LESSONS LEARNED

MY METAMORPHOSIS FROM

“PERSON”By Dennis R. Laffer, MD, FACG, Tampa, FL to “PATIENT”

Top: Dr. Laffer with his wife and children. Right: Dr. Laffer. Photos courtesy of Dr. Laffer. It all began with a persistent cough from an upper respiratory infection. After this went on for several weeks, my wife suggested that I see a physician. I hate going to doctors. At the time, I had been a a solo GI practitioner for approximately 20 years, so I paid a visit to an internist on my floor. I simply wanted him to listen to my lungs for any sign of pneumonia. The chest was clear, but a complete blood count demonstrated a microcytic anemia; a subsequent ferritin was 23 ng. My medical history was unremarkable with the exception of well-controlled irritable bowel syndrome. There were not any alarm symptoms. A Hemoccult was negative. The clinician region of my brain concluded that I had colon cancer. I was 53 years old, a husband, father of 15- and 13-year-old daughters, and a physician. The clinical plan was obvious: colonoscopy followed by surgery.

Now I was faced with a major dilemma: did I tell my spouse of 18 years that I knew I had a malignancy? I decided to wait until the completion of the endoscopy, so en route to the hospital I simply said I hoped that they would not find anything that required surgery. After all my years as a physician, this was my first real experience on the other side of the proverbial bed.

My transition from individual to patient to object began slowly but quickly accelerated as my individuality was lost in the progression of paperwork, finger printing, photograph, and name band with date of birth, allergies, and medical record number. The colonoscopy demonstrated nine tubular and tubulovillous adenomas of varying sizes distributed along the length of the colon. However, a two-cm, moderately differentiated adenocarcinoma was also detected.

When the effect of the sedation resolved, I was informed of the findings but was not surprised or overly alarmed. I anticipated imaging followed by laparoscopic surgery and a six-week recovery time. However, a preoperative CT scan, confirmed by a PET exam, demonstrated a fourcm left hepatic lobe metastasis. Stage IV disease—not an uplifting finding.

At this point, the game changed dramatically. I realized that the situation had become more serious and complicated, but I never doubted my survival. Surgery was going to be more extensive, followed by six months of chemotherapy.

The hardest thing to face at that time was telling my daughters of the results in a manner that allayed any fears. I also wondered whether I was going to return to my practice—my alter ego—following surgery, and during and after chemotherapy. As it turned out, I did not return. A permanent peripheral motor-sensory neuropathy from oxaliplatin forced my involuntary retirement. The years of building up a practice from the ground up seemingly vanished overnight. My professional identity was

lost. The landscape of those affected by my disease grew larger and compelled my office “family” to seek employment elsewhere. This last change was for me a profound example of how an illness reverberates and impacts those connected with the patient.

I decided to have the surgery performed at a nearby cancer center with very experienced colorectal and liver surgeons. Again, I went through the same impersonal admission process and headed off to the operating suite on September 1, 2004, where a colonic resection and left hemihepatectomy were performed. When I awoke, I had IV and arterial lines and tubing galore, accompanied by incisional pain. An anesthesiologist advised me preoperatively to have an intra-epidural catheter placed for administration of fentanyl, claiming this provided better pain control, decreased ileus, and promoted earlier mobilization. It wasn’t true. The anticipated hospital stay was five to seven days, but lasted much longer. The nasogastric tube was discontinued on day one, followed a few days later by removal of suture line staples. When asked, the surgeon told me that this resulted in a better cosmetic effect.

One night, at approximately 0400 hours, a nurse came to change the PCA pump’s fentanyl bag. After she left the room, I pushed the button for a dose and lost consciousness. When I woke up in the intensive care unit, I was intubated on a ventilator with an internal jugular catheter in place. An unremarkable head CT had been obtained en route to the ICU. Somehow, a respiratory arrest occurred secondary to narcotic overdose, complicated by aspiration pneumonia. Coughing induced a one-cm dehiscence of the wound, prompting a surgical resident to open half of the incision due to the possibility of an infection. There wasn’t. When the time came to be transferred back to a regular room, the ICU nurse began removal of the internal jugular catheter. Without warning, he rapidly began lowering the head of the bed causing marked abdominal pain. I asked him to stop, but he ignored my complaint.

Ice chips, drinking and eating precipitated severe oral pain. I was diagnosed with oral candidiasis and placed on intravenous Diflucan. A week and a half passed without improvement. I finally looked in a mirror "I realized during my metamorphosis from husband, father, friend, physician and employer of four long-term and dedicated office staff, into a patient, that my humanity was lost. I felt objectivized and regarded principally as a 'Stage IV colon cancer' in a hospital bed–a diagnosis on a list of rounds to make. "

and recognized the hallmarks of a viral infection and requested an infectious disease (ID) consult, which confirmed my impression; parenteral acyclovir was prescribed. When the ID professor and his entourage came to the room for a several-minute visit, he asked how I was feeling. When I told him there hadn’t been any improvement, he turned around and started to walk out. I said to him, “Don’t you want to look?” He gave a cursory glance and was on his way. The stomatitis resulted in an inability to consume food or fluid for three weeks, precipitating significant weight loss. Eventually, an allergist friend visited and noted that the maintenance dose of acyclovir was being administered rather than the therapeutic amount.

When the liver surgeon made rounds for the colorectal surgeon, he would stop at the doorway, make a joke to my family and me, and leave. Two neurology fellows came to my room, stood at a distance, and declared that I needed an MRI of my brain to exclude a CVA or brain metastases. I advised them that my respiratory arrest was the consequence of a fentanyl overdose and that I did not require an MRI, nor could I lie flat for the examination due to the degree of pain. It was noteworthy, to me, that neither of these physicians in training performed a neurological examination. To complete the saga of my hospitalization, I need to mention that the nasogastric tube was reinserted around day eight, and during its placement, every fascial suture “popped,” one after the other, resulting in evisceration, a second surgery, and a significantly longer hospital stay. The repair produced a large symptomatic ventral hernia, which necessitated a third abdominal operation following completion of a six-month course of chemotherapy.

I’m describing my experiences for a variety of reasons. I realized during my metamorphosis from husband, father, friend, physician and employer of four long-term and dedicated office staff, into a patient, that my humanity was lost. I felt objectivized and regarded principally as a “Stage IV colon cancer” in a hospital bed—a diagnosis on a list of rounds to make.

It is critically important for health care providers to recognize that we are not treating an ICD-10 code in a gown but rather, first and foremost, a person who happens to have a medical malady; an individual with a host of people attached to him or her. My experience as a patient helped me appreciate the great deal of stress that hospitalizations and illnesses create for the patient and their family. From my time in the hospital, I saw how limited or absent engagement by the physician and staff with the patient and the family, as people with lives outside of a health care facility, significantly interferes with communication, proper delivery of care, and fosters a disconnected and unfeeling environment.

Failure to actively interact with the person, increasingly without the laying on of hands, compounds this sense of estrangement. In this age of escalating reliance upon electronic medical records and technology, when time is at a premium and reimbursements are falling, there is a danger that the art of medicine will degrade or be lost.

I try to teach residents under my charge to always remember that they are dealing with a human being and a family who have entrusted them with their medical care and lives. This is a unique and awesome responsibility that must not be taken lightly. As physicians, we have a duty owed to those we are given the privilege to serve.

William Osler once said: “The good physician treats the disease; the great physician treats the patient (the person) who has the disease.”

Resolved BEATto

COLON By Brian C. Davis CANCER

He couldn’t keep down any food. His stomach didn’t feel normal. He kept shedding weight. “My clothes were fitting like grocery bags,” he says. His primary care physician told him it was constipation. It was not constipation. He was certain.

Now seven months after his diagnosis, he momentarily laments that he was not more aggressive in pinpointing the problem once his clothes began to sag. Almost immediately he relents, giving himself a warranted break. "But who actually knew” about his diagnosis, he rhetorically asks. As he engages in the first of a series of interviews with ACG MAGAZINE, he is two days away from starting his 15th round of chemo treatment. He is fully aware of the formidable challenge ahead. Lawrence Meadows, 39, husband to Angela and father to Addie, eight, and Lawson, four, is battling Stage IV colon cancer.

ARRIVING AT A DIAGNOSIS

It was August 2016 when Meadows first visited his physician in response to his symptoms. The physician advised that Meadows take constipation medication. He continued to experience the symptoms and knew he was confronting something more significant.

“I kept going back until he finally referred me to a specialist,” says Meadows, who saw the physician four times before he was referred to a colorectal surgeon locally in Spartanburg, SC, where he lives and serves as a Baptist Pastor and funeral home co-owner.

Unearthing the issue had been a slow process, but it accelerated the moment Meadows saw the surgeon. Two days after undergoing a CT scan, on October 13, 2016, the surgeon told Meadows there was a baseball-sized mass on his abdomen that he believed to be cancerous, and that they should schedule surgery immediately.

“Numb.” That’s how Meadows felt when he heard the news. But, true to his nature, he grew optimistic.

“I’m thinking…‘Alright, once he removes [the mass], we’re home free,’” Meadows says.

The surgeon performed the surgery two days later, removing the mass and 16 inches of the colon.

The news following surgery didn’t match Meadows’ optimism. While in the recovery room, the surgeon told him he could see that the cancer had metastasized to the abdominal linings of his stomach, and that there were small spots on his hip bone and upper chest cavity.

“Of all the people who could get a diagnosis like this, I was flat out stunned it was him,” says Craig Melvin, Meadows’ brother, during the May 2017 interview.

Throughout his life, Meadows has generally made sound health choices, which made the diagnosis more confounding.

Photos on pages 22-29 courtesy of Lawrence Meadows and Craig Melvin. Pages 22-23, front left to right, Ryan Melvin, Craig Melvin, Lawrence Meadows; Lawrence Meadows, Craig Melvin. Photo top, left to right, Lawson Meadows, Angela Meadows, Lawrence Meadows, Addie Meadows. Photo at right, left to right, Addie Meadows, Lawrence Meadows, Lawrence Melvin, Craig Melvin, Ryan Melvin, and Jasmine Melvin. Pages 26-27, top to bottom, left to right, Craig Melvin, Lawrence Meadows, Addie Meadows; Craig Melvin following his colonoscopy; Angela Meadows, Addie Meadows, Lawrence Meadows, Lawson Meadows. Pages 28-29, Addie Meadows, Angela Meadows, Lawrence Meadows, Lawson Meadows.

WATCH THE VIDEO War on Cancer: Craig Melvin shares his brother’s colon cancer battle, TODAY: bit.ly/TODAYFeb17

“No cigarettes. No alcohol. I've never seen him drink a whole beer or a glass of wine,” says Melvin, who is Co-Anchor, NBC News’ “Weekend TODAY,” National Correspondent, “TODAY,” and MSNBC Anchor.

The surgeon counseled that the next steps were to allow the body to heal and then to see an oncologist to determine the plan of action, since this was Stage IV colon cancer.

Not knowing much about cancer, Meadows asked how many stages there are in cancer.

“'Oh, this is the final stage,’” the surgeon replied.

FAITH AND FAMILY

You might not guess Meadows is fighting colon cancer if you turn down the volume and only watch his facial expressions during the story on NBC’s “TODAY,” in which he shares his cancer story, his brother posing the questions to him. You see Meadows confidently speaking from the front of his church, inducing head-nods from parishioners. You see him grinning as he quips

about the irony of receiving this diagnosis despite his healthy lifestyle. He is comfortable making jokes while recounting his diagnosis, as Melvin points out in the story.

In his interviews with ACG MAGAZINE, he is the same way—his wit and charm emanate. When asked how his diagnosis affects his work, he explains that his funeral home work came to a necessary halt because of the link between formaldehyde—used for embalming—and cancer.

“I'm just not rushing over to the office,” Meadows jokes. “I don't want to add insult to injury.”

Accompanying his humor are his optimism and drive, which are readily apparent. His maternal grandparents raised him on a 90-area farm in Moore, SC. He started working on the farm as soon as he was able to carry a bucket of water to water the plants and gardens.

“My grandparents just worked us like there was no tomorrow,” says Meadows, who credits them for instilling in him a work ethic that he has carried through his education—including walking on to the football team at Wofford College—and into his career.

The importance of faith was also ingrained in him by his grandparents.

“They just insisted that there's nothing too hard that God can't handle, whether it be sickness, suffering or whatever the issue,” Meadows says.

All these years later, Meadows, who is Senior Pastor and Teacher at the New Bethel Baptist Church and co-owner of The First Family Funeral Home, maintains that conviction and believes that he must be strong for his family and his church community.

“I can't pastor people, encouraging them and sharing with them to be able to lean and depend upon their faith in God, and then I'm a reed shaken in the wind when I have some issue come my way,” Meadows says. “I can't pastor people, encouraging them and sharing with them to be able to lean and depend upon their faith in God, and then I'm a reed shaken in the wind when I have some issue come my way.”

FINDING A HOME FOR TREATMENT

Following his surgery, Meadows heeded the surgeon’s advice and saw an oncologist, who recommended that Meadows be kept comfortable and that he get ready for palliative care.

“That wasn't the diagnosis and the prognosis that I wanted to hear,” Meadows says.

Seeking a second opinion, he did some research and saw a reference to The University of Texas MD Anderson Cancer Center (MD Anderson) as “the best adult cancer facility in the country.” It is there—under the direction of Associate Professor Scott Kopetz, MD, PhD—that Meadows has been receiving care ever since, traveling the nearly 1,000 miles from Spartanburg to Houston. Every other Wednesday, Meadows flies to Houston and begins treatment the following day. He consults with Kopetz and is administered a three-hour chemo treatment. Next, he leaves the hospital with a chemo pump and retreats to the home of a mutual friend with whom he has taught at the National Baptist Student Union Retreat. After 46 hours, he returns to the hospital, is disconnected from the pump, and flies back home on Saturday night.

The traveling has been challenging for the family, particularly Meadows’ children. During his first interview with ACG MAGAZINE, he says he will be missing his daughter Addie’s dance recital that upcoming weekend. His son, Lawson, expects him to be there when he gets ready for bed each night.

“[He] just insists that every night my responsibility is to tuck him in bed and say prayers,” Meadows says. “When I'm out of town, I'm derelict in those duties.”

His mom, brothers, aunts and uncles, and Angela’s family form the backbone of a strong support system, making sacrifices to help out when he travels to MD Anderson.

The treatment in Houston has yielded “aboveaverage results,” as the cancer on his liver and hip no longer exist, Meadows says during the first interview, relaying the latest news from Kopetz.

Meadows appreciates that Kopetz is “straight up” in explaining his prognosis. Channeling Kopetz, he describes:

“He says, 'Lawrence, there is no quote unquote cure... but it's kind of like mowing your grass. The more you mow it, the more you mow it, and the lower you get it, the lower you get it, 'till eventually it just of course, you know, dies.' So we're in the process of just mowing the grass.”

KNOWING—AND SHARING—ONE’S FAMILY HISTORY

In his funeral home work, Meadows has witnessed sons and daughters and nephews and nieces first learning about a family member’s chronic health condition when they read the cause of death on their death certificate.

“They, of course, would be just flabbergasted,” says Meadows, who then roleplays how the ensuing conversations would go: “‘Oh gosh, we had no idea Mom, or Dad, or Auntie or Uncle had those issues.’”

This became somewhat of an irony for Meadows. While he was in the hospital, Meadows discovered that both of his paternal grandparents had colon cancer.

“I found out more about the [family] cancer trail while I was in the hospital recuperating,” Meadows says. “When you have family reunions and birthday parties,” he says, “You just don't sit around and talk about it.”

Meadows seems determined to change that. He’s told his family and his church community to ensure they have a primary care physician, be informed about their family cancer history and, if there is a family cancer history, to share that information with their physician.

“Cancer is a silent killer,” Meadows says.

SPREADING THE WORD

Meadows is not going to be mum about colon cancer and the important lifesaving messages he can share. "I definitely want to keep everyone informed,” says Meadows, describing why he chose to share his story. “I want as many people to get screened as possible.”

In Melvin, Meadows had the right partner to help tell his story. Melvin was a little nervous, he says, and found the story was harder to tell because it was about his brother.

“I spend a fair amount of my time telling stories that are pegged to the ‘news of the day,’” but this story was not, Melvin says. “This was one that hit pretty close to home.”

The TODAY story was the first of several opportunities Meadows and Melvin have publicly taken to share colon cancer awareness messages, including speaking at an MD Anderson patient advocacy meeting and the Colon Cancer Alliance’s annual Blue Hope Bash, which Melvin emceed. Melvin has imparted messages on his Twitter account, including that his colonoscopy revealed he had no polyps.

“Peace of mind is a powerful thing. And the fact that I’ve got some peace of mind for awhile now, yeah, it’s a good thing,” Melvin says during an interview.

In addition to family history, Meadows focuses on paying attention to one’s body and potential symptoms—whether it’s weight, diet or simply feeling different— and visiting both primary care physicians and specialists, if possible.

In a December 2017 interview, Kopetz recommends that those younger than

“Peace of mind is a powerful thing. And the fact that I’ve got some peace of mind for awhile now, yeah, it’s a good thing.”

—Craig Melvin, on his colonoscopy revealing no polyps. recommended screening ages be “aggressive” if they experience symptoms such as changes in bowel habits and blood in the stool. He encourages patients wanting to be proactive to “make sure that their concerns are being heard, and that they're getting appropriate evaluations for recurrent symptoms.”

Meadows feels that recommended screening ages need to be reviewed, particularly given the early-onset indicators in the African American community.

“My case being case in point,” he says.

As it relates to screening ages, Kopetz believes in unifying behind

the recommendation that African Americans be screened at age 45. He says that while there is a “long-standing recognition” of earlier onset in the African American community, all guidelines do not unanimously recommend African Americans be screened at age 45. ACG’s colorectal cancer screening guidelines have included this recommendation since 2005.

“Because it's not universal in its recommendation in the guidelines, I think it's not as well practiced in the community,” Kopetz says.

LIFTING UP OTHERS IN #EVICTINGCANCER

ACG MAGAZINE interviewed Meadows again in September 2017, a few days after he completed his 22nd chemo treatment. About two weeks prior, a surgeon had performed laparoscopic surgery to remove tissue from his abdomen, which was to be used to create a personalized immunotherapy vaccine that would then be re-inserted into Meadows leg, which Kopetz says will probably happen in 2018.

The purpose is to “re-educate the immune system to attack the cancer cells,” Kopetz says.

As Meadows fights his battle, his approach ignites others. Following the TODAY story’s airing, Melvin continually heard from viewers who were moved to action, being screened themselves and prompting others to be screened.

“That's precisely what we both wanted,” says Melvin, who attributes the story’s resonance to Meadows’ honesty and the access he provided—to the treatment, to Kopetz, and to his wife, Angela.

“I am using your brother’s words because I love it! I am working on #evictingcancer,” one person tweets to Melvin, referencing Meadows saying that his sole goal is “evicting cancer” from his body.

In another tweet, a woman expresses thanks for the story, saying it makes her husband “see how serious” it is that he go in for the colonoscopy he has been delaying. Polyps were found in the colonoscopy he underwent at age 50.

Meadows’ impact is even felt at MD Anderson. The team enjoys interacting with him, appreciates his insights into the disease, and, unsurprisingly, “his willingness to roll his sleeve up and tackle any problems that come up.” His message really resonated when he spoke at the patient advocacy meeting at MD Anderson, says Kopetz, who describes Meadows’ attitude and perspective as “refreshing.”

Rest assured, Meadows will remain perpetually optimistic, unbroken and resolved to beat colon cancer.

“If we read in the New Testament over and over and over those 35 miracles that Christ performed…he is still performing miracles still today, in modern times,” Meadows says.

“[He] just insists that every night my responsibility is to tuck him in bed and say prayers,” Meadows said. “When I'm out of town, I'm derelict in those duties.”

2018 ACG AWARD Honor Your Colleague with an ACG Award Nomination NOMINATIONS 2018 ACG AWARD Honor Your Colleague with an ACG Award Nomination NOMINATIONS 2018 ACG AWARD Honor Your Colleague with an ACG Award Nomination NOMINATIONS

The ACG Awards Committee is seeking nominations from all members for the following distinguished awards. The ACG Awards Committee is seeking nominations from all members for the following distinguished awards. The ACG Awards Committee is seeking nominations from all members for the following distinguished awards.

Berk/Fise Clinical Achievement Award The intent of the Berk/Fise Clinical Achievement Award is Berk/Fise Clinical Achievement Award Master of the American College of Gastroenterology Masters of the American College of Gastroenterology shall Master of the American College of Gastroenterology to recognize an individual who has provided distinguished The intent of the Berk/Fise Clinical Achievement Award is Berk/Fise Clinical Achievement Award have been Fellows who, because of their recognized stature and Masters of the American College of Gastroenterology shall Master of the American College of Gastroenterology contributions to clinical gastroenterology, which could include: to recognize an individual who has provided distinguished The intent of the Berk/Fise Clinical Achievement Award is achievement in clinical gastroenterology and because of their have been Fellows who, because of their recognized stature and Masters of the American College of Gastroenterology shall (a) clinical medicine, (b) technology application, (c) health care contributions to clinical gastroenterology, which could include: to recognize an individual who has provided distinguished contribution to the College in service, leadership, and education, achievement in clinical gastroenterology and because of their have been Fellows who, because of their recognized stature and delivery, and (d) related factors such as humanism and ethical (a) clinical medicine, (b) technology application, (c) health care contributions to clinical gastroenterology, which could include: have been recommended for designation as Masters. contribution to the College in service, leadership, and education, achievement in clinical gastroenterology and because of their concern. It is not intended that this award be given in honor of one’s laboratory research accomplishments. Community Service Award The Community Service Award is bestowed upon an ACG delivery, and (d) related factors such as humanism and ethical concern. It is not intended that this award be given in honor of one’s laboratory research accomplishments. Community Service Award (a) clinical medicine, (b) technology application, (c) health care delivery, and (d) related factors such as humanism and ethical concern. It is not intended that this award be given in honor of one’s laboratory research accomplishments. Minority Digestive Health Care Award The ACG Minority Digestive Health Care Award is an achievement award that will recognize an ACG Member or Fellow whose work in the areas of clinical investigation or clinical have been recommended for designation as Masters. Minority Digestive Health Care Award The ACG Minority Digestive Health Care Award is an achievement award that will recognize an ACG Member or contribution to the College in service, leadership, and education, have been recommended for designation as Masters. Minority Digestive Health Care Award The ACG Minority Digestive Health Care Award is an Member who has initiated or has been involved in numerous The Community Service Award is bestowed upon an ACG Community Service Award practice has improved the digestive health of minorities or other Fellow whose work in the areas of clinical investigation or clinical achievement award that will recognize an ACG Member or volunteer programs/activities or has provided significant Member who has initiated or has been involved in numerous The Community Service Award is bestowed upon an ACG underserved populations of the United States. These efforts can practice has improved the digestive health of minorities or other Fellow whose work in the areas of clinical investigation or clinical volunteer service post-training. The service must have been volunteer programs/activities or has provided significant Member who has initiated or has been involved in numerous be shown by community outreach activities through clinical or underserved populations of the United States. These efforts can practice has improved the digestive health of minorities or other performed on a completely voluntary basis and not for the volunteer service post-training. The service must have been volunteer programs/activities or has provided significant educational programs, or research in an area of digestive disease be shown by community outreach activities through clinical or underserved populations of the United States. These efforts can completion of training or position requirements. performed on a completely voluntary basis and not for the volunteer service post-training. The service must have been that negatively impacts minority populations such as colorectal educational programs, or research in an area of digestive disease be shown by community outreach activities through clinical or International Leadership Award The International Leadership Award is given to a Fellow or Master of the ACG in recognition of outstanding and completion of training or position requirements. International Leadership Award The International Leadership Award is given to a Fellow performed on a completely voluntary basis and not for the completion of training or position requirements. International Leadership Award cancer, hepatitis B and C, cirrhosis and other GI cancers. Samuel S. Weiss Award The Samuel S. Weiss Award is granted in recognition that negatively impacts minority populations such as colorectal cancer, hepatitis B and C, cirrhosis and other GI cancers. Samuel S. Weiss Award educational programs, or research in an area of digestive disease that negatively impacts minority populations such as colorectal cancer, hepatitis B and C, cirrhosis and other GI cancers. substantial contributions to gastroenterology, to the College, or Master of the ACG in recognition of outstanding and The International Leadership Award is given to a Fellow of outstanding service to the American College of The Samuel S. Weiss Award is granted in recognition Samuel S. Weiss Award and to the international gastroenterology community. substantial contributions to gastroenterology, to the College, or Master of the ACG in recognition of outstanding and Gastroenterology over the course of an individual’s career. of outstanding service to the American College of The Samuel S. Weiss Award is granted in recognition and to the international gastroenterology community. substantial contributions to gastroenterology, to the College, Gastroenterology over the course of an individual’s career. of outstanding service to the American College of and to the international gastroenterology community. Gastroenterology over the course of an individual’s career. deadline for all nominations: April 16, 2018 deadline for all nominations: April 16, 2018 Nominations should be sent to:Nominations for all awards must:deadline for all nominations: April 16, 2018 • Be accompanied by two letters of recommendation Nominations for all awards must: William D. Carey, MD, MACG Nominations should be sent to: • Include the nominee’s CV• Be accompanied by two letters of recommendation Nominations for all awards must: Chair, ACG Awards Committee William D. Carey, MD, MACG Nominations should be sent to: • • • Conform to the specific requirements listed Include the nominee’s CV Be accompanied by two letters of recommendation 6400 Goldsboro Road, Suite 200 • Bethesda, MD 20817-5842 Chair, ACG Awards Committee William D. Carey, MD, MACG • • • Be unsolicited by the nominee Conform to the specific requirements listed Include the nominee’s CV Email: awards@gi.org 6400 Goldsboro Road, Suite 200 • Bethesda, MD 20817-5842 Chair, ACG Awards Committee • • Be unsolicited by the nominee Conform to the specific requirements listed Email: awards@gi.org 6400 Goldsboro Road, Suite 200 • Bethesda, MD 20817-5842 • visit www.gi.org/awardees-and-special-lecturers for nomination requirements. visit www.gi.org/awardees-and-special-lecturers for nomination requirements. Email: awards@gi.orgBe unsolicited by the nominee visit www.gi.org/awardees-and-special-lecturers for nomination requirements.