Emory Medicine Magazine - Fall 2022

W H AT ’ S I N S I D E

TACTICAL PHYSICIAN 24 PA PROGRAM IS 50

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3D PRINTING OF (BODY) PARTS

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Medicine FALL 2022

RECLAIMING YOUR PATH FORWARD PAGE

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RE THE POWER OF

“It’s like watering a plant . . . you can’t water it all the time, or it will be just as bad as no water at all.

Take time to recover in between, whether passive recovery like unplugging or active recovery like meditation, yoga, or swimming.”

“You can start small, and it might still feel scary, but fearing other humans is an unnatural state. We need to relearn how to overcome our fears and reach out in ways that bring us joy and reconnection.”

“As you recharge and get stronger, you can go a bit further.”

“It’s almost as if we’ve been rebirthed, like a forest after a fire.

How do you want to rebuild?”

“This was a time to reestablish boundaries, reevaluate our lives, and redefine our goals.”

“Re-engagement reinvigorates people.

It gives you a boost of energy, which leads to motivation and restarting a routine that gets you on a path of wellness.”

“People’s comfort levels are not one-size-fits-all. Everyone is at a different starting point and that is OK and needs to be respected.”

SEE PAGE

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FROM THE DEAN

Reconnecting. Reclaiming.

Reengaging.

A lot of us have been grappling with these concepts as we move into a new world: one where COVID-19 and its Vikas P. Sukhatme, md, scd variants are likely to be with us Dean, Emory School of Medicine for awhile, even as other health Chief Academic Officer, Emory Healthcare threats are emerging. Medical research, clinical care, and public health efforts are more critical than ever.

I am proud that Emory Medicine and its partners are actively engaged in so many areas: studying long COVID, developing vaccines, leading clinical trials, inventing and repurposing drugs and other therapeutics, and reexamining medicine at every level to make it more inclusive.

The following pages are full of “The Power of Re.” Reimagining, renewing, recalibrating.

You’ll see what Emory physicians recommend as the best ways to reclaim our resilience and find a personal path to wellness (p. 18). Why an Emory emergency physician recalibrated to also become a SWAT team member (p. 24). How physician assistants are reshaping the landscape of health care (p. 30). And how anatomical structures like heart tissue, joints, and tracheas are being produced by 3D printing (p. 36).

Also, we are revising our medical school curriculum for the first time since 2007. Our educational programs are highly ranked and widely known for producing outstanding clinicians and scientists. Now, we must ensure our curriculum is keeping up with addressing the complex health challenges we face. School of Medicine graduates will continue to be excellent clinicians and scientists, but in today’s environment they must also be able to lead change across health systems and communities.

“It’s part of an overall strategic effort to improve our ability to change the world,” says J. William Eley, executive associate dean for medical education and student affairs. To learn more or to contribute input, email TransformMedEd@emory.edu.

My motivating “re” word, by the way, is repurpose. What is yours?

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Emory Medicine Editor Mary Loftus Art Director Peta Westmaas Director of Photography Jack Kearse Contributors Jim Auchmutey, Eric Butterman, Michelle Hiskey, Tiffany Judkins, Rosemary Pitrone, Sylvia Wrobel Editorial intern Deanna Altomara Production Manager Stuart Turner Copy Editor Susan Carini Advertising Manager Jarrett Epps Web Specialists Lindsay Paroczai, Stuart Turner Associate VP, Health Sciences Communications Nikki Troxclair Director of Communications, Emory School of Medicine Jen King Executive Director of Content Jennifer Checkner

Emory Medicine is published twice a year for School of Medicine alumni, faculty, and staff; patients; donors; and other friends. © 2022 Emory University.

Emory University is an equal opportunity/equal access/affirmative action employer fully committed to achieving a diverse workforce and complies with all applicable federal and Georgia state laws, regulations, and executive orders regarding nondiscrimination and affirmative action in its programs and activities. Emory University does not discriminate on the basis of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, or veteran’s status.

Inquiries should be directed to the Office of Diversity, Equity, and Inclusion, 201 Dowman Drive, Administration Bldg., Atlanta, GA 30322. Telephone: 404.727.9867 (V) | 404.712.2049 (TDD).

COVER UP

ARTificial Intelligence The most recent cover of Emory Magazine was designed by an anesthesiology student at the School of Medicine.

Sharon Lee 23M used an artificial intelligence (AI) app to design the cover for the Spring/ Summer 2022 issue of the university alumni magazine, which highlights Emory’s commitment to AI, especially in terms of ensuring that it exemplifies our highest values rather than amplifying humanity’s worst flaws. “This was such a cool competition,” Lee says. “I loved using the DREAM by Wombo app to try out a new form of artistic inspiration.”

22-SOM-DEAN-0006

The Power of Re

Emory Brain Health Center and Georgia Public Broadcasting continue their partnership on the Emmy–winning news magazine Your Fantastic Mind, hosted by Jaye Watson (p. 10).

class this “ No Thursday, it’s SWAT training day.”

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PHOTO JEREMY ACKERMAN

FEATURES

Dinner with a Doctor: The Power of Re 18

Tactical physician Jeremy Ackerman, associate professor of emergency medicine

“

Emory physicians David Prologo and Sharon Bergquist talk about reconnecting, reengaging, and reclaiming resilience by finding your “path to wellness.”

PHOTO COURTESY OF JODIE GUEST

Recalibrate: The Making of a Tactical Physician 24

Jeremy Ackerman can go from scrubs to body armor in 24 hours. Ackerman, associate professor of emergency medicine, works at Grady Hospital in Atlanta. He’s also a tactical physician with a SWAT team.

Reshaping Healthcare: Physician Assistants to the Forefront 30

The Emory Physician Assistant Program, one of the oldest PA programs in the nation, is at the forefront of preparing students for an increasingly demanding and complex health care landscape.

Replacement (Body) Parts: 3D Printing of Anatomical Structures 36

Heart tissue, joints, tracheas, stents, and knees are just a few of the anatomical structures and medical devices that can now be custom-made with a 3D printer.

THE BARE BONES

Briefs 4 Atlanta top docs, US News rankings, scaling mountains after surgeries, the new COVID-19 bivalent booster, Forbes 30 under 30, update on monkeypox, You Be the Doctor, M1 scavenger hunt, promising PTSD device, Winship shared resource hub, children’s COVID-19 vaccines, Amos loan forgiveness program.

AND MORE

The Last Word 40 When cancer turned her life upside down three years ago, Sylvie Leotin, founder of Equity Health, was inspired to fight for health equity and improved cancer care.

Alumni Profiles 42 Byron Crowe 17M is co-founder of Healthcare by Design. Mark Fenig 10MR is executive director of the New York City– based Medical Justice Alliance.

What’s Up, Doc? Class Notes 44 Visit us online at emorymedicinemagazine.emory.edu for bonus content. Send letters to the editor to mloftus@emory.edu.

Today’s PA students care for patients of all ages, with all types of needs, in all organ systems, and in all types of clinical settings.”

—Ted Johnson, family and preventive medicine

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‘Best in Their Field’: Our Top Docs

PHOTO NATALIE MONTANER

Yet again, Emory physicians have made a stellar showing in Atlanta magazine’s 2022 “Top Doctors” issue. This year, 463 physicians representing Emory Healthcare, Emory Healthcare Network, Emory medical staff, or faculty of Emory School of Medicine made the list—an impressive 42% of the 1,097 top doctors selected.

“We are proud of our physicians, who demonstrate compassionate care and deliver transformative medicine across a wide range of specialties at Emory,” says Jon Lewin, then-executive vice president for health affairs and CEO of Emory Healthcare. “Congratulations to those who were nominated by their physician peers as a leader in their area of expertise.”

To compile this year’s list of “Top Doctors,” Professional Research Services firm conducted an online peer-reviewed survey of all licensed physicians in the metro-Atlanta area.

Physicians were asked to nominate fellow physicians they deemed to be the best in their areas of practice. More than 10,000 votes were cast honoring excellence in all fields of medicine.

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Emergency medicine resident and adjunct assistant professor of environmental health Jamaji Nwanaji-Enwerem was invited to join the White House Office of Public Engagement’s Clinical Innovators Roundtable Series, an ongoing forum for national leaders to discuss health policy and clinical practice innovations. Much of his work leverages molecular health biomarkers to improve our understanding of how chemical toxins and environmental exposures impact human aging and health—particularly for the underserved.

SHINE ON Report’s “America’s Best Graduate Schools” guide.

“As a global leader in research and academic excellence, we are committed to producing and empowering the next generation of thinkers and doers,” says Provost and Executive Vice President for Academic Affairs Ravi Bellamkonda. “Our renowned and dedicated faculty foster an environment where students can think critically about the world around them, and the complex issues we face as a society, to discover how they can make a positive impact in our world.”

Emory School of Medicine ranks 22nd nationally among research-oriented medical schools. The Coulter Department of Biomedical Engineering PhD program, a joint effort among Emory School of Medicine, Emory’s Laney Graduate School, and Georgia Tech, ranks 2nd. In medical specialty rankings, Emory’s anesthesiology program ranks 16th; internal medicine, 17th; obstetrics and gynecology, 19th; pediatrics, 14th; radiology, 14th; and surgery, 12th. And the family medicine program, newly ranked this year, is 18th. n

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PHOTO KAY HINTON

Emory’s medical school, departments, and programs continue to be ranked among the best in the nation, according to the 2023 edition of U.S. News & World

SCALING MOUNTAINS

HOW NEUROMODULATION HELPED CRYSTAL WELCOME GET TO THE TOP OF MT. WHITNEY

From the top of Mount Whitney, the highest peak in the

down and considered what it took for her to get there: “Here’s a reminder of all the crap I’ve been through, and here I am at the summit. I look at all these switchbacks, all these surgeries.

And here I am now.” Welcome has had more than 15 cranial surgeries, managing a rare condition called pseudotumor cerebri that causes her body to respond as if she has a brain tumor. She struggled with chronic pain and sickness until she met Emory neurosurgeon Nick Boulis, who pioneered neuromodulation for cranio-facial pain and wanted to see how Welcome would respond to a neuromodulator.

PHOTOS COURTESY OF CRYSTAL GAYLE WELCOME

continental United States, Crystal Gayle Welcome looked

STRICKEN WITH A RARE DISEASE WHERE HER BODY RESPONDS

AS IF SHE HAS A BRAIN TUMOR, INCREASING THE PRESSURE

INSIDE HER SKULL, CRYSTAL

WELCOME ENDURED MULTIPLE SURGERIES BEFORE BEING

SUCCESSFULLY TREATED BY

NEUROSURGEON NICK BOULIS (ABOVE, LEFT).

To read about the surgery that changed her life, and her inspirational climb to the summit of Mt. Whitney, scan the QR code.

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RE

THE BARE BONES

REUP/REBOOST/REPEAT

PHOTO MYBOYS.ME

THE POWER OF

To Boost Again, and When? That Is the Question

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varies quite a bit by age, with more than 92% of those older than 65 being vaccinated and a majority of that group having received at least one booster.

Now, an Omicron-specific booster has been authorized by the FDA, the first redesign of the coronavirus vaccine since it became available in late 2020. These new boosters target Omicron subvariants, and the goal is for the redesign to help elevate antibody levels in a way that restores the protection conferred by the initial vaccines against symptomatic infection in many people. These new boosters are made by both Pfizer and Moderna. Pfizer’s is available for people as young as 12, and the Moderna booster is for those 18 and older.

Jodie Guest, professor and senior vice chair of the department of epidemiology at Emory’s Rollins School of Public Health, teamed up with Carlos del Rio, distinguished professor of medicine, epidemiology, and global health and executive associate dean of Emory School of Medicine at Grady Health System, to discuss the new boosters. Their conversation is part of an online video series hosted by Guest, who leads the Emory COVID-19 Outbreak Response Team, answering questions related to the COVID-19 pandemic.

Q: What is different about these boosters?

This vaccine is called a bivalent vaccine because it has two different antigens in it. It contains the original strain, like the previous vaccines, but it also contains a BA.4/BA.5 antigen. The idea is that it will give protection also against BA.4/ BA.5, which is the most common strain circulating right now. This new booster is approved for ages 12 and older; however, if you’re between 12 and 18, you will receive Pfizer because Moderna hasn’t been approved for that population yet. If you’re over 18, it doesn’t matter—you can take either Pfizer or Moderna. The boosters we had previously are no longer available. If you have not been vaccinated yet at all, you need to get your primary series with the original vaccines— could be Pfizer, could be Moderna, could be Johnson & Johnson, could be Novavax. You can get any of those vaccines and then you can get a booster with this bivalent vaccine.

Q: Who needs to get this new bivalent booster?

Anyone over the age of 12 who has received their primary series of COVID-19 vaccine is eligible to get the new booster. A “big concern is that we don’t have a high percentage of the population boosted—in particular, people over 50, who are at high risk of severe disease and death,” says del Rio. “So we need to make an effort, clinically and in public health, to target the people that need to get boosted. When people over the age of 50 say, ‘Do I need to get boosted?’ I say, ‘Absolutely.’ For people over

PHOTO COURTESY JODIE GUEST AND DEL RIO BY KAY HINTON

Across the United States, 67% of the population has received their first series of COVID-19 vaccinations and 33% have also received a booster. This

age 65, I say even more so, ‘Absolutely.’ But for people under 50, I say, ‘Yeah, get it if you want to, but it’s not really that important for that younger age group . . . . It’s going to help you some, but it’s not going to be a slam dunk.’ ” Q: When should individuals get this new booster?

“We do have some modeling that suggests that there will be a fall wave that would peak around December 1, and so rolling out this new vaccine at this time is really meant to help control current infections and also protect against this future surge, which we should all want to do,” Guest says. Yet, both del Rio and Guest agree that if you got your last booster within the last four months, or you got infected within the last three months: wait. You don’t need to get it right away.

In fact, there is [some evidence] that getting your booster within three months after an infection blunts the impact of the booster. Del Rio says, “If you got infected with Omicron in July, in August, last month? Wait until November. Now, if someone is in their late 60s, who has never had COVID that they know of, got their last booster in March? Absolutely, go and make your appointment and get the new booster right away.”

Q: How can we be sure the new booster is safe?

They changed the antigen, not the mechanism, for this new vaccine. Clinical trials aren’t necessary when you’re just making changes in the antigen.

Q: Are we going to need new boosters routinely?

“We should stop calling them boosters, because this is not really a booster, it’s a different vaccine.

We don’t tell people that you’re going to get your flu booster, right? Every year we say ‘You’re going to get your flu vaccine.’ We need to get away from this terminology of boosters and say, ‘You’re getting your COVID vaccination.’ It may not be annual; it may be biannual. But getting away from the concept of a booster and into the concept of a regular vaccination, just like we do with the flu, I think that’s a good way to think about this going forward,” says del Rio. Q: If someone hasn’t gotten any of their initial series of vaccinations, can they start with this new bivalent vaccine?

They need to have the original vaccines. “They

need to go to A before they go to B. This is following your ABCs. We have the data that priming your immune system with the original vaccine is important,” says del Rio. “It’s not too late to start them,” says Guest. “We know that there’s a wide variability in uptake, particularly by ages, and there has not been a large uptake in our youngest children who are available to get these vaccines, even as school has started.”

Q: People ask, “Should I be mixing and matching?”

For example, if your original series was Moderna, should your booster be Pfizer?

“I tell people to get whatever is there and whatever is available,” says del Rio. “There’s no point in purposely mixing and matching. The mixing-and-matching studies that were done show that it’s safe, there’s no contraindication.

But there’s really no additional benefits. Quite frankly, your immune system doesn’t really know the difference, and that’s why the Advisory Committee on Immunization Practices in their most recent recommendation did not say the names, they said, ‘We’re approving mRNA bivalent boosters.’ ” The only real difference will be if you’re between the ages of 12 and 18, and “that’s when you’re going to be getting Pfizer and not Moderna,” says Guest. “But the place that you go to get your vaccine will certainly be able to help walk you through that.”

Q: Where is the new booster available?

The government has done an incredible job getting these vaccines into pharmacies. The idea is that 90% or more of Americans are going to be five miles or less from a site where you can get a vaccine. So, if you go to Vaccines.gov and enter your zip code, it’s straightforward to find vaccine availability.

To view the full Facebook Live conversation on COVID boosters, scan this QR code with your smartphone camera then click the link.

Q: Can I receive a COVID-19 vaccine or booster at the same time as my flu vaccine? Or a monkeypox vaccine?

The answer is yes. There’s no problem with combining them and it will not change the effectiveness of the vaccines. Del Rio says, “I always tell people, ‘Never miss an opportunity to vaccinate.’ The value of vaccines, whether it’s COVID vaccines or any other vaccines — it’s enormous.” n

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THE BARE BONES

Neuroscientist Makes Forbes 30 under 30 Her research is driven by three questions: 1. H ow are mature, unique neurons generated and maintained in the brain?

2. How do pathologic mechanisms disrupt molecular and cellular events during neuron generation and development?

3. Why do rare genetic diseases preponderantly affect the nervous system of children?

Her postdoctoral research addresses the molecular and cellular events disrupted in Menkes.

“I am investigating the role of mitophagy in mitochondrial retention seen in Menkes disease by using mouse and Drosophila (fruit fly) models,” she says. n

PHOTO COURTESY OF KAELA SINGLETON

Kaela Singleton, a developmental neuroscientist and postdoctoral researcher at Emory in the School of Medicine’s department of cell biology, was named a Forbes 30 under 30 recipient.

She researches the role of mitochondria in Menkes disease, a rare genetic disorder that interferes with how the body regulates copper.

Singleton aims to empower other diverse scientists as the cofounder and president-elect of Black In Neuro. She is a NINDS DSPAN scholar, a Burroughs Wellcome Fund Postdoctoral Enrichment fellow, and co-founder and president-elect of Black In Neuro.

As a postdoc in the Faundez Lab, she investigates mitochondria integrity and localization in Menkes, which causes a progressive form of childhood neurodegeneration.

“As an early-career scientist and future independent investigator, my goal is to encourage, inspire, and support trainees to pursue careers in neuroscience and build a sense of belonging within the scientific community,” Singleton says.

Emory postdoctoral researcher and neuroscientist Kaela Singleton studies Menkes disease in children.

Endowed professorship honors scientist behind key tool in fighting COVID-19

PHOTO KAY HINTON

Painter will be the first to asAn endowed distinguished prosume the endowed distinguished fessorship at Emory will honor professorship in the Department George Painter, the CEO of of Pharmacology and Chemical DRIVE (Drug Innovation Ventures Biology in the School of Medicine. at Emory) and the director of the “I’m deeply honored that my work Emory Institute for Drug Develhas inspired the creation of an opment, for his life-saving work endowed chair devoted to develin developing critical medicines oping antiviral agents to address including molnupiravir, which is unmet medical needs, especially approved globally for the treatment in underserved populations. It’s of COVID-19.

George Painter will be the first recipient of the George R. Painter III endowed distinguished professorship. encouraging this vital mission at Painter, an Emory alumnus, has Emory is getting the long-term devoted his career to developing support it deserves,” says Painter. The professorship’s donor, antiviral drugs. He holds more than 150 patents, many of who asked to remain anonymous, made a gift of $5 million which have led to approved, commercially available drugs to support the establishment of this distinguished professoror combinations of drugs for the treatment of HIV, hepatitis ship and requested that it be named for Painter to honor his B, smallpox, influenza, and coronavirus infections, and has numerous contributions to pharmacology. n published more than 120 peer-reviewed papers.

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ILLUSTRATION MARINA GRINCHUK

Monkeypox outbreak grows

YOU BE THE DOCTOR

Seeing Is Believing Monkeypox is a zoonotic virus from the Poxviridae family

PHOTOS COURTESY OF JODIE GUEST AND DAVID HOLLAND

The growing international outbreak of monkeypox virus will require careful coordination among public health officials, clinicians, and the community to control, say the authors of a new JAMA Viewpoint article. Monkeypox cases are increasing worldwide, including across the United States, which has more than 22,000 cases. The World Health Organization declared the spread of monkeypox to be a global health emergency, and the US declared it a national health emergency.

Monkeypox is an infectious disease that can cause skin lesions, swollen lymph nodes, fever, chills, muscle aches, headache, sore throat, and fatigue.

“The current outbreak illustrates the easy human-to-human transmissibility by direct, intimate contact with lesions Facebook Live that contain the virus,” writes the article’s authors, Jeannette Guarner, Emory proTo learn more, view host fessor of pathology and laboratory mediJodie Guest and David cine; Carlos del Rio, Emory distinguished Holland, associate professor professor of medicine in the division of of medicine at Emory and infectious diseases; and Preeti Malani, chief clinical officer for the professor of medicine in the division Fulton County Board of Health, of infectious diseases at the University discussing the monkeypox of Michigan. outbreak. Scan the QR code: Many of the current cases have been reported among men who have sex with men, suggesting possible transmission through sexual networks.

“While monkeypox is not a sexually transmitted infection in the typical sense, it can be easily transmitted during sexual and intimate contact,” the authors write.

Direct contact with skin lesions or materials such as clothing, bedding, or towels used by someone with monkeypox should be avoided.

The incubation period for monkeypox infection ranges from five days to three weeks, and infection typically lasts two to four weeks.

While there are no specific drugs for the treatment of monkeypox, there are antivirals that can alleviate symptoms. n

This case comes from Emory Associate Professor of Medicine and Distinguished Physician Ketino Kobaidze and Emory Assistant Professor of Medicine and Distinguished Physician Noble Maleque.

A previously healthy physician from West Africa in his early 30s was referred from an ophthalmology clinic for progressive vision loss over the previous four months. He had traveled between West Africa, Israel, and the United States during the past year. He reported not eating meat but no special dieting. He was experiencing headaches, dizziness, and a sudden decrease in bilateral vision with a significant decrease in color saturation, followed by “flashes.” The patient was admitted to a local hospital with a negative workup for neuromyelitis optica (NMO), syphilis, Lyme disease, and tuberculosis.

Steroid treatment was ineffective. Repeated ophthalmology evaluations over the next several months demonstrated decreased visual acuity.

Repeat serology for NMO was negative. Vitamin A level was within normal limits. Magnetic Resonance Imaging (MRI) of the brain and orbits revealed a new enhancement of bilateral nerve sheaths. Patient was admitted to Emory University Hospital Midtown for further evaluation, including a lumbar puncture and high-dose steroids.

He confirmed observing a vegetarian diet without any tobacco or alcohol use. His vital signs were normal, and a physical examination revealed no abnormalities. A stool specimen for ova and parasites, however, showed an intestinal protozoa (Blastocystis hominis).

Reader, what is your diagnosis?

The patient was found to have nutritional optic neuropathy, a dysfunction of the optic nerve resulting from a deficiency of specific nutrients. In this case, the patient’s multivitamin deficiency was due to poor gastrointestinal absorption from intestinal parasitic disease. Steroid treatment was stopped, and vitamin B12 and B9 (folic acid) replacement was initiated along with a course of metronidazole to treat Blastocystis hominis infection. Eight months later, the patient’s vision had improved to the point where he elected to stop taking the supplements.

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THE BARE BONES

Are You Watching ‘Your Fantastic Mind’?

(If not, you’re missing out)

“Your Fantastic Mind,” an Emmy-winning television series partnership between the Emory Brain Health Center and Georgia Public Broadcasting (GPB), is currently in production for Season 4 set to launch in Spring 2023. The news magazine–style show highlights patient stories and reports on pioneering science and clinical advances in the areas of neurology, neurosurgery, psychiatry,

rehabilitation medicine, and sleep medicine.

Season 3 wrapped this spring and explored topics including the human brain in love and grief, research helping patients regain arm function up to a decade after a stroke, and a new study showing how the brain functions of grandmothers may play an important role in our social lives and development. “ ‘Your Fantastic Mind’ harnesses the power of storytelling to describe the science of the human brain and share the profound experiences of patients, doctors, and medical professionals,” says Emory President Gregory Fenves.

The show has received seven Emmy awards from the National Academy of Television Arts & Sciences Southeast Chapter, including best TV series. Seasons 2 and 3 are nationally WATCH IT HERE: pbs. syndicated and have aired or are curorg/show/your-fantasrently airing in 200 television markets tic-mind. and 42 states across the U.S. n

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3/25/22 8:52 AM

PHOTO SUPPLIED BY M1 SCAVENGER HUNT TEAM

C R I S S C R O S S I N G CA M P U S First-year medical students, or M1s, took part in a scavenger hunt on the last day of July’s orientation. Starting and ending at the School of Medicine, the teams explored spots of interest around campus, including the new Health Sciences Research Building II (below), still under construction.

The web-based hunt sent 20 teams on unique routes to answer 38 questions. This was a first for the School of Medicine, which partnered with Stray Boots to create the two-hour hunt, followed by a pool party on the Clairmont campus.

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“One of the most incredible things that I’ve experienced at Emory is the support of grateful patients for our work in clinical and basic science research.

These remarkable people recognize the importance of academic medicine and basic science to improve outcomes for patients in the future. They know that the programs they’re donating to likely will never impact their personal health, but they still choose to give because new discoveries help others.”

– Carey Jansen 22G 24M

2036.emory.edu 12

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PTSD Treatment Receives Breakthrough Devices Designation One in 11 adults in the US will be

Bremner and Inan believed that

diagnosed with Post-Traumatic

a commercially available device—a

8 million living with the condition.

Core used to treat migraines—could

Stress Disorder (PTSD), with about

handheld stimulator called gamma-

PTSD might develop after a per-

be used to also treat PTSD by reduc-

son experiences or witnesses trau-

ing the physiological response to

matic events, and symptoms include

stress triggers.

chronic anxiety, intrusive memories,

When held to the side of the

and trouble sleeping.

neck along the vagus nerve, the

in repurposing an existing device to

function and symptoms of PTSD,”

Recent research showing success

device can “decrease sympathetic

treat PTSD, led by an Emory-Georgia

says Bremner.

Institute of Technology team, was

This helps to reduce the “fight

recently given a Food and Drug

or flight” response and other symp-

Administration (FDA) Breakthrough

toms of PTSD.

Devices Program designation.

“Research participants reported

The pilot study involved non-

invasive vagus nerve stimulation,

and was conducted by J. Douglas

significant improvement in concenILLUSTRATION CATHY GENDRON

tration,” says Bremner.

The research team monitored

Bremner, professor of psychiatry and radiation in Emory’s

study participants treated with the noninvasive vagus

and bioengineering and associate professor in the School

three months, and the study yielded meaningful results,

School of Medicine, and Omer Inan, chair of bioscience

of Electrical and Computer Engineering at Georgia Tech.

Vagus nerve stimulation already had FDA approval to

treat neurological conditions such as epilepsy and depres-

sion by regulating brain response via an implanted device.

IN THE PRESS

Sanjay Gupta, CNN Health Most healthy older adults should not take a daily aspirin for heart health, says the US Pre-

ventive Service Task Force.

After years of recommending regular aspirin to prevent heart attack and stroke, scientists now see little benefit for most healthy people and say it may contribute to a risk of bleeding in the stomach or brain, which goes up as one gets older. The task force now says

nerve stimulation (nVNS) device twice per day over which were published in the Journal of Affective Disorders Reports.

The authors concluded it was a “practical, safe, and novel treatment.”­­—Tiffany Judkins

people older than 60 should not start taking a daily aspirin for primary prevention of heart problems, in most cases. For those between 40 and 59 years old, the task force leaves it up to them and their doctors to decide whether they should take a daily aspirin in specific circumstances. Doctors say a healthy 40-year-old with no major risk factors could do more harm than good with daily aspirin, as the risk of bleeding would exceed the benefits. But if someone has had a heart attack, a stroke, or other heart or circulation problems and their doctor has put them on daily aspirin, they should not necessarily stop. Instead, they should talk with their doctors about what the new recommendations mean for them.

SANJAY GUPTA PHOTO CREATIVE COMMONS WIKIMEDIA

Fall 2022

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THE BARE BONES

SHARE AND

Winship Cancer Institute’s New Shared Resources Hub at Emory The amount of expensive technology amassed in modern research labs is stunning. A flow cytometer alone can cost hundreds of thousands of dollars.

Fittingly, collaboration and consolidation have become priorities, with some labs being designed or renovated to serve as shared resource hubs. These modern, bright spaces can accommodate multiple users, frequent visitors, and high traffic volume, as well as providing common space for brainstorming.

Take, for example, Winship Cancer Institute’s new Shared Resources Hub. Centrally located in Emory Clinic Building B on Clifton Road, the suite brings under one roof more than half of Winship’s 12 core facilities. The hub provides broad access to advanced technologies, services, and expertise to support investigators from multiple disciplines. “This renovation has created a modern space designed to support multiple shared resources and collaborative, interdisciplinary workflows,” said Winship Deputy Director Adam Marcus, scientific director of the Integrated Cellular Imaging Shared Resource.

“It will meaningfully benefit our people and the groundbreaking science our shared resources help facilitate.”

The research hub has private offices with outside windows and frosted glass that allow natural light to spill into the hallways. Conference rooms provide hybrid meeting technology. The hallways and meeting spaces have comfortable sitting areas with white boards, and the breakroom has multiple tables for eating and science talk. “Light feels good when you’re in an interior environment,” says Rebecca Doo-

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little, associate director of facilities at Winship. The previous labs were “dark and felt like somebody’s basement. They had been built in the 1980s, so the bench layout was antiquated and there was only one small shared resource along with a dry lab and a freezer farm.”

In the new, spacious wet and dry lab areas, workflow processes and movements are well thought out. The hub is now the primary location for the Biostatistics, Cancer Animal Models, and Cancer Tissue and Pathology cores, and is an additional site for Flow Cytometry, Integrated Cellular Imaging, and Cellular and Immunotherapy. Working in proximity helps investigators prevent redundancy and integrate skill sets, says Finesha Colton-Lee, director of research administration operations at Winship. “Let’s say someone needs help with tissue processing — they are sitting right by the Tissue Core. You don’t have to have a tissue processing specialist in each unit,” she says. “Also, with flow cytometry, customers will be there using that core, but we have some other cores that use flow cytometry as well, and they would be able to work together to meet those needs at a greater level.”

The research suite is “very inviting,” says Monica Cloyd, research manager of facilities planning at Winship. “I love that we have consolidated all the shared resources that had previously been scattered across Winship and the Emory campus in different buildings. We’re going to see a big boost of researchers using the resources.”

Having a common drop-off point for samples already

SHARE ALIKE PHOTOS:STEPHEN NOWLAND

should facilitate and accelerate strong has increased traffic flow. “It’s been collaborations,” says Jeffrey Switchennice, as people are coming in to drop ko, director of the Biostatistics Shared things off and pick things up, they also Resource at Winship. start discussing their projects with The staff has a “daily huddle” our team,” says Jennifer Robertson, every morning in the main lab. “And director of research projects at Emory. the big conference room is available This neighborly feel leads to swapping when we have visiting groups,” both supplies and information. “It’s a Robertson says. close-knit group, and experts from the This proximity of staff and equipdifferent cores are happy to interact,” “It’s been nice, as people are comment benefits investigators who says Robertson, technical director of ing in to drop things off and pick require multiple resources to address Winship’s Cancer Tissue and Pathola complex scientific question, says ogy Shared Resource. “People will things up they also start discussing Gregory Lesinski, associate director say, ‘Oh, you’re with CAMS (Cancer their projects with our team.” for Basic Science and Shared ResourcAnimal Models Shared Resource), let —Jennifer Robertson, es at Winship. “Data and biospecime ask you a quick question about my director of research projects mens can be efficiently passed among study.’ Another day, someone working at Emory. the shared resources to maximize use next door came over and asked, ‘Can of technology and minimize transit I borrow your oven?’ ” (And no, this time,” he says. isn’t a kitchen-type oven that bakes Because so much of the technolcookies, but a countertop lab oven that ogy and equipment is new, there’s provides pinpoint temperatures and is a bit of a learning curve for hub users. “If you build it, they used for tasks like drying slides.) will come,” Colton-Lee says. “The new technologies are here, “If you don’t know each other, you might not walk around and we want to be at the front of the research by helping looking for that kind of thing,” Robertson adds. and supporting the researchers. This is truly transformaThe space welcomes researchers from all disciplines. tional.”—Mary Loftus “Having an open, modern, and flexible work environment

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THE BARE BONES

COVID-19 Vaccines for Young Children

Are They Safe and Effective?

ILUSTRATION MATT CHINWORTH

In June, the Centers for Disease Control and Prevention (CDC) recommended that all children six months through 5 years should receive a COVID-19 vaccine, joining the agency’s previous recommendation for children 5 and older. “These vaccines have been well studied and thousands of children have been involved in the clinical trials that provided data to support their approval,” says Anderson, who didn’t hesitate to have his own children vaccinated for COVID. “I’ve got four kids and all got COVID-19 vaccines on the day vaccinations became available in their age range. I trust in the clinical trial process and the scientific method, which is driven by data.”

Anderson hopes to reassure parents by sharing his knowledge and providing straightforward information.

Although it is rare for children to become seriously ill from COVID, tens of thousands have. About 1,300 youth have died from COVID in the U.S., and more than 40,000 have been hospitalized with the virus. Additionally, more than 8,500 children have developed COVID-related multisystem inflammatory syndrome in children (MIS-C), which causes inflammation of internal organs and can be fatal.

Additionally, a substantial number of COVID infections occur in young children. “We saw relatively large numbers of hospitalizations in children who were not vaccine eligible, and a relatively large number of deaths occurred in infants and children less than 5,” Anderson says.

COVID vaccines have been well studied and

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have proven to be safe and effective. “We have a wealth of experience from children 5 years of age and older, as well as in adults, related to COVID-19 vaccines,” Anderson says. “It’s a unique situation, as hundreds of millions of doses have been given in the U.S. This should provide additional reassurance to parents.”

Vaccine side effects are almost always mild and easily controlled. The most common side effects of the COVID vaccine are fever, chills and generally not feeling well. Local symptoms include pain, redness, soreness and tenderness at the site of the vaccination. “In general, most of these vaccine side effects are less pronounced in children than in adults,” Anderson says. “Most can be easily controlled with medications like Tylenol or ibuprofen.”

When a pregnant mother receives a COVID vaccine, it’s been determined that this provides protection against severe COVID outcomes in the baby in the first six months of life, according to data that partly came out of Children’s Healthcare of Atlanta and Emory. “This is probably due to antibody transfer through the placenta, and it also helps the mother by protecting her against COVID-19 and the risk of transmitting it to her baby,” he says.

Anderson recommends that children and family members in households with new babies also should be vaccinated for COVID to protect the youngest infants.

Children receive smaller doses of the vaccine than are given to the adults, but also require multiple shots.

Experts say that young children need two doses of the Moderna vaccine and three doses of the Pfizer vaccine.

Children who have had COVID previously are

somewhat protected from serious illness if they get the virus again, says Anderson.

“But the immune response and breadth of immune response appear less robust in such cases than what is observed after two doses of COVID-19 vaccination,” he says, “So vaccination is likely to decrease risk of recurrent infection and may provide better cross-protection against current and future variants.”—Mary Loftus

PHOTO COURTESY OF EVAN ANDERSON

A conversation with Emory Professor of Pediatrics and Medicine Evan Anderson, an infectious disease physician at Children’s Healthcare of Atlanta.

Emory pediatrician Evan Anderson was involved in clinical trials testing COVID-19 vaccines for children ages six months to 11 years.

Lightening the Burden GIFTS OF NOTE

New Amos grants help erase Emory medical school debt, boost rural health care Medical school debt is a lighter burden to Lindsey Garrett 25M because of a new loan forgiveness program that aims to bring more primary care doctors to rural Georgia.

PHOTO JACK KEARSE

Georgia will need an additional 2,099 primary care physicians.

Garrett, from Snellville, Georgia, wanted to practice in state well before she’d ever heard about the Amos program.

She believes that a rural area with a physician The Kathelen and Dan Amos Medical Stushortage would be ideal, as would the stipuladent Loan Forgiveness Program has complettion to be clinically active, seeing patients at ed its second of 10 cycles of $40,000 grants least half of the time. to students who pledge to commit to at least After learning in high school about racial two years of primary care practice where health disparities, she chose medicine as needed in Georgia. her way to make a difference. Grim statistics “I did start having doubts about going about maternal mortality for Black women into primary care, just knowing that it’s one in Georgia motivate her further. “The materof the least paying specialties,” says Garrett, nal mortality rate of Black women has actuwho expected to owe at least $200,000 for an ally gone up, and it’s about four times that of education preparing her for family medicine. white women,” Garrett says. “Obviously, it’s “The Amos Loan Forgiveness Program is due to a lot of different factors but prenatal amazing because it’s pointed exactly to what care, access to family planning, and other I want to do—primary care. Knowing I’ll have factors like that are important. That definiteless debt is really reassuring.”

Lindsey Garrett 25M is taking ly inspires me to be in family medicine.”

The grants are funded through a $5 milpart in a new loan forgiveness “I want to be accessible to my communilion gift from Emory Trustee Kathelen Amos program that aims to increase ty and to help women in the most direct way 79C and her husband, Dan Amos. She is the the number of primary care I can,” she adds. “I hope to be the doctor they president of the Aflac Foundation; he is Aflac physicians in Georgia. go to with their problems, the main person chair/CEO. A previous Amos gift funded the they will seek out for medical advice and care.”

LaHouse Family Medicine Resident Scholars, allowing the The loan forgiveness program, which began in 2021, will School of Medicine to train more family medicine residents.

“Can Emory be about primary care only in Atlanta or is Em- award about 20 grants each year and applicants must go through interviews. Other loan repayment programs have ory’s medical school for all of Georgia? I would say the latter, made a difference in Georgia. According to the Georgia Board but we have to provide pathways for students to get to those sites and settings,” says program director Theodore Johnson II, of Health Care Workforce, 89 percent of doctors and dentists who participated in similar programs remained in Georgia to chair of the Department of Family and Preventive Medicine. practice and 72 percent still practice in a county considered Beyond funding, the program seeks to create a netunderserved in health care. work of alumni practicing across the state. “We’ve got to “Residency is a strong predictor of where you’re provide mentors and coaches who are familiar with those going to practice, so we hope people will graduate settings and can help medical students,” Johnson says. “It’s from Emory medical school, go to Georgia resihard to find your rural practice leads. We’d love to be in dencies, and stay in the state,” Johnson says. close contact with Emory alumni who are in practice “But we’re also working with residents in rural settings in Georgia who want who went out of state to get them to work with medical students.” back in Georgia. If you can grab Georgia’s patient-to-primary their interest and help them care provider ratio of 1,744:1 financially during their lean is greater than the national years of medical school average of 1,463, according to and residency, the feeling is the Robert Graham Center’s they will anchor and have Policy Studies in Family a generation of service to Medicine and Primary Care.

Georgia.”—Michelle Hiskey By 2030, the center projects ILLUSTRATION SORBETTO

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RE THE POWER OF

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DINNER WITH A DOCTOR: RE-ENGAGING

The Power of Re

Finding your path forward by reclaiming your resilience By

Mary Loftus n Photos by Jack Kearse n Illustration by Davide Bonazzi

The past few years have been rough. We haven’t previously lived through a single event that cost our country as many lives as the COVID-19 pandemic. By mid-April 2020, the death toll was as if 9/11 were happening every other day. We have now surpassed a million COVID deaths in the United States and globally, more than 6.5 million have died of the virus.

Even those not touched by death or illness lost something during the pandemic: a job or workplace, school with friends, gathering with loved ones, a sense of security. Some who recovered from the virus are still suffering the aftereffects. Not surprisingly, rates of depression and anxiety have increased as have some chronic physical ailments.

And yet, we are resilient.

With spring comes renewal and regeneration, and in that spirit, we asked two doctors well versed in helping patients achieve health and wellness to host this issue’s Dinner with a Doctor.

It was the first such in-person dinner in

two years, and our group met outside on the patio of General Muir at Emory Point.

Sharon Bergquist, an internist, is a Rollins Senior Distinguished Clinician, master clinician, and associate professor of medicine, as well as director of Emory’s Executive Health Program and founder and director of Emory Lifestyle Medicine & Wellness. She has been treating and preventing chronic diseases for more than two decades, and hosts a podcast, The Whole Health Cure.

David Prologo, an interventional radiologist and obesity medicine specialist, is an associate professor of radiology and imaging services and

Above: Emory physicians David Prologo and

Sharon Bergquist hosted a Dinner with a Doctor on finding your own “path of wellness.”

co-director of the Division of Computational and Image Guided Research.

He uses image-guided techniques to deliver stem-cell therapies, treat cancer pain, and address obesity, and recently released The Catching Point Transformation: A 12-Week Weight Loss Strategy Based in Reality.

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DINNER WITH A DOCTOR: RE-ENGAGING As the evening cools, Drs. Bergquist and Prologo settle in at a long patio table as panelists gather around them. Panelists for the dinner are: Rory Abrams, Ruth Burton, Nada Boualam, Linda Dobson, Elizabeth Hautau, and Sydney Park.

Keeping with the times, the first question is a remote one from an Emory Medicine reader from North Georgia, Edye Bradford, a cancer survivor successfully treated at Emory’s Winship Cancer Institute.

She asks: “What about the effect the isolation caused by the coronavirus pandemic has had on older people like me, who live alone?

What can we do to keep our balance and get back into the old routine without fear? Vaccinations are protecting our bodies but how do we protect our emotional and mental health from this long, dark cloud hovering over us?”

Everyone nods, and there are expressions of empathy from the table. “A very important part of being human is our connection to others,” Bergquist says. “Researchers have found that loneliness and social isolation can be as damaging to our health as smoking 15 cigarettes a day. Our biochemistry is changeable and is impacted by human interactions. Eye contact alone can increase dopamine levels and touch can aid in stress relief by reducing cortisol levels.”

While many people have tried to replace personal interaction with video conferencing apps like Zoom during the pandemic, virtual interaction doesn’t appear to have the same physiological impact. A study in the Journal of Experimental Psychology last year found that Zoom disrupts the natural rhythm of conversation—something experienced by anyone who has talked over someone in a virtual meeting or tried to make a well-timed joke.

“Because communication is not occurring in real time but instead has a split-second delay, you don’t get as engaged with the person you are interacting with,” says Prologo.

RE-ENGAGEMENT AT YOUR OWN PACE

“People’s comfort levels are not one size fits all,” says Bergquist. “Everyone is at a different starting point and that is OK and needs to be respected.”

For some, this might mean inviting people over to play bridge on the deck, eating outside at restaurants, and having small

gatherings of vaccinated friends and family.

For others, it might include taking long-delayed vacations and flying, whether overseas or across the country.

“Re-engagement reinvigorates people,” says Prologo. “It gives you a boost of energy.

Which leads to motivation and restarting a routine that gets you on a path of wellness.”

“Start with things that give you joy,” adds Bergquist. “The more you do these things, the more you will feel like doing. Motivation is hard to come by right now. You have to take action first, then the motivation will come.

You can start small, and it might still feel scary, but fearing other humans is an unnatural state. We need to relearn how to overcome our fears and reach out in ways that bring us joy and reconnection.”

“Anxiety and guilt are not motivating emotions,” says one panelist.

“Yes, we are all in the same boat, we are kind of beginning again,” adds another. “The pandemic has dragged on for a long time and it isn’t going away, it will just become endemic. We have to decide what is best for our mental health and, for me, that is some type of community. I have been forcing myself to walk to my classes.”

“I just try to get myself up and going. Maybe my standard for being active isn’t what it used to be, but I’ve been hiking a lot.”

“One thing at a time,” says Prologo. “Don’t bite off more than you can handle. You’re not going to go from zero to your prepandemic life. There are steps in between. Pick a happy thing, don’t start with a struggle. As Sharon said, something you enjoy will build momentum, and activities will build on each other.”

RECONNECTING

Edye Bradford, Emory patient, Clayton, Georgia

“Vaccinations are protecting our bodies but how do we protect our emotional and

THE ART OF RECONNECTING

Several of the panelists were concerned about their children, from school-aged to young adults, in the face of the rise of anxiety and depression during the pandemic.

Despite being in closer proximity to our families than ever, agreed the doctors, we may need to purposefully and deliberately engage our children, especially if they have disengaged from friendships or activities they previously enjoyed.

“Sometimes just a change of scenery can help,” says Bergquist. “Take a short trip, which can disrupt negative thought patterns and

mental health from this long, dark cloud hovering over us?”

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routines. When you physically change the environment, you also change thinking patterns.”

For teens, says Prologo, sometimes it takes “introducing new sources of dopamine. Sitting in their room and being withdrawn might not be unusual for their age, but it’s not the best thing for them emotionally. Be deliberate about engaging them.”

Parents should be honest and transparent with their kids about their own thoughts and feelings: “Let them know if things like resocializing are awkward or uncomfortable for you as well. They may be experiencing a lot of the same feelings, and you can normalize that by speaking your truth,” Prologo says.

Avoid “should do’s,” though … as in “You should do this,” or “You shouldn’t do that.”

“Should do’s never work. Adopting a new behavior is about baby steps,” says Bergquist. “As physicians, we often come to realize the goals we have for our patients are not the same goals they have for themselves. That involves a lot of checking in, asking questions, seeking clarification, and listening.”

Narrative medicine can be a powerful tool since it involves storytelling, which can empower people to begin to script and control their own stories.

One of the panelists says it was quite a shock to go from high school to college during the pandemic. “It felt very overwhelming at times,” she says.

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Prologo acknowledges what a strange experience the pandemic has been for college students, some of whom left home briefly only to return for remote classes, or who ended up being cloistered in a dorm or apartment far from friends and family. “Always hold on to your why,” he says. “Why did you do this in the first place? What does college mean to you? A lot has changed around you, but your why has probably stayed pretty consistent.”

TAKE TIME FOR RECOVERY

While re-engaging in ways you find safe and enjoyable, this “stress exposure” can also be draining.

“It’s like watering a plant … you can’t water it all the time, or it will be just as bad as no water at all. Take time to recover in between, whether passive recovery like unplugging or active recovery like meditation, yoga, or swimming,” says Bergquist. “The growth happens during the recovery.”

Unplugging can be especially important in a world where we are virtually connected 24/7 through laptops and smartphones.

“I actually put my smartphone in a lock box sometimes,” says one panelist.

“That gives you time to think,” says Prologo. “We don’t take time for that anymore.”

It’s especially important to hear your own, inner voice right now, adds Bergquist, because this is a time of decision

making and transition. “It’s almost as if we’ve been rebirthed, like a forest after a fire,” she says. “How do you want to rebuild? There are less expectations about doing things a certain way.”

From resetting priorities to truly reexamining work/life balance, “you get to have a little more agency in your life,” she says.

One panelist says she has “used the pandemic as a chance to stop and breathe, to restart my story. I didn’t feel like I had to go-go-go like a rat on a wheel. I went hiking, began drawing more, and took time to focus on myself.

I lost a loved one to COVID, which really brought it all home.”

BOLSTERING RESILIENCE

Another panelist agrees: “The pandemic gave me a chance to reestablish my boundaries, reevaluate my life, and redefine my goals.”

Several panelists mention the stress caused by the pandemic becoming political and the wearing of masks becoming a point of contention. “This was a unique opportunity to work on being empathetic and understanding,” says Prologo. “To have real conversations and talk about real issues. We learned that not everyone thinks like us and the best way to convince them may not be by arguing but by being empathetic. We have to coexist.”

The restrictions during the pandemic were more than most of us had

DINNER WITH A DOCTOR: RE-ENGAGING

experienced in our lives, which can be scary to some, he says.

One of the main themes that keeps emerging in her podcast, says Bergquist, is empowerment: “The pandemic exposed our vulnerabilities. How can we bolster ourselves physically and mentally to prepare and endure?”

For example, people with co-morbidities that threaten to make acute illnesses like COVID more severe can be empowered by putting more energy into prevention.

“With positive lifestyle changes, 80 percent of chronic disease could be prevented—60 percent of that through a better diet alone,” she says. “We can focus on what’s in our control.”

Prevention is key for maintaining not only physical but mental health.

“Some physicians,” she says, “are writing prescriptions for ‘lifestyle medicines’ like healthy foods and walks in the woods.”

An upside to the connectivity of

smartphones and the internet is that there are personalized resources available for healthy recipes, nearby hiking trails, outdoor yoga, walking groups, and other methods of support, including telemedicine and online therapy.

Virtual options expanded out of necessity during the pandemic and aren’t going away any time soon, the doctors point out.

Weight gain has been another side effect of the pandemic for some, with gyms closed and remote work leading to a more sedentary lifestyle (and easy access to the fridge.) Stress can also lead to comfort/binge eating.

Prologo says people have trouble losing weight on diets not because they lack fortitude but because their body compensates for their efforts.

“Diets are interpreted as starvation events,” he says. “Your body will counter and go on a food-seeking mission, as well as try to preserve its store of fat.”

Therefore, you can’t do everything at once.

“You must stop and let your body acclimate to each step along the way,” he says. “Then, as you recharge and get stronger, you can go a bit further.”

Prologo encourages starting with exercise, which can mitigate the effects of the body’s resistance.

At some point, the body adjusts to “a life of less sugar, less calories,” he says.

“It becomes less of a struggle.”

As always, start with easy adjustments—a walk around the neighborhood with your dog or a friend, not eating late-night snacks in front of the TV. “It gets to where it’s easy and fun, and you don’t need help,” he says.

The panelists stay long after the doctors leave, talking with each other about the changes in their lives—those that have already happened and those they want to script into being.

“I have so enjoyed tonight,” one says. “It’s nice to remember what being out to dinner and having interesting conversations over good food can be like.” n

PANELISTS

Rory Abrams

Ruth Burton

Nada Boualam

Linda Dobson

Elizabeth Hautau

Sydney Park

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RE THE POWER OF

RECALI THE MAKING OF A

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LEFT: PHOTO COURTESY JEREMY ACKERMAN RIGHT: PHOTO JACK KEARSE

RECALIBRATING

IBRATE TACTICAL PHYSICIAN By

Jim Auchmutey

Fall 2022

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O

ONE SUMMER WHEN HE WAS

ALMOST 45, JEREMY ACKERMAN EN-

ROLLED IN A POLICE ACADEMY NEAR HIS HOME IN ATLANTA.

On the first day of class, the instructor asked students to introduce themselves with the nickname they preferred.

Ackerman’s sounded like something from an old movie: Doc. “Why do they call you Doc?” the instructor asked.

“Because I’m a doctor,” Ackerman answered.

“We’ll talk later,” the instructor said, not sure whether he was being pranked or looking at one of his best-educated recruits.

Jeremy Ackerman is indeed a doctor and an associate professor of emergency medicine at Emory’s School of Medicine, who works three or four shifts a week in the Grady Memorial Hospital Emergency Care Center in downtown Atlanta.

He’s also a tactical physician, a sworn police officer who deploys with a SWAT team and has received a medal of honor for taking part in an operation.

Ackerman can go from scrubs to body armor in the course of 24 hours.

Students in his class on designing medical devices at Georgia Tech, where he has an appointment in the department of biomedical engineering, have grown used to announcements like the one he made from the podium one afternoon this spring.

“NO CLASS THIS THURSDAY,” HE SAID. “IT’S SWAT TRAINING DAY.”

He usually comes to the lecture hall wearing tactical pants with multiple pockets that might be hiding a pair of handcuffs. He’s often accompanied by his 75-pound greyhound, Donovan.

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“He’s a pretty cool professor,” says Lama Bahanan, a fourth-year student at Tech.

Although Ackerman clearly relishes the excitement of police work, his motivation grows out of broader concerns as a doctor. In the Grady trauma center, he sees victims of gun violence almost every day.

Ackerman believes the discussion about guns in America has become politically treacherous. He also believes that anyone trying to make suggestions about firearm safety ought to know something about firearms.

“In school, they teach you that a doctor has a responsibility to meet patients where they are,” he says, “even if you have a problem with them.”

In Ackerman’s case, it wasn’t hard to empathize with gun owners because he is one. It all started because of a teenage crush.

••• The way Ackerman talks about shooting, it almost sounds like yoga.

“People think it’s like what you see in action movies,” he says. “It isn’t.

Competitive target shooting is a sport about standing perfectly still. You try to control every part of your body so that when you press a tiny lever of metal, a projectile gets launched with high precision through a piece of paper. It’s about being calm and controlling your breathing. We used to meditate and slow our heart rate so we could pull the trigger between heartbeats.”

When Ackerman discovered the zen of shooting as a teenager, no one was more surprised than his parents. The family lived in Bethesda, a relatively liberal suburb of Washington, and his parents supported gun control organizations.

Michael and Judy Ackerman both hold doctorates and achieved high academic positions—he as a biomedical engineer at the National Library of Medicine, she as a mathematics professor who became provost at Montgom-

ery College in Maryland. Then their son came home from high school and said he wanted to learn about guns. He had met someone—his first girlfriend—who was a near-Olympic-level shooter. “Her pick-up line was, ‘You’re the least nerdy guy on the chess team. If you teach me how to play chess, I’ll teach you how to shoot,’” Ackerman says.

In 30 days, he went from never having touched a firearm to becoming a member of the varsity rifle team.

His parents were not overjoyed.

“That probably wouldn’t have been the sport of choice in our household,” his mother says.

A fatal tragedy close to home weighed heavily on them. When Jeremy was young, one of his regular babysitters was out of town with her husband when their son discovered the couple’s handgun and started playing with it. He held the barrel to his head and pulled the trigger. It was loaded.

The Ackermans were confident their son would be safety-conscious, however, and as Jeremy grew more interested in shooting, his parents kept an open mind and bought him a competition rifle custom made for a left-handed shooter.

He spent two years on the high school rifle team and then drifted away from the sport when he went off to college at Washington University in St. Louis.

Ackerman met a student there who became his wife, and they followed other martial pursuits. “He’s always been interested in different weapon technologies,” says Amber Ackerman. “In college, we did fencing and were on the karate team and did stage combat.”

In the coming years, Ackerman didn’t have time for shooting. He wanted to become an engineer but feared he might end up designing missile systems that killed people.

He remembered a high school friend’s mother who died of cervical cancer and decided he’d rather cure people. He earned two doctorates at the University of North Carolina—in bio-

RECALIBRATING

medical engineering and medicine— and did his residency in emergency medicine at Stony Brook University Hospital in New York. By the time he took a post at Emory in 2007, he and Amber had started a family.

Their first child, a son, later joined the Boy Scouts and became interested in shooting at summer camp. Ackerman went to the attic and dug out his competition rifle, which he hadn’t touched in years. He restored it—woodworking and metalworking are among his hobbies— and took it to the range with his son.

“I didn’t realize how much I’d missed it,” he says.

••• Ackerman knows all too well that people with guns can inflict unimaginable heartbreak. He has witnessed the bloody aftermath of firearm violence throughout his medical career. He finds it particularly hard to inform a family that their loved one has died, since gunshot victims are usually young and the death is often sudden and unexpected.

Other cases left him perplexed.

When he was a medical student at North Carolina, a man was wheeled in with abdominal bullet wounds that missed a critical artery by a millimeter. It was the sixth time he had been treated for gunshot or stab injuries.

A few days later, when Ackerman was giving him discharge instructions, the patient asked,

“HEY, SHOULD I QUIT SMOKING?” ACKERMAN LOOKED AT HIM IN DISBELIEF AND SAID, “SIR, IT’D PROBABLY BE BETTER FOR YOU TO QUIT GETTING SHOT, AND THEN WORK ON THE SMOKING.”

In his clinical rounds at Grady, Ackerman sees everything from

PHOTO JACK KEARSE

ER physician and SWAT team member Jeremy Ackerman (above, left) encouraged ER colleague Lauren Hudak (right) to learn more about gun safety by going to a range and target shooting.

sprained ankles and digestive troubles to strokes and heart attacks. He has delivered babies, treated inmates, and helped patients in mental health crisis.

Most emergency patients suffer from chronic ailments that are not immediately life-threatening. About 20 percent require admission.

Ackerman prefers to work on trauma cases such as gun injuries. With his knowledge of firearms, he can often recognize injury patterns and reconstruct some of what happened: The type of gun. How the shooter was positioned.

Which hand the shooter used to hold the weapon.

“Gunshot wounds can be deceptive,” Ackerman says. “Wounds from slow-moving rounds can look terrible but they’re probably less life-threatening. A wound from a fast-moving round can look like no big deal, but when you get inside, the energy from the bullet has caused much more serious damage.”

Ackerman has made safe handling and storage of firearms a particular

PHOTO JACK KEARSE

Lauren Hudak, assistant director of Emory’s Injury Prevention Research Center, studies firearm safety and violence prevention.

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cause. He took a gun safety course from the National Rifle Association and became an NRA instructor without joining the organization because he has qualms about some of its political positions.

When he treats gunshot victims who have accidentally wounded themselves, he can be blunt. “If you own a firearm and end up shooting yourself, I think that really calls into question whether you should own a firearm,” he says.

Ackerman found a kindred spirit in an emergency medicine resident he helped mentor. Lauren Hudak earned a master’s from the Rollins School of Public Health at Emory while pursuing a medical degree. She wanted to study firearm safety and violence prevention, subjects that have interested her since an early job with an organ donor network in Tennessee. She drove organs to the Knoxville airport, many of them harvested from people who had died in car crashes or from gunshot wounds.

Hudak is now an ER doctor at Grady, an associate professor at Emory School of Medicine, and assistant director of the Injury Prevention Research Center.

When she told Ackerman she wanted to bring a public health approach to studying firearm safety, he advised her to learn about guns so she’d know what she was talking about.

Their conversation led to a research project in which they and other investigators interviewed patients at Emoryaffiliated hospitals about their firearm practices. As part of the preparation, the doctors invited their surveyors and other medical students to visit the QuickShot range near the Emory campus and shoot guns themselves.

Hudak and Ackerman have published a paper with other Emory researchers about patients’ firearm safety knowledge in the Western Journal of Emergency Medicine, and they plan to do more. But events in the spring of 2022 convinced Hudak that it wasn’t enough just to study the issue.

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Mass shootings that killed three dozen people in New York, Texas, and Oklahoma made her resolve to speak out for more stringent gun laws.

“UNFETTERED ACCESS TO GUNS IS A RISK TO OUR SOCIETY,” LAUREN HUDAK SAYS, “AND WE HAVE TO DO SOMETHING ABOUT IT.”

Ackerman believes in a measure of regulation, that not everyone should own a gun and that there needs to be a better system of background checks.

In his view, an epidemic of gun violence is exactly when more academic study of guns is needed. “If you want to solve a problem,” he says, “you start by defining it.”

Mass shootings like the ones that came in rapid succession in 2022 make him value his SWAT team experience even more. “If something happened here,” he says, “I at least have the training to do something about it.”

••• Ackerman and Hudak wondered whether their work on firearm safety might benefit from a partnership with law enforcement. Ackerman would meet officers in the ER and float the idea. One force in metro Atlanta invited him to come along with its SWAT team to help their efforts in return for providing medical assistance and training. He jumped at the chance.

Tactical physicians are doctors who embed with law enforcement so they can be on the scene during police actions in case officers or others need medical care. Some go through police training and earn a badge, usually on an unpaid volunteer basis, as is the case with Ackerman. Many other medical professionals—nurses, paramedics, physician assistants—also serve in tactical roles.

No one knows exactly how many tactical physicians there are in the United States, but one indication comes from the American College of Emergency Physicians, whose Tactical Medicine Section counts 500 members.

“It’s a slowly growing field,” says the group’s chair, John Wipfler, a tactical physician in Peoria, Illinois, who also works in an ER and teaches at the University of Illinois College of Medicine.

“Most doctors don’t want to support their community by stepping into the line of fire.”

Emory currently has one other tactical physician, Mark Rosing, an assistant professor of emergency medicine and ER doctor at Emory University Hospital who deploys with the North Metro SWAT team. He made the news in 2018 when he testified in the highly publicized trial of Tex McIver, an Atlanta attorney accused of killing his wife. Rosing treated McIver after the incident.

The day he showed up for court, Rosing was in camouflage pants and a SWAT team hoodie, prompting the judge to ask, “May I assume you are not coming from the hospital?” He wasn’t. He had been on a SWAT call. “I would have come dressed as a doctor, but they didn’t tell me I was needed in court until an hour beforehand,” Rosing says.

••• Ackerman started training with the police but realized when his unit was assigned to provide security for the Super Bowl that he might be a liability in a crisis because he couldn’t carry a gun. The only way to do that legally was to become an officer.

In summer 2019, he juggled his crowded calendar to allow for 408 hours of police academy training. “That’s what he did for his summer vacation,” Amber Ackerman says. “Some of our friends

PHOTO COURTESY OF MARK ROSING

PHOTO COURTESY OF JEREMY ACKERMAN

RECALIBRATING

Mark Rosing, assistant professor of emergency medicine and ER doctor at Emory University Hospital, who deploys with the North Metro SWAT team.

teased him about it. They’d say, ‘What kind of midlife crisis is this?’ ” Ackerman was not the oldest recruit—a handful of recently retired veterans were older—but he was the most unusual one. That was obvious when he failed the academy’s written exam for cardiopulmonary resuscitation (CPR) because he was absent due to speaking at an emergency medical conference in Las Vegas on the day of the test.

At first, Ackerman drove his Nissan Leaf to SWAT team training and had some Georgia Tech students help fabricate a gun safe in the back after a fellow officer pointed out that it probably wasn’t wise to store police property in a hatchback. As his gear and personal weapons increased, Ackerman purchased a retired Ford Interceptor SUV from a police department and installed secure storage.

His SWAT training has brought him perspective about how and when firearms are used. He talks about “trigger discipline,” the way police and soldiers are taught not to keep their fingers on

Jeremy Ackerman recently received a Medal of Honor for a SWAT team operations

the trigger but close by instead, so they don’t fire reflexively.

In a first-person article for the AMA Journal of Ethics, Ackerman described an experience that led him to believe he was doing some good. The SWAT team was sent to arrest a heavily armed suspect with a record of violent crime.

After the police took the suspect into custody without incident, an officer told him, “Doc, when you’re here, it’s easier to keep my finger off the trigger.”

•••

ACKERMAN HAS PARTICIPATED IN MORE THAN 90 SWAT TEAM OPERATIONS, TYPICALLY HIGH-RISK WARRANTS SERVED IN THE PRE-DAWN HOURS

WHEN THE CHANCES OF RESISTANCE AND COLLATERAL DAMAGE ARE LOWEST.

In March 2022, Ackerman was awarded the department’s Medal of Honor, the highest honor the department grants.

“This was in recognition of bravery and heroism while attempting to overcome a violent armed individual who had barricaded himself in a home with multiple firearms and explosives,” reads the notice from the American College of Emergency Medicine.

For the past two years, Amber Ackerman wasn’t sure which was riskier: her husband working in a public hospital ER during the coronavirus pandemic or him deploying with a SWAT team.

“I’m not sure he tells me everything,” she says. “I’m not sure I want him to.” n

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PHOTO JODIE GUEST

THE POWER OF

WALKING THE WALK

RESHAPING HEALTH CARE

Physician Assistants to the Forefront

By Sylvia Wrobel

The Emory Physician Assistant Program is one of the oldest PA programs in the nation, having just celebrated its 50th year. With intense, hands-on student training and a distinctive emphasis on providing culturally sensitive care to medically underserved communities, Emory is at the forefront of preparing PA students for an increasingly demanding and complex world.

“Increasingly, health care has become a team effort and as one of the medical school’s strong health professions programs, the PA program is crucial in helping us reshape patient care for today’s medicine, providing a higher quality of care accessible to all,” says Douglas Ander, assistant dean for medical education.

For a growing number of Americans—and many others across the world—their first and often most frequent provider encounter is with a physician assistant. Numerous surveys show that patients regard PAs as effective and trust them with their health care needs.

As well they should, says Emory PA Program Director Maha Lund. “Physician assistants play an important role in solving the health care challenges facing our nation,” she says.

PAs are highly trained, licensed health care professionals, and the fastest growing segment of the healthcare provider team in the country.

While the original idea of PAs was to help in primary care, more and more PAs today are working in specialties and subspecialties in virtually every healthcare setting, responding to the growing com-

plexity of medicine and demand for patient care.

Legally, PAs work as part of a medical team under the direction of a physician. In practice, they have increasing autonomy in medical decision making. They take medical histories and perform physical exams, order and interpret diagnostic studies, prescribe medications and treatment regimens, and assist in surgery.

“The wide range of abilities of PAs, their intra-profession collaboration, and their outreach to often overlooked communities are some of the reasons why Emory School of Medicine views training PAs as such as important part of our educational mission,“ says Dean Vikas Sukhatme. “The PA program is vital to the school’s goal to reimagine medicine, not only through scientific advances but also in how healthcare is provided.”

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Far right: Kathy Yadegari, PA class president 2022, did elective neurosurgical oncology rotations at Emory University Hospital and Emory Decatur Hospital, where she posed for this photo with a model brain and spine. Right: PA students also work in ultrasound labs and master other high-tech devices. Below: A PA degree from Emory represents many hours of hands-on, patient- care experience.

PHOTOS COURTESY EMORY PA PROGRAM

NEW PROGRAM TAKES ROOT

The nation’s first PA program was established at Duke medical school in 1965 by Emory medicine alumnus and former medical dean Eugene Stead Jr. The program was born of urgency about the growing physician short-

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PHOTO COURTESY MAJA LUND

age and recognition of the military’s success in fast-tracking medical training. The first four students at Duke were Navy Corpsmen with patient-care experience, often gained under trying circumstances.

At Emory, pioneering cardiologist J. Willis Hurst realized the problem of too few physicians and too many demands would only worsen, as fast-moving scientific developments made medicine more powerful and more complicated.

Hurst and Stead, longtime friends, talked often. In 1967, the year Stead’s first students completed certification, Hurst created a Medical Specialty Assistant Program focused completely on cardiac care at Grady Memorial Hospital. Hurst’s first three students, also corpsmen, were “serious-minded, hardworking, capable”—and also “courageous,” he wrote, since with no established accreditation process at the time, there was no guarantee they would be allowed to practice.

The gamble paid off. It also changed Emory School of Medicine. In 1971, medical dean Arthur Richardson saw the value of Hurst’s small cardiac program and claimed it for the School of Medicine, expanding enrollment and broadening the curriculum and clinical rotations. The new PA program was made part of the division of Allied Health (now Health PA Program Director Maha Lund Professions), then moved into what would

As was the objective from the beginning, PAs are well positioned to help with the pressing issue of access to care.

As Lund points out, they can do 85 percent of what a physician can do and are trained in a shorter time span.

Although PA students’ in-program training is condensed, their preparation as providers begins before they even apply for admission. Emory PA students need a college degree and a minimum of 2,000 hours of experience in a patient care setting. For incoming students, the average is closer to 5,000 hours.

“That requirement is one reason our students are so special,” Lund says. “They have put aside established careers as EMTs, paramedics, physical or respiratory therapists, and other important work, uprooted their families and saving accounts, and committed to 29 months of combined didactic and clinical training before certification and licensing, all to pursue a career they believe will allow them to do more for patients.”

$121,500

66% 34%

”best job”

PART OF THE TEAM

When Bearden began practice in 1973, he felt the need to prove to physicians what PAs could do.

That’s much less of an issue today, says Susana Alfonso, medical director of the Emory PA program. “Today’s generation is so much more blind to hierarchy, more open to collaboration.”

And Emory-trained physicians certainly know what PAs can do, she says, because they worked beside them during clinical experiences in medical school and residencies.

When Alfonso arrived at Emory in the 1990s for her own residency, she had never heard of PAs. “I was blown away by their exemplary medical decision making and patient skills,” she says.

Today, she works in the department’s residency program, bringing together medical and PA students to learn techniques and collaboration at sites like Emory at Dunwoody, a family medicine clinic with a large underserved population.

PA and medical students also work side by side to provide care to underserved populations at ancillary sites such as the Good Samaritan clinic.

And the highlight of Alfonso’s year is being one of the main preceptors at the Emory Farmworker Project, the PA program’s hallmark service-learning experience

In 1965, Emory medical alumnus and former medical dean Eugene Stead Jr. established the nation’s first PA program at Duke Medical School. A few years later, his friend and colleague, cardiologist J. Willis Hurst, established what would become Emory’s PA program.

PHOTO COURTESY OF CHARLES BEARDEN

top five

match organs and donors.

A half century later, Bearden is still coordinating organ transplants and has placed nearly 3,000 organs over the span of his career.

Fifty years after graduating with Emory’s first PA class, Charles Bearden still enjoys working as an organ transplant coordinator and remains in touch with many recipients, including Leilah Lomeli (above left, with Bearden), who in 1986 became the first female newborn donor heart recipient.

PHOTO COURTESY OF DAN JEFFREY

become the Department of Family and Preventive Medicine.

That’s a home that makes sense, says Ted Johnson, the current chair of Emory’s Department of Family and Preventive Medicine. Our department “cares for patients from birth to death, cradle to grave, like today’s PA students who care for patients of all ages, with all types of needs in all organ systems and in all types of clinical settings.”

In December 1973, Emory’s first official PA class graduated, not with certificates like their cardiology program predecessors but with academic degrees. The class members also took the first national PA certification exam. Of those first 25 Emory PAs, most were medical corpsmen, many back from Vietnam, a handful of women, and an eager 19-year-old named Charles Bearden.

Bearden became hooked on medicine when his mother, a Grady employee, arranged Emory has been for her 15-year-old son to see ranked in the an autopsy. His summer jobs at Grady included responding to emergency codes, racing to bedsides with one physician assistant of the hospital’s then limited programs since EKG machines. When Hurst the US News & World Report appeared, followed by a bevy PA program of medical students and three rankings began. competent, no-nonsense cardiac medical assistants, The median wage Bearden saw clearly what he for PAs was wanted to be.

He especially loved his clinical rotations across surin 2021, according to gery, medicine, pediatrics, and the US Bureau of cardiology. And like today’s Labor Statistics.

PAs, he loved how his training allowed him to move laterally, There are more than to work in family medicine, 114,000 PAs currently then neurosurgery, investigatemployed in the US, ing medical fraud for the state, and urology at Grady.

In 1979, a former classmate women, recruited Bearden to start the first organ bank in Atlanta to support kidney transmen. plantation at Grady. Bearden evaluated donors, gained US News & World Report family consent, and medically consistently ranks PA managed and flew donors to as the No. 1 leading transplant centers in the US and Canada, where he scrubbed in with pioneering overall and in health care. transplant surgeons. He also helped develop systems to

PHOTO JACK KEARSE

WALKING THE WALK

Inspired by Emory’s Farmworker Project, Emory PA alumnus Dan Jeffrey (above) established a community health rotation at Midtown Community Health in Ogden, Utah, giving other PA students the opportunity to see the health challenges faced by migrant and underserved populations.

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PHOTO COURTESY OF MARJORIE TAYLOR

that offers care to Georgia’s migrant workers by coming to them where they live and work through pop-up field clinics. Her husband often goes with her to serve as another interpreter.

PHOTO COURTESY OF SUSANA ALFONSO

A first-generation college student, Marjorie Taylor is now a PA at the Atlanta VA Medical Center’s emergency department. She remembers how helpful the VA was to her family during a difficult time. “Now, as a PA, I’m honored and prepared to help other veterans,” she says.

PHOTO COURTESY OF JODIE GUEST

Susana Alfonso met her first PA students when her academic department chair asked her, as a native speaker and young family medicine resident, to teach them basic medical Spanish. Today, as medical director of the PA program, she teaches the students how to practice and work as part of a medical team.

For more than 18 years, Associate Director Jodie Guest has supported the Emory PA Farmworker Project—and it’s a family affair: her husband, a cardiologist, works as a preceptor with the PA students, and her children have participated in Teen Corps.

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SERVING AN INVISIBLE COMMUNITY

Working as a nurse in a newborn ICU in Utah, Dan Jeffrey always felt he wasn’t doing enough—or, more specifically, wasn’t allowed to do enough—for his patients.

He decided to go back to school. What drew him to Emory’s PA program was its emphasis on providing care to underserved patients, and what sold him was the Emory Farmworker Project.

That happens a lot, says Jodie Guest, associate director of Emory’s PA Program and director of the Farmworker Project: “It helps explain why we attract such remarkable, community-minded, culturally-sensitive students.”

For two weeks every June and another weekend in October, Emory PA students provide care in the most austere of settings: the fields of rural South Georgia, where migrant workers spend long, hot hours picking fruit and vegetables and sleep in crowded barracks or temporary housing. During clinical rotations at Grady and various intercity community clinics, Jeffrey thought he had seen it all. The farmworker experience was a revelation. He woke early every morning to find a long line of men, women, and children—patient, quiet—already lined up. Some requested checkups for their children. Others had suffered for weeks with musculoskeletal injuries, ear infections, respiratory diseases, the

effects of pesticide exposure. They saw workers with digestive problems, urinary tract infections, cuts, sprains, and back pain, asthma, diabetes, hypertension. For many of the farmworkers, this would be the first time they had seen a healthcare provider and they were nervous.

Most were treated on site, under a large canopy or in a mobile air-conditioned medical truck unit with examination rooms. Some—like a man hit by a tractor three weeks earlier and in excruciating pain from infection—were taken to a local hospital. Jeffrey accompanied him, using Spanish acquired during a two-year mission trip to Paraguay.

The Emory Farmworker Project has been a vital part of the Emory PA program since 1996 when faculty member Tom Himelick first took eight students to the South Georgia fields.

Today, says Guest, more than 200 interprofessional students and providers participate in the program annually, providing care to more than 2,000 workers and their families. The program recently realigned clinical rotations, making it possible for all students to participate.

The Emory Farmworker Project strengthens PA students’ sensitivity to underserved communities, wherever they end up working, Guest says, and enhances their entered in the fall of 2021, ability to work collaboratively. with 18 applicants The project has expanded for each slot to include Emory medical, public health, and physical therapy students. Students and faculty volunteers come from Mercer University’s PA from Georgia, program, the University of Georgia’s College of Medicine and College of Pharfrom other states macy, Morehouse School of Medicine, the family therapy and nursing programs at Valdosta State University and Bainbridge State College, and female, the Haitian Culture Club at Florida State University.

Many others, including PA male program faculty and sometimes their families, have volunteered to help. Lund’s husband often accompanies underrepresented the team to interpret Haitian minorities in medicine Creole, which he learned while serving on a mission

The Next 50 Years (starting with the Class of 2023)

54 students

23% 77% 89% 11% 28%

WALKING THE WALK in Haiti. Their daughter also has helped.

Everyone who goes finds that the experience has a profound impact on them, says Alfonso. The impact can go beyond medical care. A young man who remembers the Emory Farmworker Project coming to the camp where his parents were working in the fields has since become a physician.

In 2011, Guest created Teen Corps, in which high school students interested in medicine, immigration, and social justice accompany the team to the fields, shadowing PA students and learning how health care is provided in such complex situations PHOTO JODIE GUEST while the PA students gain teaching experiEach June and October, the Emory Farmworker Project provides free health care to more than 2,000 ence. The Teen Corps program is unique in farmworkers and their families, a population that plays a key role in Georgia’s billion-dollar fruit and the nation—and highly competitive, with vegetable industry but often lacks access to even basic medical care. applicants from across the US vying for the 12 to 18 slots.

Guest, vice chair of the Department of Epidemiology in Director Allan Platt, assistant professor of medicine. “He was a Emory’s Rollins School of Public Health, bridges the PA prograndfather figure, something I never really had. He was hongram and Rollins. She coordinates the dual master of medical est, warm, and inviting, like everyone in the program turned science-PA/master of public health degree, first awarded in out to be,” says Taylor, a first-generation college student. “I 2009. PA students who elect to pursue both degrees are esperealized that was where I needed to be.” cially well prepared for health education, such as designing Her conviction never wavered, even during the 11 hard intervention programs for workplaces, she says. weeks when rotations were paused due to COVID restrictions As it does for many Emory PA students, Jeffrey’s time with and students focused on case studies and jumped more deeply the farmworker project sent him in a new career direction. into telemedicine. “Becoming a PA—and doing it at Emory— After graduation, he spent four years working for the Yakama were two of the best decisions I ever made.”

Farmworkers Clinic in Salem, Oregon. He now works at the She now has a position at the Atlanta VA Medical Center as Cache Valley Community Health Center in Logan, Utah, where a PA in the emergency department. more than 80 percent of patients are migrant workers, largely in slaughterhouses, meat-packing plants, and giant dairy LOOKING AHEAD farms—hard, wearing, often dangerous work. He says his EmoThe PA program’s curriculum will continue to adjust as dery education strengthened his cultural sensitivity and taught mands on health care providers change and medicine evolves, him the flexibility he uses daily in moving from industrial says Lund, which can be seen with the incorporation of ultrainjuries to prenatal care. sound and other technologies into the classroom.

Like many PA programs across the country, Emory is DOING MORE FOR PATIENTS discussing how best to address the growing demand for PA During her time in Emory’s PA program, Marjorie Taylor education. sometimes felt as if she were drinking from a fire hose. After Also pressing is the need to help more clinicians undercompleting a PA Post Graduate Primary Care residency at the stand what PAs can do to address access to care issues in the US Atlanta VA Medical Center, a residency directed by Emory PA and to enlist more providers to serve as preceptors. This also alum Shelia Palmer, Taylor realizes how much she learned means opening more practices, especially where PAs are most during that steady deluge of information. needed.

Taylor had worked for two years as a certified pharmacy As president of the Georgia Academy of Family Physicians, tech and four years as a certified nuclear medicine tech. Her Alfonso is conducting a study of barriers that prevent PAs patients would often ask why she couldn’t do more for them. from finding positions in rural areas.

Why couldn’t she be one of their primary providers? She saw “If Emory’s medical school didn’t have a PA program, we a way to do that. Working alongside PAs for years, she knew would have to create one,” says Johnson, chair of the Departwhat they were capable of. ment of Family and Preventive Medicine. More and more medTaylor decided to apply to Emory’s PA program after ical schools are adding PA programs, he says, because “it’s that attending an open house, where she met with Admission important to health care.” n

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PHOTO JACK KEARSE

Emory medical illustrator Andy Matlock holds a model trachea that was created with a 3D printer to teach medical students about anatomy.

INNOVATION IN ACTION

REPLACEMENT (BODY) PARTS 3D-printed anatomical structures are growing in popularity By

HEART TISSUE, JOINTS, TRACHEAS, AND KNEES ARE JUST A FEW BODY PARTS THAT CAN NOW BE CUSTOM-MADE. MODEL HEARTS, BONES, AND TRACHEAS

As a medical illustrator, Andy Matlock fuses two worlds that are often seen as dichotomous: science and art. But his work, housed in the Center for Surgical Anatomy and Technique, is critical for educating a new generation of surgeons and medical students. His job? To make intricate anatomical structures leap off the page, literally.

“There’s something you get out of a 3D space, seeing a real model, that you can’t really get from a 2D image,” he says, holding up a 3D-printed heart and pointing out the coronaries wrapping around the organ. Then he opens the heart like a locket, revealing carefully shaped cavities and tiny, flapped valves.

Most of his products end up in the Anatomy Lab and Suture Lab courses, where students can examine the models up close. Using 3D-printed materials helps to reduce the demand for organs harvested from pigs and cadavers. And printed bones, unlike the real thing, can be handled more freely and even taken home for further study.

Deanna Altomara

A synthetic trachea, one of his most popular models, allows students to practice tracheostomies. The 3D-printed plastic is covered by a thin silicon skin made of the same material used for special effects gore in movies. Matlock recalls the challenge of building the perfect design for the model—not only did he have to search for a material that could simulate cartilage, he had to maneuver the material through different types of extruders and printer heads. He also built an online blueprint for the model and decided where to incorporate structural supports so the trachea wouldn’t fall apart during the printing process into a “spaghetti of extruded plastic.”

His favorite project modeled a small section of the bronchiole. Using PET/ CAT scans from a cancer patient, he created a model that showed precisely where the tumor was in the lung. Surgeons took the model into the operating room and used it as a guide to ensure that they removed the entire mass while preserving as much healthy tissue as possible.

One project he works on in the Serpooshan Lab is a cardiac patch, complete with blood vessels, that can be applied to a patient’s heart after a heart attack or other major trauma. The patch delivers drugs and provides anatomical support that heals the muscle and prevents further tissue damage.

“We are really trying to not treat the symptoms, we want to be able to treat the causes,” says Tomov. He highlights the importance of the interdisciplinary nature of the work. “If you focus only on the engineering side, you might lose sight of what you’re actually making and you’ll have this great platform that’s not usable. Or if you’re just looking on

TISSUE FOR HEART PATCHES

At the Wallace H. Coulter Department of Biomedical Engineering, Martin Tomov builds technologies with an eye toward clinical applications. Using bio-inks, or specialized formulas that can support living cells, he creates realistic tissue replicas that can be used for research or patient care. His job is to “make something that both resembles the tissue in three-dimensional space and has a lot of the functionality of the tissue.”

PHOTO JACK KEARSE

“We are really trying to not treat the symptoms, we want to be able to treat the causes,” says Martin Tomov, assistant scientist.

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the other side, at the clinical aspects, you may come up with a great concept that is still 50 years into the future because we don’t have the engineering capability to create it. Communication between the two sides is very important for the field and that’s what’s going to move it forward faster and more efficiently.”

PEDIATRIC HEART DEFECTS

Assistant Professor of Pediatrics Holly Bauser-Heaton works with 3D models of the heart, specializing in models of pulmonary vein and artery defects. Many children are born with these defects, which often require surgical correction.

But Bauer-Heaton noticed a recurring problem: even if the surgery went smoothly, scar tissue would sometimes develop, causing the corrected vein or artery to narrow.

Bauser-Heaton uses 3D-printed models to test whether different surgical techniques, such as tweaking the angle or diameter of a vein, might prevent scarring. “I work with the surgeons a lot with pulmonary artery reconstruction and it’s really challenging when you say, ‘Oh, can you move this a half a millimeter over?’ ” she says. “They’ll say, ‘No, not really.’ ” The 3D-printed models allow surgeons to analyze, plan, and test different techniques, all without any risk to the patient. After surgeons have tested a new technique, Bauser-Heaton hooks the 3D-printed models up to a machine that simulates blood flow. By pumping

synthetic blood through the models, she can measure the changes in flow patterns, vein stiffness, and dilation.

These models are beneficial because they don’t just replicate the anatomical structure of the heart; they also capture cell behavior. The cells in the model can expand, dilate, and react to different environments just like the cells in a person’s heart. This characteristic makes the models ideal for studying pharmaceutical interventions. Bauser-Heaton can make several copies of the same heart, treat them each with a different drug, and see which drug produces the best results in a specific patient.

Bauser-Heaton is meticulous about producing models with realistic textures and consistencies. “We use something called gelatin methacrylate as our ink,” she explains, “We almost make a gummy-bear consistency by using methacrylate to give it structure. Then you’re able to print it in whatever shape you want and alternate the stiffness. I can make it harder or like jelly.” She can add the cells to the ink before the printing process or insert them into the gelatin structure afterward.

CUSTOM KNEES

Mathew Pombo, an orthopedic surgeon and director of Emory’s soccer medicine program, uses 3D printers to design custom replacement knees for patients. The technology offers quicker recovery, less blood loss, easier range of motion, and better long-term wear for patients.

At the Heart of it All Holly Bauser-Heaton, assistant professor of pediatric cardiology at Emory School of Medicine, is the co-director of the Pulmonary Artery Reconstruction Program at the Children’s Heart Center. Having cardiomyopathy herself, Bauser-Heaton says, gives her special understanding of her patients.

PHOTO ROBIN HENSON

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“After performing a CT scan, we use an automated design that maps the size and shape of the joint in 3D,” says Pombo, assistant professor of orthopedic surgery at the Emory School of Medicine. “The software allows us to precisely match implants and instrumentation to the model of the knee.”

The unfortunate reality is that all athletes “transition from their prime into the aging athlete category where you can see the impact from a lifetime of sports and activity,” says Pombo, who has performed more than 500 3D knee-implant surgeries. “The patient-specific 3D knee implant is ideal for an aging athlete who suffers from an arthritic knee and is considering surgery.”

Patients’ hospital stays have been reduced by this procedure, which allows surgery to be performed as an outpatient procedure with patients returning home on the same day.

A STENT THAT FITS

When COVID-19 and a fungal co-infection destroyed part of Judina Taylor’s windpipe, the situation seemed dire.

A month after contracting the disease in January 2021, she was still having difficulty breathing, speaking, sleeping, and swallowing. She sought treatment at Emory Hospital Midtown, where pulmonologists Abesh Niroula and Wissam Jaber took on her case.

“When I met Dr. Jaber and the team back in 2021, I felt like I was going to die,” she said, “COVID-19 really took over my body with no remorse. I will never forget Dr. Jaber saying, ‘You fight, we fight!’ ” But the fight was not easy. Upon seeing that Taylor’s left airway had collapsed, the doctors implanted a stent to help her breathe. There was one problem: the stent didn’t fit.

Traditionally, stents are made to be one size fits all, an approach that works well in straight airways. Taylor’s airway, however, was misshapen from extensive inflammation and scarring. As a result, the stent kept moving out of alignment, creating tiny gaps where bacterial

INNOVATION IN ACTION

PHOTO JACK KEARSE

truly optimistic and 100-percent hopeful about my recovery,” she says.

PHOTO COURTESY EMORY ORTHOPAEDICS AND SPINE CENTER

infections could take hold. Every three weeks or so, she would end up in the emergency room, where she would text Jaber, “Hey, I’m here.”

Over the course of the next year, she underwent up to 18 bronchoscopies to clean or replace the ill-fitting stent. Then Niroula had an idea: Why not customize a stent for Taylor?

The physicians uploaded copies of Taylor’s CT scans into software from the Vision Air company based at Cleveland Clinic. The Emory doctors designed the stent, placed the printing order, and within a few weeks, received a stent designed to perfectly fit Taylor’s airway.

In February 2022, Niroula and Jaber implanted the new, custom-made stent.

The results were incredible.

Not only did Taylor finally clear the persistent infection that had haunted her for a year, but she experienced significant improvements in breathing, coughing, and sleeping. Eventually she will need surgery, but in the meantime this development has enhanced her quality of life. “Since the placement of the present silicone stent, I have been

REPAIRING AN ANKLE JOINT

After a severe car accident, Natasha Bass wondered if she would ever walk again.

With both legs and ankles broken in multiple spots, healing was complex.

She developed talar avascular necrosis, which meant her ankle bone was losing blood supply and dying.

She was referred to the Emory Orthopaedics & Spine Center, inside the Emory Musculoskeletal Institute building in Brookhaven. Rishin Kadakia, an orthopedic surgeon, suggested they try a 3D-printed talus implant coupled with an ankle replacement and the surgical fusion of several bones.

In August 2021, Bass received a custom, 3D-printed cobalt chrome talus implant. “I was really excited to have something so new,” she says. “And it was going to give me the best quality of life so I could go back to work and be able to do things I used to do.”

Careful patient selection and counseling is key to 3D-printed implants, says

Kadakia: “They are not for every case— but in some instances they can provide an innovative option when there are limited surgical solutions.”

Bass has been dedicated to her rehabilitation and recovery since day one.

She’s getting back to visiting her friends and family and taking daily walks. She enjoys riding her bike and being in nature “to have that peaceful time for myself and calm my nerves. Nature makes you realize you’re alive.” n

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RE

THE POWER OF

THE LAST WORD

REEXAMINE

Factoring in patients’ experiences is essential for moving the needle on health disparities By

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EMORY MEDICINE

Sylvie Leotin n Illustration by James Steinberg

From being butchered during a biopsy and then later receiving a diagnosis of breast cancer by email, my health care experience was a nightmare from start to finish. It led me, a Black person with broad multidisciplinary expertise in research and innovation, to pivot my career to improve cancer care for underserved patients by bringing their voices into research and design.

I am currently the principal investigator of a $750,000 health equity innovation grant from Genentech, in collaboration with Emory School of Medicine.

As part of the grant, which began in the winter of 2021, I have been conducting in-depth research with Black people with cancer. My interviews have revealed heartbreaking stories of poor treatment and biased care. A young Black woman was denied a mammogram despite a growing lump, persistent pain, and swollen lymph nodes. A Black man was sent to a shabby, questionable clinic for cancer treatment, even though he had good insurance and better options abounded. A Black woman landed in the emergency department with a blood clot in her lung after a crescendo of dismissed symptoms.

Marginalized people know that these stories are not uncommon. Yet health care institutions are either somehow unaware of this or turn a blind eye to it.

Clinical research shows that Black people bear a significantly higher burden of medical errors, dismissed symptoms, misdiagnoses, treatment delays, and substandard care than white people. A Black woman in America is three times more likely to experience pregnancy-related death, has a 41% higher chance of dying of breast cancer, and is more likely to die of a slew of other illnesses, including Covid-19.

Racial health disparities in health and health care are not new. They have been observed and quantified across all major diseases for decades. Funding for health equity has increased.

Yet the needle doesn’t seem to have moved. I see this as a people problem.

Before being diagnosed with cancer, I spent several decades in technology innovation, helping companies decode human problems, uncover unmet needs, and translate them into innovative products. I repeatedly witnessed how companies failed when they tried to build products to solve human problems without understanding users’ perspectives.

Human-centered design processes were developed to address this gap. They start by seeking to understand the feelings, needs, and perspectives of the people being designed for and end with purpose-built solutions to meet their needs.

Human-centered design is widely used in many industries today, but its use is lagging in health care.

While digging deeper and reading through health equity research and publications, I was astonished to discover that

patients’ perspectives were largely absent. The research was largely conducted by clinicians and often exhibited only a superficial understanding of patients’ experiences.

To uproot the inequities that have plagued the US for centuries, it is essential to understand the experiences of underserved and marginalized people. There is no shortcut or way around it. Fixing health disparities without insights from them is like diagnosing an illness without knowing a patient’s history. It leads to false assumptions and misdiagnoses. Doctors know this; they are taught that 80% of the diagnosis is the patient’s history. To be sure, access is an important barrier to health equity. I applaud the researchers and health equity champions who have worked hard to improve access to health care, which benefits countless people. But access is only half of the equation.

Improving access doesn’t change what happens inside hospitals and clinics once Black and marginalized people are admitted and seen.

As a Stanford-trained scientist who has worked in high-tech for decades, I love data. But as a patient, I have come to recognize that scientific rationalization is not enough to Sylvie Leotin is founder and CEO of improve outcomes. UnlockEquify Health, a health care innovaing progress means no tion lab dedicated to health equity.

She is partnering with Emory School longer seeing health disof Medicine as PI on a health equity parities as statistics. Health innovation grant. inequities are, first and foremost, a human experience problem. They manifest viscerally as excess physical, emotional, and psychological pain that depletes people already weakened by severe illnesses. The perils of addressing health equity without understanding patients’ experiences are significant.

They lead to slow progress and stagnation—every year without moving the needle results in continued excess deaths. To see health disparities evaporate in this generation, they must no longer be treated as a data problem. Only the marriage of data and human insight will unlock human progress. For this, we must factor in the lived experiences of those excluded and poorly served by the health care system.

Until health care recognizes that disenfranchised patients are part of the solution, not the problem, significant improvement won’t be made in health care equity. If the goal is inclusive care, the road to getting there must also be inclusive.

Equity in care cannot be achieved with a mindset and processes that exclude the very people who hold the keys to the solution.

This essay first ran in STAT news as a First Opinion piece.

PHOTO COURTESY SYLVIE LEOTIN

Three years ago, when cancer turned my life upside down, I never imagined I’d have to fight to receive high-quality care at one of the country’s best hospitals. But I did.

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News and views from Emory School of Medicine alumni Fall 2022

Healthcare by Design

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PHOTO COURTESY BYRON CROWE

Mass Avenue Bridge

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T EMORY, BYRON CROWE 17M WAS PRESIDENT OF THE EMORY CYCLE AND TRIATHLON CLUB. NOW, HE EXCELS IN A DIFFERENT TYPE OF EXERCISE: THE DESIGN SPRINT.

Crowe is co-founder of Healthcare by Design, a nonprofit that uses human-centered design to improve clinical care spaces. The organization places people firmly at the center of care by focusing the needs of patients, families, and staff. Healthcare by Design has run design sprints with participants from across the globe, training healthcare workers in design methods and exploring innovative solutions to the most pressing problems. Crowe’s fascination with improving health systems began years ago.

An Atlanta native, Crowe earned his undergraduate degrees in biochemistry and molecular biology and history at the University of Georgia before taking a job at Emory Healthcare. As a program coordinator in the Office of Quality and Risk, he reported to William Bornstein, the chief quality and medical officer at Emory, who taught him the foundations of healthcare quality improvement. At Emory’s School of Medicine, he became interested in a parallel form of systems improvement called design thinking, which looks at how humans interact with a complex system.

Crowe explored this field in-depth during his residency, when he worked as a physician-in-training and medical director at a healthcare technology startup, Solera Health.

At Solera, he guided the organization in deploying digital health tools to help commercial Alumni key

5 Things to Know About Byron Crowe

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After moving cross-country to Boston, he has now officially traveled to all 50 states.

As a new Bostonian, his favorite activities are riding his bike to work across the Mass Avenue bridge and enjoying the great Italian food in Boston’s North End. A former president of the Emory Cycle & Triathlon Club, he still enjoys endurance sports, and most recently undertook a mountaineering expedition to Denali in Alaska.

He loves space history: one of his favorite medical school memories was a trip to Cape Canaveral to watch the launch of a SpaceX mission.

His favorite place in Colorado is Estes Park, the gateway to Rocky Mountain National Park.

A-allied health B-business C-Emory College FM-fellowship M-medicine MR-residency N-nursing OX-Oxford College PH-public health

EMORY MEDICINE

PHOTO COURTESY BYRON CROWE

insurers address chronic disease prevention and management using evidence-based approaches.

“Understanding people is a critical part of deploying our digital health capabilities,” he says. “When we put ourselves in our users’ shoes—looking at their clinical, social, and emotional circumstances—we can see the world through a new lens that allows us to design solutions that can be broadly adopted.”

Crowe not only examines the clinical evidence behind the intervention, he asks, “What is this going to do from a physiological standpoint?” and “How do we deploy it in real life with real human beings?”

Humans, he says, are not only driven by a desire to achieve optimal health.

They have competing demands on their time and energy.

He favors spaces that “allow a mixture of clinical knowledge—the scientific background on the treatment and management of disease—with the opportunity for creative exploration of large, unstructured problems.”

His fusion of design thinking—aptly called human-centered design—and quality improvement methodologies enable him to effectively analyze medical problems embedded in complex personal and social contexts.

His work with design thinking and quality improvement was recently showcased in the article, “To Improve Quality, Leverage Design,” published in BMJ Quality and Safety, the leading international journal for healthcare quality improvement.

Healthcare By Design has hosted international design sprints with hundreds of participants to tackle problems such as maternal health, the digital revolution in health care, and delivering COVID-19 vaccines to children.

The process of a design sprint, which can last anywhere from a half-day to several months, is based on the double-diamond model developed by the British Design Council. It features a four-step process: discover and diverge, define the problem, develop a variety of solutions, and deliver the solution.

Last year, Crowe used this process to mentor an Emory team in the Pre-Applications Clinical Knowledge and Skills block of Emory School of Medicine’s curriculum. The team, which created a prototype within the electronic medical record to contextualize high-risk radiology results made available to the patient, was a finalist in the competition.

When it comes to his own solutions, Crowe’s expertise lies in digital health. Most people think of digital health as telehealth or the electronic medical record, he says, “but digital health is much broader than that. Digital health encompasses all the different ways that computers and computing technology enable us to deliver healthcare differently.”

Examples include wearables, health-monitoring apps, and more. “I think of it as the intersection between analog care and human capabilities,” he says.

“What can we do with our minds and our senses, and what can we do to use the power of computers to take in and analyze data and produce insights.”

This past year, Crowe graduated from residency and began work as an academic hospitalist at Beth Israel Deaconess Medical Center and instructor in medicine at Harvard Medical School. He continues to pursue his work in digital health as Chief Medical Officer at Solera, alongside his ongoing work at Healthcare by Design, and is planning to complete a master’s in clinical informatics at Stanford.—Deanna Altomara Alumni key

Working Against Injustice When Mark Fenig 10MR sees injustice around him, he does something about it.

As executive director of the New York City-based Medical Justice Alliance, Fenig has enlisted more than 100 doctors to help PHOTO COURTESY MARK FENIG inmates get better medical treatment, free or at minimal charges. “There was a team of public interest lawyers in the state of Oregon who were trying to stand up when it came to the rate of people getting sick and dying of Covid being much higher in prison than outside of prison,” says Fenig, who also works as an emergency medicine physician at Montefiore Medical Center.

“They needed physicians to provide expert testimony as part of the court cases.”

He learned there was also a need beyond offering expert testimony. “I began recruiting physicians and residents,” he says. “We took on dozens of cases in Oregon to help the habeas teams and it changed conditions for the better.”

Since, the Alliance has helped lawyers in more than 20 states, with about 150 doctors doing work for the Alliance between shifts, he says. Efforts have shifted from COVID to areas such as compassionate release. “There can be a medical component to the request or claim, and lawyers will ask us to provide written documentation about the [inmate’s] medical conditions. It seems to make a big difference,” he says. “We help show the judge the medical picture, which is essentially about educating the judge through translating medical jargon to lay terms.”

The Alliance has helped prisoners acquire medical needs from medications to a CPAP machine.

Fenig credits Emory’s Emergency Medicine Residency Program with improving his ability to adapt. “I miss Grady.

I learned so much there,” he says.

During his last year of residency, he volunteered with response efforts after the 2010 Haiti earthquake: “In just a few days, I helped set up and stock a kind of urgent care clinic and trained two people to run it after I had to leave.”

His work with the Alliance supporting inmates has been incredibly gratifying as well, he says. “Some of the health conditions are just wrong,” he says. “These are human beings and they need to be treated that way.”

“It can be hard when you’re seeing so many of your own patients,” he says, “but you can be done with a shift and make a call related to a case, or find a doctor who is able to be an expert for a case, and you remember, ‘This is part of why I became a doctor.’ ”­—Eric Butterman

A-allied health B-business C-Emory College FM-fellowship M-medicine MR-residency N-nursing OX-Oxford College PH-public health

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HEALING PEOPLE SHOULD START WITH

HEALING BUSINESS

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Emory University Alumni Records Office 1762 Clifton Road Atlanta, Georgia 30322

C071997

This is my legacy.

“AFTER MY HUSBAND ALAN LOST HIS BATTLE WITH LYMPHOMA, I wanted to help find a cure. As a lifelong educator, I believe that private research universities promote the insatiable desire for knowledge

Red Sky at Night

that leads to breakthroughs. At the Emory

Robert Taylor, director of cardiology, captured this fiery sunset and a slice of the Atlanta skyline from the physicians’ parking deck of Emory University Hospital.

found the right way to honor Alan through

School of Medicine, with its focus on education, research, and patient care, I my estate—by creating a scholarship for a deserving medical student.”

Have you planned your legacy? giftplanning.emory.edu 404.727.8875 Sandra Kirschenmann Marietta, Georgia