Medicine on the Midway - Fall 2010
University of Chicago Biological Sciences Division - Medicine on the Midway
The Brain's Electrical Storm page 9 FA L L 2 010 Contents Extracting New Therapies from Venoms By Rob Mitchum The toxins of venomous animals, such as snakes, scorpions and spiders, are among nature's most finely-tuned weapons, sharpened by millions of years of evolution to hit a molecular target. For Zoltan Takacs, PhD, research associate and assistant professor at the University of Chicago, those qualities have made snakes and venom a life-long source of fascination. From expeditions around the world to catch and collect animal tissue to laboratory experiments that explore the potential of those toxins for research and clinical use, Takacs has turned a childhood love of creepy-crawlies into a career. Acknowledging Takacs' unique existence as half-scientist and half-adventurer, National Geographic in May named him as one of their 2010 Emerging Explorers. One of 14 award recipients, Takacs earned $10,000 for new expeditions. Having visited more than 130 countries, Takacs brings back tissue samples from venomous animals he has tracked, looking to repurpose the venomous tricks of nature into highly selective ligands that could have therapeutic value. "It's a straight connection between rain forest and lab bench," Takacs said recently from a snake-free conference room in Hyde Park. "Nature is not limited to the African savannah with elephants and lions. There also is the underlying molecular biodiversity, and if that's erased, then we lose the potential for new drugs." Takacs estimated that 10 million to 20 million different toxins exist in nature. Only 10,000 or so have been discovered, and of those, only a couple hundred have been thoroughly studied. But at least 12 drugs already have been derived from those toxins and are currently in use for treating high blood pressure, heart failure, heart attacks, cancer pain and diabetes. "If you face a heart attack in the United States, there are three drugs for emergency treatment and two of them are derived from snake venom," Takacs said. "These are truly lifesaving drugs." Takacs teamed up with Steve Goldstein, MD, PhD, director of the Institute for Molecular Biophysics at the University of Chicago and an expert on ion channels, to create libraries of toxins based on templates obtained from nature. Recently, they sought to create a specific ligand for a potassium channel expressed on immune system T-cells. In autoimmune disorders such as multiple sclerosis or arthritis, T-cells can be overactivated and will attack a person's own tissues instead of foreign invaders. Inhibiting a potassium channel, called Kv1.3, can turn down T-cell activity, so a drug that selectively blocks Kv1.3 likely would be a valuable therapeutic tool. Excellent blockers of Kv1.3 channels comes from an unlikely source: scorpion venom. But scorpion toxins cause undesired side effects by simultaneously blocking similar potassium channels in other tissues. So Takacs, Goldstein and their collaborators set about creating a better Kv1.3 blocker using the scorpion's venom as a starting point. "What's interesting is you still have to go back to nature and pick up the template," Takacs said. "It doesn't matter how good we are, the first one still has to be something time-tested by evolution." Creating and screening a library of novel toxins took about three years and utilized expertise from several University of Chicago laboratories. Starting with all known scorpion toxins targeting potassium channels, a combinatorial library yielding over 11,000 novel toxins was designed and built. The massive library yielded a powerful winner: a novel toxin, dubbed mokatoxin-1 ("moka" means "fun" in Hungarian, Zoltan's native country), that is highly selective for Kv1.3 without inhibiting other potassium channels. Mokatoxin-1 is a Frankenstein molecule, made up of segments from three different natural toxins found in different parts of the world. Takacs hopes this approach can be applied to other toxin families, creating new ligands for favorite venom targets, such as the acetylcholine receptor or clotting agents. But the foundation of that research is still old-fashioned fieldwork. As Takacs told National Geographic, the draw of exploring new lands and wilderness will always tempt him. "Since I need DNA samples from snakes, their prey and predators, my work requires unconventional travel strategies and ventures into unfamiliar territories," Takacs said, "explorations I absolutely love." A War of Wills with Cancer Between treatments for recurring metastatic breast cancer, a young woman was able to complete her education and travel the world. by Kadesha Thomas features Ally Bain "Can't Wait" to Tell Her Story Ally Bain's experience at age 11 inspired her to fight for a law that mandates anyone with a medical emergency must be granted access to a bathroom. by Barbara Rose 7 8 The Brain's Electrical Storm Neurological disorders are increasing, but Medical Center physicians and researchers are working together to understand how to stop the brain from malfunctioning. by Kadesha Thomas and Rob Mitchum Hope for Heart Failure Surgeons at the Medical Center are saving lives with heart assist devices similar to the one former Vice President Dick Cheney recently received. by Kevin Davis Haiti: Mending Body and Spirit Days after the Haiti earthquake, Medical Center volunteers set up a field hospital and staffed an overrun hospital in Port-au-Prince. by Cheryl L. Reed Partnering to Transform Urban Health An initiative at the Medical Center is tackling health disparities on the South Side. Medical Center Physician Named to White House Fellows A Hyde Park native takes his clinical experience and passion for social justice to Capitol Hill. by Kadesha Thomas 9 13 17 22 23 The diversity in toxin libraries is created by shuffling fragments of a handful of template toxins isolated from venomous animals, like this Emperor scorpion (Pandinus imperator) from West Africa. Photo by Dan Dry departments Letters from the Editor/Midway News Learn how to receive the latest news at the Medical Center via the new electronic magazine landing page, and catch up on the latest research and news in medicine and the biological sciences, including the appointment of a new dean. Medicine off the Midway: Stellar Scientific Research and the Bag to Match At age 25, one stylish Pritzker student has two patents pending, three degrees, two more on the way and just received the Paul and Daisy Soros Fellowship for New Americans. by Kadesha Thomas 2 24 Blanding's tree snake (Toxicodryas [Boiga] blandingii), Kakamega forest, Kenya. Left: Getting tissue samples, either for toxin or its target receptor DNA/RNA, sometimes requires unusual travel strategies. Here Zoltan Takacs sleeps under a tarp in the Congo basin rain forest while searching for snakes. Photos by Zoltan Takacs Taking Preventive Care to the Masses A third-year internal medicine resident wasn't satisfied with coaching only his mother on getting healthy. Instead, he wants readers to learn which measures are crucial to achieving good health. by Kadesha Thomas Pritzker News/Alumni Updates/Class Notes Read about students and alumni of the Pritzker School of Medicine and the Biological Sciences Division. Perspectives: Orthopaedic Surgery in Crisis Orthopaedic surgeon Kris John Alden, wasn't a "disaster junkie," but when he saw the devastation of the Haitian earthquake, he knew he had to get involved, even if it meant temporarily leaving his wife with their newborn baby and their three other children. 25 26 32 Front Cover: The Brain's Electrical Storm: One hundred billion neurons in the human brain regulate every aspect of thought and activity. In a healthy central nervous system, the exchange of rapid-fire electrical impulses begins in an area of the cerebrum and can fire up and down the human body more than 50 times in one second. Letters Letter from the Editor After each issue is launched, there is a lag time between when the magazine comes off the press and when it lands in readers' mailboxes. It's generally about three weeks, but I know right away because that's when my phone starts ringing with requests for additional copies. This past issue -- which included our special cancer feature and our colorful pull-out section on the Urban Health Initiative, among other great stories -- was especially popular. Since the magazine came out in June, we've had 800 people sign up to become subscribers. Besides new subscribers, we've also had more requests for additional copies. I usually oblige anyone who asks or sends an e-mail request. But this month the voluminous requests made me wonder: Just who were these extra magazines going to? So I called back one of the requesters, John Barrett, SM '76, a retired board certified orthodontist from Freeport, Illinois. He spent a couple of years living across the Midway in the mid1950s doing an internship at the Zoller Dental Clinic. His wife worked as a nurse in the Chicago Lying-in Hospital during the time. He returned to campus in the mid-1970s in the graduate orthodontia program for his master's in pediatrics. Barrett has received the magazine since he graduated and jokes that he reads "every single sentence." He may not read every word, but he certainly could tell me, without prompting, details of the stories he found compelling. He'd asked for the copies, Midway News BRIEFLY Medical Center Provides $220 Million of Charity Care Annually Nonprofit hospitals, such as the University of Chicago Medical Center, receive exemption from taxes as long as they provide a community benefit, including "charity care," or medical services to patients who are uninsured or underinsured and do not have the ability to pay for the medical services they receive. In April 2010, the Illinois Supreme Court withdrew the state exemption from a hospital in Urbana, Illinois for not providing enough charity care, although the court did not rule on how charity care should be defined or how much should be required in order for a hospital to maintain its state exemption. At most academic medical centers, about 50 percent of patients are covered by private insurance and 50 percent are covered by government payors, such as Medicare and Medicaid. At the Medical Center, 60 percent of patients receive medical coverage through government payors, which often reimburse hospitals less than the cost of care. Charitable provision of medical services to the poor -- including uncompensated/charity care, losses due to unpaid hospital bills, and losses resulting from Medicaid and Medicare shortfalls -- adds up to about $200 million each year, making the Medical Center one of the most charitable hospitals in Illinois. That's equal to about 20 percent of total operating revenues. As an academic institution, the Medical Center provides another $70 million a year to subsidize medical education and research, also considered a community benefit. This brings the total to $270 million. by the way, to send to an oncologist friend and her sister. He thought they should know the research that is going on at his alma mater. I appreciate such dedicated readers. And to keep you all better connected, we've launched a new website where we feature the magazine in a turn-page format. You can link to the site from uchospitals.edu/midway. The website allows us to update stories about ongoing developments at the Pritzker School of Medicine, research discoveries in our Division of Biological Sciences and the latest advances in medicine and patient care at the Medical Center. Check out the new website, sign up to receive bi-weekly updates electronically and, above all, stay connected. Sincerely, Cheryl L. Reed Executive and Managing Editor email@example.com Brooke Bergeron, 38, of Naperville, Illinois, with her family, became the first American patient implanted with the S-ICD device in March. Photo provided by Brooke Bergeron Mother of Four Receives Innovative Defibrillator Martin Burke, DO, knows firsthand the importance of improving the technology for implantable cardiac defibrillators (ICDs). Not only has Burke implanted hundreds of the devices -- which detect arrhythmia and shock a patient's heart back to a normal rhythm -- he has removed many of them from patients because of malfunction or infection. But on March 5, Burke, associate professor of medicine and director of the Medical Center's Heart Rhythm Center, became the first physician in the United States to implant a new, experimental defibrillator. The first procedure was performed as part of a worldwide clinical trial of the Subcutaneous Implantable Cardiac Defibrillator (S-ICD) device produced by Cameron Health. "It's a new concept that might allow for more adequate treatment to prevent cardiac arrest in indicated populations," Burke said. "Patients with congenital heart disease or genetic disorders who would probably fall through the cracks can benefit from this new technology." Classic ICDs deliver their shock via electrical leads placed inside the heart, where the risk of infection and the necessary use of flexible materials reduces the device's lifetime. Burke hopes that the new device, with leads positioned beneath the patient's skin, will be a safer, more durable option for younger patients. Those improvements made sense for Brooke Bergeron of Naperville, Illinois, who in March became the first American patient implanted with the S-ICD device. Only 38 years old, Bergeron suffered a heart attack in late 2009 while giving birth to her fourth child, forcing a cesarean section and double-bypass surgery only hours apart. Bergeron made a complete recovery, but Burke told her she would need to be implanted with a defibrillator to prevent future attacks. Still, Bergeron said she was unsure about being one of the first to receive an experimental device, no matter how durable. "I wasn't sure if I wanted to be a test dummy," Bergeron said. "Do you want to get it right away, or do you want to wait until they get the kinks out?" But she agreed, and only a month after the procedure, Bergeron was on a jet ski in the Gulf of Mexico vacationing with her family. "I didn't want to have the current technology, and then in 10 years go back and have to do this again with a new device. It just didn't make sense," Bergeron said. "I wanted to get moving with my life; I wanted to go on spring break and swim with my kids." "It's working like a charm," Burke said of the early results. "It's not giving spurious shocks. Each day is a testimony to its effectiveness." New Dean Appointed Kenneth S. Polonsky, MD, a prominent diabetes researcher, physician and educator, has been appointed dean of the Division of Biological Sciences (BSD) and the Pritzker School of Medicine and executive vice president for medical affairs at the University of Chicago, effective October 1. Polonsky joined the University of Chicago faculty in 1981, was promoted to professor in 1990 and became the Louis Block Professor of Medicine in 1995. He became section chief of endocrinology in 1987 and also directed the university's Diabetes Research and Training Center. Most recently, he served as the Adolphus Busch Professor and chair of the Department of Medicine at Washington University in St. Louis and physician-in-chief at Barnes-Jewish Hospital since 1999. Polonsky brings to his new role an unwavering commitment to education, clinical care and high-quality research, as well as "deep roots at the university," said Robert J. Zimmer, president of the University of Chicago. "Kenneth Polonsky is an ideal leader for us." For Polonksy, taking the helm of the Medical Center, BSD and Pritzker feels like returning home: "It's a great honor to return to Chicago, where I began my academic career and where I have maintained strong professional and personal connections," he said. He praised "the extraordinary quality of the faculty and staff, the commitment to scholarship and discovery, the passion for teaching and the growing partnerships throughout the community." Born and educated in Johannesburg, South Africa, Polonsky graduated cum laude in 1973 from the University of Witwatersrand Medical School. He completed his residency in Kenneth S. Polonsky, MD, a prominent diabetes researcher, physician and educator, was appointed dean of the Division of Biological Sciences and the Pritzker School of Medicine, as well as, executive vice president for medical affairs at the University of Chicago. internal medicine at Michael Reese Hospital and Medical Center in Chicago. He first came to the University of Chicago in 1978 for a fellowship in endocrinology. Polonsky has published more than 250 papers and won numerous career honors, including the Outstanding Scientific Achievement Award of the American Diabetes Association in 1994 and a highly selective National Institutes of Health MERIT Award in 1997. Since 2006, he has been a member of the Institute of Medicine of the National Academies, one of the highest honors for medical scientists in the United States. Zimmer offered special thanks to Everett Vokes, MD, interim dean and CEO of the Medical Center, who will return to his role as chair of the Department of Medicine on October 1. "He guided the launch of a research and clinical strategy process in advance of the opening of the New Hospital Pavilion," Zimmer said. "And he has expanded our community health care partnerships. I am immensely grateful for his outstanding service." Protecting Kids First The Kids First Clinic, which opened in December 2006, is the outpatient arm of the child protective services team at Comer Children's Hospital at the University of Chicago. The clinic provides a primary care physician for children at risk for severe physical abuse, sexual abuse or neglect. Last year, 79 children were seen in the clinic, 48 percent of whom had been previously hospitalized for abuse or neglect and then referred to the clinic for ongoing care. Kelley Staley, MD, the clinic's director, said many of the clinic's patients fall through the cracks in the health care system because their families face barriers, such as mental illness, family violence or cognitive impairments. 2 University of Chicago Medicine on the Midway Fall 2010 3 Symposium Panelists Discuss Challenges of Women in Science Evalyn Gates had completed a doctorEven those women who push through ate and two postdoctoral training prothe pipeline to the tenured position earn grams in the early 1990s, but none of the only 85 percent of what men make in the academic departments where she worked same job. had even one female faculty member. Statistics suggest that tenured faculty She understood why after she revealed to positions are not the only scientific arena a faculty member at one of the postdoc in which women are underrepresented. programs that she was not only married, Females make up nearly 50 percent of but had three children. high school physics classes in the United "If he had known, I suspect he would States, yet by college graduation, that not have hired me," said Gates, PhD, assisnumber drops to 21 percent for not only tant director of the University of Chicago physics but also engineering and comKavli Institute for Cosmological Physics. puter science. This trend occurs despite Gates' struggle to balance career with the fact that high school girls tend to have family proved to be ubiquitous for other higher grade point averages in math and panelists and attendees at the first Women science than high school boys, according in Science Symposium, sponsored by to the U.S. Department of Education. the Association for Women in Science Panelists noted that making scientific and the Chicago Council on Science careers more visible to girls, particularly and Technology. through mentorship, is a powerful way to The symposium, held address the disparity. April 17, served as a day-long Gabrielle Lyon, PhD, discussion about the parand her husband, University ticular challenges women of Chicago paleontologist face in traditionally malePaul Sereno, PhD, founded dominated scientific fields, Project Exploration with such as the physical sciences, a mission to make science technology, engineering and accessible to the public, mathematics. especially students of color For example, in academ- Gabrielle Lyon, PhD, director of and girls. ic science careers, women Project Exploration. "We noticed that there steadily drop off the path Photo by Lloyd DeGrane are students just blocks from college graduation to tenure. The from the University of Chicago who had phenomenon is so pervasive it's been never touched a fossil," Lyon said durgiven a nickname: the "leaky pipeline." ing the symposium. "When you touch The only fields that are close to avoiding something that is 130 million years old, or this leak are the social and biological sciwork next to a passionate scientist who is ences, with nearly 50 percent of doctorate full of curiosity, your perspective changes." degrees going to women. About three-fourths of the program's The primary explanations among participants are girls, and 43 percent of them panelists for such disparities centered on go on to pursue scientific fields in college. confidence and timing. At one time, Evalyn Gates considered For both women and men, the pursuit leaving physics research. However, some of a tenured faculty appointment often soul-searching helped her move beyond overlaps with the prime reproductive the crisis. years. Yet in the struggle to obtain ten"I made a list of pros and cons," she ure, married mothers tend to be at a dissaid at the symposium. "I realized that all advantage compared to married fathers, my `pros' were about how much I loved according to an analysis published this the job, and all the `cons' were confidence year by the American Association for issues. I decided not to let my fears keep University Women. me from doing it." Doctorate Degrees Tenured Faculty Members NOTEWORTHY Maryellen Giger, PhD, professor and vice chair in the Department of Radiology at the University of Chicago Medical Center, has been elected to the prestigious National Academy of Engineering. This year's Faculty Physician Peer Role Model Award was given to David P. Cohen, MD, associate professor of obstetrics and gynecology. George Bakris, MD, professor of medicine and director of the Hypertension Center at the Medical Center, was inaugurated president of the American Society of Hypertension in May. Stephen Archer, MD, the Harold Hines Jr. Professor of Medicine and chief of cardiology at the Medical Center, has been named presidentelect of the American Heart Association's Metro Chicago board of directors. The National Lipid Association installed Michael Davidson, MD, professor of medicine and director of preventive care at the Medical Center, as national president in May. Mitchell Posner, MD, the Thomas D. Jones Professor, vice chairman of surgery and section chief of general and oncologic surgery at the Medical Center, was sworn in to a one-year term as president of the Society of Surgical Oncology in March. Silvia Kriuki, a graduate of the University of Chicago and a researcher at the Medical Center, was one of five individuals to receive the 2010 Gilliam Fellowship for Advanced Study from the Howard Hughes Medical Institute, which awards $44,000 per year in graduate school support to individuals from disadvantaged backgrounds underrepresented in the sciences. Holly Humphrey, MD, dean for medical education at the Medical Center, has been named a Master in the American College of Physicians. The National Academy of Sciences has recognized Janet Rowley, MD, as one of 17 individuals who have made extraordinary scientific achievements in biology, chemistry, geology, astronomy, or psychology. Rowley is the BlumRiese Distinguished Service Professor of Medicine, Molecular Genetics, Cell Biology and Human Genetics at the Medical Center. Janice Phillips, RN, PhD, FANN, manager of nursing research, received a standing ovation from the Illinois legislature at Gov. Patrick Quinn's State of the State address for her work introducing the Reducing Breast Cancer Disparities Act. She also was appointed the Robert Wood Johnson Foundation Health Policy Fellow. An authority on the genes that influence complex biological behaviors such as fertility, allergy and cardiovascular disease, Carole Ober, PhD, has been named the Blum-Riese Professor in Human Genetics and Obstetrics and Gynecology. Christopher Rhodes, PhD, has been named the Kovler Family Professor in Medicine. He is an expert on the mechanisms that control the production of insulin by pancreatic beta cells and how this process goes awry in diabetes. Martin Feder, PhD, an internationally recognized authority on how organisms adapt to their environments, has been named the Elise and Jack Lipsey Professor in Organismal Biology and Anatomy. The Pritzker School of Medicine and the graduate programs in the Biological Sciences were both ranked 13th in U.S.News & World Report's April 27 list of the best graduate schools in the United States. No program in Illinois scored as highly in either field, and both programs have been rising steadily in the rankings. Will this adorable African Pygmy Kingfisher (Ispidina picta) wipe out the human race? Photo by Jason Weckstein In Search of the Next Bird Flu Each animal is its own ecosystem, a mysterious world of viruses, bacteria and parasites that can range from harmless to deadly. While it is rare for such pathogens to jump from animal to human, those that have crossed species, such as SARS and HIV, have proven highly dangerous. Searching after the fact for the genetic mutations that made human infection possible is difficult, slowing science's ability to treat and contain the disease. But researchers may have a head start on the next outbreak, thanks to an ambitious new collaboration announced in April between scientists at the University of Chicago and the Field Museum: the Emerging Pathogens Project. Working from 1,100 bird and mammal specimens collected during a 2009 expedition to the African nation of Malawi, scientists from the Institute of Genomics and Systems Biology, directed by Kevin White, PhD, will sequence the organisms within the organisms. "This project is all about potential -- the potential for understanding biodiversity, for understanding new pathogens, and for the application of new technologies," said White, the James and Karen Frank Family Professor of Human Genetics and the director of the Institute for Genomics and Systems Biology. The sequencing, scheduled to begin this summer, will create a massive dataset of genetic information from blood and tissue samples collected during the expedition. Scientists then can study how potentially dangerous pathogens mutate over time, which can inform treatment strategies in case of a crossover to humans. "We're really interested in comprehensively knowing what lives in and on these organisms," said project co-leader Shannon Hackett, the Richard and Jill Chaifetz Curator and head of the Field Museum Bird Division. New Clinics Help Children Get Some Sleep Sleep disorders can negatively impact a child's behavioral and cognitive development, as well as lead to chronic conditions, like hypertension and diabetes. Parents now can bring their children to one of the Medical Center's Pediatric Sleep Clinics for a good night's sleep. The Department of Pediatrics recently opened several clinics to research and treat children with chronic sleep disorders, including obstructive sleep apnea, nightmares or night terrors, insomnia and narcolepsy. "When a child has insomnia or any other sleep disorder, it can be very disruptive to the family's quality of life," said David Gozal, MD, chief of pediatrics at Comer Children's Hospital at the University of Chicago. Gozal treats patients along with Hari Bandla, MD, chief of the Section of Pediatric Sleep Medicine. "We can help with that and make sure the disorder is not causing the child any long-term damage." Patients up to age 18 first can be evaluated through analysis of sleep diaries, questionnaires, blood tests or overnight surveillance by a team of board-certified physicians, nurses, sleep scientists and technologists. The laboratories are located on campus at the Bernard A. Mitchell Hospital and at Adventist Hinsdale Hospital in Hinsdale, Illinois. The labs are equipped with digital technology to measure moment-to-moment blood pressure, assess variations in the sympathetic nervous system and analyze brain waves to detect seizures. Patients then are treated with a range of personalized, inpatient and outpatient services, from behavior modification suggestions to medication or surgery. Treatment clinics are located in Westmont, Illinois, and Merrillville, Indiana. The focus on researching and treating pediatric sleep disorders follows the University of Chicago's history of breakthroughs in the field. In 1953, Medical Center researcher Nathaniel Kleitman, PhD, helped discover rapideye-movement sleep, which is linked to vivid dreams. In December 2009, Gozal continued the tradition of innovative sleep research. Instead of using expensive diagnostic tests, Gozal discovered that a simple urine test can detect obstructive sleep apnea, a condition that causes a person to stop breathing while sleeping. Physics 16% Engineering 20% Computer Science 21% Engineering 7.2% Computer Science 22% Electrodes are attached to the surface of the patient's skin for a polysomnogram to record data for various tests, including an electroencephalogram (EEG), electroculogram (EOG), electrocardiogram (ECG or EKG) and an electromyogram (EMG). Additional body sensors are placed to assess breathing and respiratory functions, and a pulse oximetry measures blood oxygen levels. Photo by Dan Dry Only 16 percent of doctorate degrees in physics go to women, 20 percent for engineering and 21 percent for computer science. The dropoff continues as women pursue tenured positions at universities. A mere 7.2 percent of tenured faculty members in engineering are women, and fewer than 22 percent are tenured faculty members in the other scientific fields. Source: American Association of University Women 4 For more information, call 1-888-UCH-0200 or visit uchospitals.edu Fall 2010 5 Ally Bain More than 300 former patients, friends and family members came to the Medical Center's ceremony for cancer survivors treated with stem cell transplants. Photo by Ronald Orzel to Tell By Barbara Rose "Can't Wait" Her Story a perforated colon in April 2005 that required a six-hour emergency surgery and a temporary colostomy, a procedure that attaches the colon to the abdominal wall Ally Bain helped draft Ally's Law, which states along with a pouch. This pouch functions as an that anyone with a medical emergency alternative path for stools. must be allowed private restroom access. She pulled through surgery and ultimately found Photo by Dan Dry freedom from her debilitating symptoms when And that promises to be a lot. A dean's two months later she began treatment list student majoring in communications with David T. Rubin, MD, associate proat Lake Forest College, Bain's considered fessor of medicine and co-director of the becoming a lawyer, a doctor, a journalist, Medical Center's Inflammatory Bowel a novelist and an artist. "I don't accept Disease Center. Rubin was able to put limits," she said. In addition to carrying her disease in remission, and Alessandro five courses, she continues her advocacy Fichera, MD, associate professor of work as a member of the National Youth surgery, reversed the colostomy in Leadership Council of the Crohn's & December 2005. Fichera operated again Colitis Foundation of America. the following year to treat complications With a professor's help, she found a from the perforation. Rubin also began literary agent to represent a memoir she drug therapy to treat her Crohn's disease. is writing entitled, "I Can't Wait." The "When I saw Rubin the first time, he phrase is about more than bathrooms. "It promised I would be in remission within also means, `I can't wait to tell my story,'" six months," Bain said. "He definitely she said. kept his promise. When a doctor is that One of her goals is to see Congress confident about your care, there's no enact a federal version of Ally's Law. She'd turning back. That kind of confidence like to bring together on Capitol Hill all is what every patient with Inflammatory of the people who lobbied for state laws Bowel Disease should strive for." --"all of us with our families and our Rubin said Bain's prognosis is very friends and our gastroenterologists to say good, based on how well she's respondwhy Congress needs to act," she said. ed to infliximab, known by the trade "I've learned those singular voices name Remicade,� which was approved coming together have the most impact," in 1998 by the U.S. Food and Drug she said. "It definitely would be a Administration as the first drug to treat memorable experience. It would be very Crohn's disease. Remicade is a form empowering." of biologic therapy that restores the immune system's ability to fight infection and disease by targeting specific proteins using artificial antibodies. "She should anticipate doing everything she wants in life," he said. Fall 2010 7 Reunion Celebrates Stem Cell Transplant Survivors Before beginning his story, Orland Park resident Russ Sonneveld, 60, warned the crowd that he might start crying. After he was diagnosed with multiple myeloma in 2002, physicians told him that nothing could be done -- until he came to the University of Chicago Medical Center. His account was a moving but familiar story for the more than 300 people in the room. Most of them also had survived leukemia, lymphoma, myeloma or other cancers of the blood and bone marrow thanks to stem cell transplants at the Medical Center. The Medical Center's second annual celebration for stem cell transplant survivors, held April 10 in the Duchossois Center for Advanced Medicine, drew patients throughout the Midwest to share stories of triumph over a group of cancers that kill more than 53,000 people each year in the United States. Stem cell transplants save patients by first treating the patient's malignant white blood cells with either chemotherapy or radiation therapy. Then, the patient's own treated stem cells or stem cells from a healthy donor are infused into the patient, restoring his or her ability to produce healthy white blood cells, red blood cells or platelets. The Medical Center performs up to 130 stem cell transplants each year, using the patient's own stem cells or donated stem cells "It's a moving and highly gratifying experience to see patients not just survive, but thrive," said Andrew Artz, MD, assistant professor of medicine, who treated several of the patients present. "They discuss their stories in front of everyone and really invest themselves in other patients.They will even reach out to other patients in the early stages." For more stories of survivors, see http://sciencelife.uchospitals.edu. A Fish Extinction With Evolutionary Legs In the prehistoric Devonian period, aquatic species dominated the Earth's waterways, earning it the nickname "The Age of Fishes." But roughly 360 million years ago, those species experienced a dramatic shake-up, a mass extinction that set the stage for modern vertebrate evolution. The timing and significance of that deadly turning point was reported in May by Lauren Sallan, a graduate student in the laboratory of Michael Coates, PhD, professor of organismal biology and anatomy at the University of Chicago. The research, which appeared in the May 17 online edition of Proceedings of the National Academy of Sciences, illuminates a previously underappreciated event in the history of life on Earth. "Everything was hit; the extinction was global," Sallan said. "It reset vertebrate diversity in every single environment, both freshwater and marine, and created a completely different world." Sallan used fossil data from around the world and ecological analysis to The event also occurred at an important time in Earth's history, as vertebrates took their first tentative steps on land. By leaving only a few species behind, the extinction may have created a bottleneck that set the mold of future vertebrate features. For example, the authors said, a surviving ancestral fish with five digits may be the reason all of today's mammals, birds and reptiles share a five-digit limb in their embryonic stages. "It's a big extinction during what was already considered a critical time in vertebrate evolution, so it's surprising that it went unnoticed for so long," Sallan said. "But it took the right methods to reveal its magnitude." Professor Michael Coates, PhD, in his Culver Hall lab near a Gladbachus shark fossil that is used in his research. Photo by Jason Smith identify the Hangenberg event as the critical Devonian extinction. While the event's cause is unknown, the consequences were dramatic, with once-dominant lobe-finned and placoderm fish species replaced by the more modern ray-finned fishes. Nematoptychius lived approximately 330 million years ago. It's easy to underestimate Ally Bain. For starters, she stands just 5 feet 1 inch tall. A soft-spoken and thoughtful college sophomore, she's not someone you would expect to step willingly into the public spotlight. And, yet, that's exactly what she did at one of the most difficult moments in her life. Bain was diagnosed nine years ago at age 11 with Crohn's disease, an autoimmune disorder affecting the gastrointestinal tract. Before she began her treatment at the University of Chicago Medical Center in June 2005, Bain's condition flared unpredictably. It was during just such a flare-up in June 2004, while shopping with her mother, that Bain urgently needed to use a bathroom. She was doubled over in pain, tears streaming down her face, but still the store manager repeatedly refused her access to the store's private restroom. She's never forgotten his words -- "I'm making a managerial decision" -- or how powerless at age 14 she felt to prevent what happened next. She had an accident there in the store. Not many teenagers would be willing to talk about something so humiliating. Bain not only spoke about it, she contacted her state representative and helped draft the Restroom Access Act, also known as Ally's Law, which states that anyone with a medical emergency must be allowed private restroom access in establishments with three or more employees. In early 2005, Bain told her story to a committee of legislators in Springfield, and the law was adopted in Illinois in August that year. Eleven other states followed suit, most recently Wisconsin. "I still think I'm rather shy," she said. "(But) when I'm passionate about something, I have energy that only comes out when I feel that passion." During the year after her accident, Bain's symptoms got worse. She developed 6 University of Chicago Medicine on the Midway "I am determined to live my life." -Eloise Orr Eloise Orr was able to complete school, travel the world and beat recurring metastatic breast cancer all at the same time. Photo by Dan Dry A War of Wills With Cancer By Kadesha Thomas Eloise Orr had plenty on the horizon. As a 20-year-old junior at the University of Illinois in Champaign, she had finals coming up. Then she'd be off to Spain in the fall for a semester abroad. After graduating that spring with a degree in Spanish, she planned to celebrate in Puerto Rico. None of those plans included breast cancer. Orr, from Chicago's South Shore neighborhood, had never feared breast cancer growing up, even though AfricanAmerican women in Chicago are more than twice as likely as Caucasian women to die after being diagnosed, regardless of socioeconomic status. Orr's mother died of the disease at age 35, when Orr was just 5 years old. In April 2002, Orr had to face her risk. She noticed a heavy discharge from one of her nipples. Nora Jaskowiak, MD, discovered that Orr had ductal carcinoma in situ, an early-stage cancer usually limited to the breast duct. But Orr's breast cancer would be anything but limited. In fact, it would threaten her life for the next five years. "I didn't have time for radiation," Orr said, opting instead for a double mastectomy to avoid recurrence. "I was determined to go to Spain." And go she did. "We tailored an entire regimen around her plans so this wouldn't be an obstacle in her life fulfillment," said David Song, MD, chief of the Section of Plastic and Reconstructive Surgery, who placed Orr's breast implants. "If you let the treatment process take over, it can diminish the patient's sense of hope." After the surgery, Orr juggled summer classes with weekly follow-up appointments. However, the final pathology showed that some cancer cells had escaped the breast ducts. "That's when we knew we were potentially not out of danger," Jaskowiak said. When Orr returned from Spain in January 2003, a tumor in her right armpit had grown large enough for Jaskowiak to detect by touch. The breast cancer had metastasized to her lymph nodes. Surgery was scheduled for March, but Orr had Jaskowiak postpone the chemotherapy and radiation until after her graduation trip to Puerto Rico. Summer 2003 was the closest Orr came to hitting a low point. "Losing my hair was the easy part," she said of chemotherapy. "I was so sick that I prayed to my mom for strength to go to the hospital, like `Mom, I need you to get me there.'" The cancer was as stubborn about recurring as Orr was about beating it. The following year in 2004, the cancer came back a third time as two tumors -- in her brain. And it kept coming back every year until 2007, leading to six diagnoses, all before she turned 26 years old. Throughout treatments, Orr refused to stop traveling abroad or going to school. Every treatment regimen had to consider her plans. "Her whole attitude is unbelievable," Song said, choking up. "Imagine you're 20 years old, and you get the same disease your mother died from. But with Weezy -- that's what I call Eloise -- maybe she cried a couple of times, but she always picked herself back up. This kind of resilience is rare because most people don't make it." Song said the probability of mortality is exactly why accommodating a patient's life plans during treatment is standard practice at the Medical Center. "Imagine if Weezy had never gone to Spain or graduated from college," he said. "She would have survived the cancer, but she would also regret not having taken advantage of life." Orr, now 28 years old, teaches English and Spanish at Francis M. McKay Elementary School on Chicago's Southwest Side. She finished a graduate degree in elementary education in June 2010 with a 4.0 grade point average. "I am determined to live my life," said Orr, who has been cancer-free since 2008. "I think that's why I kept beating it. I'm just like my mom in that way. Whatever she wanted to do, she did, and you'd have to work around her schedule. I know she was with me to keep me strong." The Brain's The Brain's Storm Electrical Electrical Storm of neurons fire lightning-like Inside every person's brain is an electrical storm. Billions By Kadesha Thomas and Robert Mitchum By Kadesha Thomas and Robert Mitchum spikes as often as 200 times a second, skidding through the cerebrum's deep-wrinkled Inside every person's brain is an electricalat up to Billions of neurons fire lightning-like landscape and charging throughout the body storm. 328 feet per second. The output of spikes as often as 200 times a second, skidding through the we make, every word we this furious chatter is everything we do or think: every movement cerebrum's deep-wrinkled speak, every memory thatthroughout the body at up to 328 feet per second. The output of landscape and charging is sparked. this turning chatter of this magazine do or think: every millions of neurons in the priJust furious the pageis everything we involves lighting upmovement we make, every word mary motorevery memory that is sparked. we speak, cortex, spreading through the brain's network like a flash of light. Without this electrical cascade, of thiscould not lift a lighting With brilliant choreographythis electrical grid, with Just turning the page you magazine involves finger. when something breaks down in and precision, up millions of shoot signals down the neck, along particular neurons dying mysteriously or acting strangely the neurons neurons in the primary motor cortex, the spinal cord and into the arms, jolting spreading through the brain's network like a flash of light. -- sometimes resulting in an all-out power outage. the hand electrical cascade, you could not lift a receptors Though brain disorders may seeminformation muscles to respond. Sensory finger. in the fingertips fire back rare, neurological Without this along a parallel sensory precision, the neurons disorders the tactile higher the page, healthy With brilliant choreography andhighway, relaying to the braincontribute to a feel of percentage of its shoot signals down the neck, along the spinal cord and into neurons coordinate every punctilious or HIV/AIDS, weight, its thickness and smoothness. These years lost than cancer, respiratory diseases detail the arms, signaling the hand muscles to respond. Sensory according to estimates from the World Health Organization. of how thethe fingertipsbe turned. receptors in page will fire back information along a About 12 percent of deaths worldwide can be attributed parallel sensory highway, relaying to the brain thegrid is interrupted or misfires? While the vast majority of But what happens when this electrical tactile to a neurological disorder. feel of the page, its weight, its thickness and smoothness. these deaths are stroke-related, other conditions that These neurons coordinate every particular detail of how the In neurology, the focus is on determining what damage thewhen thesystem arenetwork fails. happens nervous brain's becoming a larger page will be turned. concern to neurologists. The dramatic symptomselectrical grid is interruptedMultiple Sclerosis, Parkinson's, epilepsy and are of diseases such as But what happens when this Deaths from unexplained neurological disorders other neurological conditions, like the ataxias, all result but unlike other conditions, theirdown in or misfires? increasing, when something breaks causes cannot In electrical focus is on particular neurons be blamed on a tumor, blockage or virus. Tests and this neurology, thegrid, withdetermining what happens dying mysteriously or acting strangely only show when the brain's network fails. The dramatic symptoms of that the brain's neurons have stopped sending electrical resulting in as multiple sclerosis, Parkinson's, epilepsy signals normally for no obvious reason. And that's where diseases, such an all-out power outage. and other neurological conditions, like the ataxias, all result the puzzle begins. Fall 2010 9 8 For more information, call 1-888-UCH-0200 or visit uchospitals.edu Christopher Gomez, MD, PhD, chairman of the Department of Neurology, is leading an effort to integrate clinical practice with laboratory research. Photo by Dan Dry "The ultimate solution is to put in a device that could sense when the brain is gathering itself to start a seizure." -- David Frim, MD, PhD "The most fascinating thing to me about the human brain is how one tiny cell can develop into an entire nervous system with billions of neurons from head to toe." -- Christopher Gomez, MD, PhD Elsewhere on the University of Chicago campus, the laboratory of Brian Popko, PhD, the Jack Miller Professor of Neurological Disorders, is using genetics to understand how neurons become insulated with myelin. In a study recently published in the journal Genes & Development, Popko's group took a mutant mouse with a persistent muscle tremor and traced its symptoms back to a single gene, called Zfp191. That gene, which likely coordinates successful myelin insulation, may be a promising target for new MS drugs, Popko said. Those successes bring a wider array of options for patients but also require medical centers that have a strong foundation in basic science research. "It's getting to the point where only very highlevel medical centers or sophisticated neurology groups can handle these drugs," Reder said. "Many of the new therapies require us to be neuroimmunology specialists. We can handle that here, and clearly remain at the forefront in developing these therapies." David Frim, MD, PhD, chief of the Section of Neurosurgery, treats patients with intractable epilepsy. Photo by Dan Dry L eading the Medical Center's Department of Neurology, Christopher Gomez, BS '77, PhD '81, MD '83, is pushing an increasingly collaborative effort to understand the fragility and resilience of the body's electrical epicenter: "The most fascinating thing to me about the human brain," he said, "is how one tiny cell can develop into an entire nervous system with billions of neurons from head to toe. It can allow an individual to learn and function, sometimes for 30, 40 years, and then break down, all because of one part or even one genetic mutation." That's what happened to Dan Bulow, a tall man with freshly cut steel-gray hair and a celebrity-next-door persona. The 54-year-old, former college football star, radiates a confidence that makes his walking cane look like a fashion accessory. Unfortunately, it's not. In 2003, Bulow's wife noticed he had a slight limp in his right leg. Bulow, from Orland Park, Illinois, underwent a battery of tests, including an MRI and a spinal tap at the Medical Center, which confirmed a diagnosis of multiple sclerosis (MS). Observed since the 19th century, MS has long baffled doctors as a debilitating disease that is difficult to manage and treat. What scientists and physicians know is that brain signals travel through a network of axons that act like fire wires linking neurons throughout the body. A myelin sheath insulates these axons with a layer of fat that conducts the electrical impulses in the right direction at just the right speed. In patients with MS, like Bulow, cells from the immune system chew away at the myelin sheath. So, when Bulow takes a step, the electrical impulses moving down his leg to stimulate his muscles either move too slowly or fizzle out. That's because the sheath is too damaged. Because he cannot quite lift his right leg high enough, he uses the cane to keep from tripping. In 85 percent of people with MS, the myelin sheath will rebuild itself after an attack from the immune cells, restoring the neurons' ability to send electrical signals to full function -- until the next attack. This is known as Relapsing-Remitting MS, the condition's mildest form. With Secondary-Progressive MS, the myelin sheath and limb function are only partially restored after an attack and the disease slowly and continuously worsens. "The more times you get hit, the more impaired you become," explained Adil Javed, MD, PhD, assistant professor of neurology. "So you have to stop the hits. That's where the drugs come in." Six effective treatments have been developed for these two types of MS, thanks in part to Barry Arnason, MD, professor of neurology and former chair of the department. He involved the Medical Center in more than 50 clinical trials of new MS drugs. In 1993, he helped bring beta interferons to the market. These drugs constrain the attacking cells of the immune system. But the lesions on Bulow's cerebrum showed that he had Primary-Progressive MS, the most aggressive form. With this type, there are no peaks of remission and valleys of relapsed attacks -- it's a downhill slope that gradually becomes steeper. Bulow exercises five days a week, but he had to trade the 10-mile runs and basketball games for lower-impact routines on the stationary bike and rowing machine. His biggest fear is needing a wheelchair. No treatment exists for Primary-Progressive MS. But Anthony Reder, MD, professor of neurology, is working to change that. He is the principal investigator on a multisite, randomizedcontrolled trial involving Bulow, along with 10 other Medical Center patients and about 1,000 other people throughout the country. The trial is testing a pill, known as FTY720, a drug that traps immune system cells in the lymph nodes so they don't reach the brain. It also may restore motor function by rebuilding the myelin sheath. Un Jung Kang, MD, is collaborating with neurobiology researchers to find treatments for Parkinson's Disease patients. Photo by Dan Dry "This is a great example of clinical and basic research going back and forth, synergizing with each other." -- Un Jung Kang, MD Fixing Power Outages Finding a genetic link to a neurological disorder gives researchers a slight advantage -- it identifies a source for the problem. Ataxias are a family of little-known movement disorders that sometimes resemble MS. Only about 150,000 people in the United States have been diagnosed, and two-thirds have a hereditary form. Usually the symptoms begin with a loss of balance and coordination in a patient's arms and legs. Damage to neurons in the cerebellum, located under the base of the cerebrum at the back of the head, prevents these neurons from properly sending electrical impulses that regulate balanced, coordinated movement. In his laboratory, Christopher Gomez, MD, PhD, chairman of the Department of Neurology, has been able to illustrate how gene mutations can cause impaired movement. "As one of the brain's most vulnerable regions, the cerebellum is the canary of the nervous system," Gomez said. "It can tell us about common disease mechanisms, like protein misfolding mutations, which have implications for Parkinson's, Huntington's and Alzheimer's, or DNA repair problems, which cause cancer. Our research has implications for all of these disorders." Even in ataxias, other brain areas may be silently affected. Gomez's lab is now ready to apply his research to patients, examining whether ataxia patients' retinas get thinner as the disease progresses. In Parkinson's patients, the neurons in an area of the brain called the substantia nigra die out over time and no longer produce the chemical neurotransmitter dopamine. Without dopamine to push electrical impulses along, movement ceases to follow a specific pattern, causing involuntary movement in some muscles and complete rigidity in others. As a young resident, Un Jung Kang, MD, now the director of the University of Chicago Movement Disorders and Parkinson's Disease Center, immediately could identify advanced Parkinson's patients: "Their movements were so abnormal," he recalled. Sitting Multiple sclerosis has reduced 54-year-old Dan Bulow's range of motion in his in the waiting room, the patients often stared straight ahead, not blinking because their ability to move their facial muscles had been destroyed. Their hands and fingers trembled, while their arms and legs were rigid, like a statue. Kang's team now is in the early stages of a multisite clinical trial -- involving 600 patients nationwide -- to understand how to stop the disease from progressing to the statue point. Kang is monitoring a group of recently diagnosed Parkinson's patients to see if the nutrient Coenzyme-Q-10 can help them maintain motor function without L-dopa, a treatment to replace dopamine used since the 1950s. Another experiment, using a mouse model, has raised questions about when physicians should prescribe L-dopa. Jeff Beeler, PhD, a postdoctoral researcher in the laboratory of Xiaoxi Zhuang, PhD, associate professor of neurobiology, is studying motor learning with a unique mouse strain, called aphakia mice, with a genetic mutation. These mice naturally develop a severe, 90 percent depletion of dopamine neurons, similar to the loss seen in advanced Parkinson's patients. Yet oddly, these mice exhibit only very subtle motor deficits. Beeler ran the mice on a rotarod test, a slowly rotating cylinder that the mice must learn to navigate, like a competitor in a log-rolling contest. Normally, the mice fell off the rotarod in seconds and didn't show much improvement with repeated trials. But with L-dopa, the aphakia mice steadily improved their rotarod skills. By the fifth day of training, they were able to stay on for a couple of minutes, similar to normal mice. Even after the mice stopped getting L-dopa treatment, they continued to excel on the rotarod. Further experiments found that L-dopa was helping the mice successfully learn, rather than perform, the rotarod task. For Parkinson's patients, this suggests that the loss of dopamine not only impairs movement but that the disease may actually be a learning disorder. Beeler's research suggests that in the absence of dopamine, patients are essentially learning incorrect movement. The finding, if replicated in humans, could lead to earlier treatment of L-dopa, allowing patients to maintain correct movement learning because the dopamine is being replenished. "This is a great example of clinical and basic research going back and forth, synergizing with each other," Kang said. "Now, we are examining patients to specifically test the role of dopamine in motor learning and their ability to do everyday activities." 10 For more information, call 1-888-UCH-0200 or visit uchospitals.edu right leg, but regular exercise helps him to manage the symptoms. He has participated in two clinical trials at the Medical Center, which he hopes will help lead to a cure. Photo by Jason Smith Fall 2010 11 "At first, I said, `No way. You want to cut open my child's head and take out a piece of her brain?'" -- John Hillier Grace Hillier, 9, came to the Medical Center to be treated for intractable epilepsy. Her parents, Sheila and John Hillier, agreed to let neurosurgeon David Frim, MD, PhD, operate. Grace has not had a seizure since the surgery. Photo by David Christopher Taming Electricity With Electricity On an electroencephalogram (EEG), the lines monitoring electrical activity in the brain flow across horizontally, showing gentle hills and valleys. But when an epileptic seizure strikes, a wave of chaos sweeps across the different channels of the EEG. Sheila and John Hillier, from New Lenox, Illinois, witnessed their youngest daughter, Grace, have her first seizure at just five weeks old. After nearly every breast feeding, Grace would jerk her body into the fetal position, scrunching her tiny, trembling fists together while her eyes rolled back and forth like pinballs. After about 30 seconds, she'd relax her body into a normal position again. Increasing doses of anti-seizure medications controlled Grace's seizures until she was 5 years old, but then grew ineffective. With intractable epilepsy, like Grace's, neurons in a certain part of the brain send electrical impulses uncontrollably. On Grace's EEG, all of the electrical activity looked normal, except in the occipital lobe, the area of the brain responsible for vision located beneath the back of the skull. Erratic electrical impulses from the neurons in the temporal lobe, near her right ear, made the EEG spikes in her occipital lobe look like the frenzied scribbles of an angry toddler. The family met with Michael Kohrman, MD, director of the Medical Center's Pediatric Clinical Neurophysiology Laboratory, to discuss possible treatments. Brain surgery to remove the overactive brain tissue was the only possible way to stop Grace's seizures, which were impairing her ability to read and follow instructions. "At first," recalled John Hillier, Grace's father, "I said, `No way. You want to cut open my child's head and take out a piece of her brain? What if they make a mistake and she becomes handicapped?'" But families like the Hilliers, who ultimately take that risk, not only are helping their child's disease, they also are advancing epilepsy research. After David Frim, MD, PhD, chief of the Section of Neurosurgery, surgically removes the problematic brain tissue where the seizures originate, the resected tissue is analyzed by Wim van Drongelen, PhD, professor of neurology and pediatrics. Using drugs, van Drongelen induces a seizure in the tissue, and films the brain's chaotic activity with a camera in his microscope. The goal is to develop targeted treatment based on individual brain activity, as well as to understand the mechanisms that generate the seizures in the first place, said van Drongelen. But inducing a seizure in human brain tissue comes with limitations. The activity in a human brain slice only lasts about 24 hours, and it's susceptible to side effects from the seizure-inducing drugs, just as a patient would be. To overcome this limitation, van Drongelen's group has created a computer replica of the brain's neocortex, the area where many seizures erupt in pediatric patients. After two years collaborating with scientists in the Netherlands and at Argonne National Laboratory, van Drongelen's group built simulated networks of as many as 150,000 cells, mimicking the complex electrical activity in this brain region. The closer van Drongelen comes to understanding the role that both electrical and metabolic activity play in jump-starting a seizure, the closer his team gets to developing new anti-seizure drugs, as well as a device that can read brain activity to warn patients when a seizure is coming. Recently, van Drongelen and Wave Technology Group announced a prototype epilepsy monitoring device that can send real-time information to a smartphone, warning the patient and emergency contacts about an oncoming seizure. Researchers hope to begin testing the device by the end of this year. If researchers develop a way to predict seizures, surgery may no longer be necessary for patients like Grace, now 9 years old, who has not had a seizure since her surgery. "The ultimate solution is not to take any brain out, but rather to put in some sort of device that could sense when the brain is gathering itself to start a seizure," Frim said. "Then it could send precalculated electrical stimuli to the brain surface." The seizure would come to a halt, using electricity to tame electricity. In the eight years that van Drongelen has been asking patients if he can analyze their brain slice after surgery, not one patient has said no. "It is humbling to know that our patients are willing to let us do this research, even though it may not directly help them," he said. "They know how terrible this disease is and how significant it could be if other children in the future could benefit from our findings." Judy Guriel, 73, of Chesterton, Indiana, mows her grass with her ventricular assist device batteries strapped to her waist. Guriel is an active woman who gardens and plays backyard baseball with her grandchildren. Photo by Dan Dry Hope for Heart Failure Ventricular Assist Devices Replacing Heart Transplants as Favored Therapy By Kevin Davis Shortly after her 71st birthday, Judy Guriel lay dying of advanced heart failure in an intensive care unit in northwest Indiana. Hospital staff had asked her family whether they had considered signing a "do not resuscitate" order. Guriel had previously been active and already had a pacemaker but had become too frail for a heart transplant. But then a cardiologist suggested her family contact the University of Chicago Medical Center, where Guriel might have options for more advanced care and treatment. Twelve days later, Guriel was on a helicopter bound for the Medical Center, where she was a candidate to receive a left ventricular assist device (LVAD), a pump that could be surgically grafted to her weakened heart to boost blood flow. Patients like Guriel, who are at Stage D, the most advanced level of heart failure, are at a critical point, says Allen Anderson, MD, director of the Advanced Heart Failure Program at the Medical Center: "At that stage, they are dying. It's a terrible, terrible process and there are few options." The options in such cases are palliative care to keep patients comfortable in their final days, heart transplantation or implanting some type of ventricular assist device (VAD) to assist blood flow. Patients entering Stage D need to move quickly. "The longer you wait, the worse the outcome," Anderson said. "It is humbling to know that our patients are willing to let us do this research, even though it may not directly help them." -- Wim van Drongelen, PhD 12 For more information, call 1-888-UCH-0200 or visit uchospitals.edu Wim van Drongelen, PhD, analyzes brain tissue from epilepsy patients to understand where seizures generate. Photo by Dan Dry Fall 2010 13 "We always used to think transplant I n deciding whether a VAD or transplant is appropriate, or even feasible, Anderson and his colleagues consider the patient's age, overall health and whether there are other medical problems, such as liver or kidney dysfunction. "In the big picture, you'd like to know whether there's a good chance of giving them a quality of life," he said. The use of VADs received widespread publicity recently when former Vice President Dick Cheney was implanted with the Thoratec HeartMate� II. Cheney's disclosure indicated the seriousness of his condition since these devices are reserved for only the sickest patients. For patients like Cheney, ventricular assist devices are proving to be an effective alternative to heart transplantation and, in some cases, the only feasible therapy for patients with advanced heart failure. "We get many people who are not ideal transplant candidates," said Valluvan Jeevanandam, MD, chief of cardiac and thoracic surgery, who has implanted hundreds of the devices. VADs first were used exclusively as a temporary measure or a bridge to transplant. The goal was to keep patients alive until they were strong enough to receive a new heart. As a result of the shortage of transplantable organs and advancements in technology, the device is becoming a permanent therapy, making it the first and, perhaps, the last choice for patients with end-stage heart failure, Jeevanandam says. The University of Chicago Medical Center is among about 130 hospitals nationwide that offer the procedure, and is now involved in clinical trials to test the next generation of devices that are even smaller and better engineered. Guriel, a healthy and active person who loved to dance, was a perfect candidate for a VAD. After evaluating her condition, physicians approved Guriel to receive a HeartMate II LVAS (Left Ventricular Assist System), the same kind implanted in Cheney. first, and now we're 50/50... The paradigm is shifting." -- Valluvan Jeevanandam, MD A Bridge to Transplant The quest to mimic the functions of the heart with mechanical devices goes back more than 50 years, with inventions ranging from total artificial hearts to smaller devices designed to assist failing ones. Among the most sensational and widely known efforts came in 1982 when Seattle dentist Barney Clark received a total artificial heart designed by Robert Jarvik. Clark survived for 112 days but never left the hospital. The earliest artificial hearts triggered many complications, including a high incidence of infection and stroke after implantation. And the risk of mechanical failure was too grave. "If it stops, you're dead," Jeevanandam said. "So that led to the idea of an assist device rather than a whole replacement." Dozens of companies have since created implantable devices to assist the heart's pumping action. The first generation of long-term, mechanical circulatory assistance devices were pulsatile devices, meaning they were coordinated with the patient's heartbeat and supported pumping through a pusher plate, rotary pump or bladder compression inside the heart. The early versions had limits. They were bulky, had a high incidence of infection and bleeding and could wear out quickly. The control systems and battery packs worn outside the body were cumbersome. Jeevanandam, a pioneer in the field of mechanical circulatory assist devices, has been studying and implanting VADs for nearly two decades and serves on the FDA's Circulatory Devices Panel. Before joining the Medical Center in 1998, he was surgical director of the cardiomyopathy and transplantation program at Temple University Hospital in Pennsylvania. While there, he served as principal investigator for clinical trials of left ventricular assist devices (LVADs) as both a bridge to transplant and as a permanent treatment for end-stage heart disease. In the early 1990s, Jeevanandam was among a handful of surgeons to implant the Thoratec HeartMate� XVE, a firstgeneration left ventricular assist device that, while effective, involved long hospitalizations and recovery periods and had a limited lifespan. "They were great as bridge devices, but they stopped working after 15 months," Jeevanandam said. Other types of devices also were being tested. In October 2000, Jeevanandam was the first surgeon in the world successfully to implant the CardioVADTM, a permanent circulatory assist device that uses the aorta indirectly to support circulation by triggering an inflatable diaphragm to push out blood. Still in search of smaller and better ways, bioengineers developed a rotary pump system for the HeartMate that would provide continuous blood. "It's just a turbine, or like a fuel injector in the car," Jeevanandam said. Because the continuous flow Allen Anderson, MD, director of the Advanced Heart Failure Program at the Medical Center, holds a VAD in his hand to show how it connects to the heart. The inflow cannula (right metal pipe) is implanted into the apex of the heart and the outflow graft (the yellow flexible hose on the left) is sewn into the aorta. Blood drains into the inflow cannula from the left ventricle, is ejected through the pump (in Anderson's hand) and back into the aorta. Photo by Dan Dry "At that stage, they are dying. It's a terrible, terrible process and there are few options." -- Allen Anderson, MD devices do not have to displace blood like the pulsatile devices, they are small and contain just one moving part, making them more reliable. Patients who receive them have a pulse that is difficult to detect. Blood f low has to be read through Doppler technology. Early results of the HeartMate II were promising. A clinical trial testing its use as a bridge to transplant found that 57 percent of patients were kept alive long enough to receive a transplant and another 17 percent survived for at least 180 days. The FDA approved its use as a bridge to transplant in 2008. None of these devices have been without complications and risks. Implantation requires major surgery and with it comes the risk of infection. Risk of bleeding is heightened because of the need to take blood thinners. Clotting and stroke also remain a threat. In 2005, Jeevanandam was appointed to the clinical events committee for a trial that compared the use of the HeartMate XVE and the HeartMate II. The trial included 200 randomized patients at 38 centers across the country. Results of the clinical trial, published in the New England Journal of Medicine in December 2009, showed a survival rate of 58 percent at two years for those who received the HeartMate II, double that of those who received a HeartMate XVE. The FDA approved Heartmate II for destination therapy in January 2010. Medical Center surgeons performed 37 LVAD transplants in 2009 and now are doing five to six surgeries a month. Jeevanandam says preliminary data show that one-year survival rates among patients implanted at the Medical Center are about 85 percent, slightly higher than at other centers that perform the surgery. One of those surviving patients is Ron Lekavich, 72, of Orland Park, Illinois, a music teacher and owner of two music stores. He suffered from congestive heart failure and could barely walk without losing his breath. Doctors feared he might not live another six months without getting a VAD. He had the surgery in the summer of 2009 with hopes that he would become well enough for a transplant. "I feel better than I have in a long time," he said. "It's like I'm a new man." Surgery for Guriel Guriel received her LVAD on August 2, 2008, in a three-hour surgery. She spent about a month recovering, leaving the hospital just before Labor Day. Her grandson stayed with her the first two weeks to help make sure she changed and charged her device's batteries correctly. At first, Guriel was nervous that the power would go out or that the machine might fail. "I was scared to death when little noises went off," she said. For some patients, the batteries and controller can be a burden. It requires carrying 4 to 5 pounds of gear all day, plus a holster and bags. "Physically, it's hard," said Guriel, who made herself a special vest with pockets to carry the batteries. "But I don't sit on the couch all day and watch TV. Today, I was out cleaning the shed." In fact, she's resumed Polka dancing, one of her great passions. Valluvan Jeevanandam, MD, chief of cardiac and thoracic surgery, has implanted hundreds of ventricular assist devices and serves on the FDA panel that monitors the devices. Photo by Bart Harris 14 For more information, call 1-888-UCH-0200 or visit uchospitals.edu Fall 2010 15 Music teacher Ron Lekavich had a life-saving heart surgery, which included the HeartMate II left ventricular assist device. Photo by Ryan Robinson Even smaller pumps are on the horizon. "The devices we will be testing here are no bigger than your thumb," Jeevanandam said. "With that likely will come fewer complications and less bleeding." He added, "We always used to think transplant first, and now we're 50/50 and probably in a year or so we'll be seeing more VADs. So the paradigm is shifting." To help make that shift, more people need to know about VADs and ask their physicians about them. "Patients have to realize that their doctors may not know about this device," Jeevanandam explained. Haiti Mending Body and Spirit After the January 12 earthquake devastated Haiti, 37 volunteers from the University of Chicago Medical Center traveled to Haiti to run a field hospital in Fond Parisien and to staff the Haiti University Hospital in Port-au-Prince. Cheryl L. Reed, executive and managing editor of Medicine on the Midway, traveled to Haiti to document the work of the volunteer medical teams. Even though the device is durable and has proven to be mechanically reliable, doctors counsel patients against some activities that might put themselves and their machines in danger. That means restrictions against driving or riding in a car with airbags that can deploy and cause chest trauma. "Some patients adapt incredibly well to these machines and others don't," Anderson said. "A lot of it boils down to the patient's quality of life. Most of these patients would be dead or in the terminal stages of their disease, and now they're thriving. There's a real simplicity to that." The Future for Guriel and Lekavich For patients like Judy Guriel and Ron Lekavich, the sophistication of the VAD coincided with their need. Neither is listed for transplant, and that day may never come or may never be necessary. Lekavich is happy where he is, and his rebounding energy has allowed him to return to his passion -- teaching music, including piano and woodwind instruments. "I get a lot of satisfaction out of it and really enjoy it," he said. Whether he will become strong enough for a heart transplant remains to be seen. Guriel also is satisfied with her progress, and on August 5, 2010, two years to the date of her surgery, she was fitted with new batteries that weigh a little more than half what the old ones did. She plans to make another vest to wear the new batteries. Another bonus is added battery life. Though the latest batteries are supposed to last up to 10 hours, Guriel has already tested that capacity to 14 hours. An active woman, Guriel certainly is not letting her condition keep her down. She continues to mow her own grass and tend to her garden and even bats around a ball with her grandchildren. "It's like I have a new lease on life," she said. "My neighbors say I'll soon be running around the block." At a cost of about $100,000 for the device alone, some have questioned its value for patients in such dire condition. "Someone asked me why we should spend all this money to put these devices into people who are going to die," Anderson said. "My response was, `because they might not.'" So far, the longest a patient has lived on a HeartMate II is slightly more than six years, the time when clinical trials began. Jeevanandam says the pump likely can last as long as 10 years before being replaced. Replacing Heart Transplants As the technology continues to improve, Jeevanandam says, VADs may become the first and only necessary treatment for severe heart failure for patients of advanced age. Only about 2,200 patients are able to receive transplants every year. Patients suffering from other chronic medical conditions, or who may have advanced liver and kidney failure, will not qualify for the waiting list. The ideal age for transplant patients is between 65 and 70, Jeevanandam said. The reason is that their immune systems are not as strong as that of a younger person, which means the risk of rejection in older patients is reduced. "That age group is good because their immune system is not so robust, so they can accept the heart pretty well." Transplants bring different kinds of complications and drug regimens that include some 40 pills a day. "With a VAD, the biggest advantage is that you can get your pump right away, and you don't have to take the immunosuppressant medications," he said. The need for such devices may be increasing. "Heart failure is the only cardiovascular disease that is increasing in incidence," Anderson explained. The reason: More people survive heart attacks because of advances in treatment and care. "They live long enough to have heart failure," Anderson said. On paper, it may seem that heart transplants are better. Transplant survival rates are about 85 to 90 percent after one year and about 70 to 75 percent after five years. However, comparing survival rates between transplant patients and VAD patients does not tell the whole story. Jeevanandam notes those who received VADS are largely older and sicker than transplant patients and may not even be eligible for a transplant. The next generation of LVAD, called HeartWare, about the size of a D cell battery, is now available at the Medical Center as a bridge to transplant as part of a clinical trial and will be available as a destination therapy as part of a trial beginning later this year. It has magnetically levitated parts instead of bearings that can wear out from friction. "Theoretically, it should last forever," Jeevanandam said. Left: A patient carries a water jug back from the field hospital well. Patient population in the tent hospital averaged about 270 patients daily, plus their family members, requiring some tents to house up to 13 people at a time. Photo by Jimin Kim Above: Haitian children at the University of Chicago Medical Center's field hospital in Fond Parisien, Haiti. Photo by Marshall Segal, MD By Cheryl L. Reed Scan this code to view a video of Ron's story on your smart phone. P iles of crumbled and mashed cement towered three and four stories beside the downtown streets, forming caverns of destruction. Young men and boys dug furiously through the mountains of stones, as if it were possible to find someone living, breathing, weeks after the earthquake that killed 225,000 people in Port-au- Prince. Stagnant gray sewage pooled at intersections. The smell of decay clung in the air. Amidst the ruins lay the detritus of people's lives--a woman's shoe, a handbag--all prompting me to wonder if their owners were still alive. Get the free code reader by texting SCAN to 43588 or download the free app at www.getscanlife.com on your phone's Web browser. Open the ScanLife application and scan the 2D barcode. Not working? Visit ScanLife.com for more information and to view a list of compatible phones. Standard data rates may apply. Available on select Web enabled camera phones. In the midst of the city's downtown, the landscape was like Ground Zero after the collapse of the World Trade Center. A fine mist of dust hung in the air, a fog of cement and asbestos that covered the city. There were mounds and mounds of rubble with people picking and guarding the remains. The owner of a barbershop, filled to the roof with boulders, set out to clear his building by hand, one stone at a time. On a busy side street, a man stationed himself on a chair in the middle of the road, a sawed-off shotgun laid casually across his lap. A few blocks away, the bodies of two young boys beaten to death lay discarded in the middle of the street, United Nations police circling like flies trying to determine what had happened. That was Haiti in the aftermath of one of the worst modern natural disasters: a land of chaos and vigilantism. A place where thousands slept on the ground on beds made of stone protected only by a tarp or a bedsheet, where entire extended families crowded into a single shanty the size of a closet. It was a country whose population was largely injured and homeless, hungry and destitute. It was also where more than three dozen University of Chicago Medical Center volunteers spent months mending the bodies and spirits of survivors. Two weeks after the earthquake, the Medical Center sent teams of medical volunteers to staff the University hospital in Port-au-Prince. Other Medical Center teams established a field hospital and pharmacy on the grounds of the Love-A-Child orphanage in Fond Parisien, a bumpy hour's drive from the capitol city. The teams worked 15-hour days for three weeks and then were replaced by subsequent teams on a rotating basis. Fall 2010 17 16 For more information, call 1-888-UCH-0200 or visit uchospitals.edu Rubble from destroyed buildings in downtown Port-au-Prince formed caverns of destruction. Photo by Cheryl L. Reed In the early weeks, busloads of patients arrived at the field hospital in the middle of the night, transported from hospitals in the neighboring Dominican Republic (DR) where their initial wounds had been treated. They arrived in the dark, stressed and disoriented. Because there were initially only a few lights mounted in the camp, patients were sometimes treated by miner-like flashlights strapped around physicians' heads. After one onslaught, Christian Theodosis, MD, an emergency room (ER) physician at the Medical Center, texted back to Chicago: "Just finished getting crushed: 67 patients on three buses, after dark. Conditions quite intense, quite rough. Running short on tents, short on hands. Many, quite vulnerable people. Hungry and tired." By May, a total of 37 Medical Center volunteers had experienced that Haiti rush, a mixture of adrenaline, sweat, hunger and compassion that kept us going long after we thought we could. Thirty-one Medical Center volunteers served at the field camp and another six at the University hospital in Port-au-Prince, with a couple serving at both sites. At the field hospital, we inhaled dust from winds that scraped the arid ground and breathed in diesel fumes from the generators that powered the field camp. At night, we traded stories about the injured and how we'd stifled our emotions. We ate one hot meal a day: rice with specks of beans. We took cold bucket showers and drank tepid well water. We slept on the ground in tents as the strange sounds of Creole gospel songs wafted from the nearby hills. We had no luxuries like cold drinks, vegetables or self-pity. In brief moments of despair, we were reminded of all that we had and all that our injured patients did not. Homeless earthquake victims packed into donated blue and beige Eddie Bauer tents, sometimes burgeoning with up to 13 people a tent. At first glance, the nine uniform rows of tents resembled an Outward Bound adventure trip, but then a man with a missing leg hopped by on crutches. Later, during the rainy season, two tennis court-sized tents donated by the World Health Organization (WHO) housed patients to get them off the soggy ground. Though modest, the field hospital was a place of refuge. Medical Center volunteers, along with medical personnel from Harvard University and medical organizations from 15 different countries, staffed the hospital. From late January until early May, the camp treated 2,000 patients and performed 1,500 minor procedures and 300 major surgeries. The Catacombs of Port-au-Prince What had been the main entrance of the University hospital in Port-au-Prince was an eerie, empty place. Discarded hospital beds lay scattered in giant, dark rooms. After the earthquake, most patients were treated in tents and Quonset huts hastily constructed on the hospital grounds. The tents were hot and crowded, patients lined up next to each other as the few doctors rushed around speaking in different languages. At its peak, nearly 1,000 patients were treated daily at the hospital. Brian Callender, MD, a Medical Center hospitalist, arrived in February and was first assigned to the hospital's internal medical ward. "My first day, it was chaotic with dismal working conditions," Callender said. "There were 50 some patients and only two physicians, myself and another man. I quickly concluded that not all the patients were going to be seen." Most patients in the ward, he said, had chronic and acute conditions for which there were no real medical options. Many had cancer, others had suffered catastrophic strokes, some suffered from liver disease and heart failure. "It was nicknamed `the catacombs' because it was dark and dank, and it was where people went to die," he said. "You'd walk through the next day and patients were gone. You had no idea what happened to them. It was not uncommon to walk through and declare someone dead." Each night, Callender went back to the hotel, where he shared a room with three other Medical Center volunteers. Others at the hotel were camped out in tents in what had been the ballroom. From the hotel's balcony on the second floor, Callender watched the Champs de Mars tent city, the largest in Port-au-Prince. It was the same balcony from where CNN's Anderson Cooper and Soledad O'Brien broadcasted. Callender, 35, BA '97, MA '98, MD '04, grew up in the Chicago suburb of Naperville. As part of his medical training at the Pritzker School of Medicine and as a resident at the Medical Center, Callender volunteered in Cambodia as well as in the Dominican Republic. But those were not disaster situations. In Port-au-Prince, at times, he felt frustrated and depressed: "I questioned, as one individual seeing so many patients a day, was I really making a difference? I started taking the attitude that I had to do the best I could with what I had, knowing that in that setting people were going to die." Two months later, when Callender was sent to the field hospital in Fond Parisien, he was stunned by the contrast: "At Fond A Haitian Nurse's Struggle One factor in the Medical Center's success in Haiti was the inclusion of nurses who had grown up in Haiti, could speak the language and knew the culture. Elvire Laplanche, RN, an ICU nurse from South Shore Hospital, and Nicole Muse, RN, a Comer Children's Hospital NICU nurse, were sent with the first team. Later, Marie LaFontant, RN, a Medical Center burn unit The Magic of Western Medicine nurse, was sent. Like patients at the Port-au-Prince hospital, patients at "Everyone throughout the camp understood that Elvire and the field hospital feared further aftershocks and preferred Nicole were the pivotal people in their functions," said Richard sleeping in tents away from buildings. At night, the ground Cook, MD, of the Department of Anesthesia and Critical Care, beneath us rumbled, frightening patients and staff who feared who was sent with the first and last teams. "That was far more further tremors. important than anyone had anticipated." During the day, the temperature in Muse ended up making three "tours" the tents was so stifling that Melanie to Haiti, rotating back to Chicago just Plumley, RN, a pediatric emergency nurse long enough to check in with her 16-yearfrom Comer Children's Hospital at the old daughter. Muse grew up in Port-auUniversity of Chicago, cared for patients Prince, finishing middle school before in between tents where there was an occaher family moved to Chicago when she sional breeze and a sliver of shade. was 14. Seeing the devastation was espe"There's never enough people," she cially difficult. "These are my people," she said as she ripped at the stiff mold around said, looking around the triage tent at the a man's leg. "There's always something to injured in complicated casts. "I want to be do. I can't do enough." here as long as I can." Meanwhile, Medical Center physical Muse's primary responsibilities at the therapists, led by Diane Davis, PT, director field camp were working in the triage of therapy services at the Medical Center, tent and overseeing the unaccompanied went "door to door" urging patients to minors in camp, children who had been exercise their injured body parts, especialseparated from their parents, many of ly those with amputations whose muscles whom were feared dead. Patients felt comneeded to be stretched. fortable telling her their stories as well as In the triage tent, the cots were nearly reporting problems in camp. The weight always full. Besides the earthquake vicof those stories, though, was almost too tims, the sick in the surrounding commu- Christian Theodosis, MD, co-director of the Fond difficult for Muse to bear. nity arrived every day, having heard about Parisien field hospital, sits among the rubble of "I cry every day," Muse admitted one the field hospital. We saw chronic illness Port-au-Prince, where he met almost daily with day in the triage tent. She could clean and injuries from car or motorcycle acci- officials from the World Health Organization the wounds of amputated and injured dents. Many children suffered from severe and secured many grants for the field hospital patients, care for mothers with dying, and school. Photo by Marshall Segal, MD malnutrition. Some Haitians practice malnourished children, and be fine, but voodoo, and our Western medicine seemed just as mysterious then a 5-year-old asking for underwear, something so basic, and magical to them. But they often went away disappointed would make her break down. that they couldn't be immediately cured. Like a pied piper, Muse was often trailed by little girls pulling at her hips. Seven-year-old Samanthina Francois followed Parisien, the situation was more hopeful because there was an end in sight. The patients were taking care of their external fixators and keeping their wound sites clean. After a surgical team removed the fixators and they had some physical therapy, they were up and walking. Within a couple of days, they were being discharged." Mobilizing on Short Notice The decision to send medical teams into Haiti was backed by both Medical Center trustees and Everett Vokes, MD, then interim dean of the Division of Biological Sciences and the Pritzker School of Medicine and interim CEO of the Medical Center, who wanted the hospital and university to respond to the medical crisis. No one was sure, though, whether an academic institution had the capability to mobilize a response team quickly. When Carolyn Wilson, RN, Medical Center chief operating officer and associate dean, and Olufunmilayo "Funmi" Olopade, MD, FACP, associate dean for Global Health, put out a Medical Center-wide e-mail three days after the earthquake asking for volunteers, they were overwhelmed with the more than 200 people offering to go. The Medical Center took a tactical approach. What were the needs on the ground, and who at the Medical Center could fill those specific needs? How could the Medical Center send skilled people who weren't crucial to patient care at the Medical Center in Chicago? How could the Medical Center send senior staff who would be directed by junior staff trained in disaster medicine? A vetting committee had to determine how a person working under duress in a clinical hospital setting might respond in a disaster and perform amidst chaotic conditions and tropical heat with little food. "That was the most critical part," admitted Christopher 'Sola Olopade, MD, clinical director of the Global Health Initiative and chair of the vetting committee. "There was a toughness factor we had to consider. People who were too squeamish and too methodical, we couldn't take them. We needed flexible and creative people, those who could figure out alternatives when certain supplies and equipment weren't available." Meanwhile, both Wilson and Funmi Olopade, co-leaders of the Haiti mission, were trying to organize supplies along with Mike Sorenson, executive director of information technology. Sorenson had managed to get a donor to pay for a chartered plane that would take the first group of volunteers and more than 1,100 pounds of medical, surgical and pharmaceutical supplies. On January 26, the day the first team was to deploy, Funmi Olopade was e-mailing and fielding calls about Haiti constantly, so much so that a policeman pulled her over on 53rd Street and cited her for talking on her cell phone while driving. "I'm trying to get people deployed to Haiti," she told him. He wasn't swayed. By the end of the weekend, Olopade's thumb was in a cast because she'd strained it responding constantly to e-mails on her iPhone. "In a matter of a couple days, people were mobilized," said Olopade. "We got them vaccinated, credentialed. We got the equipment. I never even imagined that we were capable of doing that so quickly." 18 For more information, call 1-888-UCH-0200 or visit uchospitals.edu Fall 2010 19 "I don't know that the University of Chicago needs to put out all the fires in the world. But they sure showed they know how." -- Christian Theodosis, MD Muse around so much, calling her "Miss Nicole," that the girl's mother urged Muse to adopt her daughter and take her back to the United States. "She loves my daughter," the mother, Evana Alexandre, 48, said of Muse. "I know she would take care of her. I'm afraid for her future if she stays in Haiti." Muse tried to get another girl, 16-year-old Magana, to make contact with family members. Magana's right leg had to be amputated below the knee. But Magana resisted any efforts by the staff to find her family. "They don't want me," Magana insisted. Muse turned away from Magana for a moment: "This breaks my heart," she said in sotto voce, wiping her eyes. There were small successes. When Nicole returned on her final tour, she was able to get a 15-year-old boy Nicole Muse, RN, with earthwho'd been abandoned by his quake survivors Evana Alexandre and her daughter, Samanthina parents to an orphanage. Francois. Photo by Cheryl L. Reed "I felt great about that," Muse reflected shortly after she returned to Chicago from her last tour. "I think we helped them the best we could. We could not take all these children. My heart remains in Haiti. You cannot measure what we did." The God of Survivors By March, the daily inpatient population at the field hospital remained steady at about 270. With family members and volunteers, the total camp count was often near 1,000. Patients couldn't be discharged unless they had a safe place to go. Most didn't. A little less than a quarter were amputees, and many were urged to remain until they could be fitted with prostheses. One of those with multiple amputations was Louphine Demorcy, 31, a mother of three. Demorcy spent much of her day lying on a mattress on the floor of the tent she shared with her family and two other patients and their families. A vendor in Port-au-Prince, Demorcy was getting ready to go home the day of the earthquake when the sidewalk underneath her feet suddenly opened up. Demorcy called out: "Jesus, Jesus, help me." She was thrown into the street, where a store wall fell onto her arm and another wall fell onto her leg. Two days passed before someone found her. But during her three days in the hospital she never saw a doctor. Eventually, she was transported by an ambulance to the Dominican Republic, where a doctor had to amputate most of an arm and leg because they were infected. She was later transported to the Fond Parisien field hospital to recover. "I didn't have hope after I lost my arm and leg," she told me through an interpreter. Like most patients, Demorcy speaks Haitian Creole with a smattering of French. "Then I told myself that most people died, and Jesus is going to help me." Demorcy, like many patients in camp, credited God for her survival. Religion plays an important part of the culture and every night patients gathered for a religious service that included hours of singing. Each Sunday morning, the lower portion of the tent hospital transformed into a church, with preachers delivering sermons from a pulpit with a microphone and patients swaying to music from a live band. "If I had the same patient at home with an amputated arm and amputated leg, at this stage they would be depressed and on Prozac and Ativan and seeing a psychiatrist," said Plumley as she restocked the shelves in the supply room. "These people don't have a psychiatrist. And they are getting through this better than anyone I've ever seen. They are not crying in their tents, they are not moaning `Why me?' They are getting up, washing themselves, feeding themselves. Doing the next thing. It's amazing." The Medical Center did send Angela Smyth, MD, a clinical psychiatry associate, to Leogane, the epicenter of the earthquake, where she taught nurses how to treat traumatized patients. Success That Closed the Camp By early April, the rains and flooding had started. The camp's delicate septic field overflowed, flooding the triage and post-op tents and covering the ground with sewage. Rivulets of water coursed through camp, undermining tents. The rain came nearly every afternoon around 4 p.m. and with the water came mosquitoes. "I was covered head to toe with bites," said Dima Awad, PharmD, a Medical Center pharmacist. "Repellant did not work." Awad had arrived with the first group at the end of January and set up the pharmacy. She transported many special-order drugs and vaccines from Chicago and combed through boxes and boxes of donated drugs, many from other countries, and discarding those that were expired. Though she speaks fluent French, Left: Chris Sullivan, MD, checks on a young patient in the field hospital triage tent. Right: Chrissy Babcock, MD, greets a Navy helicopter delivering four patients to the field hospital. Photos by Cheryl L. Reed Diane Davis, PT, teaches field hospital patient Louphine Demorcy how to wrap her amputation wounds. Photo provided by Diane Davis, PT Awad was challenged by the multiple languages on field hospital could return to its original purpose: the drug labels and often had to rely on an internaan elementary school. In August, the Medical tional drug index that gave the names of drugs and Center secured a $100,000 grant from the United their generics in multiple languages. Establishing States Agency for International Development to the pharmacy was one of the field hospital's major train Haitian college students in disaster relief and accomplishments and allowed physicians to treat community health. patients and track their medicines better. "From a humanitarian perspective, the field When Awad arrived for the second time in hospital was a huge success," said Theodosis, who early April, the camp had evolved into something ran camp operations at Fond Parisien, along with that looked routine, organized. There were more Christine Babcock, MD, also a Medical Center latrines and even showers, though they operated ER physician. "The University of Chicago gave us only a few hours a day. A patient chart system on everything we needed to be successful. We said we donated iPhones that had a bumpy start was fully needed an X-ray machine; they sent it. We said we operational; physicians were able to view electronic needed frozen measles vaccine; they shipped charts and X-rays with a touch of a button--more them all the way to our field in Haiti on dry streamlined than back in Chicago. ice. We were the first hospital in Haiti where Along with Awad, the last team from the Medical all of our patients were vaccinated. The Medical Center had a mix of nurses and doctors, mostly Center operated from a model of generosity. I don't orthopaedic surgeons whose know that the University of goal was to take off any Chicago needs to put out all the remaining external fixators. fires in the world. But they sure At three months out from showed they know how." the earthquake, 80 percent Though the field hospital of the patients were healed. closed in early May, the Medical Some needed surgical proCenter has matched an anonycedures, others were being mous $100,000 donation and fitted for prostheses and is planning on sending more receiving physical therapy. medical teams of faculty and "I think we did accomplish staff volunteers, along with what we thought we should residents and students, to Haiti. do," said Chris Sullivan, MD, The Medical Center has already pediatric orthopaedic surgeon donated nearly $400,000 to its at Comer Children's Hospital. Haiti missions and is discuss"It was a unique situation in ing ways to become involved that everyone had been injured in building up Haitian mediat one time and healed up at cal schools. It is one way the one time. We were so success- Jorel Altema, 38, a Baptist pastor who was Medical Center, as an academic injured in Port-au-Prince when his home ful that the hospital outgrew caved in on him. Photo by Cheryl L. Reed hospital, can facilitate learning its function." experiences for its staff, who In the last few weeks of camp, handfuls of can, in turn, teach from those experiences. patients were being discharged every day. Those "In Haiti, we learned an organizing principle that who had no place to go ended up at the International will help us respond to any medical emergency on Displaced Persons (IDP) camp down the road the planet," said Olufunmilayo "Funmi" Olopade, from the field hospital. The IDP camp looked like MD, FACP, associate dean for Global Health. Haiti a poorer version of the field hospital, with many of will play a key role in the Medical Center's develthe same blue and beige Eddie Bauer tents. There, oping Global Health Initiative. "We demonstrated patients cooked for themselves on crude burners. that the Medical Center and the university can work Many of the WHO funds for which the Medical collaboratively. It gave us confidence. And we will Center had applied were eventually allocated to run absolutely use that confidence to respond to other the IDP camp and to repair the damage done so the emergencies around the world." Haiti Volunteers Deployed to Fond Parisien: Christian Theodosis, MD Rex Haydon, MD Richard Cook, MD Elvire LaPlanche, RN Nicole Muse, RN Dima Awad, PharmD Chrissy Babcock, MD Keegan Checkett, MD Kris Alden, MD Sean Clancy, OT Diane Davis, PT Walter Flores, RN Marie LaFontant, RN Elizabeth Mouw, PharmD Vivian Liese Marshall Segal, MD, JD Michael Sorensen John Kress, MD Chris Sullivan, MD Karen Arndt, RN Karen Wilson, RN Megan McDonald, PT Catherine Kennedy, PT Cheryl L. Reed Melanie Plumley, RN Sabine Cadeau Jimin Kim Melodie Kinet Nada Williamsom, RN Yadira Martell, RN * Deployed to Port-au-Prince Heather Costello, MD Steve Schrantz, MD Brian Callender, MD Mark Haseman, RN Kathy Luba, MD Nilam Soni, MD Daniel Johnson, MD * Deployed to Leogane Angela Smyth, MD Administrators Michael Millis, MD Nicholas O'Hearn, RN Carolyn Wilson, RN Funmi Olopade, MD Christopher 'Sola Olopade, MD Jeffrey Finesilver Joyce Keldsen John Easton Mohan Gundeti, MD Gregory Bales, MD * Deployed to both Fond Parisien and Port-au-Prince Fall 2010 21 32 For more information, call 1-888-UCH-0200 or visit uchospitals.edu Medical Center Physician Named White House Fellow Former Pritzker Alumnus Also Selected By Kadesha Thomas Thomas Fisher, MD '01, insists that nothing has changed. He is still the same person who grew up in Hyde Park and, as a high school student at Kenwood Academy, noticed that some families had plenty, while others had less. Fisher's education at Pritzker School of Medicine only heightened his passion for addressing social inequities on the South Side. In September, Fisher, 36, assistant professor of medicine, will take that passion to Washington, DC, as one of 13 early career, but highly accomplished, professionals selected for the 2010-2011 class of White House Fellows. The fellows were chosen from more than 700 applicants to work with federal agencies, such as Veterans Affairs, the Department of Health and Human Services or the National Security Council, to name a few. Fisher said his main goal is to gain "a new understanding of how to allocate scarce resources when there is so much need." As a physician in the Bernard A. Mitchell Hospital emergency room, Fisher sees this need every day. The emergency room serves a population that has higher rates of chronic diseases, like hypertension and diabetes, than other areas in Chicago. As a student at Pritzker, Fisher combined his interests in social justice and medicine by helping to launch Project Brotherhood, an initiative to address social and health disparities among African-American men. He also participates in "Ask the Doctor," a monthly forum with Woodlawn residents. The White House Fellow appointment, Fisher said, is an extension of what he's been doing all along. "This is just an opportunity to do it differently." Pritzker alumnus Pat Basu, MD '05, MBA '05, a radiologist at Stanford University and the VA Palo Alto Health Care System, also was selected. U.S.News & World Report Names Medical Center Among Best Hospitals The University of Chicago Medical Center once again was ranked as one of the best hospitals in the United States in the U.S.News & World Report annual survey of nearly 5,000 hospitals nationwide. In its 2010 "Best Hospitals" issue released in July, the magazine ranked 11 Medical Center specialties among the top programs of their kind in the country. They included: � Digestive Disorders (#6) � Cancer (#15) � Endocrinology (#18) � Respiratory Disorders (#21) � Kidney Disease (#21) � Neurology and Neurosurgery (#26) � Heart and Heart Surgery (#27) � Urology (#28) � Geriatrics (#29) � Gynecology (#34) � Ear, Nose and Throat (#38) Among 170 pediatric centers, the magazine listed the 30 top-ranked hospitals in 10 specialties. Comer Children's Hospital at the University of Chicago was ranked in three pediatric specialties: � Endocrinology and Diabetes (#21) � Neurology and Neurosurgery (#24) � Neonatal Care, the care of critically ill or very premature newborns (#26). The Medical Center's rankings were based on a mathematical formula that takes into account factors, such as available technology, mortality rates, patient and community services, procedure volume, nursing care and the institution's reputation based on a poll of 200 specialists in each field. Comer Children's Hospital was scored using a three-part blend of reputation, outcome and measures, such as nursing care, advanced technology, credentialing and other factors. "When the stakes are high, you want the best care you can get for someone close to you," said Avery Comarow, health rankings editor for U.S.News & World Report. "These are hospitals that are used to getting the sickest patients." The lakefront path on the South Side of Chicago attracts many walkers and bicyclists. Photo by Dan Dry Partnering to Transform Home to great artists like blues musician Muddy Waters, gospel singer Albertina Walker and authors Richard Wright and Lorraine Hansberry, Chicago's South Side is one of America's great cultural treasures. But its 1 million residents suffer disproportionately from diabetes, hypertension and asthma, while its infrastructure suffers from a dearth of grocery stores, pharmacies and primary care physicians and clinics. The Urban Health Initiative (UHI) is the University of Chicago Medical Center's commitment -- in partnership with civic leaders, community organizations, health care providers and residents -- to correct these disparities through clinical care, community-based research and education. UHI's comprehensive and holistic approach to improving long-term health on the South Side of Chicago also may provide a model for improving urban health nationwide. A major factor in long-term health is having reliable, appropriate solutions for everyday health needs. Through the South Side Healthcare Collaborative (SSHC), a network of 25 health centers and six local hospitals, UHI helps South Side residents connect with community health centers and doctors who can provide preventive care, regular treatment for nonemergency health problems, long-term management of chronic disease and referrals to specialists. UHI and its community partners also use research, surveys and other neighborhood-based approaches to discover new ways to keep people healthy. The Center for Community Health and Vitality is developing a community facility to help track and integrate local research to improve health. Another research program is the South Side Health and Vitality Studies, a family of connected studies designed to gain a deep understanding of the health of the community by collecting data on local resources, the environment, individual health and technology. One of the studies is the Resource Mapping Project, a comprehensive census of all commercial, health care, social, cultural and civic resources on the South Side. The studies are led by teams of university and community members who are making the data available to the community to inform investments, programs and policy. The first phase of resource mapping data is available at SouthSideHealth.org. Through education, UHI encourages physicians to practice in underserved communities. The REACH (Repayment for Education to Alumni in Community Health) program gives financial help to graduates of the University of Chicago Pritzker School of Medicine or affiliated residency programs who choose Urban Health to practice medicine at a community health center or hospital on the South Side. The first REACH participant began practicing family medicine in fall 2009 at Chicago Family Health Center. Two others will join the program this fall. Meanwhile, the Office of Community-Based Medical Education exposes physicians in training to the rewards and challenges of practicing in underserved areas and encourages young physicians to focus on primary care and community health. Programs include student-run free clinics, quarterly days of service, health education and the Summer Service Partnership, which pairs medical and public high school students to work on sustainable community health service projects. Harlan M. Krumholz, MD, a nationally recognized authority on public health at the Yale School of Medicine, told the Chronicle of Higher Education that UHI is "one of the most ambitious and innovative efforts being undertaken by urban teaching hospitals." Reform of our nation's health system will not be complete without improving preventive care, promoting more cost-effective medical services and helping people in underserved communities get better routine care. Through UHI, the University of Chicago Medical Center and its partners are addressing these issues head on. Thomas Fisher, MD, assistant professor of medicine, (center) plans to take his experience attending patients in the Bernard A. Mitchell Emergency Room to the federal government. Fisher was recently appointed to the 2010-2011 class of White House Fellows. Evan Babb talks to a resident in the 6400 block of South Ingleside Avenue. Field researchers have been surveying South Side neighborhoods since the summer of 2009. Photo by Lloyd DeGrane Pat Basu, MD `05, MBA `05, also was selected to be a White House Fellow. 22 University of Chicago Medicine on the Midway Fall 2010 23 Stellar Scientific Research and the Bag to Match An Extraordinary Pritzker Student By Kadesha Thomas Taking Preventive Care to the Masses By Kadesha Thomas W Katarina Ruscic, a student at the Pritzker School of Medicine, is combining her medical degree with a PhD in computational neuroscience. Her research involves observing frog egg membranes through a microscope to study the ion channel proteins that regulate heart rhythm. Photos by Dan Dry Though the label on her red, snakeskin handbag is eye-catchsuch problem at 10 years old. For more than a year, she'd been ing, it is not nearly as impressive as the labels on her curriculum carted back and forth to the hospital with swollen lymph nodes. vitae: two patents pending with Argonne National Laboratory; They were benign, but the other children she became friends undergraduate degrees in biology, chemistry and biochemistry with weren't so fortunate. When she asked her mother why they from the University of Chicago; and dual MD, PhD degrees had no hair, her mother told her, "they have cancer." Ruscic still coming soon from the Pritzker School of Medicine's Medical remembers how helpless she felt. That feeling has driven her Scientist Training Program. At age 25, she exemplifies the type passion for physics, biology and research. of high achievement for which the Medical Center is known. Ruscic knew the ideal place to blend those interests was just In May 2010, Ruscic, originally from Croatia, became the across the Midway at the Pritzker School of Medicine. After her second Pritzker student selected for the Paul and Daisy Soros first two years at Pritzker, Ruscic began doctoral studies at the Fellowship for New Americans. The award is given to 30 outInstitute for Molecular Pediatric Sciences, located in the Gordon standing graduate students from immigrant Center for Integrative Science. Her research families out of nearly 900 applicants and comes focuses on understanding how the ion chanwith a $40,000 tuition scholarship and a $50,000 nels that produce electrical impulses regulating scientific research grant. the heartbeat lead to heart arrhythmias. The Ruscic was introduced to scientific research research also has implications for conditions early on. Her parents left Zagreb, the capital of like epilepsy and cystic fibrosis, each linked to Croatia, for positions at Argonne when Ruscic an ion channel mutation. was 3 years old in 1987, just three years before "This is one of the most demanding projects war broke out in Croatia. As a toddler, Ruscic in the laboratory," said Steve Goldstein, MD, thought laboratories had the magic of Disney, PhD, the institute's director and Ruscic's faculty with liquid bubbling through tall, looping glassmentor. "I would only give this project to a very ware. "It was like a magic show," Ruscic said, special student. She is multifaceted with intelli"except it was real. It was science." gence and creativity that one observes, not only in Katarina Ruscic, 25, won the As a sophomore in college, Ruscic went back Paul and Daisy Soros Fellowship her approach to science, but to life. She is unique." to Argonne for a summer fellowship in 2003. At for New Americans. Her bold, European fashion sense bears witage 19, she and chemical physicist Rex Gerald, ness to her individuality. She has won accolades PhD, convinced a room full of attorneys and directors to supfor that, too: "Best Dressed" in high school and "Most Likely port patent applications for their battery concept, which used to Have Scrubs Tailored" at Pritzker. Shopping trips in Croatia nanotechnology to overcome the limitations of standard lithiand flipping through fashion magazines give her a break from um ion batteries and could potentially be used to power electric her arduous academic research. The half hour she spends getvehicles. She'd like to give more detail, but the patents are still ting dressed, she said, is her creative release. pending, she said, smiling. Goldstein has no doubts about Ruscic's future prospects: Ruscic liked quantitative science, but she wanted research "One day she'll be popping a champagne bottle to celebrate the findings to be more readily applicable to real people's problems, opening of her own research laboratory." as they tend to be in biology. Ruscic came face to face with one And, of course, she'll be impeccably dressed for the occasion. 24 For more information, call 1-888-UCH-0200 or visit uchospitals.edu henever Shantanu Nundy, MD, called or went to visit his parents in Baltimore, he always brought some new "doctor's orders." Nundy was then a neophyte medical school student at nearby Johns Hopkins University, and, as his medical education progressed, so did his directives to his parents. "We'd talk about infectious diseases in class, and I'd say, `Hey Mom, get a flu shot,'" recalled Nundy, now 28. "Then, we'd study GI and I'd say, `Hey Mom, you're over 50, get a colonoscopy.' But she's just one person, having one doctor's visit." His intent was to educate, not to confuse her, a woman struggling with Type 2 diabetes. However, that's exactly what the deluge of information did. During his first two years, his coursework focused on the minutiae of how each organ works -- or stops working -- but only scantly covered how to prevent even the most common chronic diseases. Before he graduated from Johns Hopkins, he decided he would do something about it. He would write up 10-page checklists of preventive measures every patient should request during a doctor's visit, then randomly drop them in people's mailboxes. But then he realized that the logistics of that idea -- getting the mailing addresses and delivering them to the appropriate people -- were unrealistic. The idea became the basis for Nundy's new book, Stay Healthy At Every Age: What Your Doctor Wants You to Know. The book, published in April 2010, contains more than 350 pages about the preventive screenings, counseling sessions and medications patients should have, based on recommendations from the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention. When Nundy first pitched the idea to The Johns Hopkins University Press, he was only a third-year medical student and a concerned son. "I went looking for this book to give my Mom," he said. But market research showed few people with any medical training had bothered to write about preventive health care. He signed a contract two months later. Nundy, now a third-year internal medicine resident at the Medical Center, still thinks physicians need to take more responsibility -- primary responsibility, in fact -- for helping patients prevent chronic diseases or detect them as early as possible. "The patient's job is to just show up," he insisted. His passion is clear when he talks about how pop culture magazines have ripped the dissemination of health information from real physicians, causing even more confusion -- and physicians, he believes, have let them. "How many more magazine covers do you need about losing weight?" he asked. "How many trillions of health-related Web pages are out there, and how many were written by physicians? I want more physicians to share their information with people, in books, on blogs, on twitter, somewhere." This motivated Nundy to start his blog, beyondapples.org. Instead of being counseled on lifestyle changes and screening tests during medical appointments, patients are turning to sketchy consumer sources, he said, if they are getting this information at all. Shantanu Nundy, MD, a third-year internal medicine resident at the Medical Center, has published a book of personalized screening measures to help prevent illness. Photo by Dan Dry Nundy's primary care patients can expect to spend their 30-minute appointment talking about their main concerns and his. Kametta Clark, 36, came from her home in Matteson, Illinois, to ask Nundy how she could prepare for an upcoming surgery. She threw out questions one after another: What kind of medications should she take? What should she eat beforehand? How long would the surgery take? And what about scarring? After answering, Nundy took advantage of the time to fire off plenty of questions for her too, but not about the surgery: Did she smoke? Did she exercise regularly? What did she eat for breakfast? No, yes, and egg whites with turkey bacon, she said confidently -- answers that made Nundy give a slight grin and a nod of approval. "I'm glad you're being so proactive," he said. "It's all about knowing what keeps you healthy." Fall 2010 25 Alumni Reunion 1 2 A Weekend of Medical Center Memories By Kadesha Thomas The field of medicine has changed tremendously over the past 50 years. During Reunion 2010, more than 215 alumni of the Pritzker School of Medicine and the Division of Biological Sciences spent three days observing, marveling and debating how the Medical Center has evolved to keep up. 1 2 3 3 4 5 1 During an indoor picnic, Amber Pincavage, MD `07 (left), and Amrita Arora, MD' 09 (right), enjoy themselves. At the time of the reunion, both were residents in internal medicine at the Medical Center. 2 Mark Hoffer, MD '60, with his wife, Margo. 3 Alumni, family and friends of the class of 2000 celebrated their 10-year anniversary of graduation from Pritzker School of Medicine. Photos by Tricia Koning 1 (back row from left) Eugene Mindell, SB '43, MD '45; John Partridge, SB '43, MD '45; Stewart Taylor, SB '43, MD '45; and (seated) C. Frederick Kittle, MD '45, came to Reunion 2010 to celebrate the 65th anniversary of their graduation from medical school. 2 A special reception at Primitive, an art gallery in downtown Chicago, honored leadership donors, including Larry Nathanson, MD '65, and his wife, Anna Nathanson. 3 Paul Rockey, MD '70, who attended the reunion with his wife, Linda Rockey, accepted an award on behalf of his class for having the highest number of classmates donate. 4 At the awards ceremony, Robert J. Costarella, MD '64, (right) reunion chair of the alumni council, presented the Distinguished Service Award to Gary Borisy, PhD '66, (center) and Otis Brawley, MD '85 (left). 5 Russ Zajtchuk, SB '60, MD '63, (left) shares a laugh with Coleman R. Seskind, AB '55, SB '56, SM '59, MD '59, (center) and Robert M. Doroghazi, MD '77, (right) at the celebration to honor leadership donors. Photos by Tricia Koning Many of the changes are obvious, from the new roster of senior leaders to the ambitious research goals and strategies designed to tackle health disparities through the Urban Health Initiative (UHI). Even the lurking construction of the 10-story New Hospital Pavilion (NHP) poses as a bold reminder to alumni that more changes are imminent. "This has to be one of the most avant-garde campuses in the country, and it is constantly reinventing itself," said Anthony Cutilletta, MD '68, president of the Medical and Biological Sciences Alumni Association. A walking tour of the campus -- which looked entirely different for those who remember when Billings was the main hospital -- led to questions about why the Medical Center has not yet fully implemented electronic medical records. The $40 million price tag has been an obstacle, but the system should be close to completion by the time the NHP opens in 2013, explained Everett Vokes, MD, then interim dean of the Division of Biological Sciences and the Pritzker School of Medicine and interim CEO at the Medical Center, at the alumni senate meeting. The NHP was a point of excitement and constant discussion for most alumni, who were able to view a detailed presentation on the increased space and advanced technology the hospital will offer patients and families. During the weekend's awards ceremony, Vokes said the Medical Center's ability to revamp is "not in small part" because of alumni commitment. An award went to the class of 1970 for having more alumni donations, 37 percent, in fiscal year 2010 than any other class. The class of 1960, celebrating its 50th reunion, was honored with an award for the highest turnout, and two alumni were recognized with the Distinguished Service Award for significant achievement in the biological sciences or medicine: Gary Borisy, PhD '66, current CEO of the Marine Biological Laboratory, and Otis Brawley, MD '85, chief medical and scientific officer and executive vice president of the American Cancer Society. Coleman Seskind, MD '59, former chair of the alumni editorial committee, was recognized for his leadership of Medicine on the Midway, the Medical Center's magazine for alumni, faculty, patients and referring physicians. Seskind also received an Alumni Service Award from the university's alumni association. While most alumni had plenty to celebrate, they also came with plenty to discuss. Mixed opinions flew across the Billings Hospital board room during a lively debate at the alumni senate meeting regarding the Urban Health Initiative. Some senate members wanted to know how the Medical Center is ensuring quality care at the partnering community health centers and hospitals. Vokes said that Medical Center physicians and those at many of the community health centers are in constant collaboration, learning from each other about how best to serve patients. The best example of this is the Medical Center's 24-bed unit at nearby Mercy Hospital and Medical Center. The senate suggested that future changes in clinical leadership include more women, perhaps by supporting a spousal hiring program or onsite child care. Seth Haber, MD '58, FACP, a medical school alumnus and member of the alumni senate, said that while the door to women in clinical leadership is not closed, the Medical Center and alumni could open it more widely. Despite how the Medical Center is evolving, "it still has a culture that appreciates learning," said Brawley. "It values inquiry and is not tolerant of people who are not moving forward." 26 University of Chicago Medicine on the Midway Fall 2010 27 Graduation/Match Day Left to right: Randy Sweis, now a resident in internal medicine at the University of Michigan Hospital; Eric Sun, now a resident in anesthesia at Stanford University Programs; and Dan Storey, now a resident in family medicine at the Medical College of Wisconsin, lead the procession of the Class of 2010. Photo by Tricia Koning John and Joanna McGetrick, both MD '10, matched in competitive medical specialties at the University of Wisconsin-Madison. Photo by Dan Dry Graduation 2010 The day was "a long time coming" for Juliesta Sylvester, 31, of Los Angeles. For more than four years she had been pursuing a doctorate in biochemistry. Now, she was just minutes away from officially listing a PhD behind her name. Outside Alumni Caf�, her fellow graduating students from the Biological Sciences Division and Pritzker School of Medicine buzzed with chatter, nervous energy and relief as they lined up to enter the Divisional Academic Hooding Ceremony on an especially humid afternoon. The ceremony honored graduating students from both the Pritzker School of Medicine and the Biological Sciences Division and featured two commencement speakers -- one addressing the rising physicians and another for the scientists. One hundred ten of the 115 graduating students of the Pritzker School of Medicine participated in the commencement ceremony on June 11, along with 46 students receiving PhDs from the Biological Sciences Division. Eight other students in the Pritzker graduating class also completed doctoral degrees from the BSD. Another five Pritzker students had tacked on additional credentials, completing dual degrees in public health, public policy, business and law. Jennifer Newberry, MD, JD, was one of those five. She paused her medical education after third-year rotations to pursue a law degree at the university. Newberry, 29, from Battle Creek, Michigan, is now doing a three-year residency in emergency medicine at Stanford University. The training in medicine and law will allow her eventually to move from clinical practice into legal advocacy for international disaster relief. "One of the reasons I came to the University of Chicago was because of the range of excellent study areas," she said. In his address to BSD graduates, Keith Yamamoto, PhD, said such strong training is the key to successful problem-solving. The mark of a successful scientist is the "capacity to identify an imperfect problem and break that problem down into experiments," said Yamamoto, professor of cellular and molecular pharmacology and executive vice dean at the University of California, San Francisco. "Then, choose which experiments to follow." Scott Stern, MD '84, FACP, Pritzker's assistant dean for technology and innovation, advised the graduating medical students to remember that medicine is a sacred profession and performing well professionally often means taking time for personal interests. "Carve out some piece of your life for yourself," he said in the final commencement address, directed at Pritzker students. "You will need this to care for others." The Tightrope of Couples Match By Kadesha Thomas B Pritzker's Class of 2010 Celebrates Match Day On Match Day, more than 15,000 graduating fourth-years nationwide uncovered the prize they had been preparing for throughout their medical education -- residency placement. Family members, friends and fellow students packed into the Billings Auditorium on March 18 to witness the milestone with the fourth-years at the Pritzker School of Medicine. Holly J. Humphrey, MD, dean for medical education at Pritzker and the Medical Center, described Match Day as a "sign post, one of those days you measure time against." As with most Pritzker classes, all of the 115 graduating Pritzker students in the class of 2010 had been accepted into a residency program by Match Day. Though they would fan out to 24 states, the highest percentage of students, 14 percent, was accepted into programs at the Medical Center. Another 10 percent went on to Stanford University in California, and another 7 percent joined programs at hospitals affiliated with Harvard University in Massachusetts. The most popular specialty among Pritzker students was internal medicine, comprising 22 percent of the class. About 14 percent will go on to train in surgical subspecialties, such as orthopaedics, vascular surgery or urology. Also, 11 students applied for family medicine residency programs, Pritzker's highest number in recent memory, making it the third most popular specialty, said Kelly Smith, manager of residency advising at Pritzker. This coincides with a national increase of 9 percent in the number of medical students applying for family medicine programs, according to the National Residencies Matching Program. Markus Boos, MD `10, celebrates matching at his top choice residency program with his wife, Eileen Rhee, MD `06, a Pritzker alumna and clinical associate in the Department of Pediatrics. Photo by Bruce Powell Based on the burst of cheers, hugs -- and a few students who jumped on their chairs -- most students opened their envelopes to find one of their top choices listed. "That day was full of nervousness, excitement, anxiety -- everything," said Markus Boos, MD '10, PhD '08, from Bloomfield Hills, Michigan. Boos, 31, had his wife Eileen Rhee, MD '06, a Pritzker alumna and clinical associate in the Department of Pediatrics, looking over his shoulder to see where the two would be moving. After visiting the University of Pennsylvania in Philadelphia, Rhee had given Boos the green light to rank the school's dermatology residency as his first choice out of the 30 programs to which he had applied. He also wanted to spend one year training in pediatrics at the Medical Center before heading to Pennsylvania. "We got exactly what we wanted." etsy Barnes, MD, '10, knew she wanted to be a surgeon at 4 years old. But in medical school, she made a decision that put that goal at risk: If she matched at her top choice residency program, she would only go if her husband, Sean Barnes, MD '10, had matched nearby. Being separated was not an option, especially since each one's training program would mean at least five years apart. While applying for residency, Sean and Betsy Barnes, who were married in May 2010, were attempting a delicate balance between love and career. This meant limiting residency applications to those programs where both could work in the same city. One hundred percent of the class of 2010 had been accepted into a residency program by Match Day, but this year, more Pritzker School of Medicine students than ever tried to hit both jackpots. Six couples were both Pritzker students, while two other Pritzker students applied to match with students at other schools, said Herb Abelson, MD, Pritzker's senior associate dean for admissions and student affairs. The National Residency Matching Program uses an algorithm to match the students' and program directors' top choices. Couples Match has more risk because the algorithm has to maximize two variables -- both students' lists of preferred programs -- rather than just one. For most couples, the formula works. But for 7 percent of couples nationwide last year, the formula either left one or both people out. To avoid separation, Sean and Betsy Barnes had to make sure their top choices were in sync. "It's like the NBA draft," said Sean Barnes, 26, from Wheaton, Illinois. "If I moved one player up, she had to bump one down." Most programs supported this approach, and Betsy Barnes said her interviews focused just as much on her husband's goals as her own. This kind of accommodation was not so universal when Susan Glick, MD '90, associate professor of medicine at the Medical Center, was applying for internal medicine residencies. She graduated from Pritzker with her husband, David Glick, MD '90, now associate professor of anesthesia and critical care at the Medical Center. Couples Match was only 6 years old then and somewhat stigmatized. Glick was advised to remove her engagement ring before interviews. "We wanted to go to the best programs we could get into," Glick recalled. "So if taking off the ring was the best way to make that happen, that's what we did." Her plans to marry never came up in interviews. The number of couples applying for residency nationally has more than doubled since the Glicks applied, because now "it's not seen as a disadvantage," Abelson said. "If students don't want to be separated, that doesn't mean you should doubt if they are serious." Newlyweds Betsy (above left) and Sean Barnes, both MD '10, matched together at residency programs at Johns Hopkins University in Baltimore. Photo by Dan Dry 28 For more information, call 1-888-UCH-0200 or visit uchospitals.edu John and Joanna McGetrick, both MD '10, faced more than just doubt. Their classmates and families back in Winter Haven, Florida, thought the high school sweethearts were plain crazy. Urology and dermatology have far fewer residency spots than other specialties. Plus, urology programs require an earlier application. In January, when John McGetrick, 26, was accepted to the urology program at University of WisconsinMadison, Joanna's list was narrowed down to one. And the school's dermatology program only had three spots. "This was like two people walking a tightrope, starting from either end and trying to meet in the middle," said Joanna McGetrick, 26. Joanna McGetrick was on-call during the Monday before Match Day when students find out if they have been selected, just not where they have been selected. Since Joanna McGetrick had only applied to one school, her notice that she'd been matched would actually confirm her acceptance. John McGetrick met her in the student lounge of Billings Hospital to get the news via e-mail. Around 10:30 a.m., "the nervousness hit me like a ton of bricks," Joanna McGetrick said. Her husband suddenly felt pangs of guilt. His choice had eliminated all but one of hers. The two kept hitting refresh, refresh, refresh as they stared at Joanna McGetrick's inbox. When the e-mail popped up, Joanna jumped out of her seat, screaming hysterically. The University of Wisconsin-Madison didn't think they were so crazy. Next week, at the Match Day ceremony, Sean and Betsy Barnes packed into Billings Auditorium with the rest of their class. At 11 a.m., everyone ripped open their envelopes. Before Sean slid the paper completely out, Betsy was yelling and screaming. They were both going to Johns Hopkins University in Baltimore. Fall 2010 29 Class Notes 1950s Leonard F. Barrington, PhD '55, reports: "At 86 years old, I continue to serve the Prairie Crossing community as a local poet in residence and writer of the honored novel: Feasting With the Deacon." 1990s Hossein Jadvar, MD '93, writes: "After completing an internship in internal medicine at University of California, San Francisco, a residency in radiology and nuclear medicine at Stanford University and a fellowship in positron emission tomography/nuclear oncology at Harvard University, I became a faculty member of the Departments of Radiology and Biomedical Engineering at the University of Southern California in Los Angeles, where I am now a tenured associate professor (and in the process of promotion to full professor). My wife, Mojgan Maher, DDS, our two daughters and I live in the foothills of Mount Wilson in historic Pasadena, California." 1960s Robert L. Hunter Jr., SM '65, MD '65, PhD '69, recently received the George T. Caldwell Distinguished Service Award from the Texas Society of Pathologists. Bernard Silber, MD '37, passed away on March 20, 2010, at the age of 98. Throughout his long life, he maintained that the University of Chicago was the best medical school in the country, having given him a strong foundation to practice excellent medicine. He met his wife of 64 years, Bernice Garrett Silber, a medical social worker, while completing his medical residency at Los Angeles County Hospital. Silber practiced internal medicine and cardiology in Redwood City, California, and at Sequoia Hospital and Stanford University Medical Center. Silber was also an expert calligrapher, a student of etymology and several languages, including Yiddish, his first language. kidney disease. As Medical Center faculty from 1968 to 2002, Katz established a dialysis program, served as section chief of nephrology and professor of medicine and authored or co-authored more than 300 articles and book chapters. Katz was born in Romania, and his family fled to Israel during World War II after his father was captured by the Nazis. Katz has received prestigious awards for his life's work, including a Medical Center nephrology research fellowship established in his honor. Philip S. Ulinski, PhD, passed away from heart disease on May 25, 2010, at the age of 67. He was professor emeritus and former chair of the Department of Organismal Biology and Anatomy and the Committee on Computational Neuroscience and an expert in the field of neuroanatomy. Ulinski studied the organization of brain structures in turtles, snakes and other animals, focusing primarily on the circuitry of the visual system. Ulinski is survived by his wife, Mary, nee Kalinowski; a son from a previous marriage; a daughterin-law; two granddaughters; and many nieces and nephews. Sylvia Griem, MD, 81, passed away on June 3, 2010 after a long illness. A physician, teacher and leader in the Department of Dermatology at the Medical Center for more than 30 years, Griem was one of a handful of women to graduate from the Wisconsin School of Medicine and Public Health in 1953. In 1981, she served as president of the Chicago Dermatological Society. Griem was an active supporter of Save the Dunes in her native Ogden Dunes, Indiana. Griem is survived by her husband, Melvin Griem, MD, professor emeritus of medicine at the Medical Center, her three children and three grandchildren. Morton F. Arnsdorf, MD, 69, died June 9, 2010, in a car accident in northwest Indiana on his way home from work. Professor emeritus and associate vice chairman of medicine and former section chief of cardiology at the Medical Center, Arnsdorf was a nationally renowned cardiologist. He was best known for his foundational research on abnormal heart rhythms and the molecular structure of drugs to treat them. Arnsdorf received numerous honors for his research and leadership, among them Master of the American College of Cardiology, an honor bestowed on fewer than 60 cardiologists. Arnsdorf is survived by his wife, Rosemary Crowley, by her four children and five grandchildren. Andranik Ovassapian, MD, died June 17, 2010, at the age of 74 following a stroke. He was professor of anesthesia and critical care at the University of Chicago. Ovassapian, of Highland Park, Illinois, was a pioneer in the development and teaching of fiber-optic intubation. A tireless advocate for patient safety, Ovassapian helped the American Society of Anesthesiologists develop its guidelines for management of difficult airways. Ovassapian played the violin and enjoyed reading, golf, chess and traveling. He is survived by his wife, Ashghen, his three children and eight grandchildren. 1940s Loren T. Dewind, MD '45, passed away on December 26, 2009. E. Gregory Thomas, SB '44, MD '46, died on March 11, 2010, in Los Altos, California. Thomas was born in 1922 in Cape Giradeau, Missouri, but grew up in Chicago. He attended the University of Rochester, where he was an All American football player. He then enlisted in the U.S. Navy and attended the University of Chicago for medical school. In 1948, he married Lillion Ruth Lukes, a nurse for the Navy. They were married for 55 years until her death in 2003. Thomas served his internship in Hamilton, Ohio, and his residency at Highland Hospital in Oakland, California. In 1954, he settled in Castro Valley, where he built a successful surgical practice. He served as chief of surgery and president of the Eden Hospital medical staff, as well as chief of staff at Doctors Hospital in San Leandro. Norman Leaf, MD '66, writes: "It's not Dostoevsky; it's not Melville; it's not even Jackie Collins. It's the release of my new book, a collection of stories, anecdotes and reflections of my 35 years of plastic surgery practice in Hollywood, or more specifically, Beverly Hills. Are Those Real? True Tales of Plastic Surgery from Beverly Hills is the story of my journey, a humble (kind of) Chicago boy who brings his Midwestern, down-toearth world view to the over-hyped world of celebrity-at-any-cost L.A." William A. McDade, PhD '88, MD '90, was elected secretary/treasurer of the Illinois State Medical Society. A member since 1981, McDade has served on numerous councils and committees, including the Student Section Governing Council, the Health Care Access Committee and the Governmental Affairs Council, for which he served as chair. Most recently he served as a board member representing the Chicago metropolitan area. McDade is a board-certified specialist in anesthesiology and the associate dean for multicultural affairs at the University of Chicago Pritzker School of Medicine. 1970s Lee C. Ballance, MD '70, continues to work at the Kaiser Medical Center in Vallejo, California, as a musculoskeletal specialist. Ballance serves as the chief of Continuing Medical Education and co-chair of the Pharmacy and Therapeutics Committee, as well as the medical director of the acupuncture program. He also serves as a small group leader for the Healer's Art course at University of California, San Francisco and Touro. His daughter, Zoe, is a senior at Yale University and is beginning work on her MPH. Ballance volunteered with his wife and daughter at the Matibabu medical clinic in Western Kenya last summer. Brett J. Vassallo, MD '95, is in a private urogynecology practice serving the northern and western suburbs of Chicago. His wife, Carol F. Ellman, MD, is in a private OB/GYN practice at Evanston Hospital. They live with their three children in Wilmette, Illinois. 1950s Marjorie A. Bohnhoff, SB '44, SM '50, passed away on March 4, 2010. For 40 years after graduating from the University of Chicago, she published original research, co-authoring several significant studies of sexually transmitted diseases. James E. Keasling, MD '54, died on November 28, 2009. Jay E. Wagner, MD '57, died of ALS on August 27, 2009. He completed his internship and general surgery residency at Roosevelt Hospital in New York City, as well as an orthopaedic surgery residency at Columbia Presbyterian Hospital. Wagner served as captain in the Army Medical Corps for two years. He practiced orthopaedic surgery for 42 years in Bay Shore, New York. He is survived by his wife, Mickey; beloved daughters, Lauren Cantor and Margot Wagner; and treasured granddaughters, Andrea, Hallie and Jacqueline. 2000s David Peter Beckmann, MD '08, will serve as chief resident at University of Wisconsin-Madison next year. Albert Brooks (Leveille), MD '78, has written a book about trading in the futures market titled Reading Price Charts Bar by Bar: The Technical Analysis of Price Action for the Serious Trader (Wiley 2009). Yousef Yassin Turshani, MD '06, was appointed in 2009 to the faculty at University of California, San Francisco's Department of Pediatrics as an assistant clinical professor. He notes: "More exciting has been the successful attempt to create an Adolescent Substance Abuse Program (ASAP) chapter at University of California, San Francisco based on my experiences as a medical student. (The flagship chapter of this program was created by Pritzker medical students about 10 years ago and the model has spread to more than 40 medical schools.) Some students have gone to juvenile hall, Boys and Girls Clubs and even in the home of a faculty member who invited parents/teens from the community to discuss drug abuse. I'm proud to see the ASAP tradition live on. Thanks to University of Chicago for giving me the foundation!" David E. McMahon, MD '78, writes: "In May, after 15 years in academic medicine, I left my position as director of ambulatory clinics and associate program director of the internal medicine residency program at Mount Carmel Medical Center in Columbus, Ohio. Prior to leaving, I received the Teacher of the Year Award for the second time from the residents in the program. I have joined a primary care practice in Grove City, Ohio, where I plan to continue teaching students from The Ohio State University and Wright State Schools of Medicine. My daughter, Allison, started her first year of medical school this year at Wright State." Current and Former Faculty Adrian Katz, MD, 77, passed away in August 2009 from complications of heart failure. Katz was an expert on kidney regulation of salt and water and on the diagnosis and treatment of 1980s Michele M. A. David, MD '88, recently received the 2010 William A. Hinton Award. She also was selected to deliver the 2010 William A. Hinton Lecture, titled Health Disparities: A Physician's Journey from Haiti to Advocacy. David is an assistant professor of medicine at the Boston University School of Medicine, director of community health programs at the Boston University Center of Excellence in Women's Health and co-director of the Boston Medical Center Haitian Health Institute. In Memoriam 1930s Harold Laufman, SB '32, MD '37, PhD, died of natural causes on Monday, May 3, 2010, in his New York apartment. At age 15, Laufman won several violin competitions, one of which presented him as soloist at a Young Peoples Concert with the Chicago Symphony Orchestra. He attended the University of Chicago for his undergraduate degree and received his medical degree from Rush Medical College. He helped pay his tuition by working as a medical illustrator. He served in World War II in 1942 as an evacuation hospital surgeon, which inspired him to earn a PhD in surgery. Laufman was appointed a professor of experimental surgery at Northwestern University Medical School before joining New York's Albert Einstein College of Medicine as a professor of surgery in 1965. He also served as the director of the Institute for Surgical Studies at Montefiore Medical Center in New York. Medicine on the Midway A publication of the University of Chicago Medical Center Fall 2010, Volume 64, No. 1 Executive and Managing Editor Cheryl L. Reed, assistant director, publications Contributing Editors Denise Alamad, director of publications, and John Easton, director of communications Editorial Contributors Rob Mitchum, Barbara Rose, Kelly Smith, Casey Reid, Kadesha Thomas, Ankur Thakkar, Kevin Davis, Kelin Hall and Kris Alden, MD, PhD Photo Contributors Dan Dry, David Christopher, Jason Smith, Lloyd DeGrane, Tricia Koning, Bruce Powell, Jason Weckstein, Ronald Orzel, Jimin Kim, Marshall Segal, MD; Zoltan Takacs, PhD; Bart Harris, Cheryl L. Reed, Ryan Robinson and Sean Clancy Design Firm Words&Pictures, Inc. Editorial Committee Chairwoman Chris Albanis, AB '96, MD '00, Lampis Anagnostopoulos, SB '57, MD '61, John Benfield, MD '55, Arnold Calica, SM '61, MD '75, Patricia Martin, AB '74, MD '78, Jerrold Seckler, MD '68, and Coleman Seskind, AB '55, SB '56, SM/MD '59 Medicine on the Midway is published for friends, alumni and faculty of the University of Chicago Medical Center, the University of Chicago Division of Biological Sciences and the Pritzker School of Medicine. Articles may be reprinted in full or part with permission of the editor. We welcome your comments and letters to the editor. Address correspondence to: Editor, Medicine on the Midway University of Chicago Medical Center 950 E. 61st Street Third Floor, Suite 323 Chicago, IL 60637-1470 Telephone (773) 834-8089 Facsimile (773) 834-5926 E-mail editor firstname.lastname@example.org E-mail class news email@example.com Find us on the Web uchospitals.edu/midway James Nelson Gingerich, MD '85, is the founder and medical director of Maple City Health Care Center in Goshen, Indiana. The Center fosters healthy community by providing affordable, accessible health care. Gingerich received the National Neighbor Works Dorothy Richardson Award in 2006. National Public Radio's "Morning Edition" featured a November 10, 2009, story about the Maple City Health Care Center's "More Than Money" program. Through "More Than Money," unemployed patients can volunteer in the community in exchange for health care at the center. 30 University of Chicago Medicine on the Midway � September 2010. University of Chicago Medical Center, Division of Communications and Marketing, Department of Publications Fall 2010 31 Perspective Orthopaedic Surgery in a Crisis: University of Chicago Haitian Earthquake Response By Kris John Alden, MD, PhD "Only then did I realize, even with no words exchanged, the profound difference a few minutes can make on a single life." -- Kris John Alden, MD, PhD Having endured five years of residency at Johns Hopkins University during a sizable spike in Baltimore's gang violence in 2006, I felt particularly prepared for the awaiting trauma. Three and a half weeks after the earthquake, I found myself on a bus crossing the crowded and chaotic border that had become a quagmire for supply trucks going into Haiti. Hours after leaving Santo Domingo, Dominican Republic, we arrived in Fond Parisien, a small village tucked into the potentially scenic yet deforested hills of the Haitian countryside. I could relate the stories of many individual patients, but one special girl remains in my mind today: Amelie Deroche. Amelie is an 8-year-old girl, originally from the outskirts of Portau-Prince, whose father was killed in the earthquake. Her mother, Jean, was ill-equipped to care for Amelie and her four younger siblings, now all homeless. Amelie, luckily, escaped the earthquake with only a fractured leg bone, which could be treated without surgery. While mourning the loss of their father, the family nursed their injured extremities and slowly rebuilt their fragmented lives. My daily rounds took me to visit the family, and I watched as Amelie cared for her younger siblings, never complaining about the stifling heat as she lumbered about the tent with her long leg cast. Amelie's cast told a dual story: it was gracefully decorated with happy, artful scenes of life before the earthquake. Yet, its edges were less ideal: frayed and torn, swathed in a layer of soil and sweat-- realities of being homeless and without a father, having to live in a tent, sleep on the ground and drag herself along the dusty trail to the portable toilets. After the earthquake, Amelie made her way from Port-au-Prince with an untreated broken leg and was treated in a hospital in the Dominican Republic. She and her family were quickly repatriated to Haiti, where they found themselves in our care at the field hospital in Fond Parisian. More worried about her mother and younger siblings than her own health, Amelie never sought the attention of the nurses, physicians or physical therapists on their daily rounds. Finally, weeks after the list. Frustrated by the rocky terrain and uneven soil that slowed the forward progress of her wheelchair and wasted precious time, I found it easier to carry Amelie the 50 yards to the X-ray tent. Lifting her tall, yet bony, frame in my arms, encumbered by the 15-pound plaster cast that hung around her leg, I realized she was easily the weight of my 6-year-old daughter, Suzanne, safely at home. Carrying Amelie was easy; putting her down was extraordinarily difficult. With her arms clinging tightly around my neck, I sensed that perhaps some peace and security had been restored in her life, something that had been stolen by the destruction of January 12. When I tried to place her gently on the stretcher outside the radiology tent, her thin arms clutched my neck. As I sensed that she wasn't ready to sit alone, my urgency to assess her fracture healing ceased, and I focused on what she could not verbalize. I understood then that her physical trauma would heal without me, as broken legs have healed long before doctors existed. But it was at that moment when I realized that my presence seemed to lessen the psychological pain that she silently carried. If only healing her mind were as easy as healing her leg, I thought as we sat together in the minutes preceding the X-ray. As I carried her back to her tent, with her fractured leg now healed, I placed her back in the care of her anxious mother. Walking back to the triage area, I turned back to say goodbye and glimpsed the first smile light up on Amelie's formerly dour face. Only then did I realize, even with no words exchanged, the profound difference a few minutes can make on a single life. Each patient we touched, we salvaged a life potentially destroyed by the earthquake. Seeing the pure gratitude on Amelie's once hopeless face reinforced within me why I chose medicine, and that validation was a far better gift than anything I could have given to the Haitian people. While I am not a "disaster junkie"-- one of those people who seek out humanitarian crises -- I am well aware of the serious pain and suffering that edges our often secure lives. My work as an orthopaedic surgeon exposes me to emergency rooms filled with broken arms and legs. Prior to January 12, 2010, the majority of my daily work at the University of Chicago Bone and Joint Center at Weiss Memorial Hospital focused on the orthopaedic issues of the middle aged and elderly. Such ailments are not minor concerns but certainly not on the scale of an international disaster. I cannot fully explain what changed on that day in January, but like every American watching CNN, I was shocked and saddened by the images filtering back from Haiti. But those images also compelled the physician in me. I was appalled by the humanitarian crisis unfolding before my eyes and felt especially helpless as I sat in my comfortable home, which provided my family more than the basics of life. I felt compelled to go to Haiti despite the dangers it likely presented. In addition, the timing for me personally was less than desirable: seven days after the earthquake, my fourth child was born. Leaving my wife, who was recovering from a C-section, with our four children so that I could help injured Haitians, was not something I easily could do. Fortunately, my wife is staunchly independent and was able to get by (and perhaps even excel) in my absence with the help of extended family and close friends. She also understood why I felt compelled to go and encouraged me to go. Kris John Alden, MD, PhD, escorts a young boy to the radiology tent to evaluate the healing of his femur fracture. The boy was initially treated in Jimani, Dominican Republic, and was transferred to the field hospital in the days after the earthquake. They are assisted by the boy's older brother. Photo by Sean Clancy injury, it could not be avoided; it was time to obtain new X-rays of her leg to assess the healing of her shattered tibia. Hopeful to get her cast off, I started to wheel her to the radiology tent. If I removed the cast, it would be one less patient to worry about, one less X-ray to check. I could focus my mental efforts on the many other patients who had not yet surfaced to the top of my Kris John Alden (AB '91) is an orthopaedic surgeon at the University of Chicago Bone and Joint Center at Weiss Memorial Hospital who specializes in hip and knee reconstruction. Alden is a University of Chicago Hall of Fame inductee (swimming) and was the recipient of the Amos Alonzo Stagg medal. He received his MD and PhD from the University of Illinois at Chicago, trained in orthopaedic surgery at Johns Hopkins Hospital and completed a fellowship in hip and knee reconstruction at the Mayo Clinic. Kris John Alden, MD, PhD, a surgeon at the University of Chicago Bone and Joint Center at Weiss Memorial Hospital, holds Amelie Deroche, an 8-year-old girl injured in the Haitian earthquake. Photo by Sean Clancy Fall 2010 33 Nonprofit Organization U.S. Postage Chicago, IL Permit No. 5179 PAID Alumni Association 1170 East 58th Street Chicago, IL 60637 FSC_MS_2_PNBW_rev.pdf 1 9/13/10 8:53 AM 10% For more information, call 1.888.UCH.0200 or visit uchospitals.edu, or uchicagokidshospital.org. For more information about these stories, contact firstname.lastname@example.org or visit us at uchospitals.edu/midway.