MUSC Catalyst 5-29-2015

May 29, 2015

MEDICAL UNIVERSITY of SOUTH CAROLINA

Trauma network offers survivors hope, lifeline

“It happened just like that.

You just never know.”

By Dawn Brazell Public Relations

photo by Sarah Pack, Public Relations MUSC nurse Connie Barbour wants to help other trauma survivors now that she knows what a devastating experience it can be.

Trauma leaves lasting scars

By Dawn Brazell Public Relations

T

he worst part was the mirror on Christmas Day. Connie Barbour knew she had to face herself and that it wouldn’t be pretty.

She tried to look on the bright side.

Despite a vehicle crash that landed her in the emergency room just two days earlier, she was alive to see herself.

Barbour’s face was swollen, she had

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lost her eyebrow and even her lashes on the left hand side of her face and had a wound that would leave a jagged scar going from her eye to her scalp. It had required almost 80 stitches that had to be done in layers since the glass had slashed so deeply through muscle down to the bone. Her neck was in a brace from a 7th cervical spinous fracture, and she was still feeling the effects of having a mild TBI or traumatic brain injury.

Her worry was about her family,

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especially her mother who had Alzheimer’s disease. How was she supposed to explain it to her without scaring her? It was a normal thought, though. She clung to that. Being able to think about still celebrating Christmas Day felt really good.

The reality about being a trauma patient is there is no preparation, and the emotional fallout leaves patients struggling to find what’s normal again.

Trauma surgeons see lives changed daily — often in a tragic way.

As a Level 1 trauma center, MUSC receives hundreds of cases each month, said Bruce Crookes M.D., medical director of trauma. Just last year, 2,400 adults and almost 500 children were seen at MUSC. “You can’t plan for trauma. It’s not like you sit down in your doctor’s office and your doctor tells you have cancer and have to go through chemotherapy. Trauma happens like that,” he said, snapping his fingers. “No one has any time to prepare for it or get ready for all the changes that all of that brings on. What you wind up with are families who are shattered and lives that have to be put back together.”

This month MUSC becomes part of a national group called the Trauma Survivors Network (TSN). The network is committed to improving the quality of life for people affected by trauma by offering resources to help them rebuild their lives. One way the network does that is to connect survivors who are willing to share hard-earned lessons as peer mentors with patients and their families. The group also provides practical information and referrals, enhances survivor skills to manage daily challenges and helps patients and their families get tied into

See Trauma on page 8

See Network on page 8

Next Steps

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Daisy Award

Beloved academician and physician heading north.

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Meet Ramin

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Wellness Column

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2 The CaTalysT, May 29, 2015

Cardiac Care nurse is DAISY winner The May DAISY (Disease Attacking the Immune System) award winner is Ashley Bukay, RN, who works in Ashley River Tower 5East. Bukay was nominated by Rachel Knight, a patient care technician (PCT) and nursing student.

Below is her nomination: “Ashley was caring for a patient on 5East who was one of those special patients whom everyone loved.

The patient Bukay had been on the unit for an extended period of time and developed relationships with most of the unit staff.

The patient originally was admitted for an Endovascular Aneurysm Repair, however unfortunately he developed multiple complications (unrelated to surgery) which prolonged his stay. As his days grew longer as an inpatient and he clinically deteriorated, the patient became increasingly frustrated and anxious with his lack of progress. The patient went from being fully mobile and walking the unit to requiring max assistance. Imagine the devastation he must have been going through. On April 23, the nurses called a code due to his declining status, but he recovered enough to remain on the floor. On April 26 and April 27 Ashely cared for the patient. That day, other staff members listened as Ashley expressed her concern

Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425.

843-792-4107 Fax: 843-792-6723

Editor: Cindy Abole

catalyst@musc.edu Catalyst staff: Mikie Hayes, hayesmi@musc.edu Dawn Brazell, brazell@musc.edu J. Ryne Danielson, daniejer@musc.edu Helen Adams, adamshel@musc.edu Sarah Pack, packsa@musc.edu Jeff Watkins, watkinsj@musc.edu

for the patient. She felt he was in limbo, was falling through the cracks and needed an advocate. Over the course of her first morning with him, she was observed spending more than two hours talking with the patient and listening to his wishes and concerns. Initially she was able to work with the primary team to get additional pulmonary and cardiology consults. Each consult led to additional workups and new diagnoses requiring further treatment. The following day the patient expressed to Ashley that it was all just “too much” and he wanted to be a ‘do not ressucitate” order. Although it was Ashley’s personal wish that he keep fighting, she listened to his wishes and his code status was changed. Mr. B. then got a thorough bath and they communicated more about the finality of his code status. When they were done with his bath, he grabbed her hand and sincerely thanked her for all of her patience and the wonderful care she had given him. Later that day the patient continued to detiorate and become more hypoxic, confused and scared. As the on– call team assumed care of the patient and tried to move him to the ICU for further observation and treatment, the patient looked to Ashley as an advocate. He then coded and the doctors in the room were ready to jump in and aggressively treat him and Ashley stopped them all and expressed the patient’s wishes. She was his biggest supporter putting her personal beliefs aside and following his wishes. As a PCT working through nursing school, watching Ashley care for Mr. B. over the last two days was The Catalyst is published once a week.

Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: sales@moultrienews.com.

inspirational, an example of advocacy, and the type of nurse I aspire to be one day. This commitment to Mr. B. is just one example of Ashley’s willingness to appropriately advocate of behalf of her patients. She exhibits the attributes of a Daisy nurse and is a testament to MUSC Excellence in her daily practice.”

Each month, MUSC nurses are honored with the DAISY Award for Extraordinary Nurses. It is part of the DAISY Foundation’s program

recognizing the efforts that nurses contribute daily in their jobs.

The award is given to outstanding nurses in more than 1,800 health care provider hospitals in the U.S. and 14 other countries. Nominations can be submitted by anyone — patients, visitors, physicians, fellow nurses and all MUSC staff and volunteers. To nominate a nurse, visit http://www.musc.edu/ medcenter/formsToolbox/DaisyAward/ form.htm.

New area code prompts 10-digit dialing The Tri-county and coastal areas of South Carolina are adding a new area code to its existing 843 overlay for telephone numbers. The new area code overlay is 854 and will serve communities in the Charleston, Hilton Head Island, Myrtle Beach and Florence areas.

Beginning immediately, callers on MUSC’s campus should begin using 10-digit dialing (area code + telephone number) for local calls.

Calls made using seven–digit dialing will still be accepted until Sept. 19. After Sept. 19, calls made without using 10– digit dialing will not be completed and a recording will instruct the user to hang up and dial again.

When calling from MUSC, users will need to dial 9 followed by the 10–digit local number, or 9 followed by 1+ area code + telephone number for long distance calls. Calls within MUSC to 792 or 876 numbers will continue to use the 5-digit extension to extension dialing.

This new overlay will not affect current telephone numbers and area codes.

Everyone is reminded to make the necessary adjustments to accommodate this new dialing procedure by setting and reprogramming equipment such as fax machines, alarms, Internet dial-up numbers, security systems, speed dialing, call forwarding settings, voicemail services and similar functions. Employees also should check their websites, business cards and stationery, contact lists, etc.

Information on updating abbreviated dial buttons on your MUSC phone can be found on the University Communications website at https:// sp.musc.edu/ocio-is/infrastructure/uct on the Basic Phone Information and Instructions page.

For more information, contact University Communications at 792-9980 or email uctdir@musc.edu.

New resource to share research successes Attention all research faculty, students and staff: Do you have exciting research news or findings that you would like to see shared with the MUSC community, other scientific institutions and/or the general public?

To help increase awareness about the research successes found here at MUSC, we have created a dedicated email address through which that information can be collected and appropriately disseminated.

Send an email to research-comm@ musc.edu with some basic information about what you would like to have shared, and you will be contacted by a communications expert who will help deliver your message to the appropriate audience(s).

Share this address with everyone in your research cohort and encourage its use whenever appropriate. Help spread the word out about the amazing work being done here at MUSC.

The CaTalysT, May 29, 2015 3

Epilepsy Center patients can wind down with video games

By J. ryne Danielson Public Relations MUSC’s level IV Comprehensive Epilepsy Center offers the pinnacle of care: advanced diagnostics, multidisciplinary treatments and a full range of medical and surgical interventions, but there was one thing missing.

“Patients are often here for days or weeks to be monitored or to recover from surgery, and these plannedadmission patients would bring in their video games and DVDs only to find we didn’t have a way for them to access them,” said Andrew Todd Ham, an inpatient EEG technician in the Epilepsy Monitoring Unit. “We discovered that the televisions that are built into the rooms are actually just computer monitors. To program and reconfigure them to play DVDs or video games is a time-intensive process. And it’s time-intensive to switch back to regular TV. And, in the process, we have to disable the Get Well Network, a patientcentered intranet, which is one of our biggest selling points as far as patient experience is concerned. That was a big disappointment to a lot of folks.”

That’s no longer the case. The Epilepsy Center has been awarded a grant from the MUHA Giving Back Grant Program to fund the purchase of a dedicated video game and multi-media cart for the EMU, allowing patients to access familiar entertainment from home during their stay at MUSC. As important as entertainment can be to patients enduring a protracted hospital stay, that wasn’t the most important reason for the award.

“One of our goals is to trigger seizures while these patients are here to be monitored,” said Kelly Kornegay, patient care coordinator for the Epilepsy Monitoring Unit, who wrote the grant application. “Video games are one of the more common real–world triggers of seizures. The faster we can trigger seizures, the shorter time the patient has to be here. So, if this new system triggers seizures in a particular patient, it could shorten an admission from a week to just a couple days, which not only reduces costs, but also improves the patient experience across the board.”

In addition to the 32–inch HDTV, rolling cart, DVD player and audiovisual connector cables purchased with the grant, hospital staff have donated a library of DVDs and even a Wii game console for patients to use in addition to whatever they may bring from home.

“We’ve got “Rambo,” “The A–Team,” “The Patriot” — one of our EEG techs is actually in that movie; he’s with General Cornwallis, wearing a powdered wig — and Kelly donated a big bag of romantic comedies. That’s in addition to everything else Kelly does for patients.”

“Some of our patients stay for weeks,” Kornegay said. “We all chip in to make them comfortable.”

The grant program was established in 2011 as a way for grateful patients and families to give back to MUSC. Administered by the Office of Development, the grants go to employeedriven projects and are funded completely by patient donations.

“I love that the Giving Back Grant Program is an option,” Kornegay said.

“It’s a great program. These things don’t fit into the hospital budget, but they’re Patient Charles Dixon and EEG tech Andrew Todd Ham enjoy a game of Remington Great American Bird Hunt on the Nintendo Wii.

photos by J. Ryne Danielson, Public Relations

Video games serve as both entertainment and clinical tools. Dr. Jonathan Halford, from left, patient Charles Dixon, Andrew Todd Ham, Kelly Kornegay and Sherrie Feaster enjoy a welcome diversion while monitoring for epileptic seizures. very important to patients.”

One of those patients is Charles Dixon, who is thrilled at having access to familiar entertainment during his stay in the EMU. “It gives me something to do and keeps my mind active,” he said. “It keeps me focused. Tonight I have to be

sleep deprived, so it gives me something to do to stay awake, as opposed to watching TV, which would put me to sleep. When I’m playing a game, it’s more active.”

It also reminds him of home, Dixon said, and that’s a big comfort.

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Stanford prof shares insights on writing patient histories

By J. ryne Danielson Public Relations

K

elley Skeff, M.D., Ph.D., the George DeForest Barnett professor of medicine at Stanford University, presented the Julius Sagel Endowed Lectureship in Internal Medicine at MUSC May 19.

MUSC physician Jeff Wong, M.D., has been among the many people Skeff has influenced over the years.

“Perhaps Dr. Skeff’s greatest achievement has been his work with the Stanford Faculty Development Center, which he helped to create,” Wong said. “The Stanford Faculty Development program was created to help busy clinicians become more effective in their teaching activities. I first met Dr. Skeff in 1992 when I attended facilitator training at Stanford, and it was a life-changing event for me.”

Through his talk, titled, “Reassessing the HPI: Understanding the Patient’s Story,” Skeff hoped to improve the clarity, efficiency and usefulness of something most doctors use daily — the patient history.

“All of us have dealt with patients who have said, ‘My doctor didn’t hear me.’ I think we can do a better job of listening to patients, understanding their stories, and structuring the patient history to better reflect that understanding.”

According to Skeff, there has long been difficulty with patients communicating their stories effectively and physicians understanding what patients were trying to say. He said this phenomenon led early physicians to discount the patient’s story entirely and act more like pediatricians or veterinarians than adult-care doctors.

These doctors privileged objectivity over subjective experience. The problem was, and still is to some extent, that the subjective experience of some was taken as objective fact, while the experiences of other groups were discounted.

“We know that women’s heart disease is diagnosed more slowly than men’s,” Skeff said. “Historically, women were seen as less rational, less objective, so their experiences were ignored by physicians.”

“In the 19th and early 20th centuries,” Skeff said, “there was a dichotomy between getting information from the patient, and the physician putting on a bit of a show. Patient histories were not recorded to be useful, so much as to demonstrate to patients how much the doctor cared.”

He continued, quoting an instruction manual from 1905: “‘The physician must remain aware that these patients were his public, the source of his custom, and that the taking of a history was essentially the physician’s storefront.’”

Prose is getting us into trouble A backlash to this lack of patient respect, Skeff said,

Stanford University professor Dr. Kelley Skeff, an expert on medical education faculty development, was the guest speaker at the 2015 Julius Sagel Endowed Lectureship. has led to the adoption of detailed patient histories, written in paragraph form. While the focus on respect, he believes, is key, this has led to an inefficient form of recording patient histories. “Doctors, like everybody else, have limited cognitive ability. Prose is getting us into trouble.”

Stories recorded in paragraph form, he said, make it easy to leave out important details that don’t match with physicians’ preconceived notions. “Students are taught that a patient history should be consistent with the assessment and plan of treatment. But, what are we telling people to do when we teach that your history should support your assessment and plan? What if some of the data doesn’t support your assessment and plan?

You might subconsciously leave it out. Many students are also taught to leave out irrelevant data. How do you determine what data is irrelevant?”

Skeff believes a better approach is to document patient histories chronologically, with a series of bullet points, and that nothing should be left out. “The history has time in the left column and what happened in the right column. When did it happen, what happened? Time gets locked, which enables physicians to better see the variables that are moving, the ones that are important.”

Skeff believes that too much data confuses physicians, especially when it is delivered in clunky prose. “We need better tools to organize our data,” he said.

“Consider, what I call the ‘and also’ syndrome. It’s sort of like when the doctor’s leaving the room and the patient says, ‘and also...’ When it shows up in the notes, it means we’ve forgotten to include something.

To rewrite all those paragraphs to put in this thing we forgot is an impossibility, so we put it at the bottom, and the cognitive burden to understand that piece in context goes up. But, if you’re writing in timeline form, it can go in where it belongs.”

Responding to concerns that patients will feel doctors are being insensitive for “making them talk our language,” Skeff said, “I’m a believer in patient-centered care, but I’m also a believer in doctor-centered care. I think there are times when we have to ask the patient to talk in a manner that enables us to think analytically.

So, we need to say to the patient, ‘Walk me through the story, piece by piece. What happened? Then what happened? Then what happened?’”

The key to avoiding charges of insensitivity is to build a relationship with the patient, Skeff said. This allows the best assessment of the problem and provides the basis of collaborative care to treat the problem.

How to build a better doctor–patient relationship?

“Patients have a different feeling of how you connect with them when you empathize and reflect how you think they feel, when you say, ‘You seem frustrated,’ ‘You seem angry,’ ‘You seem sad,’ ‘You’re at wit’s end.’”

That’s the first step, Skeff said. The next is to legitimize those feelings.“When you say, for example, ‘I’d be frustrated as well if I had sat in the waiting room for two hours.’”

The final step is respect. “Every human deserves unconditional respect for how they feel. Respect is about empowerment. It’s very easy to make a patient dependent entirely on us as physicians—for example, making the patient lie down while we walk around them. When that happens, their power almost goes away.”

Skeff believes empowerment is the cornerstone of collaborative care. “If everything is done in the hospital and suddenly they’re home and asked to take over care for themselves, that’s not a good model. Instead, we should be thinking about the strengths and weaknesses of a family and working with those, highlighting their strengths and working on their weaknesses. We can say, ‘This is what you’re going to do at home whenever you leave the hospital, I want you to begin practicing it now.’”

“Before patients care about what you know,” Skeff said, “they must know that you care.” What is caring to Skeff? It is building a relationship with the patient through reflection, legitimation, respect and collaboration.

See History on page 11

The CaTalysT, May 29, 2015 5

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6 The CaTalysT, May 29, 2015

MUSC educator takes new direction training doctors

By Mikie hayes Public Relations

D

r. Jeff Wong’s nurse, Michele Peplowski, R.N., walked in the exam room, blood pressure cuff in one hand, an EKG reading in the other.

“What are we going to do without him?” she asked, rhetorically, referring to Wong leaving MUSC to start a new medical school at the University Park Regional Campus of Penn State College of Medicine.

“It’s like one of his patients said this week,” she continued. ‘The only solace we have, is that he will hopefully produce hundreds more just like him.’”

“Wouldn’t that be nice?” she asked.

Wong officially leaves MUSC in June. As the education dean of the new campus, which will be located in State College, Pennsylvania, Wong will provide leadership and oversight for medical students and resident teaching activities beginning July 1. In addition to recruiting faculty to this new program, his role is to reinvent medical education from the bottom up — something he is greatly looking forward to.

While his patients and staff lament his leaving, he is returning to his first love: education. “I’m so excited,” he said. “I get to do the education stuff, which is my favorite.”

Jerry Reves, M.D., distinguished university professor and dean emeritus of the College of Medicine, recruited Wong to MUSC in 2004 to serve as senior associate dean for medical education and reinvent MUSC’s medical school curriculum. Reves credits him with “dragging MUSC into the 21st century”

Dr. Jeff Wong and College of Medicine Dean Emeritus Dr. Jerry Reves.

Reves recruited Wong to MUSC in 2004.

and taking the program to the next level.

"Jeff Wong came to MUSC in the midst of our accreditation and helped us continue to have an unblemished record with medical school accreditation,” Reves explained. “Then he set about the challenging task of changing the entire medical school curriculum so that there was more clinical material in the first two years. There was nothing that Dr. Wong undertook that he and his team were not successful in accomplishing in his quiet, deliberate and most effective style."

According to Wong, Reves recruited him to move the medical school from the classic “Flexnerian” model where students spend two years of didactic instruction before having the opportunity to treat patients to a more updated way of teaching medical students, exposing them to clinical settings earlier in their education.

“Jerry Reves and I published a paper about the Flexnerian revolution,” he recalled. “Flexner, in 1910, had outlined the state of medical education in the U.S. He essentially said medical education was a mess, with some schools at the time doing it well and others not so well, and that medical education needed to be based on certain parameters. This Flexnerian model was an important and critical change for 20th century medicine. As a result, many med schools have been comfortable staying with this structure. However, there are many reasons to believe that educating young people for practice in the 21st century medicine may require newer innovations and ideas.”

An example of that would be Hofstra Medical School in Long Island, New

Above photo: Dr. Jeff Wong teaches physical diagnosis with then-MUSC medical students Ankit Patel, Brent Soder and Andrew Sas. Left photo: Dr. Wong played his part as one of several facultystaff leprechauns during the St. Patrick’s Day Match Day event in 2011. photos provided

York, a program that requires every medical student to get certified as an EMT. In this model, students right out of the gate get hands-on experience with illness, injury, death and taking care of patients. That, said Wong, is moving students the right direction.

“Instead of sitting in classrooms, they are learning early on how to do this even before they learn anatomy or biochemistry – the thought being, if you bring information to students that way, you actually bring a context upon which all other learning becomes so relevant.”

The struggle Wong had when recreating the MUSC curriculum was that it was difficult moving away from the entrenched model of discipline– based courses, where students were required to take courses like anatomy, biochemistry, histology and physiology during their first two years.

“In the old model, the basic science professors would provide an enormous amount of content in a short period of time and say, ‘OK learn this all, you don’t know where it’s going to come into

See Educator on page 7

The CaTalysT, May 29, 2015 7

eDuCaTor

Continued from Page Six

use, but learn it all, memorize if for the test and then see if you use it two or six years from now.’ That’s a crazy way to teach and to learn,” he said.

“Part of the problem,” he continued, “was these courses were typically taught by science educators in those basic science fields, and there wasn’t a good sense, necessarily, of providing the information that is pertinent for medical students: What do they need to know about being a doctor as opposed to what biochemists need to know about biochemistry? When we redid the curriculum, we took it out of a discipline mode and put it into longitudinal themes that would use the concepts of all the fundamental basic sciences, and we created cases around which the learners could contextually learn.”

As Wong explained, if John Ikonomidis, M.D., Ph.D., for instance, was treating a patient who needed an aortic valve replacement, Wong would get the students involved in the case even before the students knew anything about the heart. “They are following the interaction, they are talking about it, they are watching a bit of the surgery, the follow–up and everything else. The students take that case and from it they then learn in a context of this patient and this doctor having to take care of this patient, and what do I need to know about in order to take care of them.

Then we would fill in the gaps.”

That type of early exposure to patients will be incorporated into the new program he will be building at Penn State. “We want to have it so our students on day one, week one are working in real clinical experiences in the community. And, rather than asking student to try to figure out what fundamental basic science concepts they need to remember in clinical years, we want flip that around so they’re using these early clinical experiences to inform their fundamental basic sciences learning.”

FliPPing medical school Wong said he plans to do very specific things. For one, he doesn’t plan on having any lectures; rather, he will be moving toward what is called “the flipped classroom.” Instead of having the students come to the classroom and the teacher teaching the material to them,

photo provided

Drs. Larry Raney, from left, Jack Feussner, Jerry Reves, Jeff Wong and Louis Luttrell worked as a team during a Grands Round presentation.

They wore shades to signify how MUSC’s future was looking bright. curricular activities and not be beholden whatever the teacher would have taught to what has always already been done.” during that session in the classroom is What was done before has constantly provided to them ahead of time. It’s changed when Wong was involved. expected that they will watch the video In 2012, after serving eight years as or read the chapter or do whatever else the senior associate dean for medical is assigned, then come back to class with education in the College of Medicine, the teacher and a discussion will ensue. he was selected as the Kimitaka Kaga “The student’s experiences, then, are driving the learning, in term of what they Visiting Professor at the University of Tokyo in the International Research know or don’t know,” Wong said. “It’s Center for Medical Education. Only elite a different way of teaching. Most grad medical educators throughout the world students don’t sit through lecture after are selected for this honor and only one lecture. If you look at business school or law school, what they’re doing is learning per year. During his time in Japan, he was able to help administrators redesign on their own and the interactive time with their professors is spent challenging their programs, and as a result, his work became well known, setting the stage for them, making them ask questions or such a prestigious job offer. making them analyze things. It’s not telling them the facts. These are really agent oF change smart kids – there are lots of different When considering the best candidate sources to provide them with the to reinvent medical education, Penn knowledge they need to learn; we don’t State had one person in mind: Jeff need to waste their time merely talking Wong. The innovative work he did to them about it. What we need to try at MUSC and in Japan caught the to figure out is how to maximize their attention of many in this field; for that learning, making sure they understand the material and how to use it. They also he has been called a change agent.

Tom Waldrep, former executive need to be able to know when they don’t director of MUSC’s academic support know something, and how to figure it services, who worked closely with Wong out. It’s not just memorizing facts so they can pass a test, it’s because they have on behalf of the medical students, could not agree more with that moniker. to meet with Mrs. Smith this afternoon “Medical students love him because and need to be able to take care of her.” he becomes their collaborative learner.

How he gets to that point is only He is an explorer for new knowledge constrained by his imagination. He and new solutions for problems. calls it “refabricating the way things He is collaborative, not hierarchal. are done,” and his intention is not to Many educators could learn from his repeat anything that’s ever been done sensitivity, teaching style, and knowledge. before. “We’re really trying to rethink how medical education is conducted, the I did,” he said.

Whether it was his planning of structure of how it’s set up, the sequence the Sagel Lectures, impressing upon of how students should go through their

students the importance of incorporating humanism in their practices, or reinventing medical school curricula, colleagues, patients and friends were not surprised that Wong was tapped to head up this monumental project at Penn State.

Jack Feussner, M.D., distinguished university professor, was chairman of the Department of Medicine when Wong joined the faculty, but they were friends long before that. “I have known Jeff since his days as a medical house officer at Duke. Even at that early time in his career, it was clear to all that he was a special physician. Jeff has always been a doctor’s doctor. His calm and thoughtful manner, coupled with his prodigious intellect, explain his remarkable skills as a medical educator. His students have always admired him even though he pushed them to levels they thought unattainable. He is internationally recognized and acclaimed for his achievements and excellence as a medial educator. Jeff is a critical thinker, an education innovator, always driven to do more and to do better for his students.

Dean Jerry Reves did MUSC proud when he recruited Jeff to come here from Yale. As a one-of-a-kind physician and educator, he will be sorely missed and impossible to replace.”

Waldrep agrees and feels Wong is uniquely qualified to tackle such an enormous project. “Walking away from Dr. Wong’s initial interview at MUSC, over 10 years ago, interviewers knew his knowledge and his valuing of collaborative medical education and integrated curriculum were far superior to theirs. I know: I was one of those interviewers. Dr. Wong taught me much about collaborative learning among medical students. The Center for Academic Excellence and its work was totally supported by that knowledge and each level of training from their white coat ceremony to match day. From Dr. Wong’s initial interview to the present, I have never questioned his concern for the best medical curriculum and education for every student accepted by the college’s admission committee. His departure to Penn State is a phenomenal loss not only to MUSC but also to Charleston.” our loss, their gain As deeply as Wong’s patients care for

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8 The CaTalysT, May 29, 2015

neTwork

Continued from Page One

online communities of support.

“The goal of this is to make that transition easier and to let those people and those families know they are not alone - that what they are dealing with is not something they have to deal with by themselves in a vacuum. It’s a way to help them transition back to a normal life or a better life.”

And, it’s long overdue. That’s something Crookes and Samir M. Fakhry, M.D., president of the American Trauma Society and chief of MUSC’s Division of General Surgery, agree on wholeheartedly.

“If we’re really trying to build a trauma system,” said Fakhry, “we need to provide everything a patient might need - the entire spectrum of care. Healing has to be not just physical, it has to be the emotional and the psychological.”

Fakhry said he was exposed to how the network worked when practicing at Inova Fairfax in Virginia and liked how it worked. “It’s so obvious, it begs the question why it hasn’t been done sooner?”

The answer is there have been other priorities, such as creating the best trauma services and rapid access to a Level 1 trauma care center that would prevent fatalities, he said. In 2013, the U.S. saw more than 32,000 deaths and

TrauMa

photo by Sarah Pack, Public Relations Dr. Bruce Crookes, far right, enjoys the fast pace of trauma and welcomes that MUSC is going to be part of the Trauma Survivors Network. more than 2.3 million injuries from motor vehicle crashes alone.

“The focus until now has been dealing with handling injuries so that people get to the hospital and survive what’s called the golden hour – that first hour for a severely injured patient to get to the right trauma center to survive,” he said, explaining that there’s a 25 percent better chance of surviving if a seriously

injured person goes to a Level 1 trauma center.

“The things that kill you are bleeding to death or having a severe brain injury. Those are two things that only big hospitals with trauma teams and trauma surgeons and all the other support structures can take care of.

It all ended when the patient left the hospital, though. It wasn’t for the lack of

enthusiasm or the desire to help people.

We were just on to the next patient.”

Research shows it’s not enough.

Fakhry, who’s involved in several trauma recovery studies, said he has been surprised at the need these patients have for more care. One MUSC study followed patients within two months of discharge to see how they were recovering emotionally and psychologically. Nearly 50 percent screened positive for post-traumatic stress disorder (PTSD) or depression and nearly everyone who did screen positive had no idea what to do about it.

As an academic medical center, it’s important for MUSC to be involved in research not only to maintain Fakhry the hospital’s Level 1 status but also to keep improving the quality of care, he said. “You have to keep discovering new things and new ways of dealing with problems. Research is really the underpinning of what we do.”

The military has made amazing progress in recognizing and treating PTSD in veterans, and that experience can be passed along to other trauma

See Network on page 9

Continued from Page One

In the blink of an eye, life changes. Instead of joyously celebrating a holiday she loved, she was figuring out how to get showered and how something so horrible could have happened.

“That was what was going through my mind. ‘I can’t believe that this happened.’ It happened just like that.

You just never know. And then you go: ‘What if I left five minutes earlier? What if I have gone a different way?’ And on and on.”

Barbour now knows that’s just part of the recovery for a trauma victim, and it’s why she’s decided to participate in MUSC’s new Trauma Survivors Network.

As a registered nurse at MUSC who sometimes cares for trauma patients, Barbour had only seen what it was like for survivors from the medical side.

Now, she was living it.

The network will use volunteers such as her to help other trauma patients navigate the medical and emotional trials and sometimes legal and financial fallout that often accompany trauma incidents.

That role reversal from nurse to patient came for

Barbour Dec. 23. It was a cold, foggy day and had been raining during the night. Cocooned in her warm vehicle heading into work, she was happy. She had just returned from a trip to the Bahamas and was done with her Christmas shopping. Barbour said she could see ambulance lights coming through the fog.

“I remember as I was coming in all I could see was this green light and ambulance lights coming, and the next thing I remember is I had hit them in the side.

I remember thinking, ‘I couldn’t believe they were turning,’ but they did and I slammed on the brakes, and I hit them.”

Barbour was wearing a seat belt, but her airbag failed to deploy so she hit the side of the windshield. Two paramedics got out to check her. She thought she was fine, having no idea that she was bleeding. They asked her to crawl out through the other side and got her onto a stretcher.

“They said, ‘We are going to take you to MUSC as a trauma, Is that OK?’ We all kind of laughed because I said, ‘That’s where I was going anyway.’ In the back of

my mind, I kept thinking I couldn’t be hurt that bad.”

Trauma team professionals cut off her clothes and specialists crowded around her as she struggled to wrap her mind around what was happening and figure out how serious it was. One clue came when her daughter arrived.

“She grabbed the railing and she looked at me and said, ‘Are you OK mom?’ and I said, ‘I’m fine. Are you OK?’ because she was suddenly totally white and she said, ‘I’m OK.,’ as she slid down the railing and Dr. (Brent) Jewitt caught her as she was passing out.”

Her daughter, 26, hadn’t expected to be able to see bone and that her eye was “sort of hanging out,” Barbour said. The next shock came when plastic surgeons came in and told the medical student in attendance that the challenge would be to figure out how to line her eyebrow back up with all the swelling.

“That was scary.”

Barbour was one of three trauma patients who came

See Trauma on page 9

The CaTalysT, May 29, 2015 9

neTwork

Continued from Page Eight

survivors, he said.

“The time is now, and the time is right. We’re far enough along where it’s time for this, and the military has recognized it’s time for this too. We’re a social species and when something happens we should be reaching out and helping each other. In its most fundamental way, we want the people who provide the care and the people who have experienced this to work together to help the next person who gets hurt and is trying to recover.”

Regina Creech, who is facilitating the startup of MUSC’s TSN network and serves as the injury prevention coordinator, recently made a site visit to Inova Fairfax to see how their program works. She attended a peer visitor volunteer training that included a mix of seasoned volunteers and newcomers.

“I loved being able to hear their stories of what they felt worked well during visits with patients,” she said. “Someone asked in the training if a peer had ever cried during a visit. The man who answered was a spinal cord injury patient. He told the story of a visit he conducted where he said he did get emotional while talking to a patient—but he said they were tears of joy because the spinal cord patient he was visiting realized all the things he could do after his injuries.”

Inova, which has a robust TSN

TrauMa

program with two fulltime staff members, offers an expressive art group and a clinical harpist in the intensive care unit for relaxation. The hospital also follows up with patients after discharge with phone calls and a monthly newsletter.

“I think keeping in touch is a great idea,” Creech said. “Patients can be informed about ways they can participate in our activities. They may choose to become peer visitors or they may be interested in providing community presentations. Whatever the opportunity, they will know that there are ways for them to get involved, when they are ready to take that step.”

Creech said MUSC still is exploring how its program will develop. The patient manual is being printed and the hospital is part of the TSN national website (www. traumasurvivorsnetworkorg). Trauma survivors are being recruited to be peer visitors. They are referring patients to the NextSteps online course and will be offering a version of the Family Class called Snack & Chat in June.

Crookes, who has been involved in treating trauma patients for 12 years, said he’s so glad to have this program being developed as a resource.

One of the hardest parts for him is seeing young, formerly active patients, who feel their lives are over. Trauma is the leading cause of death for Americans

photo by Regina Creech Staff from the surgical trauma intensive care unit hold messages of hope and inspiration for Trauma Survivors Day held May 20. under the age of 44. “It’s the No. 1 cause of years of life lost. It’s a higher cause of mortality than cancer, HIV, heart disease or any of those things.”

Crookes said it’s an honor to treat these patients who often have to recreate themselves in the wake of a trauma.

“Imagine in five minutes if your entire life was ripped away – just to walk out of the office right now and get hit by a car and you lose your leg or you’re paralyzed.

It’s incredibly difficult to deal with that.

The majority are young people who are breadwinners of the family who are losing their way of life,” he said.

The hardest thing is convincing trauma patients with significant lifealtering injuries that they can live the rest of their lives as normal people. He recalls

a young, vibrant patient who had to have part of her leg amputated. They got volunteers from the Wounded Warrior Project to visit her, and Crookes could tell it was life-altering.

“It’s having someone who has had the same injury come in and say, ‘you can do this. There is hope on the other end.

You can be normal again or as normal as possible again.’ Whereas coming from me, it doesn’t have the same strength or power. I can say that all I want to and people just say I’m the guy in the white coat who’s just going to leave and go home to his family. These are people who have the same problem who are living with it and dealing with it and surviving with it. That’s where this fills the gap.”

Continued from Page Eight

in that morning. She got there a little past 7 a.m. and couldn’t leave until almost 2 p.m. because it took that long to sew her back together, she said. She was amazed at the great teamwork and how well she was cared for, despite having so many ongoing traumas. She had many great nurses, including Kelley McElligott, who was with her through the event. “I drew my strength from her while they were working on me.”

She praises the job that the plastic surgeons on call did for her. She pulls up her hair to show a faint, jagged scar line that’s healing well. Given the holiday and her nursing experience, doctors let her chose whether to stay at the hospital or go home to recover. She opted to go home.

“Around 10 that night, I doubted my decision a couple of times. When I got still and quiet, I realized it was one of the most painful things I’d ever had.”

Barbour also learned there is a component of post traumatic stress disorder that accompanies trauma.

“The first couple of days, you’re getting over the shock.

It all happens so fast. It’s all like a bad dream. After you get past this really happened and I have to get better and go on with my life, you have to figure out how am I going to get back to being a normal person again.”

Barbour, who hasn’t driven since the accident, said there are triggers that make her uneasy, such as congested traffic situations and the sound of sirens. She also had to cope with shifting her attitude. Considering herself a strong person, Barbour said she was surprised how hard the emotional part was following the crash.

“I wasn’t at all prepared for it. You just can’t prepare.”

She recalls going through a ‘self-pity period’ where she felt like she’d look like a freak for the rest of her life. But then she had a close neighbor die of a stroke, and she decided to focus on all that she had to live for.

“I realized it was stupid for me to sit here and feel sorry for myself. It was a real reality check. You can’t look at yourself as a victim. You have to know yourself and know what you have in you that will help you overcome the obstacles that you will have ahead of you.”

She’s glad MUSC will be offering a Trauma Survivors Network because she had a much tougher time than she thought and found her colleagues’ encouragement played a critical role in her healing. “When you’re involved in a trauma, it’s usually very life changing to some extent. It is very emotional. As humans, we draw on emotional support trying to heal. We need to feel that someone cares. It goes beyond getting put back together and getting a lot of medical attention.”

By participating in the network Barbour hopes to help others, but she knows it also will help her continue to heal. It’s a process.

“I feel fortunate that I’m here and alive and that I was able to pick up the pieces and go on with my life,” she said. “Not everyone is that fortunate. Or they have lost an arm or a leg or are not able to walk or are paralyzed.

My heart goes out to them because I know how hard this was for me.”

For information about the program, visit traumasurvivors@musc.edu, 792-8401.

10 The CaTalysT, May 29, 2015

annual WooF aWards recognize Patient saFety

The fifth annual WOOF (Without One Fall) awards were presented to the Medical Intensive Care Unit (MICU), left, and 7C Children’s Hospital (acute care), above, on April 21. Honorable Mention Awards for units having fewer than four falls in a calendar year include: 5West and NSICU (University hospital); CCU, MSICU (Ashley River Tower); PICU, PCICU, 8D and 7A (Children’s Hospital) and 2N (Institute of Psychiatry). The award system, established in 2009, was initated through the FIRM Ground Fall Prevention Program recognizing units who have kept their fall rates low and patients safe.

eDuCaTor Continued from Page Seven him, he cares for them just as much if not more so. His patients are having a difficult time saying goodbye. “Patients have been asking, ‘Why are you leaving?’

I’ve made more people cry in the past three months than I ever have in my whole life,” Wong said only half joking.

While they are happy for this opportunity, many patients feel as if they’re losing a part of the family.

Senator Fritz Hollings said Wong’s caring presence and thorough care will be missed. “I have enjoyed being under Jeffrey Wong’s care. He is the best.

When I returned to South Carolina from Washington, D.C. 10 years ago, I called (then) Dean Jerry Reves and told him I wanted the very best doctor. He recommended Jeffrey Wong. For doctors to say that he’s the best doctor, well, you don’t have to look any farther. I’m going to miss him, I sure will, but I know he’ll build a good medical school in Pennsylvania. He can surely do it.”

Layton McCurdy, M.D., distinguished university professor and dean emeritus of the College of Medicine, echoed the senator’s sentiments, calling Wong his

colleague, friend and doctor. “He is a fabulous guy. I had a chance to see Jeff in action as he cared for a real good friend in the final phase of his life. I’ve never seen a more confident and caring person than Jeff Wong. I’ve never seen anybody better at that. In addition to watching him in action, he’s been my doctor. I’ve tried to figure a way to follow him to Pennsylvania,” he said, laughing.

Wong has been Mickey Bakst’s doctor for the last 10 years. Bakst is the general manager of the Charleston Grill at Charleston Place. Bakst said he is thrilled for this new opportunity that Wong is about to embrace, but not sure he is replaceable. “It was doctors Ray Greenberg and Jack Feussner who first introduced me to Jeff Wong. Both told me he’s the doctor they would have as their internist. I have to say that at 63 years of age, I have never in my life had better care from a physician than Jeff Wong. His manner is the most comforting, relaxing manner I have ever seen, and I come from a family of doctors. His approach alleviates any of your fears. He has a sense of confidence in his ability. Jeff is the doctor that when I send him a text, I don’t care if he was

in Prague or Japan, he would text back nearly instantaneously and take care of the issue. I’m in the customer service business, and I’ve never been served by a doctor as I was by Jeff. That’s my heart, that’s my gut, and service is what I do.

And service is what he does. The loss of Jeffrey Wong is a major loss for MUSC. He is destined to do great things. Our loss is going to be Penn State’s gain.”

While it will be difficult for him and his family to leave MUSC and Charleston, the timing is just about as perfect as it can be. His son graduates from Academic Magnet High School in June, and will be heading to college in Vermont in the fall. His daughter is leaving middle school and was accepted into the Interlochen Center for the Arts, a prestigious boarding school that accepts only a small number of students each year from an international pool of applicants. To say there is lots of change in store for the Wong family would be an understatement.

“The community of State College is wonderful. We’re really looking forward to it. That being said, we don’t look forward to leaving Charleston or MUSC. We’ve been here 11 years,

but opportunities like this don’t come around very often. I’ve been asked to look at other jobs to do things I’ve already done, but nothing like this.

These activities are totally different because nothing is set up yet. I have to really sit down and say, ‘What is it that young people want in this day and age with the way that medical care is coming out, with all the new ways of doing things, new way of seeing patients, the expectations of patients, expectations of learners? How do I reformulate medical education to maximize their potential and get them trained in a way that provides best service to for the public they have to serve?’”

As he thinks about leaving MUSC, he contemplates his legacy and decides he is proudest of serving as dean of medical education and his ability to lead groups to think about and embrace change.

“I brought an ability to get people to work together in a way that was positive for the institution and in a way that was respectful of where existing people were. Being a practitioner and a primary care physician, I bring a completely

See Educator on page 11

The CaTalysT, May 29, 2015 11

hisTory

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Call 792-0002 or send us an email with “Wills Kit” in the subject line. Start planning now by visiting www.muscgiving.org/ willsplanner.

Continued from Page Four

Skeff related an account told to him at a recent conference: “A husband came up to me and said ‘my wife was at a very famous cancer institution in this country, and the moment we were told she had cancer, neither of us could think anymore. My wife broke down into tears, wailing, and we sat in the waiting room with physicians, nurses, everyone walking past us. Everyone walked past us, and no one touched us.’”

“So, we had a very interesting situation,” Skeff said, “in that we had someone suffering that we couldn’t touch. The husband told me, ‘All it would have taken is any of these behaviors—any reflection, any legitimation, any respect.’”

Skeff estimated that less than 10-20 percent of doctors currently use his model. “Right now, we’re studying it in such a way that we can prove with data that it does the things I claim it does. I know it in an anecdotal way, but to get doctors to switch, we need hard data.

The patient/physician communication topics, those have been studied, but physicians still don’t use those skills

eDuCaTor Continued from Page Ten

MUSC Wellness Center & Division of Developmental Pediatrics present the

Piece It Together Summer Program June 23 to July 30 An exercise, nutrition, stress reduction intervention program for teens and young adults with autism spectrum and/or mild neurodevelopmental disorders Goals of this program are to increase physical activity, improve body composition, promote healthy food choices, broaden social skills, teach relaxation skills and improve mood and calmness.

Register at http://academicdepartments.musc.edu/hsc/programs/ pieceittogether.htm Sponsored by the SC Translational Clinical Research Institute, the SC Developmental Disabilities Council, MUSC Urban Farm, Unlimited Possibilities Mentoring Services and the Lowcountry Autism Foundation

photo provided

Dr. Jeff Wong, right, joins his family, son, Andrew; wife, Lisa Preis and daughter, Eva. different concept of what it means to be a physician and interact with students.

Most of my major addresses to students here always had aspects of humanism,

enough. We need to give physicians and teachers the courage to know these are things they should be teaching. There’s such an attraction in medicine to teach about the medical illness – patient/ physician communication and analyzing the cases are not emphasized to the same degree. So, I’m trying to empower the teachers to emphasize what they know is important, not only what they think other people expect them to be teaching.”

Skeff also said that diversity in medicine is increasingly important to patient-centered collaborative care. “We all need to be skilled in dealing with diverse populations. The United States is such a melting pot that for any of us we have to use these skills for so many different cultures. And sometimes we think that a person from our culture is thinking just like us, and that’s not always true.”

For Skeff, respect is the answer, and that means hearing what a patient is actually saying rather than making assumptions based on preconceived and usually incorrect information or ideas.

compassion and of expecting them to do the right thing for their patients and being there for them.”

Wong credits his time at MUSC and the opportunities he was given for being the springboard to this new position.

“My move to MUSC was absolutely very positive. For Dr. Reves to have given me the opportunity to do what I was able to do was absolutely instrumental in getting me set to where I am. There’s no way that what I was doing at Yale, Duke, or Washington University – as good as those experiences were – would have prepared me to do this next job.

The fact that Dr. Reves took a chance on me, hired me and gave me the support and the resources and said, ‘Here’s what I want done. Do it however you want to do but get it done.’ It forced me to learn a lot, to expand my boundaries. It forced me to be a leader that I wasn’t before, to really get outside my comfort zone that I had not had an opportunity to do before. There is not a question that the eight years I spent as education dean were incredibly helpful.

It was all because of my being at MUSC.”

12 The CaTalysT, May 29, 2015

Small ‘green’ steps can add up Sustainable living was already and beyond.” part of Kiki Cooper’s personal Employee Wellness philosophy when she entered q May Monthly Mindful the April Mindful Challenge Challenge — Take a wellness Eat Sustainably. Healthy bodies. break outdoors: walk around Healthy planet! “I want to campus, find meditation challenge myself to be more spots, etc. To begin, take the purposeful in my lifestyle,” she challenge’s first survey at said. http://tinyurl.com/kahlnro.

This married mother of four A link to the final survey believes that each of us have a role will be sent at month’s end to play and that “it all adds up.” to those who take the first Her family was already moving survey.

Susan Johnson in the right direction by buying q Fit Family Challenge — locally and seasonally, composting, MUSC is partnering with Coca–Cola, recycling, taking reusable bags to Lowcountry Parent magazine, the S.C. the grocery store as well as starting Hospital Association and CVS for an a container garden at home to grow 8-week program in which residents are vegetables and herbs. After committing challenged to get out and get active to the challenge, Cooper took inventory until June 29. As partners, MUSC is of the family’s current practices to see providing resources to support families what else they could do. She found an across the state to create healthier easy change was making sure that her lifestyles. Participants can find support kids took “filtered water in a reusable via blogs, expert advice, wellness tips container instead of just buying bottled and informtion on activities at www. water and throwing that into their musc.edu/ffc. Help MUSC become lunch.” Other small improvements that the most active hospital in the state. have a massive effect include bringing For information, visit http://www. reusable cups to work: Americans use 25 myfitfamilychallenge.com. billion paper cups each year. That adds q Chair massages — Free massages up to 363 million pounds of waste and are offered to employees midday on the loss of more than nine million trees.

Wednesdays. Check Broadcast Messages As the director of Special Events for for locations and times.

Hollings Cancer Center, Cooper leads q Farmers Markets — Fresh fruits and by example in her role at MUSC as vegetables are available from local well, opting to serve healthy meals and farmers on Fridays from 7 a.m. to 3:30 beverages when planning an event. “If p.m. at the Horseshoe. each person on this planet would make one change it could make a serious MUSC Wellness Center global impact. I have to realize that it’s q Adventure Out — A year-long not just for me that this could make outdoor fitness campaign to encourage a difference, but my children, their residents to visit city parks for exercise. children and all those in my community Free fitness classes with the purchase of an Adventure Out T–shirt or tank ($10/$15) for the entire year. T–shirts purchased from previous years are valid.

Classes are designed for all ages and fitness levels. For information, visit www. musc.edu/adventureout.

Health at work

MUSC Urban Farm

Kiki Cooper, center, and family.

q Midday Work and Learn — 12:15 to 12:45 p.m., Tuesdays q Early Bird Maintenance — 7:30 to 8:30 a.m., Wednesdays q Sunset Work and Learn — 4 to 5 p.m., Thursday q Third Saturday Family-friendly Work IP02-1319562