medical school classroom in the country (Davidge Hall). And debated over what should land on our list not wanting to leave anything—or anyone—out.

And while we think this list represents an impressive array of medical innovations and innovators, the reality is that we’ve just skimmed the surface.

So much of global medical practice that now seems standard was born in Baltimore. We’ve come a long way since Archer was paid by his patients in pork and cords of wood. Thanks to all the people listed below, Baltimore continues to lead the way for medical innovation in the 21st century.

Above: JOHNS HOPKINS HOSPITAL FOUNDING PROFESSOR WILLIAM OSLER (SEATED) EXAMINES A PATIENT. —COURTESY OF THE ALAN MASON CHESNEY MEDICAL ARCHIVES OF THE JOHNS HOPKINS MEDICAL INSTITUTIONS

1. Occupational Therapy Starts Here

Sheppard Pratt is the birthplace of modern occupational therapy, a type of treatment founded by William Rush Dunton Jr. Dunton believed that participation in daily activities, including hobbies and sports, had a therapeutic effect on people struggling with mental illness. The asylum included a building that drew patients from their rooms for pastimes such as bowling, billiards, and basket-weaving, and patients were often tasked with tending to the instituition's gardens and grounds. “Occupation,” wrote Dunton in 1928, “is as necessary as food and drink.” OT is still widely used as a treatment tool.

—COURTESY OF SHEPPARD PRATT

2. The Blue Baby Operation Saves Lives

Helen Taussig is considered the founder of pediatric cardiology in 1944 and is known for her trailblazing work on “blue baby syndrome.” Along with her Hopkins colleagues, surgeon Alfred Blalock and surgical technician Vivien Thomas, Taussig developed a transformative operation to correct the congenital heart defect that prevents the heart from receiving enough oxygen, resulting in the baby turning “blue.”

Since its inception, the operation known as the Blalock-Thomas-Taussig shunt has saved countless lives and ushered in a new era of cardiac surgery that led to the advancement of open-heart surgery in adults.

Hearing-impaired from childhood, Taussig’s innovative work has been attributed to her ability to detect the rhythms of the heart through touch rather than sound. “Learn to listen with your fingers,” she once famously said.

—COURTESY OF JOHNS HOPKINS/PROVIDED BY THE KARSH ESTATE / © YOUSUF KARSH, 1975

3. In 2018, a team of nine plastic surgeons and two urologists performed the world’s first total penis and scrotum transplant at The Johns Hopkins Hospital on a veteran injured by an explosive device in Afghanistan.

4. A Treatment for Rabies

In 1897, Charles Henry Stewart became the first patient in Maryland to receive a life-saving rabies vaccine. Stewart, a Prince George’s County resident who was bitten by a rabid English setter, was treated at the City Hospital, now Mercy Medical Center, at its Pasteur clinic. Named for the French microbiologist Louis Pasteur, who created the rabies vaccine in 1885, it was only the third such clinic in the United States.

5. What Is...Sinai Hospital?

Sinai Hospital physicians Drs. Michel Mirowski and Morton Mower had an unusual idea: Create a battery-operated defibrillator so small it could be implanted in people with arrhythmia and provide a life-saving jolt whenever necessary, rather than waiting to get to an external paddle defibrillator at an emergency room. After years of innovation, Mirowski and Morton’s automatic implantable cardioverter-defibrillator, which was about the size of a deck of cards, was implanted in a human at Johns Hopkins Hospital in 1980. The device is credited with saving many lives. In 2019, Mirowksi, Mower, and their invention appeared as clue on Jeopardy!

6. William Halsted Invents, Well, Everything

William Stewart Halsted was a founding physician at The Johns Hopkins Hospital and the first chief of surgery. He was considered one of the most influential surgeons in the U.S. Along with Department of Medicine chief William Osler, he introduced a formal multitier surgical residency program in 1889 in which students and recent graduates of the new medical school trained—and lived—at the hospital (hence, the term “residents”). At that time, they had to be unmarried. The program, whose motto was, in Halsted’s words, “See one, do one, teach one,” is the model for modern residency training. Halsted’s other accomplishments include perfecting the radical mastectomy (90 percent of breast cancer patients in the U.S. received the procedure until the 1970s). Halsted was also an anesthesia pioneer, though his work led to lifelong addiction issues after experimenting with using cocaine as an anesthetic. Additionally, he invented the idea of using surgical gloves to protect his favorite scrub nurse (and later wife). Gloves were soon serendipitously found to protect patients from infection.

—COURTESY OF THE ALAN MASON CHESNEY MEDICAL ARCHIVES OF THE JOHNS HOPKINS MEDICAL INSTITUTIONS

7. An Historical Heart Transplant

In December 2021, Bartley Griffith, MD, and Muhammad Mohiuddin, MBBS, of University of Maryland Medicine asked the U.S. Food and Drug Administration for an emergency provision to conduct a xenotransplant of a genetically modified pig’s heart into a human patient. Much to their surprise, the request was granted. In January, 57-year-old David Bennett, a Maryland resident with terminal heart disease, became the first person to successfully receive this form of transplant.

Although pig heart valves have been used in humans for years, the concept of whole-heart transplants was largely abandoned after the death in the 1980s of “Baby Fae.” The difference with this procedure is that changes could be made to the pig’s complex genome to reduce the likelihood of organ rejection. Bennett, who was severely medically compromised prior to surgery, died two months after the procedure. But for the nearly 110,000 Americans waiting for an organ transplant, his story brings hope for a new era in transplant surgery.

Planes, Trains, Automobiles, Spaceships

Dramamine was being tested as a treatment for allergies at Johns Hopkins Hospital in 1947, when a woman who had broken out into hives found that taking the antihistamine also cured her chronic motion sickness. Since then, the drug has staved off nausea for people on the go—and even been taken to outer space as a cure for space motion sickness.

Organs Take Flight

For the first time ever, an unmanned drone delivered an organ to University of Maryland Medical Center in 2019, potentially changing the speed and efficiency with which donor organs can now be dispersed. The kidney was successfully transplanted into a 44-year-old patient.

Tooting Their Own Horn

In the 1880s, the Sisters of Mercy managed to book John Philip Sousa (the Taylor Swift of his time) to play a fundraiser for their new hospital. The concert netted a whopping $20,000—over half a million in today’s dollars.

A Hospital for Everyone

In the 19th century, Baltimore’s Jewish population faced antisemitism at area hospitals. Jewish doctors were excluded from instruction and employment and Jewish patients struggled to receive equitable care. Undaunted, Baltimore’s Jewish citizens rallied to open Sinai Hospital of Baltimore in 1866 to serve anyone regardless of age, race, or gender.

8. Facing the Future

In 2012, a team of plastic, reconstructive, and maxillofacial surgeons, along with over 150 nurses and support staff, completed the world’s most comprehensive full-face transplant. Although the year prior a face transplant was completed at Boston’s Brigham and Women’s Hospital, the transplant at R Adams Cowley Shock Trauma Center included the jaw, teeth, and tongue as well as all the muscles needed for the recipient to both feel and use his new face.

—COURTESY OF THE ALAN MASON CHESNEY MEDICAL ARCHIVES OF THE JOHNS HOPKINS MEDICAL INSTITUTIONS

9. The electronic defibrillator is invented by William Kouwenhoven and his team at JHU in 1957 leading to another breakthrough: modern-day CPR.

10. Landmark Hand Surgery

In 2016, the Curtis National Hand Center performed the first-of-its-kind surgery in the U.S. for radial club hand. The patient, a 7-year-old boy, was born with a shortened forearm, a bent hand, and no thumb. Surgeons used bones, a joint, a toe, and growth plates from the patient’s foot to form a functioning right arm and thumb, and to construct a full-length radius to restore the child’s forearm. Today, the boy, now a teen, is continuing to grow and has improved dexterity in his fingers and hand function that he wouldn’t otherwise have had without the surgery.

—COURTESY OF THE ALAN MASON CHESNEY MEDICAL ARCHIVES OF THE JOHNS HOPKINS MEDICAL INSTITUTIONS

11. Rounds and Residencies

In the late 19th century, Sir William Osler, the first physician-in-chief at the Johns Hopkins Department of Medicine, forever changed the course of medical training when he devised the concept of “rounds.” At that time, medical school education consisted of classes in basic science and lectures in which a physician examined patients in an amphitheater while students looked on. It was Osler who moved the mentoring to the hospital wards (which were then octagonal) where visits to the patient’s bedside with a team of physicians—known as “rounding”—became a critical component of clinical training. This allowed aspiring doctors to learn from physicians, patients—and each other. (Osler once famously said that he hoped his tombstone would read: “He brought medical students into the wards for bedside teaching.”)

On the days that Osler, known for his encyclopedic knowledge, arrived unannounced to test the residents’ understanding, the sessions were dubbed “grand rounds.” The legendary physician also instituted the idea of a medical “residency” (along with colleague William Halsted) in which staff physicians lived in the administration building of the hospital, often for many years. To this day, rounds and residencies are an essential part of medical training at teaching hospitals.

12. Safety Cap Changes Baseball

Johns Hopkins neurosurgeon (and avid baseball fan) Walter Dandy, along with orthopedic surgeon George Bennett (see below), is credited with developing a cap to protect batters from “bean balls”—a pitch thrown directly at a batter’s head. The invention—a plastic protective shield that slides into a zippered pocket of a baseball cap—was inspired by a jockey’s helmet and commissioned by Brooklyn Dodgers’ general manager Larry MacPhail, who’d witnessed a few too many injuries on the job.

It was invented in 1940 and first donned the following year by future Hall of Famers Joe Medwick and Pee Wee Reese—both of whom had suffered injuries—during Dodgers’ Spring Training in a game against the Cleveland Indians. It became the prototype for the modern baseball batter’s helmet. When the game was over, MacPhail told the media that they had just witnessed “the biggest thing that has happened to the game since night baseball.” By 1971, all players were required to wear batting helmets and the national pastime was changed forever.

—COURTESY OF THE ALAN MASON CHESNEY MEDICAL ARCHIVES OF THE JOHNS HOPKINS MEDICAL INSTITUTIONS / WALTER DANDY PAPERS, C.1941

GEORGE BENNETT

If you ever suffered a shoulder injury playing baseball and received treatment, you may want to thank the memory of orthopedic pioneer George Bennett. Bennett trained at University of Maryland School of Medicine (graduating in 1908) and went to work at Johns Hopkins University. Although he had many orthopedic achievements, he is best known as the father of sports medicine, not surprising given his own love of athletics. (He played semi-pro baseball as a teen.) Bennett garnered a national reputation and treated world famous athletes including Joe DiMaggio. At the time, he was one of a very few physicians to make a correlation between sports and medicine.

JOHN SHAW BILLINGS

John Shaw Billings, a battlefield surgeon during the Civil War, made many contributions to The Johns Hopkins Hospital and medical school, including overseeing the planning and 11-year construction of the hospital and integrating teaching and research at the institution. After supervising the dismantling of dozens of military hospitals during the war, Billings became a leading expert on hospital construction in the U.S. But his most important contribution was the indexing, storage, and retrieval of information at the Office of the Surgeon General in Washington, D.C., which laid the groundwork for the National Library of Medicine. Under Billing’s directorship, it became the largest and most complete library of medical literature in the world.

RUDIGER BREITENECKER

It’s not an overstatement to say that Breitenecker changed the landscape for how rape victims are treated in Maryland. A pathologist who studied in his native Vienna, he was the assistant state medical examiner until he joined GBMC Healthcare in 1967. Breitenecker was appalled by how rape victims were treated and in 1975 he founded the Rape Care Center at GBMC, now its Sexual Assault Forensic Evidence (SAFE) Program. He ensured women did not wait hours to be seen and that they were given compassionate care. Most notably, he made rape kits more uniform and kept DNA samples from cases, believing that someday the technology would exist to analyze those samples to identify perpetrators. He was correct. The more than 2,000 samples he preserved have been used to exonerate the innocent and prosecute the guilty and the SAFE program he created is considered one of the most notable in the country.

ANGELA BRODIE

Angela Brodie not only opened the door to a new way to treat breast cancer, she built the door from scratch where no one even felt a door needed to exist. The British-born scientist, who spent 37 years at the University of Maryland School of Medicine, pioneered the research that led to the creation of the first selective aromatase inhibitor, Formestane, to treat breast cancer. But when she was in the early stages of research, she struggled to get backing. Knowing her science was sound, she took matters into her own hands, using materials donated by a supply house and working with several post-doctoral students to synthesize the aromatase compound herself. “One needs to be tenacious if you think what you’re doing is going to work,” she said in a 2006 interview with Baltimore. Her research is the basis of a class of drugs that prevents the recurrence of breast cancer in postmenopausal women. While most of the cancer survivors who are alive today thanks to Brodie’s efforts would not even recognize her name, in the world of science, the physician, who died in 2017, is a star.

CAROL GREIDER

In 1984, molecular biologist Carol Greider discovered telomerase, an enzyme that is critical for the health and survival of all living organisms found at the end of chromosome strands (known as telomeres). Greider found that when telomeres are too short or too long, they contribute to disease. Her research now focuses on discovering how to keep the cells the right length to maintain chromosomes and mitigate disease. Her finding has deepened our understanding of cancer, lung, and bone marrow conditions, and other age-related diseases. Greider, now director of the Department of Molecular Biology and Genetics at the Johns Hopkins University School of Medicine, won the 2009 Nobel Prize in Physiology or Medicine for her work.

ALAN GUTTMACHER

Alan Guttmacher was a pioneer and international leader in reproductive rights. While practicing as an ob-gyn at The Johns Hopkins Hospital, he observed a disparity in fertility rates among his patients with different socioeconomic backgrounds. One of his findings was that women who lacked access to private physicians also lacked access to contraceptive information and services. In 1933, he published the first of a controversial series of books which gave ordinary citizens access to information about pregnancy, delivery, contraception, abortion, and infertility. Guttmacher, who later served as president of Planned Parenthood, joined the birth control movement and promoted family planning, which he called, “an urgent, democratic form of medicine.”

JANET HARDY

Janet Hardy, a pediatrics professor at The Johns Hopkins Hospital, led a landmark study that provided information on teen pregnancy and medical and social issues. In 1957, Hardy help design a federal study of 60,000 expectant mothers and their children that lasted for 20 years. She served as the lead researcher for the Baltimore portion of the 12-city project, which focused on inner-city mothers and the development of their children. Hardy was the first researcher to document the dangers of rubella during pregnancy. She also showed that the children of girls younger than 18 had lower IQs and other physical and developmental issues later in life. Her studies helped establish public programs for the economically disadvantaged and inspired investigation into the effect of environment on children’s health.

WILLIAM ALEXANDER HAMMOND

Battlefield medicine has come a long way since Hammond’s day, but today’s modern military hospitals are a credit to his contributions. Briefly a professor of anatomy and physiology at the University of Maryland School of Medicine, Hammond became surgeon general of the U.S. Army during the Civil War. There he created a system of ambulance wagons and hospitals that significantly decreased mortality while increasing the efficiency of moving the wounded. He instituted sanitary measures, and improved record keeping, eventually founding what is today known as the National Museum of Health and Medicine. Though his tenure in Baltimore was brief, he found time to introduce microscopy to the medical school, eventually creating one of America’s largest microscopic collections.

LEO KANNER

Known as “the Father of Child Psychiatry,” Leo Kanner founded the first pediatric psychiatry clinic in the United States at The Johns Hopkins Hospital’s Harriet Lane Home for Invalid Children in 1930. He also published the first English-language textbook on child psychiatry in 1935. In a landmark paper written in 1943, Kanner was the first to define and coin the phrase “infantile autism” (aka “Kanner syndrome”). He was also a devoted social activist who fought for the rights of children with autism and other disorders and is one of the co-founders of The Children’s Guild.

THEODORE WOODWARD

When Woodward graduated from the UM School of Medicine in 1938, he intended to open his own practice. World War II intervened. Woodward found himself studying infectious diseases like dengue fever in Bermuda. As part of the U.S. Army Typhus Commission, he helped combat major breakouts of that disease among Allied soldiers, work for which he received numerous awards, including from President Roosevelt. After the war he studied antibiotics and other treatments, including one that he and his colleagues found beneficial in curing typhoid fever. That work netted him a Nobel Prize nomination. Now considered a father of infectious disease study, Woodward founded one of the world’s first Divisions of Infectious Diseases (at UMB) and helped found the Infectious Diseases Society of America.

13. The Modern Birthing Room Is Born

In 1978, a time when women labored alone and dads were excluded from the delivery room, Alan Tapper, a founder of GBMC HealthCare’s ob-gyn department, established the first birthing room in Maryland. It was an appropriate step for a hospital that’s been called “the Baby Factory,” as it delivers more babies than any other facility in the Baltimore area (3,462 in the last fiscal year). GBMC’s birthing room allowed fathers and other loved ones in the room to offer support as a woman gave birth. Rooms had a homey décor—with wallpaper, paintings, and drapery—and medical equipment was largely out of sight. GBMC has other claims to ob-gyn fame, including the first perinatal center in Baltimore County (1985), establishment of the first Lactation Department in the Baltimore area (1989), and the first robot-assisted gynecologic surgery at a community hospital in the mid-Atlantic (2006).

14. The University of Maryland School of Medicine launched a preventive medicine course in 1833, the first of its kind in the U.S.

—SCHOOL OF MEDICINE CATALOG, 1835. HISTORICAL COLLECTIONS, HEALTH SCIENCES AND HUMAN SERVICES LIBRARY. UNIVERSITY OF MARYLAND, BALTIMORE

15. First Program for IVF in the U.S.

Georgeanna Seegar Jones was one of the country’s first reproductive endocrinologists in 1939. Her groundbreaking research on the pregnancy hormone (human chorionic gonadotropin) led to the finding that hCG was produced by the placenta, not the pituitary gland, as had been previously thought, making way for the development of the pregnancy tests that are currently on the market. Decades later, in 1981, she became one half of Hopkin’s husband-wife team that created the first program for in-vitro fertilization in the U.S. The work led to the birth of the first “testtube” baby here. Thanks to Jones, IVF flourished and gave hope to countless couples struggling with infertility.

—COURTESY OF THE ALAN MASON CHESNEY MEDICAL ARCHIVES OF THE JOHNS HOPKINS MEDICAL INSTITUTIONS

16. First Sex Reassignment Surgery in the U.S.

Way ahead of its time, The Johns Hopkins Hospital established The Gender Identity Clinic in 1966. The clinic was the first academic institution in the U.S. to perform gender reassignment surgery at a time when many hospital boards banned it. The clinic became a model for other such centers across the country, but bias and stigma led to its closure in 1979. By 2017, thanks to societal shifts leading to increased acceptance of LGBTQ+ individuals, the hospital opened the Center for Transgender and Gender Expansive Health. Since then, the center’s services have included vaginoplasty, penile construction, as well as hormone and voice therapy.

A Golden Idea

For most of the era of modern medicine, a severe accident meant almost certain death. Enter R Adams Cowley who, while serving as chief of surgery for the United States Army in Europe in the years immediately after WWII, saw how quickly European surgeons responded to trauma and the successful survival rate of their patients. Cowley, a heart surgeon and graduate of University of Maryland School of Medicine, formulated from this his theory of the “Golden Hour,” the brief span of time during which trauma patients either get to help at a specialized facility—or die. Cowley overturned the long-held belief that trauma patients should go to the nearest hospital, noting that the teams there likely lacked the necessary training. Instead, he advocated for rapid transit via helicopter to a shock trauma center.

Cowley grew his brainchild from a two-bed center to one that today sees more than 6,500 critically ill and severely injured people annually. Its patients have a 95-percent survival rate. The R Adams Cowley Shock Trauma Center at University of Maryland became a model for how trauma centers were designed around the world. Oh, and when he wasn’t becoming the father of trauma medicine, Cowley was “among the first to perform open-heart surgery, devised a surgical clamp named after him, and helped design a prototype pacemaker used by President Dwight D. Eisenhower,” according to his obituary in The New York Times published in 1991.

A Strong Vision

In 1944, Valley Forge Army Hospital was the epicenter of the treatment of blinding eye injuries sustained by military personnel in WWII. It was here, working with soldier patients, that Richard E. Hoover became interested in helping the blind become more independent. It was not his first experience assisting people who were blind; prior to the war, Hoover was a math and physical education teacher at the Maryland School for the Blind (MSB). For decades, white canes had been used by the blind to help them navigate obstacles but also to alert people—namely motorists—that the person holding the bright white stick was blind. While at Valley Forge, Hoover, along with MSB colleague Warren Bledsoe, devised a new way of using the conventional short, white, wooden cane for greater independence. His idea was to lengthen the cane to match the size and stride of the user and make it of a lighter weight material. He conceived of the “Hoover method” of swinging the cane back in forth to identify obstacles.

At Valley Forge, he trained others who then trained soldiers in the technique. After the war he attended medical school at Johns Hopkins, became assistant professor of ophthalmology at Johns Hopkins Hospital, and founded the Dr. Richard E. Hoover Rehabilitation Services for Low Vision and Blindness at GBMC Healthcare. He shared his teachings with MSB students and created university training programs that launched the Hoover method all over the globe..

Lending a Hand

Today we take hand surgery as a specialty for granted, but prior to WWII there was no such thing. Hand casualties in battle were treated much like any other wounded. A group of pioneering surgeons, however, saw the need for a special expertise—one that tapped into orthopedics and neurosurgery as well as plastic surgery—to treat these specific injuries. Among those surgeons was Dr. Raymond Curtis. Curtis completed a general surgery residency in Baltimore and during WWII was chief of hand service in the Army Medical Corps. Upon his discharge in 1947, he returned to Union Memorial Hospital and started a hand-focused practice. Even in the aftermath of war, the specialty was relevant, with industrial accidents and other injuries taking a great toll on patients’ finances and quality of life. Although it would not be named the Curtis National Hand Institute until 1975, by the ’60s, Curtis’ hand program had a reputation for excellence in treating injuries of the hand, wrist, arm, elbow, and shoulder.

The Curtis National Hand Center is now the largest in the world and is designated as a Level 1 Hand and Upper Extremity Trauma Center—the only such center in the U.S. Curtis began training Army surgeons during the war and true to its roots, every Army hand surgeon since 1963 has completed the hand fellowship training at Union Memorial. And Union Memorial continues to send surgeons to Walter Reed National Military Medical Center to care for injured soldiers.

17. America’s First Teaching Hospital

In 1807, the College of Medicine of Maryland opened its doors in west Baltimore, becoming the nation’s first teaching hospital. (It was re-chartered in 1812 as the University of Maryland.) Davidge Hall still stands today at Lombard and Greene Streets, the oldest continuously operating medical school building still in use in the Western Hemisphere. No surprise, it has a storied history. It was built to replicate the Pantheon in Rome and features two semi-circular theaters used for instruction including Anatomical Hall, where a plaque still stands commemorating the spot where Revolutionary War hero General LaFayette received an honorary diploma in 1824.

Its early graduates range from the famous—like Archibald “Moonlight” Graham, who was depicted in Field of Dreams—to the infamous, like Samuel Mudd who notoriously treated John Wilkes Booth after he assassinated President Lincoln. Speaking of notoriety, the school practiced the dissection of corpses and was the first school in the country to make anatomical dissection compulsory, in 1848. (That lab is now home to the alumni association offices.) While considered a normal part of anatomy instruction today, two hundred years ago dissection was thought so reprehensible that a wall was erected around the hall to keep out angry mobs that would’ve burned the building down. (In fairness, the school did sometimes obtain bodies for study through illegal means.) Since 1997, Davidge Hall has been recognized as a National Historic Landmark.

—COURTESY OF MARYLAND CENTER FOR HISTORY AND CULTURE / JULIUS ANDERSON PHOTOGRAPH COLLECTION, 1925

18. Cutting-Edge Treatment for Depression

In 2017, Sheppard Pratt conducted the largest study ever done on patients suffering from severe treatment-resistant depression. (Roughly 30 percent of those currently treated with medications for depression are drug-resistant, according to the NIH.) The results found that an implantable vagus nerve stimulation device (aka “a pacemaker for the brain”) paired with antidepressant treatment (including medication, psychotherapy, and electroconvulsive therapy) can alleviate symptoms. The study represents 10 years of research and is a new potential treatment for millions of people who do not respond solely to medication.

19. A University of Maryland professor, Dr. John Crawford, discovered germ theory in about 1790, and also determined that insects were related to human illness. Colleagues of the time dismissed his theories, but history has had the last word.

20. Understanding Lead Paint Poisoning

In 1958, J. Edmund Bradley, chief of pediatrics at the University of Maryland School of Medicine, co-wrote a paper with Samuel Bessman, Poverty, Pica, and Poisoning. In it, he reported that of a random sampling of 333 children that came through his clinic, nearly half had abnormally high levels of lead in their blood. The study collected paint samples from the homes of low-income families and found extremely high levels of lead. Through this study, Bradley correlated poor living conditions with childhood lead poisoning and called for “the cooperative effort of physicians, nurses, and social workers of municipal health and welfare departments” to combat the environmental public health issue.

21. Better Fracture Care

Dr. Nathan Ryno Smith was a chair of surgery at UMD for 50 years beginning in 1827. He is credited with inventing a better way to set leg fractures to decrease deformity. His “anterior splint” involved suspending the limb, once made rigid, so it didn’t rest on the bed. Smith’s invention was perfected just in time to be widely used during the Civil War. As the treatment record of one patient, Theodore Pease, who took a musket ball to the right thigh at Gettysburg stated: Smith’s anterior splint continued in its use. The wounds are discharging freely and bone is practically united.

—COURTESY OF WIKIMEDIA COMMONS

22. World’s First Medical Illustration School

Johns Hopkins’ Department of Art as Applied to Medicine trained illustrators in scientific illustration to help practitioners understand the workings of the human body. Established in 1911 under the direction of Max Brödel (and teaching continuously ever since), it was the first program of its kind in the world. Brödel is world-renowned for his life-like renderings based on observation of surgeries and autopsies. He single-handedly created the profession, which led to the founding of other programs across the country and remains pivotal to medical education today. “Leave paper and pencil alone until the mind has grasped the meaning of the object,” Brödel said. “Medical illustration is not drawing a pretty picture. It’s not just knowing the science. It’s being able to take science and the art and combine them to communicate.”

—ORIGINAL ILLUSTRATIONS FROM THE MAX BRÖDEL ARCHIVES IN THE DEPARTMENT OF ART AS APPLIED TO MEDICINE, JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE. USED WITH PERMISSION

23. Advances In Limb Lengthening

For years, the best method of treating limb length discrepancies was to use painful external fixators, metal devices that are attached to the bones. (Amputation was another possible solution.) Sinai Hospital physicians John Herzenberg and Shawn Standard innovated a better way. The two co-developed with another physician the Precice internal limb-lengthening nail. Introduced in 2012, the nail is a metal rod with a magnetic motor inside of it. Using an external remote control, the nail slowly lengthens the limb with less pain and scarring. As one patient stated, “Before, I had a limp in my walk; now I have a spring in my step.”

24. In the 1930s, Baltimore psychiatrist Dr. Jacob Conn developed the “play interview” (i.e., the use of dolls to act out scenarios and emotions) for the treatment of phobia in children still widely used today.

25. Identifiying HIV

Dr. Robert Gallo was in an NIH lab researching tumor cell biology when, in 1975, he was the first person to identify a leukemia virus that caused cancer. This was the same era that AIDS was claiming hundreds of thousands of lives and Gallo's NIH work proved fortuitous in the fight against that disease. In 1984, Gallo and French virologist Luc Montagnier co-discovered that AIDS was caused by a virus, which they named human immunodeficiency virus (HIV). It was a breakthrough in understanding the disease. In 1996, Gallo co-founded the Institute for Human Virology at UMB and went on to develop the HIV blood test to screen for the virus and therapies that have enabled those infected with HIV to live longer.

—COURTESY OF WIKIMEDIA COMMONS

MARY ELIZABETH GARRETT

Mary Elizabeth Garrett, daughter of B & O Railroad tycoon John Work Garrett, was one of the wealthiest women in the U.S. and used her fortune to advance higher education for women. Between fundraising and personal donations, she and her friends (known as the “Friday Evening” group, inspired by their biweekly meetings at each other’s homes) raised nearly all the $500,000 needed for the opening of the financially strapped Johns Hopkins University School of Medicine. But there were a few stipulations: They had to accept qualified women and the medical school should be a full graduate school whose applicants had to have a bachelor’s degree in science (which was not the norm at the time). After much consternation, the all-male founders agreed to the terms. When the school opened in 1893, three of the 18 students admitted were women—making it the first major medical school to do so. Thanks to her insistence, Garrett is sometimes called America’s greatest “coercive philanthropist.” William Osler, one of the school’s founding physicians, famously replied, “It was a pleasure to be bought.”

DORTHEA DIX

Dorothea Dix was a pioneering nurse and activist who was dedicated to improving conditions in jailhouses and asylums. Dix’s advocacy helped establish new institutions in the U.S. and Europe and led to widespread reform and changing perceptions at a time when people struggling with mental illness were housed alongside violent prisoners. After documenting the shocking conditions she observed in a Massachusetts prison in 1841, she spent four decades lobbying U.S. and Canadian legislators to establish humane asylums for the mentally ill.

Dix came to Maryland in 1852 to observe the state of affairs in its jails and almshouses, which is when she met Moses Sheppard. Although Sheppard did not take her up on her request that he fund a state asylum, she proved an enormous influence on him and his perception of treatment of the mentally ill, resulting in his ultimate decision to endow Sheppard Pratt. Dix was also instrumental in recruiting nurses for the Union army during the Civil War, appointing more than 3,000—or about 15 percent—of them. She was known for markedly improving care, even insisting that rebel soldiers get the same treatment as other soldiers. When there were shortages, she often obtained medical supplies, linens, and bedclothes through private sources and never took a single day off, working for four years straight through the war.

HORTENSE KAHN ELIASBERG

In the 1920s, rheumatic fever and tuberculosis were significant killers of children. In crowded, dirty cities like Baltimore, opportunities for respite were nil. In a world without antibiotics, ill children were often sent to convalesce somewhere with fresh air, good food, and rest in order to heal. Yet Baltimore had no such home. Enter Hortense Kahn Eliasberg. A resident of Reservoir Hill, Eliasberg graduated from Goucher College and Johns Hopkins University in an era when fewer than 40 percent of college degrees in the nation were awarded to women. While researching her thesis, Standards of Care for Convalescent Children, Eliasberg grew interested in respite care. At just 22 years old, the formidable Eliasberg got Dr. William Welch, chief physician at Johns Hopkins Hospital School of Hygiene and Public Health, onboard and, leveraging her personal connections, funded the creation of Happy Hills Convalescent Home, which opened in 1922. Notably, children were admitted regardless of their family’s ability to pay. Today the home has evolved into Mt. Washington Pediatric Hospital, a leader in pediatric care.

MARCIA CROCKER NOYES

When Noyes became the chief medical librarian of the Medical and Chirurgical Faculty of the State of Maryland (now the Maryland State Medical Society or, simply, MedChi) in 1896, it was at a time of robust growth for medicine and medical literature. Far from being a sleepy librarian stacking books, Noyes’ position was so demanding that she took up residence in the same building as the library, the “Faculty” building. According to MedChi, “At that time, librarians were expected to be on call 24/7. A physician could ring up at any time. . . . The physician would arrive shortly thereafter, consult the medical book, and hurry back to his ailing patient.”

Although not medically trained, Noyes learned under the tutelage of William Osler (of Johns Hopkins renown) and was by all accounts a dynamic leader. During her 50-year tenure she devised a new system of literature classification, served as the society’s executive secretary, and was the chief museum curator. The library collection grew from a few thousand volumes to 65,000. She also helped establish the Medical Library Association—where she was the first non-medical president—which continues to give an award in her honor. Noyes died the year of her 50th anniversary celebration, which was attended by more than 250 physicians. Her funeral was held in the Faculty building where she lived until her death and where staff and volunteers say her spirit still walks the halls to this day.

NELLIE LOUISE YOUNG

Dr. Nellie Louise Young was Maryland’s first Black female physician. After graduating from Howard University’s School of Medicine in 1930, she soon opened her obstetrics-gynecology practice above her father’s drugstore in West Baltimore. (Her father, Dr. Howard Young, was the state’s first Black pharmacist.) In 1938, Young opened a Planned Parenthood Clinic. In her 52 years of practice, she held numerous posts, including working as chief of obstetrics at Provident Hospital, serving as the women’s physician at the former Morgan State College, the girls’ physician at Frederick Douglass High (from which she had graduated in 1924, when it was known as the Colored High School), and staff physician at the Maryland Training School for Colored Girls. Young once said the “most wonderful thing in the world was to deliver a healthy baby, and to see the expression on the mother’s face and the father’s face.” She delivered thousands of babies before retiring in 1984.

Source

Introducing GammaPod

Megan McGaha — Fri, 29 Apr 2022 15:56:39 +0000

A diagnosis of breast cancer is scary. Patients and their loved ones may be uncertain, wondering what to do next. But there is good news — the University of Maryland Medical Center is always working to develop treatments that are more comfortable, efficient, and effective, giving patients the peace of that which comes with world-class care.

GammaPod, the first radiation therapy system dedicated specifically to treating early-stage breast cancer, was invented, studied, and implemented by faculty of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC). The therapy has been associated with a decrease in short term side effects to other radiation therapy for the breast by targeting beams directly to the breast tissue, delivering a higher dose of radiation to tumors and less radiation to nearby vital organs like the heart and lungs.

Unlike other forms of partial breast radiation, GammaPod is non-invasive and does not require daily treatments. Standard treatment for whole breast radiation after surgery for early-stage breast cancer requires anywhere from 15 to 33 daily treatment sessions, and other forms of partial breast radiation therapy often involve at least 10 sessions spread over five days. By comparison, GammaPod treatment typically only requires one to five sessions. A unique form of accelerated partial breast irradiation, GammaPod focuses radiation on only the highest risk areas affected by cancer. In appropriate candidates accelerated partial breast irradiation prevents cancer recurrence just as well as longer courses of radiation to the entire breast.

GammaPod treatment uses an approach called stereotactic body radiation therapy, which is gentler on skin and healthy breast tissue. Patients can also expect potentially fewer cosmetic side effects compared to longer courses, such as scarring or discoloration of the breast tissue, and may experience less itching or burning than they would after traditional radiation treatments.

Doctors and scientists at the University of Maryland developed GammaPod, which the U.S. Food and Drug Administration cleared for use in 2017, and the University of Maryland Medical Center is the first facility in the world to use the new technology to treat patients. GammaPod is proven to be safe and effective for delivery of radiation. A variety of clinical trials show the potential to improve cosmetic outcomes, improve patient satisfaction, and improve convenience of care for early-stage breast cancer patients. GammaPod is also just one of the latest treatment options invented and offered at UMGCCC; breast cancer patients also have access to other advanced treatments including proton and thermal therapy.

Treatment plans are unique to the needs of individuals, and decisions about which treatments to seek should be made between patients and doctors. Candidates who may be well-suited to GammaPod therapy may include, but are not limited to, patients who have early-stage breast cancers (stages 0, 1), are age 50 or older, and are eligible for lumpectomy. You can call 410-328-6080 for more information or to speak with a radiation oncologist to see if you are a candidate, or visit the University of Maryland’s website to make an appointment.

A diagnosis of breast cancer may not be good news, but patients have options. Researchers are always working to offer new and improved treatments, and GammaPod is a game-changing strategy to treat early-stage breast cancer with fewer health and cosmetic side effects, as well as increased comfort and convenience. Learn more about GammaPod today.

Source

Healing Behind the Mask

Megan McGaha — Thu, 30 Dec 2021 17:05:18 +0000

Over the last two years, time spent looking at yourself on video conferencing applications has led to an increase in those considering a cosmetic surgery procedure. And with many still working from home, there has never been a better time to discreetly improve one’s appearance. For information about the latest innovations in facial rejuvenation we spoke with Natalie Justicz, MD, a facial plastic and reconstructive surgeon at the University of Maryland.

How has teleworking and video conferencing impacted the cosmetic surgery field?

Dr. Justicz: Video conferencing is like looking in a mirror all day! People notice their mild facial asymmetries and wrinkles more in the lighting. Patients coming in to discuss rejuvenation procedures often point out the things they’ve noticed on camera. I find that computer cameras can distort the nose and make it seem larger. I reassure patients that video conferencing can be unforgiving, but there’s also some subtle things that I can do to help.

What makes now a particularly good time to consider cosmetic procedures?

Dr. Justicz: Non-surgical procedures are usually quick, and sometimes a mask even covers the site of treatment. With teleworking, many surgical patients are able to take time to recover out of the office more easily. Some of my rhinoplasty patients choose to still work remotely but keep their cameras off.

What are some questions a patient should ask at their initial consultation?

Dr. Justicz: In addition to the wonderful benefits of cosmetic procedures, I also address recovery time, risks, and alternatives with my patients. I want you to feel comfortable with me and my approach. All physicians should welcome you getting a second opinion, and cosmetic procedures and surgery are no different. It’s important to choose someone who helps you achieve natural but noticeable results.

Which treatment(s) do you recommend someone start out with?

Dr. Justicz: I generally find that a combination of gentle Botox© and skin rejuvenation with broad band light (BBL) has the one-two punch that many people are looking for. Botox© softens wrinkles that are starting to form, while BBL addresses surface redness and sun damage. However, I always analyze a patient’s particular concerns, and I modify my technique and settings for every patient.

How have advances in cosmetic surgery led to more effective, less invasive options?

Dr. Justicz: Patients are more likely to come in early for “prejuvenation.” We can do a lot with skin care, neurotoxins, and facial filler. We offer laser treatments in the office as well that used to require a visit to the OR. Some surgical procedures can even be done in the office for the right patient.

What are the newest treatments being offered?

Dr. Justicz: We offer a variety of neurotoxins, facial fillers, BBL and laser rejuvenation, and PRP (platelet-rich plasma). Our treatments are always expanding and improving. I can describe these in more detail (and show examples) in the office.

Actual UM patient before & after Botox© for crow’s feet.

How can patients avoid looking “overdone”?

Dr. Justicz: That is where I come in! For patients who are newly exploring their options, I usually recommend starting with just one treatment modality. I’ll see you back in a couple weeks, and we can discuss our next steps. I never want to talk a patient into a cosmetic procedure. This process should be enjoyable and help you feel your best.

What’s your advice for anyone debating a cosmetic procedure?

Dr. Justicz: Come in and chat with me! I want my patients to understand their options so they can feel their best. At our initial visit, I let the patient guide me with their concerns and then we discuss the options available, ranging from less invasive to more invasive. Not every procedure is appropriate for every patient, and I only offer my patients treatments that I believe will give them their desired result.

Why did you become a facial plastic surgeon?

Dr. Justicz: While I love the breadth of my otolaryngology training at Harvard teaching hospitals, I always veered toward plastic and reconstructive procedures. I completed fellowship in this area at the University of Michigan. I love helping my patients restore, rejuvenate, or enhance facial form. At the University of Maryland, I work with trauma patients, patients with functional concerns like facial paralysis, and patients interested in cosmetic procedures. I love the variety and feel so lucky to do what I do.

MEET OUR EXPERT:

Natalie Justicz, MD
Assistant Professor and Facial Plastic & Reconstructive Surgeon

To schedule an appointment with University of Maryland Facial Plastic Surgery in Columbia or Downtown Baltimore, call 667-214-1772 or email medspa@som.umaryland.edu.

Source

Keep Up Your Cardiovascular Care

Emily Kunisch — Thu, 28 Jan 2021 16:44:21 +0000

We get it—you don’t want to make any unnecessary trips out in public during the COVID-19 pandemic. You may be thinking that you’ll be fine if you delay your annual physical or care for a chronic condition until COVID-19 appears less threatening—perhaps after more of us are vaccinated. However, according to Mark R. Vesely, MD, associate professor of medicine at the University of Maryland School of Medicine and an interventional cardiologist at the University of Maryland Heart and Vascular Center, that way of thinking can be especially dangerous when it comes to your heart.

We asked Dr. Vesely about how the pandemic has changed cardiovascular care, what people need to know about COVID-19 and their hearts, and what hospitals have been doing to keep patients safe, including conducting some appointments as telemedicine visits.

What is the biggest concern you have as a cardiologist during the COVID-19 pandemic?

I’m extremely concerned about patients who are foregoing evaluation and treatment of their heart disease out of fear of coming to the hospital because of COVID-19. At the Heart and Vascular Center, some of our patients have said that they have stayed home and tried to ignore or bear through symptoms they would have normally sought help for.

We are seeing across Maryland and the country that the number of patients coming to the hospital with an acute heart attack is less than what was typical before the COVID-19 pandemic. Yet more patients are having cardiac arrest and dying outside of the hospital. We think some of this is likely due to the delay in seeking help for chest pain. By not seeking medical attention quickly, a patient’s chance of getting even sicker or dying of a heart attack or stroke is much higher.

How else has COVID-19 changed the practice of heart care?

We are learning that people who have active COVID-19, as well as some considered to be recovered from the illness, are developing problems related to heart function. We have seen some people who are very sick with active COVID-19 having issues with blood clots. Unfortunately, these clots can lead to heart attack or stroke. Some patients in this situation are very challenging to treat. However, the sooner they receive medical care, the better our chances of helping them survive and thrive afterward. Other patients, including many who were not especially sick with the initial illness, are having long-term problems with chest pain and fatigue. Some patients’ MRI studies show heart inflammation. This can continue for months after their initial bouts with COVID-19. We still have much to learn about how to best help these patients, but a delay in their care is never ideal.

What is the problem with delaying care for a heart condition or vascular disease?

For decades, cardiovascular specialists have touted the phrase, “Time is muscle,” and it’s true. The longer the delay in care for an acute heart attack, a larger portion of the heart muscle will die. The more heart muscle that dies, the greater the likelihood that a patient will get very sick or even die. The same goes for stroke, where we say, “Time is brain.” If you or a loved one has symptoms of a heart attack—chest pain, pain in the neck or jaw, shortness of breath, or even unexplained heavy sweating, to name a few—call 911 right away.

Patients with chronic cardiovascular conditions, such as congestive heart failure, heart valve disease like mitral regurgitation and aortic stenosis, aortic aneurysm, peripheral arterial disease, or others, need to keep up-to-date with their care. If they don’t, they and their doctors won’t know if their conditions are getting worse. Treatment after their disease has further progressed may be more difficult and not as effective. These patients may also be putting their lives in danger. The risks of foregoing care for these chronic conditions are much higher than the risk of potentially catching COVID-19.

What is your team doing to protect patients and provide safe care during the pandemic?

At the University of Maryland Heart and Vascular Center, we have taken measures to enhance safety in both the hospital and outpatient clinic settings. Providers and staff are all required to strictly practice safe distancing. We are also washing our hands more frequently and using other measures to decrease the chances of exposing anyone to SARS-CoV-2, the virus that causes COVID-19. All hospital staff and providers also monitor themselves daily for symptoms and exposure to others with COVID-19, and they stay home when necessary. Further, patients with active COVID-19 cases are kept separate from those in the hospital for other reasons. The hospital has also developed patient air-handling and cleaning techniques to minimize the risk of spreading the virus. For patients who need to be seen in person at the clinic, visits are spread out in time and space to decrease contact and exposure. We also provide telemedicine visits so patients can be evaluated remotely to avoid in-person contact.

Tell me more about telemedicine. What types of appointments can be completed remotely, and are they covered by insurance?

Telemedicine visits are now covered by insurance. These visits involve interaction between a patient and provider by either a phone conversation or a videoconference. Videoconference visits are done either with a computer equipped with a camera or by smartphone with an app such as Zoom or FaceTime. Most providers prefer videoconference over telephone-only encounters because they give us a better understanding of our patients’ well-being—and we like to see you too.

There are some inherent limitations in seeing a patient without a “hands-on” exam. However, telemedicine is a good alternative, especially if our patients can supply us with biometric data through heart and blood-pressure monitoring equipment they have at home. Many visits can be completed through telemedicine without a significant difference in the evaluation and care plan patients would have received in person.

Source

Checking Out of Hotel COVID

Lauren Cohen — Mon, 30 Nov 2020 20:50:11 +0000

In darkness, I feel my way from bedroom to kitchen hugging the outside wall like liquid in a centrifuge. The place is strange, gray, and round like a spaceship, alien. As I tap through the living room into the hallway toward the kitchen, an orange laser beam shoots through a window and startles me closer to consciousness.

The radiant sliver widens over the Lego-like apartments at 225 North Calvert between St. Paul Plaza and the Blaustein Building at One North Charles. Then I remember: we are 21 stories above Baltimore, in a circular penthouse with windows open to every direction, and I just traveled from the shaded westside to dawn’s early light in the east.

My wife, two daughters, and I are in Hotel COVID, known prior to this pandemic as the Lord Baltimore.

I put water on to boil for the French press as a Warhol-esque portrait of Marilyn Monroe stares at me between two windows. Empty marinara-stained Styrofoam from Sabatino’s top the garbage can while recyclables spill out of two MICA tote bags—signs of just temporary domesticity.

Half the stuff in the kitchen—utensils, pots, and pans—belongs to the hotel and half is our family’s, which was transported in stages.

Five floors below us, and descending to the fourth floor of the Lord Baltimore Hotel, the rooms are filled with local residents diagnosed with COVID-19, or people who are highly suspected of having the illness. These residents (we do not call them “patients”) are not so symptomatic as to require hospitalization, but have been shuttled here from all over the Baltimore area because they could not safely isolate. They live in, and have come from, congregate settings such as shelters, substance-use recovery houses, multi-generational households, or on the street.

My wife, Marik Moen, is an RN and assistant professor of community and public health at the University of Maryland School of Nursing. She was invited to serve as the director of nursing here at the Lord Baltimore Hotel Triage Respite and Isolation Center, a collaborative effort of the Mayor’s Office of Homeless Services, the city health department, and the University of Maryland Medical System, with support from nonprofits like Healthcare for the Homeless Maryland.

In many cases, Healthcare for the Homeless identifies potential residents who may be well served by the Triage Respite and Isolation Center. The University of Maryland Medical System provides the healthcare, and the city oversees the operation, having entered into an agreement with the Miami-based Rubell family—the owners of the popular, 1928-built French Renaissance hotel—which had been all-but-vacant since March due to the state’s lockdown order.

Wilhelm's wife Marik Moen, PhD ’18, MPH, RN, assistant professor, UMSON and director of nursing, TRI Center. —Matthew P. D’Agostino

Two years earlier, we had moved from Baltimore to Fairfaix, Virginia when I took a job at George Mason University and Marik’s work life entered a research phase that required that she commute to Baltimore just a few days a week. Then the pandemic happened.

Characteristic of returned Peace Corps volunteers, Marik, who served in Gabon for three years before we were married, asked herself, “If not now, when? If not me, who?” So she reached out to the team pulling together the Baltimore Convention Center and, after an onboarding training, picked up some shifts.

In the early days of coronavirus, Baltimore enacted a plan similar to other cities that were transforming convention centers into field hospitals for COVID-19 patients who did not require intensive care. Then, in late April, weeks into the lockdown and wrapping up our semesters as professors while overseeing the ever-changing online schooling situation of our children, the phone rang.

It was Chuck Callahan, vice president of Population Health at the University of Maryland Medical Center. Marik and Chuck knew one another from a shared interest in population health and from the Convention Center project, which Chuck oversaw. I could not hear their full conversation, of course, but I distilled it as Chuck described the Lord Baltimore Hotel project—how the population being served exactly aligned with Marik’s service and research interests. I guessed correctly that he was asking whether she would head up the nursing component

I could tell by Marik’s voice, her hemming and hawing, as well as her energy and enthusiasm, what she was thinking. “If not now, when? If not me, who?”

Throughout the weekend, we must have walked around Lake Royal in Northern Virginia 50 times: back-burnering already back-burnered research goals and tenure-track requirements, discussing home-life and school-life that had suddenly become one life, and weighing the risk of infection and contamination.

“If not now, when?” “If not me, who?” Simple: Now. You. Us.

Marik departed for Baltimore on May 3. Driving back and forth from Fairfax, the extra steps required to keep the car clean and change her clothes upon first re-entering the house, to reduce the risk of contaminating us, did not make sense, so early on Marik simply stayed in Baltimore. We only occasionally saw her thereafter. During that first month, Marik stayed in a corner room on the 25th floor of the Crowne Plaza at Fayette and Liberty Streets. On weekends, we’d either drive up or she’d return to Fairfax to do laundry, purloin kitchen utensils, and swipe condiments.

On our first visit, before residents arrived at the Lord Baltimore, Marik gave us a tour. Armed guards greeted us just inside the lobby door off of Hanover Street where we rubbed hand sanitizer into our palms and took our temperatures. A hotel employee checked us in; otherwise, the large lobby was empty.

The ornate ceiling betrayed the hotel’s opulence, with a mauve and sage floral and diamond pattern accentuated with gilded edges. A grand piano sat silent and shadows cloaked the bar. Here roamed the ghosts of Amelia Earhart, Babe Ruth, Martin Luther King, Jr., and former Maryland governor Harry Hughes, who used the hotel as his gubernatorial campaign headquarters. In fact, paranormal experts claim the hotel—Baltimore’s tallest building when it was erected just before the Great Depression hit—is truly haunted. Guests have reported seeing the apparition of Molly, dressed in white and playing with a red ball, whose parents were apparently among the hotel’s “leapers.”

On the grand two-tiered ballroom level, Marik showed us the operation center where representatives from partnering organizations had set up workstations. Bowl-shaped crystal chandeliers still illuminated the space, gold sconces glowed from the columns, and long luxurious curtains graced the windows. But gone were the round tables draped in off-white linen, sparkling glassware, and formal place settings with silver cutlery. In their place were laptops and printers, a few rows of chairs set up for team meetings, cases of bottled water, file folders, and piles of masks.

Moen with Vanessa Augustin, MS '20, RN, TRI Center nurse manager; Meshae Adams, information technology specialist, Baltimore City; Alexis Williams, RN, BSN, nurse; and Corey Wright, RN, BSN, nurse. —Matthew P. D’Agostino

We returned to the lobby and faced a bank of four elevators. Inside the lifts, duct tape covered select buttons so that no one could inadvertently access a floor where COVID residents stayed. At every third floor, elevator doors opened on donning and doffing stations with industrial-strength plastic sealing doorways. (Staff could access the non-doffing floors only through the service elevators behind sealed hallways inside the “hot zone.” Residents accessed the floors via service elevators that connected with the loading dock area.)

The process for each TRI Center staffer involved entering an antechamber and donning personal protective equipment (N-95 mask, face shield, gown, gloves, booties), and next making rounds and using a pass-through room from the east side of the U-shaped floor to the west side. Then, at the end of a shift, doffing the PPE at the opposite antechamber. About 25 rooms per floor were in service, including smoking rooms, staff rooms, and pass-through rooms. Stairways were alarmed to prevent residents from using them but still allowing for emergency exits. In addition to PPE, nurses would be equipped with stethoscopes, thermometers, pulse oximeters, and blood pressure cuffs—just enough tools, along with their smarts and experience, to determine when a resident’s respiratory symptoms worsened or complications from a present comorbidity flared.

The first residents were due the Tuesday following our first family visit. We bought oysters and a rockfish from STREETS Market & Cafe and wine from Urban Cellars. We celebrated because it was clear that we wouldn’t be seeing much of each other. Then the kids and I returned to Virginia.

William Wychulis, clinical support specialist. —Matthew P. D’Agostino

Residents arrived on May 12. Marik reported on challenges on the frontline: civilians working in but not understanding the clinical realm, droopy masks, mental health crises among some residents, others going on walk-abouts. Quarantine and cabin fever. The messiness of real life spilt over into Hotel COVID as problems that existed outside also existed here. Suddenly, a two-week reservation at the Lord Baltimore Hotel in the heart of beautiful downtown Charm City did not sound like a vacation at all.

In addition to navigating new professional relationships and corralling an entourage of mostly unfamiliar nurses, Marik got to know the hotel staff who tended to both their usual tasks and extraordinary new ones with a level of generosity not necessarily anticipated when your historic hotel morphs into a 2020 pandemic refuge. Perhaps most gracious was Onahlea Shimunek, the general manager of the Lord Baltimore, who has nearly 30 years of experience in hospitality.

Onahlea serves on the boards of such organizations as Back on My Feet, which combats homelessness through the power of running, community support, and employment and housing resources, and HealthCare Access Maryland. Naturally, she possesses a proclivity toward initiatives such as those currently occupying her 440-room hotel. Her LinkedIn page says that she “embraces challenges that create opportunities for the LBH team.” What could be more challenging than a triage, respite, and isolation center?

One might say Onahlea put the hospitality in “hospital.” She also knew the stress that working at Hotel COVID placed on Marik and her family, so she arranged for Marik to use one of the Lord Baltimore Hotel’s penthouses that came with an open invitation to us, which is how I have come to waking up several mornings a month feeling my way around the walls to the kitchen. Windows to the south overlooked the LB Skybar on the 19th Floor and the ledge from which Molly’s parents leapt.

Wilhelm at the Lord Baltimore Hotel. —Gregg Wilhelm

Wilhelm and Moen's daughters in their room. —Gregg Wilhelm

On Memorial Day, the same day Marik officially moved into Hotel COVID, a cop in her home state of Minnesota pressed his knee into George Floyd’s neck for more than eight minutes, killing him. A few days later, the kids and I packed clothes, laptops, books, and the packets that Fairfax County Public Schools mailed out and joined her. Same ritual each time entering the building: guards armed, hands cleaned, temperatures checked, express elevator to the 21st floor, and a 360-degree view of Baltimore.

On Friday, May 29, the first weekend after George Floyd’s murder and just over five years since the death of Freddie Gray while in police custody, I noticed from the bedroom window a few people walking down the middle of Liberty Street at Fayette. (Nothing unusual about Baltimoreans jay-walking.) Then, a few more bodies filtered through, then a cluster of a dozen, more, marching south.

Suddenly, a two-week reservation at the Lord Baltimore Hotel in the heart of beautiful downtown Charm City did not sound like a vacation at all.

I ran downstairs to join the flow of souls awash with demonstrators converging on downtown traffic along Light Street at Harborplace. A chorus call and response rose up: “I can’t breathe!” followed by “No justice, no peace!” That evening, the thwump, thwump, thwump of industrial HVAC fans on rooftops below the penthouse echoed the beat of helicopters that hovered above the city. The after-protest action on Saturday night was fierier than the previous night, with cars and dirt bikes making laps around blocks and against traffic deep into the early morning.

A few hours later, I feel my way through the suite to brew coffee and catch the solar uprising while humming a Joe Strummer tune (“I’m waiting for the rays of the morning sun. Somebody tell me, has the new world begun?”).

On Monday, June 1, Marik dressed and descended the elevator to the COVID-crisis below while the kids and I booted up for work and school. I constantly patrol the penthouse windows, around and around like a figurine in a Black Forest house cuckoo clock. Then it struck, at mid-afternoon, a torrent of demonstrators led by peaceful youth protesters cascading down Baltimore Street past the hotel heading toward City Hall. I dragged the girls downstairs, “You can’t miss this! You may not entirely understand it, but you must see it.”

Again, the next Saturday, a march from City Hall west along Fayette turning north on Charles Street toward the Washington Monument. Again, I masked the kids and dragged them out in hopes that the indelible impression would lead to more serious conversations, maybe today, maybe tomorrow as they grow older. We stood in the intersection: “This is important stuff girls, look at it, look at it hard.” Masked demonstrators filed past us: “Dismantle Racist Police State,” “How Many More Times Does This Shit Have to Happen Until Black Lives Matter?,” “Enough is Enough.” A thousand hand-held placards. Look hard.

Wilhelm and Moen's daughters during the peaceful protests that were organized in Baltimore after George Floyd's death. —Gregg Wilhelm

Then we returned to the penthouse at the Hotel COVID, where we could rise above it all, an act of privilege that demanded to be acknowledged.

COVID-19 uprooted our lives, as it did for tens of thousands of families, with more dire consequences for far too many. For us, it meant Mom left for the TRI Center at the Lord Baltimore Hotel while I worked remotely, taught ineffectually, and oversaw lamely the final weeks of second and fourth grade for our kids from “home.” Although her time at the TRI Center would conclude at the end of summer, Marik’s public health career would continue to rattle her world and compel her to be on site, whereas my higher ed world would struggle to reimagine its future when its past hinged on bodies physically being on campus. With our lease due for renewal, we rolled the dice and started house hunting in Baltimore.

I told Marik that the unprecedented situation dictated the move. In fact, I was homesick.

On July 17, we closed on a house and moved back home to Baltimore. (I recognized one trustee’s name on the contract, a writer whose husband is a painter whose prints hung on our walls. The other trustee’s name was an estate lawyer and partner of a colleague of mine from when I worked at MICA. And the seller’s niece was a nurse practitioner who worked at the TRI Center with Marik. In other words, the quintessential Smalltimore signs of making a good decision.)

Then we returned to the penthouse at the Hotel COVID, where we could rise above it all, an act of privilege that demanded to be acknowledged.

The next weekend, Marik collected things that had accumulated at Hotel COVID and officially checked out. Her time with this project ended in early September. On the Sunday of Labor Day weekend, Marik’s phone buzzed the way it did most mornings just after 5:30 a.m. when the day’s staffing needs started to jostle. Nurses were needed at the Lord Baltimore, but Marik had checked out—even though I think a standing reservation is on hold for her.

As of this fall, the TRI Center had served more than 750 residents, saving lives due to close monitoring and triage to higher levels of care if residents’ conditions worsened. The team prevented countless infections by isolating positive people from the wider population and stemming the chain of transmission. The Lord Baltimore Hotel Triage Respite and Isolation Center will continue to operate through December, or as long as the epidemic still demands a Hotel COVID.

As of this writing, President-Elect Biden’s transition team attempts to coordinate a more unified response to the pandemic while the outgoing administration struggles with the resurgent coronavirus. It’s as bad as March, rates of infection higher than even the summer. And as Marik takes more shifts and the TRI Center team reaches out for support, I’m reminded of the classic Eagle’s song: You can check out of Hotel COVID, but you can never leave.

Gregg Wilhelm is the founder and former executive director of CityLit Project in Baltimore and director of the Creative Writing Program at George Mason University in Fairfax.

Source

Chris Davis Contributes Largest-Ever UMD Children’s Hospital Donation

Evan Greenberg — Mon, 04 Nov 2019 17:52:00 +0000

Orioles’ first baseman Chris Davis and his wife, Jill, have been visiting the University of Maryland Children’s Hospital (UMCH) for three years. It was during one of those visits that their attention was drawn to a new project within the pediatric division that was going to be a big undertaking, and they decided they wanted to help.

Monday, their contribution became public, as the two announced a $3-million donation to UMMC—the largest amount ever from a Baltimore sports figure. The gift is inspired in part by the Davises’ daughter, Evie, who was born with a ventricular septal defect in 2018.

“We experienced it on a very small scale,” Jill says. “We already have a soft spot for the hospital and its kids. That just made it more realistic to us.”

The Davises are enthusiastic philanthropists who work with many different organizations and causes in the Baltimore area. For the past three years, they have hosted “Crush’s Homers for Hearts,” a home run derby event that benefits the UMCH Children’s Heart program.

Jill says that part of the reason that the Davises don’t have a foundation of their own is because it would require them to hone in on one specific cause rather than casting a wide net. But this past summer, around the all-star break, she and Chris decided they wanted to do something big and “unexpected.”

“This is a cause that is close to our hearts,” Chris said in a press release. “Everyone at the hospital has inspired our family.”

Officially, the Davises’ donation will support funding for what will be known as the Evelyn Kay Davis Hybrid Catheterization Suite—a space that will allow doctors to double their capacity in relation to patients and procedures. Heart surgeries and operations on infants are often intricate, and the ability to be as advanced as possible—as well as retain top talent—is invaluable for the hospital.

“As an institution, we went about investing in human talent needed to invest in progress like this,” says Mohan Suntha, president and CEO at UMMC, regarding the hospital’s commitment to a pediatric heart care wing. “Chris and Jill have been unabashed ambassadors for our program.This will impact generations in the state of Maryland.”

The Davises typically prefer to keep their donations and philanthropy private. But given Jill’s background in nursing—having studied in Dallas, worked at Texas Scottish Rite, and volunteered at UMCH—the couple was willing to make an exception in this case.

“It was too much of a good thing to skip out on,” Chris says. “I understand that—it’s something for us to be proud of. Not everybody knows what goes on in Baltimore. We want people to jump on and be aware.”

Source

Top Nurses 2016: Unsung Heroes Of Health Care

Jess Mayhugh — Tue, 03 May 2016 08:30:00 +0000

Unsung Heroes Of Health Care

Our second annual Excellence in Nursing awards honor some of Baltimore’s best RNs.

By Ken Iglehart, Rebecca Kirkman, and Christianna McCausland | Photography by David Colwell.

Okay, We Have To Ask:

In health care, why do physicians get all the credit?

The answer probably has a lot to do with a seriously outdated perception of the role played by another group of medical professionals: registered nurses. They’re the thin white line of health care that, in the past 20 years or so, has taken on a multitude of new responsibilities once handled by doctors, in sickness and in health. The other question we should be asking? “Is there a nurse in the house?”

You’d be hard-pressed to find a region with more great nurses than metro Baltimore, and our job in Baltimore’s second annual Excellence in Nursing survey was to find some of those stars.

To arrive at the results, the unveiling of which coincides with National Nurses Week in May, we solicited nominations from peers, supervisors, and patients of registered nurses—both in and out of hospitals—who represent the finest in their field, and we received an overwhelming response. And in our accompanying story, “All in a Day’s Work,” we look at the typical harried day of a critical-care nurse at a hospital that gets plenty of ER action.

There were 17 nursing specialties for which we accepted nominations in a process that took nine months. Then the hard part began: picking the finalists. For that, we relied on the Maryland Nurses Association and major local hospitals to help us recruit an impressive panel of highly experienced RN advisers, who divvied up the specialties and pored over the hundreds of nominations to arrive at our winners. Congratulations to all 55 of them.

Meet Our Survey Advisors

We offer a tip of the nurse’s cap to our seven registered-nurse advisers, who lent their time, considerable expertise, and reputations to the survey process. Our advisers—several of whom re-upped for a second year in this role—are not eligible to be on the list of winners in the year they serve.

Linda K. Cook

Linda K. Cook Ph.D., RN, CCRN, CCNS, ACNP-BC, is an assistant professor at the University of Maryland School of Nursing. Dr. Cook has nearly 40 years of nursing experience, mainly in critical care and education. She is also the treasurer of the Maryland Nurses Association. Dr. Cook currently resides in Lanham.

D. Paxson Barker

D. Paxson Barker, Ph.D., MS, RN, has been a registered nurse for 43 years, most of that as a cardiovascular nurse specialist, and now serves as a public-health nurse specializing in environmental and occupational health. She currently teaches courses in an online format for graduate and undergraduate nursing students, including community/global health, population health, and dissertation completion.

Kim Bushnell

Dr. Kim Bushnell, DNP, MSN, RN, is the vice president for patient-care services and chief nursing officer at Mercy Medical Center. Her clinical background includes trauma and emergency, critical care, and flight nursing.Bushnell received her BSN from George Mason University in Virginia, her MSN from The Catholic University in Washington, D.C., and her DNP from The Johns Hopkins University School of Nursing.

Jenny Bowie

Jenny Bowie, RN, BSN, MBA, is the vice president of patient-care services and chief nurse executive at Mt. Washington Pediatric Hospital, providing strategic oversight for nursing, professional practice, respiratory therapy, pharmacy, infection prevention, and collaborative care. Bowie previously worked in various academic and community health care settings.

Joann M. Oliver

Joann M. Oliver, MNEd, RN, CNE, CBIS, received her BSN from Penn State and her master’s in nursing education degree from the University of Pittsburgh. A certified nurse educator and a certified brain-injury specialist, she teaches at Anne Arundel Community College, and is the recent past vice president of the Maryland Nurses Association.

Lynn Marie Bullock

Lynn Marie Bullock, DNP, RN, NE-BC, is the administrative director of the nursing professional practice at Greater Baltimore Medical Center. Bullock earned her bachelor’s of nursing degree from Syracuse University, a master’s of nursing degree and certificate in nursing education from Towson University, and a doctor of nursing practice degree from The Johns Hopkins University School of Nursing.

Idriz Limaj

Idriz Limaj, LNHA, RN, is the chief operating officer of Levindale Hebrew Geriatric Center and Hospital and the post-acute division at LifeBridge Health. The post-acute services Limaj oversees include long-term care, behavioral health, chronic hospital services, and skilled nursing-home care, as well as outpatient day-treatment programs and adult-day services. The division is located at Northwest Hospital and Levindale.

Erynn Bossom

Nurse Manager, Neuro Telemetry Unit
Saint Agnes Hospital

What does your unit do? We focus on the care of the neurological population and specialize in stroke care.

What inspired you to get into the field? I come from a long line of nurses and have always been driven to help others.

How has nursing evolved during your career? The shift to evidence-based practice has allowed nurses to achieve the best possible outcomes based on research.

What is the most important attribute for a nurse? The most valuable qualities for our nurses are their compassion and their keen assessment skills, which allow them to identify the smallest of changes and act appropriately.

What’s the greatest reward in being a nurse? I’d say it’s watching the new graduate nurses grow and develop. But my favorite moment was when a nurse came to me on his last day to thank me for helping him on his journey. He had struggled significantly as a new graduate, but is now starting the nurse anesthetist program. I couldn’t be more pleased for him.

What’s your biggest challenge? Like many nurses, it’s maintaining a healthy work-life balance. I love both so much and work diligently to maintain that balance.

What other kudos have you received for your work? I’ve been nominated for many nurse-excellence awards in the category of performance improvement.

What’s your best advice for those getting into the field? Never stop learning and always ask questions.

Phyllis Hawkins

Heart care unit/subacute rehabilitation
Lifebridge Health Northwest Hospital

How has nursing evolved? There are many more demands put on nurses these days, but I also think people are often sicker than they were, perhaps because of unhealthy lifestyles and diets. There’s also a lot more work keeping up with new technology, new regulations, and new data-recording systems.

What’s the most critical quality for a nurse in your specialty? I think just having the compassion it takes to really do nursing, and understanding that it’s not just a 9-to-5 thing—you have to really want to care for people.

What’s your biggest challenge? Not having enough time in the day to get everything done.
What do you consider the profession’s greatest rewards? When you see someone get well, and you know you’ve made a difference in someone’s life, that’s the best feeling ever.

What advice do you give to new nurses? Sometimes people come into nursing not understanding that they may sometimes have to do it all: They may have to empty a bedpan, or clean up the bed if someone vomits. You better be ready to wear many different hats, but it’s such a rewarding profession.

What would you have done as a career if you hadn’t been a nurse? I think I would have been a schoolteacher. I like small kids, and would have loved to teach kindergarten to first grade.

Joan Geckle

Staff Nurse III, neonatal/pediatric nurse
Mt. Washington Pediatric Hospital

What does your job entail? I take care of neonates and infants with different diagnoses ranging from prematurity, drug withdrawal, and birth complications to congenital anomalies, to name a few.

How did you get into nursing? I was hospitalized when I was 7 and the nursing student who took care of me was very kind. I wanted to do the same when I grew up.

What’s unique about what you do? We routinely see infants with uncommon diagnoses that other neonatal nurses may see once or twice in a lifetime. We also have patients for much longer than other units—weeks to months—so the families become our families.

What do you consider the profession’s greatest rewards? Even if the outcome is a sad one, if you helped a parent cope with it, how can that not be the greatest reward?

Can you give an example of a time you felt especially rewarded by your job? I have watched a mother so scared to touch her infant because of all the tubes and equipment; she would just sit and stare. She would have to learn to care for the child with all the equipment at home (tracheostomy, ventilator, gastrostomy tube, etc.). I told her I knew she would be able to do it. She slowly learned with our encouragement. By the time they were discharged, the mother was telling us exactly how to do his care, how to suction, and how he liked his formula given. She was now his best advocate. It is the best feeling—to know you were a part of such growth.

Christina Purificato

Critical-care registered nurse
University of Maryland Medical Center

What exactly do you do? My official title is Clinical Nurse II, and I work in the surgical intensive care unit at University of Maryland Medical Center. I have worked in the SICU for the past two years, but have experience in the medical intensive care unit and cardiac surgery ICU, as well. The patients I care for suffer from various illnesses, ranging from bowel obstructions to end-stage liver disease requiring transplantation to ruptured aortic aneurysms.

What’s the most important attribute for a critical-care registered nurse?Flexibility. A patient’s status can change in the blink of an eye. I have watched a stable patient, sitting in a chair talking and joking with me about how young I look, and in the next breath, his eyes roll back in his head and his heart stops on the monitor. I have had days on the unit where I feel comfortable maintaining my two patient assignments only for a Code Blue to be called in the cardiac cath lab. Holding the code pager, I have to run into an unknown situation in an unknown corner of the hospital where someone is actively dying. The hat of an ICU nurse is always changing.

What is the profession’s greatest reward? Saving that patient. It is fascinating to me to watch the human body undergo an incredible amount of damage, only to heal, repair, and become strong again.

What would you be doing if you weren’t in this field? I would be a professional baker somewhere, making treats that are sugar-frosted, dipped in chocolate, and fried in lard.

Joseph Henry

Neonatal Intensive Care Unit
Greater Baltimore Medical Center

How did you get into nursing? In 1980, I started working at Mercy Medical Center as a temporary storeroom clerk in the lab, then as an attendant, mostly on the night shift. During those early years, it was typical that you were floated to multiple units, so I was able to learn how registered nurses worked. I especially was drawn to the encounters that RNs would have with the patients and their families, and decided nursing would be a great career choice for me.

What do you consider the profession’s greatest reward? The nursing profession affords us the honor to be with infants, parents, and families when they are most vulnerable. Making a difference to them is special and allows a closeness that is humbling as their trust in us grows.

Can you give an example of a time you felt especially rewarded by your job? One special event was when I was asked by a family to attend the blessing of their infant in church. I think back to when he was born and all of the challenges that he and his family endured. When I was at the blessing, I reflected on my job and how wonderful it is that I can be part of supporting the family as they start to assume their role as parents of a NICU infant.

What advice do you give to new nurses? First off, I recommend new nurses try multiple clinical areas before making a decision to commit to one nursing specialty. Every unit or specialty has hidden gifts that you might not discover until you’ve experienced working there.

Harriett Knight

Psychiatric nurse
Lifebridge Health Sinai Hospital

How did you get into nursing? I originally wanted to be a biologist because I love science, but I changed my mind after graduating from high school. It was during the Vietnam War, and a lot of my friends were in the military, including some as medics or nurses, and I thought nursing would be interesting, so I went back to school to be an RN.

What’s unique about what you do? I’m able to see people get better. Years ago, many mentally ill people were warehoused in state institutions for years, but with advances in medications, they can be stabilized and many can go back and function in society if they take their meds.

What is your greatest challenge? Maintaining patient safety, in the mental health unit in particular.

What advice do you give to new nurses? Make sure it’s what you really want, because it’s very demanding and, as a science, it’s not always easy. There’s always something new you must learn, from new medications and technology to new record-keeping software, patient privacy laws, and patient-safety protocols.

What would you have done as a career if you hadn’t been a nurse? I’m trained as a forensic nurse examiner and certified as a nurse educator, as well, so I think if it had not been biology, it would have been teaching. I’ve taught nursing at both the high school and college level.

Danielle Koceski

Senior Clinical Nurse
The Johns Hopkins University School of Medicine Division of Gastroenterology & Hepatology

How did you get into nursing? My grandmother is a nurse, so it’s in the genes. My decision to become a nurse was solidified when I was hospitalized as a teenager. My nurses were so kind, compassionate, and caring and were my advocates when I was too ill to speak for myself.

How has nursing evolved? Nursing has changed from white uniforms to blue scrubs, from manual blood pressure cuffs to machines, from paper charts to computerized charting. But the qualities of a nurse remain constant: Caring, patience, compassion, and professionalism are just a few of our qualities. We are the heart of health care.

Can you give an example of a time you felt especially rewarded by your job? Recently, a patient cut out all the sugars and sodas in their diet and started exercising because of a five-minute conversation I had with them on the phone. Making a small change can make a huge difference in someone’s life.

What advice do you give to new nurses? I started my career as a bedside hospital medical-surgical nurse. I tell any new grad that’s the best place to start to get a good foundation of experience and knowledge. The great thing about nursing is that there are so many opportunities and specializations, you can continue in nursing and change specialties. I’ve been a nurse for 17 years and have been a school nurse, office nurse, surgical nurse, endoscopy nurse, and hospital nurse, with many different specialties in all of those jobs.

The List

The Envelope, Please!

Here are the winners of our Excellence in Nursing survey, organized in 17 nursing specialties.

Acute Care/Family Practice/General Medicine

Susan Pribyl
Charge nurse
MedStar Franklin Square Medical Center

Brigid Carey
Intensive care, MICU
The Johns Hopkins Hospital

Cardiovascular

JoJo Abrenica
Clinical leader
LifeBridge Health
Sinai Hospital Progressive Care Unit

Theresa DeVeaux
Acute care, vascular surgery
University of Maryland Baltimore Washington Medical Center

Chona Rizarri
Cardiovascular surgery
University of Maryland Medical Center

Deborah Rouse
Vascular access nurse
MedStar Franklin Square Medical Center

Donna Thompson
Cardiopulmonary
University of Maryland Upper Chesapeake Health

Jackie Bradstock
Cardiovascular
The Johns Hopkins Hospital

Community Care/
Ambulatory Care

Merrill Chaus
Recovery room, pre-operative
Windsor Mill Surgery Center

Debora Phillips
Interventional radiology nurse coordinator
Mercy Medical Center

Danielle Koceski
Senior clinical nurse, infusion
The Johns Hopkins University School of Medicine Division of Gastroenterology & Hepatology

Patricia Underland
Clinician, nurse practitioner, nurse coordinator
Maryland Hemophilia Treatment Center The Johns Hopkins Hospital

Educator

Tracy Kostelec
Clinical educator
Mercy Medical Center

Shelia Murphy
Associate professor nursing, critical- care ICU nurse
Anne Arundel Community College

Jessica Powers
Professional development specialist
MedStar Franklin Square Medical Center

Harriett Knight
Inpatient acute-care psychiatry, educator
LifeBridge Health Sinai Hospital

Emergency Department

Jessica Black
Emergency room
LifeBridge Health Sinai Hospital

Jonathon Burger
Emergency room
Carroll Hospital Center

Martha Saroop
Clinical leader, emergency room
LifeBridge Health Sinai Hospital

Barbara Davis-Severe
Emergency room
University of Maryland St. Joseph Medical Center

Hospice/Home Health/Palliative

Erin Batton
Pediatric hospice, perinatal hospice nurse
Gilchrist Hospice Care

Pam Naumann
Inpatient, outpatient hospice nurse
Carroll Hospital Center, Dove House

Intensive care

Janet Townley
Clinical nurse IV, ICU
Saint Agnes Hospital

Mariama Diallo
Critical-care nurse
University of Maryland Medical Center

Andrea Roche
Intensive care
LifeBridge Health Northwest Hospital

Christina Purificato
Clinical nurse II, surgical intensive care unit
University of Maryland Medical Center

Management/ Nurse Executives

Amy Alsante
Manager, emergency preparedness
MedStar Franklin Square Medical Center

Tanja Gross
Nurse manager
Mercy Medical Center

Justine Kellar
Administrator, critical- care and emergency services, telemetry, sexual assault
Greater Baltimore Medical Center

Erynn Bossom
Nurse manager, neuro-stroke
Saint Agnes Hospital

Carlene Frew
Director, nursing resources
Saint Agnes Hospital

Medical-Surgical Nursing

Carolyn Reddick-Hooker
RMeg-surg bariatric unit, registered nurse II
Saint Agnes Hospital

Juvel-Lou “Jovie” Velasco
Registered clinical nurse
Mercy Medical Center

Epimaco DeGuia Jr.
Orthopedic and general surgery, bariatric surgery, plastic surgery
LifeBridge Health Northwest Hospital

Donna Audia
Senior clinical nurse I, trauma, pain management, integrative medicine
University of Maryland Medical Center

Neurology/ Psychology/ Behavioral Health

Kathy Daddario
TMS RN coordinator
The Retreat at Sheppard Pratt

Valerie Leatherman
Neurology, cardiac, telemetry
University of Maryland Upper Chesapeake Health

Oncology

Sandra Levy
Registered nurse II
LifeBridge Health Sinai Hospital

Carol Brumsted
Infusion nurse
Anne Arundel Medical Center, DeCesaris Cancer Institute; LifeBridge Health Northwest Hospital, Outpatient Infusion Center

Dyanne Barnes
Oncology nurse
University of Maryland Upper Chesapeake Health

Anna Recchio
Oncology nurse
Park Medical Associates

Orthopedics

Shannon Isaac
Orthopedic nurse
Greater Baltimore Medical Center

Walter Wilson
Orthopedic nurse
University of Maryland St. Joseph Medical Center

Pediatrics: Neonatal

Joan Geckle
Pediatric nurse
Mt. Washington Pediatric Hospital

Joseph Henry
Neonatal intensive care unit
Greater Baltimore Medical Center

Pediatrics: Non-Neonatal

Stephanie Brown
Certified pediatric nurse
The Johend wrapperns Hopkins Hospital

Lisa Catalano
Charge nurse, adolescent unit
Sheppard Pratt Health System, Ellicott City

Jasmine Noronha
Clinical nurse II, pediatric progressive care unit
University of Maryland Medical Center

Jacqueline Parler
Non-neonatal nurse
Mt. Washington Pediatric Hospital

School

Monique Bowie
The Jefferson School, Sheppard Pratt Health System

Senior Services

Phyllis Hawkins
Heart care unit
LifeBridge Health Northwest Hospital

Lauri Malin
Nurse manager, adult day care
Pikesville Adult Day Services

Women’s Health

Kirsten Martuszewski
Labor and delivery, obstetrics
LifeBridge Health Sinai Hospital

Laura Clary
Laura Clary Sexual assault forensic nurse examiner, women’s health
Greater Baltimore Medical Center

Sherry Pearson
Labor and delivery
Greater Baltimore Medical Center

Alphabet Soup

So, let’s take the case of our survey adviser, Joann Oliver. Her friends may know her as Joann, but, to you, she’s Joann M. Oliver, MNEd, RN, CNE, CBIS. Say what? To translate that, here’s our cheat sheet of just a few of the nurse certifications, degrees, and other stamps of approval, courtesy of Mt. Washington Pediatric Hospital human resources manager and RN Monica Atkinson.

ANCP-BC: Acute-Care Nurse Practitioner, Board-Certified.

BSN: Bachelor of Science in Nursing.

CBIS: Certified Brain Injury Specialist.

CCNS: Acute/Critical- Care Clinical Nurse Specialists.

CCRN: Acute/Critical- Care RN.

CEN: Certified Emergency Nurse.

CNE: Certified Nurse Educator.

DNP: Doctor of Nursing Practice.

LNHA: Licensed Nursing Home Administrator.

LPN: Licensed practical nurse.

LVN: Licensed Vocational Nurse.

MSN: Master of Science, Nursing.

MICU: Medical Intensive Care Unit.

MNEd: Master’s in Nursing Education.

NICU: Neonatal Intensive Care Unit.

NE-BC: Nurse Executive, Board-Certified.

NP: Nurse Practitioner.

Ph.D: You already know this one.

RN: You guessed it, again.

All in a Day's Work

For an ER nurse in the big city, there’s no such thing as a boring shift.
By Christianna McCausland

At 11 a.m. on a typical workday, Jessica Black, RN, clocks in for her 12-hour shift in Sinai Hospital’s Department of Emergency Medicine, known as ER-7. Like a football team huddling, all the nurses gather for shift report. It’s the moment they review any new policies and equipment, go over who’s covering which jobs—such as triage nurse or rapid-response nurse—and who will be the “float” nurse to cover everyone during their lunch hours. Black recalls one morning in particular, right after the shift report, when she was assigned four patients to cover.

On that day, everything started out pretty routine. Amongst her charges’ complaints were a toothache, a bellyache, and chest pain. Since she was always prioritizing, the chest pain was her first stop.

“I like to eyeball all my patients, even if I’m not doing a full assessment, and say, ‘I’ll be right back,’ then I’ll go to my sickest [patient] first,” says Black, who holds a Bachelor of Science degree in nursing and is a certified emergency nurse. The belly-pain patient, an older woman, was very insistent, so Black tried to make her comfortable before moving to the chest-pain case. She got the woman some Maalox. But Black’s seemingly uneventful day ended there.

“As she’s drinking it, it spills out of the left side of her mouth,” Black recalls. “So I ask her to try that again. Then I asked her to give me a smile and she’s only moving the right side and the left is drooping a little—she was literally having a stroke in front of my face.”

The team immediately delivered tPA, an intravenous medication that dissolves blood clots, and the woman stabilized nicely. But there was little time to celebrate. In a 56-bed emergency department that sees 200 to 250 patients a day, you never know what to expect. But that’s what turns Black on about her job. “I love not knowing what you’re going to get,” she says. “It keeps you busy and you’re always on your feet. I don’t like to sit.”

The 25-year-old Perry Hall resident joined Sinai right out of nursing school in 2012, attracted by the fact that Sinai is a level II trauma center, as well as a cardiovascular institute and stroke center. She was hungry to learn and knew a busy, urban emergency department was the place to do it.

As at most EDs, one common complaint at Sinai is chest pain, but on any given day, it’s not uncommon to have someone in cardiac arrest, a gunshot victim, or victims of car accidents. In addition to the trauma patients, Black also sees a lot of very sick people, like cancer patients with uncontrolled fevers and dialysis patients with fluid overload.

Then there are the seasonal outdoor injuries: If it’s spring, the ED might get the older men who didn’t get the memo about their age and fell off a ladder while cleaning gutters. In the winter, other weekend warriors return with heart attacks from shoveling snow. Kids’ sports injuries spike in the spring, as do motorcycle accidents. Late summer and fall? Think kids with football injuries.

But unlike the quiet suburban hospitals in Towson or Rosedale, Sinai is also the ambulance drivers’ frequent choice for shooting victims in that area of the city, and those cases are a pretty common occurrence for a hospital on the border of some of Northwest Baltimore’s poorest and most drug-ridden neighborhoods. They used to spike in the warm months, but recently Black has been seeing them regardless of the season.

Despite the rush he gets from the trauma cases, Black also likes pediatrics. Sinai recently remodeled its pediatric emergency area, expanding it from eight to 13 beds. These little patients can be tough—Black has had medication spat in her face more than once—but they’re also a lot of fun. Until things go wrong.

“People tell you that you can’t cry, but any pediatric death is definitely very hard,” she says. “I’ve cried with patients and with mothers and fathers. There are times you tell them and they literally collapse in your arms. Those are the days when you get in the car and cry the whole way home.”

That’s the thing about emergency departments, or EDs: While plenty of people come for relatively minor things like the flu and pregnancy tests, many people are there for life-or-death reasons.

Black keeps a journal. When things go well, like the one day she was doing compressions on a cardiac-arrest patient who successfully stabilized, she logs that in her book. In that case, she was able to see the patient reconnected with his girlfriend. On days when things go badly, she pulls the journal out to remind herself it isn’t always awful. But she’ll also tell you that affirmative journal entries aren’t enough—her job is one that requires an emotional shell.

“That’s the thing with ED nurses, you have to build a wall up,” she says. “We’re still nice and you have compassion, but if you don’t build a wall, everything’s going to beat you up and you’ll be upset all the time. That’s one of the things I needed to learn as a new nurse.”

Ironically, this is also part of the ED’s appeal for Black. If she worked on a floor with the same patients day after day, she fears she would get too attached. In the ED, though, there’s always a patient going out and a new one coming in.

Sometimes she takes down the patients’ names and follows up to see how they fared after they left her care. “Other times, especially if I know it isn’t going to be good, you just want to forget.”

Black is lobbying the hospital administration for a bereavement room where family notifications can take place and where sensitive conversations can happen (like whether it’s best to transfer a patient to hospice care). It is the physician’s role to inform a family of a death, though often a nurse is there for support. Black is trying to institute a more team-based approach to notification where the doctor, nurse, a security guard, a patient advocate, and someone from pastoral care would all be involved. She believes that would be better for the families and safer for the staff.

“Everyone has different reactions—you never know how someone is going to react,” she says. “You may have to tell a family that someone is passed and they might cry with you or they may start punching walls.”

She also envisions the bereavement room as a place where staff can debrief after particularly challenging patients. “It’s so busy, we just go on to the next patient instead of being like, ‘You know, that kind of sucked and I want to talk about it with somebody,’” she says. “We should have a room where people from that cardiac arrest [team] can say, ‘You did a great job,’ a place to talk about the bad things, but also hear the good things. We need to give ourselves time to take a chill pill.”

One of Black’s least favorite assignments is triage. In a busy ED, people wait. And wait. And they can get downright verbally abusive.

“They don’t realize you could have someone literally dying next door, and here they’re getting upset because you aren’t spending enough time with them,” says Black. “It’s hard because you can’t explain why [you’re delayed] and you can’t please everyone. You have to remind yourself they’re having a problem, too, that they don’t know what’s going on next door.”

And then there are the addicts. While the proliferation of Narcan (an opiate antidote) may have helped manage the load of heroin overdoses outside the hospital, Black says they still have cases where someone ODs and their friends dump them outside the ED doors.

“The majority of the time, we’re able to give them Narcan and they’re better,” she says, “but you want to shake them and say, ‘Do you realize what you just did there? You literally just died for a second and we saved you.’ You realize you can’t be mad at them because they have a problem. And you want to get them help, but you can’t force people to get help.”

At the time the elderly woman had the stroke with Black watching, Black was at the end of her orientation, a fresh-faced new nurse. Now she trains new orientees. The hospital’s training keeps staff abreast of everything, from how to handle an active shooter in the building to how to put on a hazmat suit if, for example, there were a chemical spill or you have a patient with possible Ebola.

When she became an ED nurse, Black never realized how culturally literate she would need to become. She has learned ways to respectfully work with patients who can’t use their call button or sign their name because they’re observing the Jewish Sabbath. And then, when it’s time to call the morgue, there are different cultural customs about the disposal of a body.

She has also learned a little police work. In the case of trauma victims, the patient’s clothes are entirely removed. If the police are involved, the clothes are bagged for them and the patient is photographed. If the person dies, the room itself becomes a crime scene.

The emergency department is so relentlessly busy that Black carries a pen and paper with her to take notes on her patients, because it could be hours before she can sit down at a computer to do her charting.

“I like the fast pace where you have a stroke or a heart attack and you have to work, work, work really fast,” she says. “Or the trauma where it could be a stab wound in the leg, it could be multiple gunshots to the chest, or a car accident. That’s the kind of stuff I like. It’s not nice to see, but I’m always learning.”

Wanted:
Nurses in Baltimore

Where to go to find the best nursing jobs? Baltimore wouldn’t be a bad choice, according to a data project undertaken jointly by the SpareFoot Blog and Indeed, the world’s largest job site by users.

In a ranking of the 10 cities with the best offerings for nurses—which considered things like average pay and housing costs—we came in No. 8 in the nation, ahead of San Diego and Phoenix, but behind No. 1 Houston.

But the medical mecca that is Baltimore ranked higher than many other locales for what nurses get paid, coming in at No. 4 with an average annual salary of $73,000, though we dropped to No. 7 when housing costs were factored in.

Racetrack Triage

If there’s one thing Black encourages all new nurses to do, it’s to work the Preakness. With its close proximity to Pimlico Race Course, Sinai is ground zero for all race-day mishaps, and Black has worked the department during the event as well as being part of a team that sets up a tent at the track on race day. “I say [to new nurses], you have to see this and then you never have to work it again. But you need to see it,” she says with a laugh. “That’s probably one of the busiest days and you better come up ready for it. You still have sick people having heart attacks, but then you also have all the young kids from the Preakness that are lining the hallways with their puke buckets.”

ER 411

About 136 million people will visit one of America’s emergency rooms this year. Here are some facts about their visits:

85

percent of patients have health insurance.

Chest and abdominal pain are the most common reasons to visit an ER.

40.2

million visits are caused by injuries.

58

The average wait to be seen is about 58 minutes.

Less than 3 percent of America’s $2.9 trillion health care tab in 2013 was spent in ERs.

Source

Life Imitates Art

Jess Mayhugh — Tue, 16 Feb 2016 08:30:00 +0000

It was Labor Day 2014 when Jay Herzog went to the emergency room. “I put on about 35 to 40 pounds within a week,” says Herzog, a professor in the theater department at Towson University and, for the last 20 years, the resident lighting designer for Baltimore’s Everyman Theatre. His ultimate diagnosis would be alpha-1 antitrypsin deficiency, a rare inherited condition that was causing his liver to fail and his body to retain water (hence the weight gain). But the only thing doctors were sure of then was that he needed a new liver—stat.

On January 21, 2015, the married father of two was wheeled into surgery at University of Maryland Medical Center to receive a new liver.

But unlike the majority of transplants performed in the U.S., for which the organ is harvested from a deceased donor, Herzog’s was a living donor transplant, meaning he received a portion of a liver from a healthy donor. Because livers can regenerate, both donor and transplant recipient end up with full-sized livers.

Living donations are often preferable, especially for patients with liver failure, says Dr. Rolf Barth, the lead surgeon on Herzog’s transplant team.

“Because of the shortage of available livers for transplantation, only about half of the patients waiting for transplantation will receive a transplant,” he says. “Deceased donor organs are only allocated to the sickest patients, thus . . . others may end up without a realistic chance of transplant if a living donor does not step forward.”

Coincidentally, while Herzog was recuperating, Everyman artistic director Vincent Lancisi was scouting plays for the 2015-2016 season. In Philadelphia, he saw Under the Skin, a new play about a father in need of a new kidney from his estranged daughter. “I just loved the play,” says Lancisi. “It’s about what it means to give a piece of yourself to someone else. I couldn’t wait to tell Jay about it.” Herzog also loved the play, which opened on January 20—almost exactly one year after his transplant—and runs through February 21.

Herzog is seizing the play as an opportunity for advocacy, with organizations, including the Living Legacy Foundation and Transplant Recipients International Organization (TRIO), distributing information in the lobby. Says Herzog: “When you go through something like this, we look for reasons why. And my reason now is to share the word about transplants.”

Source

Top Nurses 2015

Mike Smith — Thu, 07 May 2015 09:00:00 +0000

Where do you find Baltimore’s most accomplished nurses? A good start would be the Excellence in Nursing survey that follows, which highlights the indispensable and often unsung contributions that nurses make to health care and education in the Baltimore region. To arrive at the results of our survey, the unveiling of which coincides with National Nurses Week in May, we solicited nominations from peers, supervisors, and patients of registered nurses (R.N.s)—both in and out of hospitals—who represent the finest in their field, and we received an overwhelming response. In our accompanying story, “The Nurse Will See You Now,” we look at the much larger role that nurses have been playing in health care for the past decade. There were 18 nursing specialties for which we accepted nominations in a process that took nine months, and then the hard part began: picking the finalists. For that, we relied on the Maryland Nurses Association and major local hospitals to help us recruit an impressive panel of R.N. advisors, who divvied up the specialties and poured over the nominations to arrive at our winners. Congratulations to all 50 of them.

Meet Our Survey Advisers

Baltimore extends its thanks to our expert panel of advisers, who sifted through the hundreds of nominations to chose our winners.

Linda Cook
Linda K. Cook is an assistant professor of nursing at the University of Maryland Baltimore School of Nursing. Dr. Cook has close to 40 years of nursing experience, mainly in critical care and nursing education, is the treasurer of the Maryland Nurses Association, and is involved in the Maryland Action Coalition for The Future of Nursing.

Kim Bushnell
Kim Bushnell is the vice president for patient care services and chief nursing officer at Mercy Medical Center. Prior to joining Mercy three years ago, she held various leadership positions, including assistant vice president for patient care and director-level positions in critical care and emergency services.

D. Paxson Barker
Paxson Barker has been a registered nurse for 43 years, first as a cardiovascular nurse specialist and now as a public-health nurse specializing in environmental and occupational health. She is currently a nurse educator teaching graduate and undergraduate nursing courses in an online format.

Janice J. Hoffman
Janice J. Hoffman is the assistant dean of the Bachelor of Science in Nursing program at the University of Maryland School of Nursing. With over 30 years of nursing experience, she has taught in baccalaureate, associate, and diploma nursing programs, and she has served in acute-care and military staff-development positions.

Ed Suddath
Ed Suddath has served for seven years as the chief staff officer at the Maryland Nurses Association, founded in 1903 as the only membership organization for registered nurses in Maryland. He has over 40 years of experience in the combined fields of education and association management.

Joann Oliver
Joann Oliver has worked in multiple settings, including critical care, staff development, and school health, and has taught in varied academic settings. She currently teaches in the nursing department at Anne Arundel Community College and is vice president of the Maryland Nurses Association.

Lisa Rowen
Lisa Rowen is senior vice president for patient care services and chief nursing officer at the University of Maryland Medical Center, overseeing 5,000 nurses and other health professionals. She is an associate professor at the University of Maryland School of Nursing.

Kathleen T. Ogle
Kathleen T. Ogle is the interim chair for the department of nursing at Towson University. She has over 45 years of nursing experience, mainly in emergency and trauma. She also maintains a practice as a family nurse practitioner, and is the president-elect of the Maryland Nurses Association.

Renee Kwok, 32

Nurse manager, Department of Radiation Oncology, University of Maryland Medical Center

What advice do you give to new nurses? I tell them to be proactive and never be afraid to ask questions. How important is teamwork? It’s extremely important. As they say, ‘There is no “I” in team’—everyone plays an important role in teamwork. How do you handle a highly stressful day? I take a deep breath and do one thing at a time. What would you have done as a career if you hadn’t been a nurse? I would have chosen to become a teacher. Can you give an example of a time you felt especially rewarded by your job? Whenever patients hold my hands and say a simple ‘thank you’ and then smile at me.

Rebecca Dickinson, 27

Nurse team leader, Center for Pediatric and Adolescent Rehabilitation, Mt. Washington Pediatric Hospital

What makes working with kids different? The most important quality working with children is patience since you have to address the child’s fears, their family’s concerns, and procedures could take longer to make sure they are as pain-free as possible. You also have to be willing to take breaks to give out hugs, snuggle with the babies, and play games with the older kids. What would you have done if you hadn’t been a nurse? I probably would have become a forensic scientist. How do you cope with stress? I have to be able to laugh at work and make jokes or else I would be an emotional mess while I’m there.

Ganogtong “Nok” Tongprom, 52

Staff R.N., Sherwood Surgical Center, GBMC

What would you have done if you hadn’t been a nurse? Actually, nursing was not my first career. For 16 years, I worked on computer-communication networks for air-traffic control. I got interested in nursing when I moved to the United States. What advice do you give to new nurses? New nurses should make sure their heart is in the right place before committing to the job. Get as much experience as possible by learning from every doctor, nurse, and technician with whom you work. Make sure you have heart and a good attitude when you choose to be a nurse. What is your greatest challenge? As a nurse, I have to show my sincerity to each patient to gain their trust. The challenge is how to approach each individual patient to do so.

Kimberly Bowen, 44

Registered nurse II, Sinai Hospital of Baltimore

What’s the best thing about your job? Saving lives, relieving pain, reassuring people, and providing overall service to everyone who entrusts us with their care. What’s unique about what you do? The Emergency Department is fast-paced and you never know what is going to come in the door at any given time. Knowing that you have nurses, doctors, critical-care techs, and many other disciplines helping you to provide quality care to that patient is empowering. How do you cope with a difficult day? Everyone has stress—it’s all in how you deal with it. I find comfort and support from my colleagues. Sometimes it’s talking it through with someone who understands and can relate to a situation.

Lynn Richards-McDonald, 46

Cervical-cancer screening coordinator, The Johns Hopkins Hospital

How has nursing changed? Once a profession that began without formal training, nursing has advanced to a respected art and science with the expansion of roles and duties and advanced degrees. One constant is that the nurse has always been expected to perform her duties with compassion. What’s the most important quality for a nurse with your job? Advocacy. In this particular role, I see women who are underserved. It’s important that I create a relaxing and private setting to answer any questions she may have in very simple terms. What is your greatest challenge? Obtaining adequate resources to support my program. . . . I work with what I have, do my best, and, hopefully, I will one day obtain additional resources to support this incredible service for underserved women.

Todd Milliron, 41

Senior clinical nurse, University of Maryland Medical Center

How did you get into nursing? Growing up on a small dairy farm in Pennsylvania, I was always willing to jump in and help when someone was injured or an animal went down. How has nursing evolved? Opportunities for nurses continue to expand as they are utilized for their expertise outside of hospitals. However, there are so many jobs available once you have R.N. behind your name that we could see fewer experienced nurses at the bedside. What do you consider the profession’s greatest rewards? When a patient or family member comes up to you and says ‘thanks’ or writes a letter about your care, it’s like hitting the lottery.

Tanya Allen, 49

Director of health services, Roland Park Place.

How did you get into nursing? When I was very young, I had a cerebrovascular accident, or stroke. The excellent care provided to me during that time piqued my interest in wanting to become a nurse so that I, once a receiver, could now be a giver of excellent care. What’s the most important quality for a nurse with your job? Since Roland Park Place is a continuing-care retirement community, which provides services to the geriatric population, the most important quality a nurse with my job should possess is patience with families and residents alike. What advice do you give to new nurses? Find your niche in the nursing arena and flourish. And never stop learning because things are always changing and improving in the nursing field.

–Shuttersock

Florence Nightingale Would Be Proud

For today’s nurses, it’s about new roles and increased responsibilities.

By Christina Breda Antoniades

It used to be, if you wanted to see nurses in action, your best bet would be to head to a hospital. There, you’d find them hard at work, ministering to patients with every conceivable affliction. You’ll still find them there, of course, though today they’re performing more complex tasks with higher-tech tools than ever before and collaborating in new ways across countless disciplines. Increasingly, you’ll also find nurses outside the hospital walls, heading to patients’ homes to offer care or wellness education, assisting in procedures at outpatient centers, or even providing primary care in doctor’s offices and urgent-care clinics.

“The biggest change is where nurses work,” says Maryland Nurses Association (MNA) president Janice Hoffman. “It used to be, if you were really sick and needed nursing care, you had to get it in a hospital. That’s no longer true.” The shift is driven by a blend of factors, including reduced hospital stays for patients driven by changes in insurance coverage and cost-cutting motives, as well as enhanced technologies and practices that have allowed surgeries and procedures to move from the hospital to outpatient centers.

There’s another factor driving change, too: The population of Americans over the age of 65 is rapidly growing—they’ll account for an estimated 20 percent of Americans by 2030—and many are living longer, albeit with chronic health conditions likes diabetes, heart disease, and obesity. At the same time, the Affordable Care Act has given millions of Americans access to health care, increasing demand for primary care, in particular.

That increased demand—along with the desire to lower healthcare costs—has spurred a renewed focus on wellness and disease prevention, says Hoffman. “The idea is to get people before they’re sick.”

Such efforts put registered nurses into the community to help patients manage chronic conditions and stay out of the hospital. At The Johns Hopkins Hospital, once a patient is hospitalized, staff begin strategizing about how that person can best manage his or her condition when he or she heads home.

Instead of focusing just on the patient’s immediate needs while in the hospital, says Karen Haller, vice president for nursing and patient care services at Hopkins Hospital, “we’re thinking of the care provided in those days plus the 30 days after that.”

Not only are nurses in the hospital working to ensure patients leave fully prepared to manage their health, but home-care nurses also follow patients into the community to help them overcome obstacles to wellness. “They’re there to assess how patients are progressing, to make sure the patients are able to follow up on their discharge plans, that they can get their prescriptions filled, and that their side-effects are well managed,” says Haller.

A nurse visiting a patient at home might find, for example, that the patient hasn’t gotten needed medication due to the cost or has forgotten an important instruction for post-surgical care. Even seemingly non-medical challenges, like a flight of stairs that limits a patient’s mobility or an on-the-fritz air-conditioning unit, can put a patient’s health at risk. A nurse visiting the home can head off such problems, coordinating with the medical team when necessary or calling in social workers or family to improve a patient’s environment. The end result is a reduction in re-admissions and better long-term health for patients.

As nurses step out into the community, they’re also stepping up, providing care in ever more complex ways. In part, that’s because the increased demand for health care is coupled with another trend: a looming decline in physicians practicing primary-care medicine.

“We’re in this perfect storm,” says Haller. “There aren’t going to be enough primary-care physicians, so we’re going to have to think of new models.” One likely solution is to turn to nurse practitioners, a subset of the Advanced Practice Registered Nurse (APRN). In Maryland, APRNs are licensed to write prescriptions and order diagnostic tests, and they already provide primary care in many settings, including in primary-care medical practices.

Indeed, the number of APRNs (a category that also includes nurse anesthetists, certified nurse-midwives, and clinical nurse specialists) is on the rise. Shifting care of basic problems in this way lowers costs—educating a nurse practitioner (NP) is considerably cheaper than educating a doctor—and increases access to care.

“We’re more in demand than ever,” says Kathy Ogle, a family nurse practitioner who is also interim chair at Towson University’s Department of Nursing and president-elect of MNA. And nurse practitioners, who are qualified to provide care for patients with minor, acute, and stable chronic illnesses, are well-positioned to serve the community and promote preventive care. “That’s where we’re at our best,” says Ogle.

Of course, that doesn’t take the doctor out of the equation. While it makes sense to have APRNs practice to the full extent of their qualifications, “they’re not asking for an expansion of their role,” says MNA’s Hoffman. “These nurses will tell you that they have always worked in collaboration with their physician colleagues.”

APRNs aren’t the only ones obtaining skills that go beyond the basics. In addition to seeking advanced degrees in fields like information technology and community health or pursuing careers in environmental health or policy, R.N.s are also becoming increasingly specialized. Within a hospital setting like Johns Hopkins, that may mean becoming highly skilled in one treatment area like cardiac care or transplants, says Haller.

At Hopkins—whose nursing school attracts students who already have a bachelor’s in another field—Haller often sees nurses entering the field with an eye on advanced training and degrees.

“They may work in the hospital for a couple of years and then they want to be a nurse practitioner or pick up a law degree and work in risk management,” says Haller.

Still, even R.N.s who aren’t officially specialized—and don’t move on to other career paths—come to the table with broader training than they once did, says Maggie Richard, director of professional practice, research, and education for LifeBridge Health’s Sinai Hospital.

A nurse since 1986, Richard has seen a vast change in the knowledge base and educational preparation of nurses over the years. “That’s because the nature, the depth, and complexity of the patients that we provide nursing care to has changed. It is just the most evolutionary thing that I’ve ever seen.”

That evolution revolves around not just the actual medical knowledge nurses now must develop, but also around the use of new, sometimes complex, technologies that help to gather patient data, streamline procedures, or improve processes.

Given the number of aging Americans who will need ongoing, sometimes complex care and the expanding role of nurses of all stripes in providing it, there’s no doubt the field will grow in the years to come.

That growth will unfold amid a demographic change that provides challenges of its own: With a wave of older nurses approaching retirement age and too few nursing educators to turn out the number of nurses needed to meet growing demand, a nursing shortage awaits.

Nursing associations are working to increase the number of nurses to meet demand, with a close eye on quality, says Ogle. “Nursing is consistently named as the most admired profession, and we want to remain that way,” she says. “Part of our mission is to provide safe patient care for everyone in every setting. So we want to make sure we don’t grow too fast.”

Whatever the pace of the growth, one thing is certain: “The field is wide open,” says Ogle, whose career path included stints in obstetrics and the emergency room, and as a flight nurse, a nurse practitioner, and an educator. “There are a lot of opportunities. Nurses can do anything.”

THE LIST
The Envelope, Please!
Following are the winners of our Excellence in Nursing survey, organized in 18 nursing specialties.

Acute Care/ Family Practice/ General Medicine

Cathy Chapman
Nurse practitioner
Owner, Chapman and Associates Health Care 200 Glenn St., Ste. 201,  Cumberland

Sandra Nettina
Nurse practitioner
Columbia Medical Practice 5450 Knoll North Dr., Columbia

Cardiovascular

Natalie Droski
Permanent  charge nurse
MedStar Franklin Square Medical Center 9000 Franklin Square Dr.,  Rosedale

Jean Little
Open-heart step-down
LifeBridge Health  Sinai Hospital 2401 W. Belvedere Ave. 

Betheen Weed
Professional  development  specialist
MedStar Franklin Square Medical Center 9000 Franklin Square Dr. , Rosedale

Community Care/Ambulatory Care

Mary Jo Huber
Nurse manager
St. Clare Medical Outreach University of Maryland St. Joseph Medical Center 7601 Osler Dr., Towson

Susan Haskell
Triage nurse
MedStar Franklin Square Medical Center 9000 Franklin Square Dr.,  Rosedale

Nurse Educator

Carol Esche
Clinical nurse  specialist/evidence- based practice  and research educator
MedStar Franklin Square Medical Center 9000 Franklin Square Dr. , Rosedale

Vicky Kent
Clinical associate  professor, Deptartment of Nursing
Towson University 8000 York Rd., Towson

Kimberly Bowen
Emergency Department
LifeBridge Health  Sinai Hospital 2401 W. Belvedere Ave. 

Lakecia Lewis
Emergency  Department
LifeBridge Health  Sinai Hospital 2401 W. Belvedere Ave. 

Jaclyn Mueller
Emergency  Department
Greater Baltimore  Medical Center 6701 North Charles St. , Towson

Hospice/ Home Health/Palliative

Rachel Kruger
Registered nurse
The Lisa Vogel Agency 10401 Stevenson Rd.,  Stevenson

Kristin Metzger
Registered nurse
Gilchrist Hospice Care 11311 McCormick Rd. Ste. 350 , Hunt Valley

Carol Hay
Hospice case manager
Gilchrist Hospice Care 11311 McCormick Rd. Ste. 350 , Hunt Valley

Intensive care

Nicole Henninger
ICU nurse manager
Medstar Franklin Square Medical Center 9000 Franklin Square Dr. , Rosedale

Jeannine LeMieux
Intensive care
University of  Maryland Shore  Medical Center  at Easton 219 S. Washington St., Easton 

Angela Chaney
Staff nurse
Mercy Medical Center 301 St. Paul Pl.

Nurse Executive

Diane Bongiovanni
Director of  patient care for ED,  ICU, IMC, CICU
LifeBridge Health  Sinai Hospital 2401 W. Belvedere Ave.

 Jeanne Charleston
Director of  clinical research  operations
The Johns Hopkins University 1849 Gwynn Oak Ave.

Lisa Rowen
Senior vice president of patient-care services and chief nursing officer
University of Maryland Medical Center 22 S. Greene St.

Medical-Surgical Nursing:

Ganogtong Tongprom
Registered nurse
Greater Baltimore  Medical Center 6701 N. Charles St., Towson

Megan Jendrossek
Acute neurocare
University of Maryland Medical Center 22 S. Greene St.

Chiemerie Uche
Registered nurse
University of Maryland Medical Center 22 S. Greene St.

Ashley Wells
Charge nurse
MedStar Franklin Square Medical Center 9000 Franklin Square Dr., Rosedale

Neurology/ Psychology/ Behavioral Health

Rebecca Dunlop
Associate director, The Johns Hopkins Parkinson’s Disease and Movement Disorders Center
The Johns Hopkins Hospital 600 N. Wolfe St.

Lisa Ashton
Psychiatric/ mental-health nurse practitioner
Mosaic Community Services 1122 Vernon Ave.

Oncology

MiKaela Olsen
Clinical nurse  specialist, oncology and  hematology
The Johns Hopkins Hospital 600 N. Wolfe St.

Eden Stotsky- Himelfarb
GI clinical program  coordinator/ nurse clinician
The Johns Hopkins Hospital 600 N. Wolfe St.

Todd Milliron
Senior clinical nurse II
University of Maryland Greenebaum  Cancer Center 22 S. Greene St.

Renee Kwok
Nurse manager
University of Maryland Medical Center 22 S. Greene St.

Orthopedics

Erin Lock
Orthopedic trauma R Adams Cowley Shock Trauma Center
University of Maryland Medical Center 22 S. Greene St.

Stacie Roles
Inpatient  orthopedics nurse
MedStar Union  Memorial Hospital 201 E. University Pkwy.

Pediatrics -  Non-Neonatal

Colleen A. Blough
Pediatric oncology  clinician
The Johns Hopkins Hospital 600 N. Wolfe St.

Joan Marasciulo
Registered nurse
LifeBridge Health  Sinai Hospital Alfred I. Coplan Pediatric Hematology Oncology Outpatient Center 2401 W. Belvedere Ave.

Rebecca Dickinson
Nurse team leader
Mt. Washington  Pediatric Hospital 1708 W. Rodgers Ave.

Marla Newmark
Lactation coordinator
Greater Baltimore  Medical Center 6701 N. Charles St., Towson

Pediatrics:  Neonatal

Cynthia Arnold
Nurse practitioner,  intensive care unit
Greater Baltimore  Medical Center 6701 N. Charles St., Towson

Amanda Hindle
Neonatal intensive  care unit
Greater Baltimore  Medical Center 6701 N. Charles St., Towson

Michele Jacobs
Staff R.N., Center  for Neonatal  Transitional Care
Mt. Washington  Pediatric Hospital 1708 W. Rodgers Ave.

Research

Joan Warren
Director of nursing research and  magnet research
MedStar Franklin Square Medical Center 9000 Franklin Square Dr., Rosedale

Vicki Coombs
Senior vice president
Spectrum Clinical Research 1 Olympic Place, Ste. 900 , Towson

Kelly Lowensen
Research program coordinator/nurse case manager
The Johns Hopkins School of Nursing Dept. of Community Public Health 600 N. Wolfe St.

School Health

Calvert Moore
School health  resource coordinator,  education specialist
MedStar Harbor Hospital 3001 S. Hanover St.

Senior  Services

Tanya Allen
Director of  health services
Roland Park Place 830 W. 40th St.

Virginia Saunders
Manager, clinical resource nursing
Levindale Hebrew  Geriatric Center  and Hospital 2434 W. Belvedere Ave.

Women’s Health

Erin Pollitt
Forensic nurse  examiner
Women’s Health and Emergency Services Mercy Medical Center 301 St. Paul St.

Lynn Richards- McDonald
Coordinator,  cervical cancer  screening program
The Johns Hopkins Hospital 600 N. Wolfe St.

Gloria Clark
Clinical unit  coordinator
OB/GYN unit Saint Agnes Hospital 900 S. Caton Ave.

Source

Top Docs 2014: Challenging Case Files

Jess Mayhugh — Sat, 01 Nov 2014 00:00:00 +0000

From left: Stephen Bartlett, M.D.; Gavin Class; William Hutson, M.D.; Rolf Barth, M.D.

gavin’s app

case no. 1: heat stroke

University of Maryland Medical Center: Gavin Class

It’s not uncommon to faint when you’re overdoing it in the heat— especially in football practice on a scorching hot day. So when Towson University football player Gavin Class collapsed on the practice field at Towson University in August, 2013, everyone figured it was a simple case of heat stroke. But for 20-year-old Class, then a junior, it was not so simple.

Taken to St. Joseph Medical Center, doctors saw his internal body temperature was causing multi-organ failure.

Coincidentally, only a month before, Dr. Rolf Barth, director of liver transplantation at the University of Maryland Medical Center (UMMC), had met with St. Joseph pulmonary critical-care division chief Jason Marx about a new app that alerts UMMC quickly to the very sickest patients needing more advanced care. And that app helped put the wheels in motion for Class’s transfer downtown.

“We have occasionally had referrals for heat stroke, but only when the liver is so damaged it’s non-recoverable,” says Barth. “Then transplantation is the only answer. And it was clear to our team that in Gavin’s case, the heat stroke was causing everything to fail.”

Doctors from UMMC’s shock trauma and transplant teams, including Drs. Stephen Bartlett and William Hutson, acted immediately by using a new liver support machine called MARS to buy Gavin some time while a donor could be identified for an emergency liver transplant.

“Maybe five percent of people with heat stroke will have liver failure,” says Barth. But the results for this type of transplant were incredibly poor in the past—most liver failures with heat stroke had died. “Among even those with transplantation, 75 percent died,” he says. “And the chance of dying when the patient also has kidney failure is 85 percent or higher.”

The difficult recovery course took several weeks, but all of his other organs eventually recovered, and Class is living a normal life today on a borrowed liver. He’s even back on the field supporting the Tigers (albeit from the sidelines).

So now, this burly football player has a badge of courage he could use as an ice-breaker at frat parties: “He has a nice scar he likes to show off, and he’s not embarrassed to pull up his shirt and show you,” says Barth.

Dr. Adrian Park, chair of surgery at Anne Arundel Medical Center.

A gastric gambit

case no. 2: severe gastrointestinal reflux disease

Anne Arundel Medical Center: Patricia Reilly-Butcher

It was after weight-loss surgery in May, 2013, at a hospital in Delaware that Patricia Reilly-Butcher’s problems began. Within weeks of having a gastric-sleeve procedure that reduced her stomach size, the then-52-year-old nurse developed symptoms of severe gastrointestinal reflux disease (GERD) caused by a stricture and a recurrent hiatal hernia (HH), which is the protrusion of the stomach into the chest through a weakness in the diaphragm.

Before long, she couldn’t eat, drink, or work, and other experts she consulted offered no options, except for her local GI doctor.

“He said, ‘You have to see Dr. Adrian Park, he’s the best. This is not something you can fix three or four times, it has to be done right,’” recalls Reilly-Butcher.

So, desperate, she came to Park, chair of surgery at Anne Arundel Medical Center and a renowned laparoscopic surgeon in the treatment of gastroesophageal reflux disease, complex hiatal hernias, and intestinal disorders.

“She came out of that weight-loss procedure with severe problems,” says Park, 53, many of whose patients are seeking a solution to previous unsuccessful treatments, what he calls “end of line” cases. “A few weeks after the bariatric surgery, besides not being able to eat or drink, she couldn’t even swallow her own saliva, was vomiting all day, and started to waste away,” says Park, who also teaches at The Johns Hopkins University.

“When you have bariatric surgery, you’re supposed to lose weight, but not that way,” says Reilly-Butcher, who went into the Delaware surgery at 320 pounds and had lost 80 by the time she saw Park. “I was vomiting my own spit.”

“This was previously a high-functioning lady,” says Park. “But she was in a desperate way, basically starving to death in front of her husband. She was losing five pounds a week six months after the bariatric surgery. And she was right on the verge of needing tube or intravenous feeding to sustain life.”

He discovered that she had a stricture at the level of the gastro-esophageal junction and a recurrent hiatal hernia. Her extreme difficulty with swallowing also led him to study the muscular function of her esophagus, which revealed that she had almost no normal peristalsis, or muscular propulsion, within her esophagus.

Laparoscopic minimally invasive surgery corrected the stricture of the esophagus and gastroesophageal junction, and Dr. Park repaired her hiatal hernia, as well as separated of the muscle layers of the bottom of her esophagus to improve her swallowing ability.

Two days into recovery, she could drink water. And within a few days, she was eating on a restricted diet. “I’m not in any pain anymore, I can eat normally, and my weight has stabilized at 225,” says Reilly-Butcher. “My goal is to lose another 40.”

From left: Among the team in Forrest Allen’s case is Dr. Nicholas Dalesio, anesthesiology; Dr. Anand Kumar, pediatric plastic and reconstructive surgery; and Dr. Eric Jackson, pediatric neurosurgery.

A Fighting Chance for Forrest

case no. 3: skull injury

Johns Hopkins Children’s Center: Forrest Stone Allen

It was nearly four years ago that the ordeal for then-18-year-old Forrest Stone Allen and his family began. That was when the teenager suffered a devastating skull injury in a snowboarding accident that crushed his cranium from above his eyebrows to the top of his head.

And it was the beginning of a series of surgeries—not all of them successful—that eventually led him to Dr. Anand Kumar, a Johns Hopkins Children’s Center plastic and reconstructive pediatric surgeon. Kumar is a seven-year Navy veteran with experience as a surgeon at Walter Reed Army Medical Center, where he treated soldiers with traumatic injuries, expertise that is paying off for Forrest.

Forrest is benefitting from a protocol Kumar developed to treat Iraq and Afghanistan veterans with severe craniofacial injuries sustained on the battlefield.

“It was a sad case,” says Kumar. “This was a totally normal kid who had the accident after hitting a fence with no helmet. He needed a series of procedures at other hospitals that required the removal of large sections of cranial bone to treat the brain injury. Then they tried to reconstruct it with synthetic implants, including plastic and woven titanium, but none of them were successful.”

To deal with that, Kumar and his Hopkins colleagues, including Drs. Nicholas Dalesio and Eric Jackson, are employing a staged reconstruction process, approaching the job in smaller sections—first in August and again this month—using microsurgery to transfer bone from the back of the head as well as skin, tissue, and blood vessels from Forrest’s back to improve blood flow to the affected area.

“He went through three previous failed attempts. So we’re trying to turn an incredibly unfavorable thing into a success story for this kid,” says Kumar, who also does lab research looking for new ways to build cranial and facial bones from muscle stem cells.

Forrest, meanwhile, is at his Northern Virginia home with his family between procedures, winning the admiration of all around him for his determination to recover.

Writes his mother, Rae Stone, on Forrest’s family-generated blog, “You [Forrest] still tire easily and are in some discomfort, but your characteristic good humor and determination challenge us all to keep up.”

From left: Sunjay Kaushal, M.D., Ph.D.; Susan Mendley, M.D.; Adnan Bhutta, M.D.; and Isaiah Cannon, seated.

MISSION: MRSA

case no. 4: A deadly Bacteria

University of Maryland Medical Center: Isaiah Cannon

It was a lucky thing for 15-year-old Isaiah Cannon that his older brother, John Jr., was an EMT; he was the one who noticed one day in early April that something was seriously wrong with the Edgewood teenager. The symptoms—which quickly worsened to gray coloring, shortness of breath, and inability to walk—were not just the flu. Rushed first to Upper Chesapeake Medical Center, Isaiah was then flown to the University of Maryland Medical Center (UMMC), where he suffered cardiac arrest within an hour.

“I think we suspected it was related to an infection, but didn’t know what infection right away,” says Dr. Adnan Bhutta, 45, who oversees pediatric critical care at University of Maryland Children’s Hospital. Within a day, tests showed a worst-case scenario: MRSA, or methicillin-resistant Staphylococcus aureus, a drug-resistant bacteria that kills most of its victims with fast-spreading and difficult-to-treat infections.

During the hours that followed, Isaiah spiraled into multi-system organ failure and was put on a state-of-the-art machine called ECMO (short for extracorporeal membrane oxygenation). The machine, which the pediatric program had only acquired a year earlier, basically bypasses the heart and lungs, oxygenating the blood and pumping it back into the patient. In an induced coma to protect his brain, Isaiah also needed dialysis to support his kidneys and drugs to maintain his plummeting blood pressure. His muscles were showing signs of injury, and his bone marrow, which helps fight disease, was also suppressed.

“I think we all agreed if that if we didn’t use ECMO, he was likely to suffer another cardiac arrest, so we put him on it instead of waiting for him to sustain more damage to his organs,” says Bhutta. “In situations like this, where septic shock is involved, the survival rate for MRSA [pronounced “mersa”] can be extremely low, about 25 percent.”

“Survival probably would have been zero without the machine,” says Dr. Sunjay Kaushal, a pediatric cardiac surgeon who worked with Bhutta and the rest of the team.

Slowly, though, the UMMC team, which included Dr. Susan Mendly, brought Isaiah around, but it took an amazing 59 days in the Pediatric Intensive Care Unit (PICU) at the University of Maryland Children’s Hospital, 20 days in rehab at the University’s Rehabilitation & Orthopaedic Institute, and about $800,000 in patient expenses to get him on the mend.

Unfortunately, doctors had to amputate his lower right leg due to the lack of blood flow caused by the infection. And he still has a stent in his aorta to treat the damage.

“Right now, he just wants to be able to run again, but today was a good day,” says his mother Marcy Cannon on a Wednesday in late September. “Isaiah got his new leg today. He’s trying it out around the house. He’s been on an amazing journey.”

Source

Cameo: Dr. David B. Leeser

Jess Mayhugh — Wed, 21 May 2014 08:30:00 +0000

Rappel for Kidney Health is an unusual fundraiser. Can you describe it? We rappel off of the Baltimore Marriott Waterfront, and it is a 300-feet descent. The views are spectacular, but the event is not for the faint of heart.

How did you first get involved? I was asked by one of our coordinators to rappel last year and then asked the National Kidney Foundation if they wanted a chair for this year.

How did you get involved with kidney and pancreas transplantation? I was lucky enough to work with a surgeon who trained here at University of Maryland during my residency training and he really got me interested in organ transplant. He was really responsible for my coming to the University of Maryland to do my fellowship and then it went from there.

Why the kidney or the pancreas instead of the heart or the liver? One of the reasons is because we had a bigger kidney program where I trained. The other reason is that I think the patients in kidney transplantation are really spectacular. I think the ability to do living donor transplants is really amazing. We can now take kidneys out by making a small incision around the belly button. We take kidneys out of living donors with one small incision and afterwards you can almost not even tell that someone gave a kidney. I’ve always liked everything associated with taking care of patients with kidney disease. I’m very plugged in to the nephrology community, so that allows me to really create a seamless care situation for my patients.

So how much need is there for kidney transplant research compared to other organ transplants? Well, I think, in general, the National Kidney Foundation supports all kinds of research surrounding renal failure, which is a huge problem. If you look at the big problems we deal with on a public health front: We talk about obesity, we talk about hypertension, and we talk about diabetes. So, if you put hypertension and diabetes together, you have a huge risk of developing renal issues and problems with your kidneys. So I think that the National Kidney Foundation supports research in areas like that where you have a big intersection.

Why rappel for kidney health? Why not nap for kidney health? There are two reasons. One is to raise money. The other is, when you hear about people rappelling off a building that’s 32 stories, people go, ‘Wow! What’s that about?’ So it’s a way to put a spotlight on the National Kidney Foundation and the issues that underpin the organization.

You are part of a team, correct? I am part of a University of Maryland team. We were going to have one team; we now have two.

Anyone can participate, so did you recruit some of your colleagues for this team? I did. And some of them said, ‘There’s no way, but I’ll give you money to do it.’

I imagine it’s a tough sell for a lot of people. Some people said, ‘I’m afraid of heights, there’s no way you’re ever going to get me up there.’ And then some people are really interested because it is something they’d never, ever do. One of the nurses I work with, she’s on our team and is going to jump.

Well, no one is actually jumping, right? Well, no. It’s fun to say jump.

Are you generally an adrenaline junkie? Not really. I look at this as very, very safe. It’s funny, my son does rock climbing and he said, ‘Well, you’re on two ropes that both could hold up a VW bug by themselves, you’re pretty darn safe.’ Then again, he’s 18. He probably believes that if he fell, he would bounce.

I know you have a little bit of experience rappelling. Well, I rappelled a little bit when I was in the Army in my late 20s down in San Antonio, TX. That’s a little bit different because you can’t hurt yourself on this one. In the Army, it was very safe, but not quite as foolproof as this system is for the NKF rappel.

Source

A look inside the world’s most advanced emergency room

Jess Mayhugh — Sun, 31 Oct 2010 12:00:00 +0000

Allie Gold remembers being in the golf cart. She doesn’t recall falling out. Having completed her sophomore exams at the Maret School in Washington, D.C., the 16-year-old spent Memorial Day weekend with a girlfriend’s family on Gibson Island. The girls weren’t drinking, weren’t horsing around. It was the middle of a lovely day and Allie just fell out somehow.

An emergency room physician, by the hands of fate, was playing golf nearby when Allie’s head hit the concrete and she let go a deafening scream.

“I was home alone and I got a call, fraught with such anxiety, from her girlfriend’s father,” says Allie’s mother, Carol Weissbrod, who immediately asked a friend to drive her to Baltimore. “I knew she was in trouble. He said it was ‘dire.’”

The emergency room physician did not send Allie to the nearest emergency room. He requested a Maryland State Police helicopter take her directly to the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore.

Weissbrod called Allie’s father, Norman Gold, who was sailing on the Chesapeake. He got ashore and found a ride to Baltimore.

Dr. Thomas Scalea, Shock Trauma’s physician-in-chief and the attending physician that day, first wondered why what sounded like a minor accident victim was being brought to Shock Trauma.

“It seemed silly initially, with such a little accident,” says Scalea. “But she ends up with a very a serious brain injury.”

Weissbrod and Gold both arrived at the trauma center just after their daughter.

“We didn’t see her for a long time when we arrived,” Weissbrod says. “I don’t know how long; my perception of time wouldn’t be accurate. I was as frightened as I’d ever been in my life, and it began to go from bad to worse.”

First, Scalea’s team assessed her for bleeding. Allie, in fact, had bleeding in the brain, requiring immediate surgery. However, her brain continued to swell. Soon, her systems began to breakdown. Her lungs shut down. She went into cardiac failure. A few days later, her kidneys would fail.

“This was when Dr. Scalea and his team became very strategic and began trying one thing after another to save her,” recounts Weissbrod, a psychologist by profession. “I was a very anxious parent and Dr. Scalea would come and say, ‘We have to do this’ or ‘We have to do this.’”

Scalea’s team performed a craniectomy, opening Allie’s skull to relieve pressure. They also sliced open her abdomen, a procedure known as a laparotomy, relieving pressure in her torso and thereby her skull as well. Both are highly unusual techniques for treating a brain injury, according to Scalea, performed at few trauma centers in the world.

“She was an unbelievably sick kid.” Scalea says. “She was still dying when we opened up her abdomen, stood her upright.”

Her mother adds a sentiment echoed by many patients and families who have come through the Cowley Shock Trauma Center. “I don’t think she would’ve lived if she’d been taken anywhere else,” she says.

Surviving on a heart-lung machine during surgery, receiving dialysis, and with filters inserted to manage potentially fatal blood clots, Allie stayed in a coma for 21 days. Another week passed before she could be moved out of the intensive care unit.

“They felt like she began to turn a corner after 10 days and they knew she’d survive,” Weissbrod says. “Of course, no one could tell us what she’d be like mentally and physically. Later, a cardiologist told us it would be at least a year before she would be anything like herself. ‘That’s okay,’ I thought.”

Fifty years ago, Dr. R Adams Cowley, a pioneer in open-heart surgery, developed the first clinical shock trauma unit in the country, putting together a small staff and equipment—including two, and later four, beds—at the University of Maryland Medical Center. It was known as the death lab, at first, until patients given up for dead began to survive. Cowley’s credited with coining the idea of “the golden hour,” or as Scalea, the driving force at Shock Trauma for the last 13 years, explains, “the concept that trauma is a time-related disease.”

Today, with innovative techniques like those saving Allie, plus cutting edge x-ray, CAT scan, and MRI technology, ongoing research projects, U.S. military partnerships, violence prevention efforts, and a structure and communication system that countries from China to Italy wish to emulate, Shock Trauma remains at the global forefront of trauma care. Recent hardware upgrades include the largest hyperbaric chamber in the country and a digital x-ray machine, known as Lodox, which scans the entire body in 13 seconds. Developed in South Africa to search miners for diamonds, it was reconfigured for medical purposes.

“I’d like to think that the people in Maryland know they have one of the greatest trauma centers in the world in their state,” says American Trauma Society executive director Harry Teter. “Absolutely every specialty in medical care can be found there 24/7 and they attract the finest doctors in the country. I think people in the trade, most people, would acknowledge it is the best.”

When the yellow, mounted phone rings in the second floor of Shock Trauma’s resuscitation unit, a half-second of silence follows. A nurse quickly walks over and answers, grabbing a marker. Clunky, with an old-fashioned cord, the phone seems out of place in this bunker of computers and state-of-the art medical bays, each capable of serving as an operating room. She jots down the facts from the scene in shorthand on an erasable wall chart nearby: MVC (motor vehicle crash); ETA 17/18 (17 minutes for the helicopter to reach the accident site, another 18 minutes to Shock Trauma’s roof); +LOC (loss of consciousness); L4/L5 (back fracture); T5 (spinal cord injury, possibly indicating paralysis). Gender and age get marked down, too.

Later, a paramedic radios the attending physician directly, seeking advice with the deteriorating patient and asking permission to deliver morphine.

Then, minutes before the Maryland State Police helicopter arrives, two nurses take a dedicated elevator to the roof. At night, they spot it miles away, watching as a small light comes into view in the distance over M&T Bank stadium.

Not unexpectedly, the first wave of Labor Day weekend patients began arriving early Friday afternoon.

Just before 3 p.m., it was a middle-aged man, crushed by a tree. An hour later, a patient who’d fallen from a tree while intoxicated. About 90 minutes after that, a motorcyclist, found in the woods with a severed leg, was flown in—his leg alongside him in a cooler. The next minute, an unrestrained backseat passenger, she’d been ejected from an automobile after a crash.

Later, an elderly woman who’d fallen riding a bike. A minute after her, a young woman, pushed from a car. In the early evening, a pedestrian, struck by a tractor-trailer, landed on the helipad. By 10:45 p.m., 15 people had been admitted since mid-afternoon, including a victim with two bullet wounds to the neck. He died shortly after midnight.

By 5 p.m. the following day, another 24 patients arrived.

“We tend to get a lot at night, between 8 p.m. and 2 a.m.,” said nurse Meghan Brady. Like most of the nursing staff, Brady works three 12-hour shifts a week. The worst nights are pretty rough.

“I remember losing three in a row, right there in Area 4,” she says, gesturing behind her.

Cheri Carver, another nurse, has been at Shock Trauma for 15 years, raising eight children along the way. She’s treated neighbors’ children and saw a friend’s child die here. A big responsibility for nurses is taking care of patients’ families.

“Some families get it, understand what’s happening, and others don’t cope so well,” Carver says. “I have to give death notifications, and at least as far as it goes, I’d like to think I’m good at it. But you never know how to handle it. Some families are stoic, like if their kid sells drugs and they thought they might get this call someday. With others, and I’ve had to do it a lot, I’m praying with mom in the hallway.”

Early Saturday evening, a minor, shot in the face below his left eye, is wheeled into a bay, accompanied by police. Conscious, wide-eyed and scared, blood dripping from his wound, his chin and neck swelling with fluid, a dozen doctors, fellows, residents, nurses, and trauma techs surround his stretcher.

“He’s a baby,” someone says.

In a rehearsed choreography, a nurse cuts off his clothes as another asks for his parents’ phone number. An IV gets started. Blood pressure gets checked. Doctors look for exit wounds. Blood’s suctioned from his mouth. An anesthesiologist begins a sedative, preparing him for tracheal intubation. Blood gets drawn. Out of immediate danger, he’s readied for x-rays.

“I see where it is,” Dr. Deborah Stein says, minutes later, examining three-dimensional images on her computer and staring at the bullet lodged in the teenager’s lower neck. “But how did it get there?”

The three-day Labor Day weekend total was 107 admissions. Many were discharged within a day or so, but the 104-bed hospital remained at capacity. As usual.

U.S. trauma centers typically admit about 3,000 to 3,500 patients a year. Shock Trauma admits 8,000 annually. It’s the largest facility of its kind in the U.S. Ninety-seven percent of those patients survive.

“We each have very defined roles,” says Stein, at Shock Trauma since 2002. “As a result, I think, we are able to provide a really high level of care. What makes Shock Trauma stand out, however, she says, is having “the capacity to rev up and deal with whatever comes through the door. And you will never hear any grumbling from anyone.”

Ultimately, Labor Day was not dramatically different from other summer weekends. The hospital’s 13 Trauma Resuscitation Unit bays and 104 critical care beds regularly double up with patients. It’s a major reason for its $160 million expansion, which broke ground this spring. The new tower will add 64 ICU beds and 10 operating rooms.

Stein, like Scalea, acknowledges the pace and uncertain nature of Shock Trauma, while not for everyone, fits her personality—and is rewarding at the same time.

“I like not knowing what is going to happen every day,” she says. “But the other thing I love, too, is seeing people get better every day.”

Yet the workload and the tragedy, she admits, can be overwhelming at times. Doctors typically work 12- or 24-hour shifts to minimize handing off fragile patients.

“We struggle like much of the medical community to reduce hours for physicians while maintaining care,” Stein says. “But we are always prepared. We never say ‘no’ [to a request to bring a patient to Shock Trauma].” The policy comes directly from Scalea.

Since taking over as physician-in-chief in 1997, when Shock Trauma admitted 5,700 patients, Scalea has significantly expanded clinical services while also reorganizing research and education programs.

One of five children raised by a single mother in a large, “very Catholic” family in Rochester, N.Y., Scalea does not downplay that his work is his life—other than being known as a doting uncle among his staff.

He leads by example, performing some 600 operative procedures annually; 100-hour weeks are not unusual.

“I always wanted to be a musician, but I wasn’t good enough,” says Scalea, a trim, 59-year-old with a generally quiet, serious demeanor, albeit one that includes a dry sense of humor. He says his brothers and sisters are all very accomplished in a variety of challenging fields. “This is the only thing I am good at. When it’s 2 a.m. and I’m here, I feel confident I know what I’m doing.”

“I never got married and the truth is, the staff here is my family—and they know it,” he continues. “I know, for myself, I have never met a more committed group of people in my life.”

Among Shock Trauma’s unique partnerships is a collaboration with the University of Maryland School of Social Work’s Violence Intervention Program (VIP).

When a victim of gun violence, such as the above-mentioned teenaged survivor, comes into Shock Trauma, they’re visited within days by a caseworker, hoping the experience will provide them pause to reconsider their lifestyle.

“We refer to it as the second ‘Golden Hour,” says trauma surgeon Dr. Carnell Cooper, who founded VIP 12 years ago. A published 2006 study revealed participants were three times less likely to get arrested than non-participants; six times less likely to become a victim of gun violence again. It was one of the first hospital-based anti-violence programs in the country, and Cooper has since assisted other trauma centers in developing similar programs.

It’s an unfortunate coincidence, of course, but Baltimore’s level of gun violence—as well as the volume of crush and penetration victims handled at Shock Trauma—comes close to replicating the reality faced by military medical personnel. And so, on a different front, Shock Trauma partners with the Air Force’s Center for Sustainment of Trauma and Readiness Skills, training soon-to-be-deployed surgeons and medical personnel. Scalea, in fact, has flown with missions in Iraq and Kuwait, observing military procedures and protocols.

“Dr. Scalea and his staff are a phenomenal resource for us,” says Dr. David Powers, the deputy director of Shock Trauma’s C-STARS program that works with the Air Force. “Shock Trauma has an international reputation and in terms of our mission, battlefield medical care, evacuation, this is exactly what we see in their work with the Maryland State Troopers.”

Trooper First Class Eric Workman and Montgomery County police officer Alanna Ward knew Shock Trauma from their earliest days in law enforcement, but their first visits to the trauma center were as accident victims. Workman, who light-heartedly refers to himself as “a two-time alum,” returned as a gunshot victim.

Both reserve special praise for the individuals at Shock Trauma, and speak specifically of Scalea in near reverential terms.

In 1998, while working uniformed patrol, a negligent driver struck Workman from behind. Thrown 60 feet, he spent two weeks on life support, undergoing a dozen operations, and made a full recovery.

In December of 2006, Workman was shot while part of a team delivering a warrant in a pre-dawn raid. He spent two days on life support, undergoing three operations and the removal of his spleen. Scalea served as his primary physician both times.

“When I got shot, I knew I was hit bad, and I was telling somebody to call Shock Trauma and try to get Dr. Scalea—that’s what I’m preaching as I’m getting into the helicopter,” Workman recalls. “Sure enough, he’s there shortly after I arrive.”

While off-duty in 2007, a road-raging driver forced Alanna Ward off Interstate 270. Her husband, Michael, also a police officer, received a call from firefighters, who told him there had been a crash and his wife was trapped beneath her SUV.

Her vital signs started to crash as soon as she was pulled out and her heart stopped in the helicopter.

“They never got the heartbeat back in the helicopter,” she says. “I don’t know exactly how long I was dead before they got me to the trauma room and brought me back, but it was probably about six minutes.”

As in Allie Gold’s case, Scalea, who oversees all first responder cases, eventually opened Ward’s abdomen to relieve pressure in her brain. Ward still struggles with intestinal issues, but after three and half years, she’s planning to return to work this fall, initially in an administrative capacity.

Now 22, Allie struggles with similar intestinal issues linked to the abdominal surgery that saved her and Ward’s lives, but it’s improved with time and medication.

Also, like Ward, Allie intends a career in public service. Today, she’s a first-year student in Vanderbilt’s graduate nurse practitioner program.

“One of the things Shock Trauma did was allow my brother, who’d just graduated from medical school in New York, to go on rounds. He was kind of the translator for my parents,” Allie says. “I’m not sure everyone would do that.” She adds, however, it’s simple things, the bed baths and the changing of the linens, that patients remember as much as anything.

Allie and her mother have also met with new patients and their families, as part of Shock Trauma’s survivor network, offering encouragement that recovery is possible.

“What was notable to us was the investment of the nurses and doctors,” her mother says. “Dr. Scalea travels all over the world, but when he had to go away, he’d call in to check on her condition. When she finally woke up from her coma, we’d gone out to eat in Baltimore. One of the nurses called us on our cell phone right away. They were so invested, cared so much, it was incredible.”

Allie’s experience, which included years of rehab and follow-up meetings with Scalea, who remained her primary physician, proved transforming.

“They never stopped trying new things, they never gave up,” she says. “My parents put a lot of trust in them, and it was definitely not easy for my parents; it was all an incredible shock for them. It changed my perspective. It changed me.”

She’s held several research jobs while in school, but when making her career choice, she knew she wanted closer interaction with hospital patients.

“I know I’ll make a great nurse practitioner,” she says. “I know how it feels to be in that position. I know that feeling and the difference people make.”

Source