Georgetown Medicine Magazine Spring/Summer 2020

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Aging & Transformation New research, education, and approaches to care

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Aging & Transformation

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Musings Aging: We do it every day

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The Silver Lining

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Building in-person empathy with

Georgetown trains the next generation of health leaders in the field of aging

Virtual Reality

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Slowly Breaking Ground in Alzheimer’s

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A Mother’s Gift

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Ends and Beginnings

Georgetown researchers look at memory and cognition in the aging brain Accompaniment, acceptance, and love as the end draws near The unique perspective of a hospice and labor and delivery nurse

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Reader Feedback Check Up News & Research

On Campus Alumni Connections Reflections on Medicine Edmund Duthie, MD (M’76)

A note on COVID-19: Much of this issue’s content came together before the current health crisis emerged. We will explore the impact of the pandemic in our Fall/Winter issue.

Please contact us to share your stories: georgetownmedicinemagazine@georgetown.edu.

From the Archives: Healing in Nature In the 1870s, Georgetown established a landscaped sanctuary on campus, next to the college infirmary.

The tranquil pleasure ground overlooking the Potomac River offered a place of retreat and healing.

For more photos and history of the Infirmary Garden, visit the university archives at library.georgetown.edu.

READER FEEDBACK

A publication for alumni and friends of the schools and programs of Georgetown University Medical Center

A Lesson in Compassion After reading with great interest the Fall/Winter 2019 edition of Georgetown Medicine magazine about Georgetown’s response to the AIDS epidemic, I noticed a face was missing from the picture on page 18: my father, Charles R. Tartaglia, MD (C’58, M’62, R’66).

He was at Thursday Night Clinic representing the psychiatry department at Georgetown University Hospital. I was a student at Georgetown Visitation, and walked to the hospital after school. There I waited until a room became available for me to study in, until my father was ready to drive us home after seeing patients or doing hospital consults.

Thursday evenings changed in the 1980s. I waited and studied and waited some more. Dad would return after 9 p.m. with a warm hello, but I sensed he was amidst something serious and consuming. I became familiar with the names of infectious diseases colleagues Dr. Phil Pierce and Dr. Princy Kumar. I recall my parents referring to these evenings at the AIDS clinic, but I only knew the acronym stood for Acquired Immune Deficiency Syndrome. I knew not to complain about my wait. There was something very important going on.

At my father’s wake after his death in September 2013, Dr. Mary Young, a clinic colleague, approached me, thanking me and apologizing for taking my father away on those Thursday nights. She said his psychiatric expertise was needed by both the patients and the medical team.

And it all came full circle. Yes, yes, I remembered those Thursday nights.

I am a physician practicing Primary Care Pediatrics at Boston Children’s Hospital and at the Martha Eliot Health Center in Jamaica Plain. Now in my 50s, the same age my father was when Charles R. Tartaglia, MD AIDS patients first entered Georgetown Hospital, I realize that my father found his passion at work with this team of colleagues.

At that time, my father was surrounded by a team who shared his courage and confidence, and who dared to embrace AIDS at Georgetown.

He thrived in the collaborative environment. It was a clinic where they shared the same goal: the patient. “To hurt with”—this is how my father defined compassion to me. He said he was a physician first and a psychiatrist second. I learned from my father that disease is complicated and enters patients’ lives without invitation, clarity, or predictability. It at times has no end point. The HIV virus and AIDS is one such example.

My father would not have wanted me to share this story to recognize him, but to share with our Georgetown alumni how grateful he was to be part of this Thursday Night Clinic. I too was impacted by sitting, waiting, and feeling the weight in the air at Georgetown during these early years of the AIDS epidemic when the uncertainty of this deadly virus pervaded our community. Through this I learned that caring for patients is a privilege and a responsibility.

— Maria Tartaglia Pearl, MD (M’95, R’98)

Maria.Pearl@childrens.harvard.edu

Editor Jane Varner Malhotra

Assistant Editor Chelsea Burwell (G’16)

Contributors Rhea Bhatt (G’22) Bill Cessato (C’98, S’16) Kate Colwell Jeffrey Donahoe Martha Dee Gay Patti North Beth N. Peshkin Samantha Poremba Irene Sanchez Brualla Camille Scarborough Karen Teber

Design Director Robin Lazarus-Berlin Lazarus Design

University Photographers Phil Humnicky Paul Jones

Executive Vice President for Health Sciences and Executive Dean Edward B. Healton, MD, MPH

Dean for Medical Education Stephen Ray Mitchell (W’86), MD, MBA Georgetown Medicine is published by the Georgetown University Office of Advancement Communications. Visit online at alumni.georgetown.edu/medicine-magazine.

The magazine welcomes inquiries, opinions, and comments from its readers. Address correspondence to georgetownmedicinemagazine@georgetown.edu or: Jane Varner Malhotra, Editor Georgetown Medicine Office of Advancement P.O. Box 571253 Washington, DC 20057-1253 For address changes contact alumni records addup@georgetown.edu or 202-687-1994.

For information on Georgetown events and alumni news on campus and around the world, visit alumni.georgetown.edu. © 2020 Georgetown University On the cover: Friends Elliott Barnes Tomasek (6 months) and Rochelle Jaffe (82) share a moment of transformation. Photo by Lisa Helfert.

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NEWS & RESEARCH

Students Mobilize Medical Supplies On March 17, the Association of American Medical Colleges advised suspending student contact with patients, and Georgetown heeded that guidance.

Within a few hours, six third-year medical students, led by Hannah Day (M’22), had set their sights on mobilizing a national student-led movement to support those on the front lines of the pandemic response. By the next day, they had a mission statement, a new website, and a social media presence.

MedSupplyDrive collects personal protective equipment (PPE) from researchers, businesses, and individuals around the country and coordinates donations to hospitals with the greatest need.

By activating their networks, the organizers generated a remarkable response.

In just over a week, the movement attracted more than 341 volunteers from 37 states, including volunteers from 41 undergraduate universities and 66 medical schools. The numbers are growing by the n n

day, as reports of health workers facing intense shortages of PPE increasingly dominate the headlines.

“We understood that a lot of students like us were suddenly sitting on the sidelines during this crisis, wanting to be involved, and feeling downhearted that they were taken out of clinical rotations at a time when it felt essential to help,” says Zuby Syed (M’22), coordinator of communications and one of the founders.

MedSupplyDrive volunteers have collected PPE from research labs, tattoo parlors, construction and auto body companies, and individuals, among others.

There is no minimum donation—even one box of masks will help, according to the organizers.

With the exception of the pickups and deliveries of donated equipment, the entire operation is virtual.

All information from donors, health care providers, and volunteers is managed via their website:

Allison Rooney (M’21), national logistics and DC coordinator at MedSupplyDrive, collects donations from a research lab.

medicalsupplydrive.com.

Regional coordinators around the country organize local volunteers and coordinate donations.

The streamlined donation process is geared to minimize human contact. Donors are advised on how to package their equipment or supplies.

Then a volunteer arranges a “no-contact” pickup and takes the materials directly to a local hospital.

“We’ve tried to evolve quickly because every day the picture of this pandemic is changing, and the need for

PPE continues to grow,” Syed says.

The team analyzes statistics on coronavirus hot spots daily, adjusting social media outreach to ensure they reach regions most in need.

Organizing the effort has offered students a lifelong lesson about pivoting toward something positive when it feels like a door has closed.

“We believed there was definitely something we could do and needed to do,” Syed says. “Lives were on the line.

We connected with others that felt similarly.” n

“Individuals find people to blame based on their prejudices, or make themselves feel less at risk by finding points of discrimination between themselves and others.”

— Alexandra Phelan, member of the Center for Global Health Science and Security and assistant professor in the department of microbiology and immunology, addressed the perils of misinformation fueling xenophobia amid the COVID-19 global pandemic in The Atlantic in February 2020.

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New Home for HOYA Clinic The student-driven HOYA Clinic reopened last fall in a new location in the nation’s capital after the DC General Family Shelter shuttered its doors in 2018.

Temporarily closed during the COVID-19 outbreak, the free health service site, operated by School of Medicine volunteer students and faculty, sits off the lobby of The Triumph, a sparkling new family shelter in Ward 8’s Congress Heights neighborhood.

In January, the clinic was abuzz as people waited to get care.

“The word is spreading.

We’re beginning to get patients coming back to see us,” said Eileen Moore, MD, medical director of the HOYA Clinic and associate n n

dean for community education and advocacy at the School of Medicine.

Transitioning from the DC General site where the clinic had been since 2007, students rose to the challenge to establish a new location.

After months of writing grant applications, filing a certificate of need, and coordinating with the city, they secured space at The Triumph, one of the District’s newly opened temporary homes with about 50 families. The shelter is run

by Community of Hope.

With just one exam room, the new HOYA Clinic is much smaller than the fiveroom facility at DC General, so students designed efficient clinic flow with the patient’s needs first.

Portrait Unveiled In honor of her trailblazing career and unwavering commitment to patient care and medical education, Princy Kumar, MD (R’90), was celebrated with a painted portrait as the latest addition to the school’s “Women on the Walls” campaign. Kumar, senior associate dean of students, professor of medicine, and chief of infectious diseases and travel medicine at MedStar Georgetown University Hospital, is the fourth recognized in the collaborative effort to increase visibility for women’s contributions to the Medical Center.

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Nick Bader (M’22), one of the eight clinic coordinators, said that considering the patient experience was key to creating a successful plan.

“Are they being seen on time? Do they have enough time with the provider? Are they seeing a seamless clinic flow? I think that continuing this way of thinking will only help me as a physician,” he said.

The clinic’s move was significant, especially for medical students in their preclinical years.

“The students have handled every single portion of this transition,” Moore said. “They are truly the ones who made this reopening happen.”

With students at the helm, the HOYA Clinic family continues to grow, attracting students interested in social justice.

After working in a similar clinic during her undergraduate years, Julianne Kiene (M’23), an upcoming clinic coordinator, chose to attend Georgetown for its social

justice mission. Her call to work with underserved communities also stems from personal experience.

“I grew up in a small town and doctors weren’t really accessible,” she said. “When you live in an impoverished, rural community, there aren’t many places to go. It’s like a double-edged sword: people don’t have money and don’t have doctors.”

As the clinic continues to evolve, it’s clear that one thing remains the same: the dedication Georgetown students have to the DC community.

“There’s a magical interaction that happens when you take a bright, eager Georgetown student, with a social justice mission deep in their heart, and a patient living in suboptimal circumstances, and put them together in a room,” Moore said.

“The patient knows that the person really cares to be there with them. They can feel that—and that’s a wonderful chemistry we have to keep alive.” n

Research Talent Elevated Two new interim deans, representing some 70 years of combined experience, stepped up to lead at the Medical Center last fall.

In September, Carole Roan Gresenz, PhD, became interim dean of the School of Nursing & Health Studies. Gresenz is a health economist with a distinguished record of research and leadership in the health field and a professor in the Department of Health Systems Administration. She also served as senior associate dean and held the Bette Jacobs Endowed Professorship.

As researcher and scholar, Gresenz has funding from the Agency for Healthcare Research and Quality, the Department of Defense Congressionally directed Medical Research Program, and the National Institute on Aging at the National Institutes of Health.

Her research projects include examining early stage Alzheimer’s disease and financial well-being, aggressive versus conservative treatment of low-risk prostate cancer, the effectiveness of an innovative school-based dental care delivery model in high-need communities, and racial and ethnic differences in outcomes for common surgical conditions.

She holds her master’s and doctorate in economics from Brown University and a bachelor’s degree in economics from Loyola University Maryland. Prior to Georgetown, she spent

Bottom: Maria Carluccio

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more than two decades in senior leadership at RAND Corporation.

“I look forward to engaging with NHS’ students, faculty, staff, and alumni more broadly as we embark on our work together this year,” Gresenz says.

In October, Moshe Levi, MD, professor in the Department of Biochemistry and Molecular & Cellular Biology, became interim dean for research. His own study focuses on renal, hepatic and cardiovascular complications of obesity, diabetes, and aging.

He studied chemical engineering at Northwestern University and Stanford University. At Albert Einstein College of Medicine, he began to apply engineering theory to human health.

Regarded as a researcher’s researcher by his colleagues, Levi has coauthored 200 manuscripts and written nearly 40 book chapters, serves as the chair of the Board of American Physician Scientist Association and has mentored more than three dozen MD and PhD trainees.

Levi, who arrived at Georgetown in 2017, is known for his deep conviction to interdisciplinary research.

“We collaborate with other people who study other diseases including breast cancer, liver disease, and liver cancer,” he says.

“In this day and age, you can’t do it all yourself.” n

“The most important thing in public health is not to drive the population underground and make them fearful. You want them to cooperate. You want them to report their symptoms. You want them to believe that the government is there to help them and not to violate their rights. It’s very, very difficult to control an epidemic once you’ve lost the trust of the population.”

— Lawrence Gostin, Founding Linda D. & Timothy J. O’Neill Professor of Global Health Law, told NPR in January 2020 after China’s decision to begin COVID-19 shutdown procedures in Wuhan.

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Quitting Time Adding smoking cessation interventions to lung cancer screening can reduce mortality by 14% Including smoking cessation with existing lung cancer screening efforts would reduce lung cancer mortality by 14% and increase life-years gained by 81% compared with screening alone, according to a study led by researchers at the University of Michigan and Georgetown Lombardi Comprehensive Cancer Center.

The study is published in the Journal of Thoracic Oncology.

Georgetown Lombardi’s Kathryn Taylor, professor of oncology and a member of the Georgetown Lombardi Cancer Prevention and Control Program, says the new data should encourage clinics and hospitals to invest in cessation programs. n n

“For many individuals, undergoing lung cancer screening is a time in which they become very motivated to stop smoking,” Taylor says.

“Individuals who are able to quit, sometimes for the first time in their entire lives, have improvements in their quality of life and a sense of satisfaction that comes with gaining control over their smoking.”

Taylor is leading one of the eight randomized clinical trials as part of the National Cancer Institute’s Smoking Cessation at Lung Examination (SCALE) collaboration.

Annual lung cancer screening with low-dose computed tomography (LDCT) is recommended for adults aged 55 to 80 with a greater than 30 pack-year smoking history

who currently smoke or quit within the previous 15 years.

Since about 50% of screen-eligible individuals are current smokers, cessation interventions at the point of screening are recommended. However, information about the shortand long-term effects of joint screening and cessation interventions is limited.

The researchers used an established lung cancer simulation model to project the impact of cessation interventions within the screening context on lung cancer and overall mortality for the 1950 and 1960 US birth-cohorts.

Two million individual smoking and life histories were generated per cohort.

Simulated individuals were screened annually. The research team then simulated a cessation intervention at the time of the first screen, under a range of efficacy assumptions.

Even mildly effective cessation interventions could greatly enhance the impact of LDCT screening programs, the researchers say, because cessation would prevent various tobacco-related diseases. n

A bacteria typically linked to periodontal disease, Fusobacterium nucleatum (F. nuc), could play an important role in the rising incidence of colorectal cancer in people under the age of 45. Another type of bacteria, Moraxella osloensis, has been found in colorectal cancer tumors at a nearly four-fold higher rate in people over 75 than in those under 45 years of age, pointing out how differences in the bacteria that comprise the n n

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microbiome could affect cancer outcomes.

These are preliminary findings of a study from researchers at Georgetown Lombardi Comprehensive Cancer Center.

Colorectal cancer incidence has been declining for several decades in people over 55, in part because of the increased use of screening for the disease, particularly with colonoscopy, which can find and remove polyps before

they become cancerous. Such screenings are generally not recommended for people under age 50.

But colorectal cancer rates have been increasing at nearly a 2% annual rate in people under age 55 since 2006, possibly due to a rise in obesity, diabetes, and diets low in whole grains among younger people.

“We haven’t seen large genetic differences in colorectal tumors from younger versus

Bottom: iStock / Top: Ian Dooley

Linking Gut Bacteria, Age, Cancer

Global Inclusion Rhodes scholar pursues equity for people with disabilities Sara Rotenberg (NHS’20), a senior global health major committed to creating an equitable world for people with disabilities, has been named a 2020 Rhodes Scholarship recipient from Canada. The Georgetown senior joins the 26 Rhodes scholars produced by the university, including President Bill Clinton (SFS’68), and is the first to earn this achievement from the School of Nursing & Health Studies (NHS). She will use the Rhodes to pursue an M.Phil. in evidence-based social intervention and policy evaluation at the University of Oxford.

“This is an extraordinary accomplishment and our entire Georgetown community joins me in offering our sincere congratulations to Sara,” says Georgetown President John J. DeGioia. “Her dedication to her studies as well as her advocacy for the equity of people with disabilities embodies the very best of our values as a university.”

Rotenberg says her study of disability inclusion policies and global development gives rise to several questions. “What are the impacts of disability-inclusive policies? How can we use data from successful examples of disability-focused development projects to make disability a consideration in all international development projects?”

Conducting research through the Global Health and India Initiative, the Georgetown senior completed her research practicum as a part of the Department of International Health’s curriculum at the World Health Organization’s Regional Office

for South-East Asia (SEARO) in New Delhi. She spent this past summer working on two projects in India—examining the inaccessibility of transit systems and developing a transportable, collapsible stool for people with disabilities and mobility challenges.

“Ultimately, I hope to work on disability inclusion and equity in international development,” she says.

“My time working on gender, equity, and human rights at SEARO has reaffirmed this focus, as the limited data on disability demonstrates the need for more research to create Rotenberg is the first Rhodes scholar from proactive, effective policy in the School of Nursing & Health Studies. this area.”

The Toronto native says she was drawn to Georgetown’s global focus, emphasis on practical training, and world class faculty.

“I hope to both contribute to greater equity and inclusion for people with disabilities by working on disability policy and access issues in low- and middle-income countries, and by continuing to create assistive technology,” Rotenberg notes. n

older people, so we hypothesize that something else, perhaps the microbiome, is contributing to the rise in incidence of the disease in younger people,” says Benjamin Adam Weinberg, MD, an assistant professor of medicine at Georgetown Lombardi.

Scientists have known that certain microbes that comprise the microbiome, which consists of different types of bacteria, fungi, and viruses,

tumors, as well as adjacent normal tissue when available, from 31 patients with colorectal cancer who were diagnosed before the age of 45 or after the age of 65.

Overall, the investigators found 478 unique bacterial and fungal species in the tumors. One of the most common bacteria found was F. nuc, which appeared in five of the younger patients’ tumors and in three of the older patients’ tumors. The

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can disturb the lining of the colon and promote tissue inflammation. This can result in mutations to the DNA of cells in the colon and lead to cancer. Researchers also know that F. nuc can promote cancerous growth by suppressing immune responses in the colon.

To better understand the role of the microbiome in colorectal cancer, Weinberg and colleagues looked at the DNA and microbiome of archived

researchers also found a significant difference in the rate of Moraxella osloensis (11% vs. 46%) in younger compared to older patients.

“There was a much higher presence of F. nuc in younger patients than we expected,” says Weinberg. “As to whether this bacterium alone can explain some of the rise in incidence of colorectal cancer in younger people is something we need to explore.” n

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Aging & Transformation New research, education, and approaches to care

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Enjoy these healing stories, and the gift of age.

Jane Varner Malhotra Editor

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National Gallery of Art, Fidelia Bridges, Pink Roses

hat is aging, really? We all do it every day, with each breath, from our first to our last. To transform is to change shape. No denying that happens with age!

A friend who teaches middle school reminded me what an incredible transformation a seventh grader experiences just from September to May, in less than a year.

So how do our bodies, our brains, change form with age? We’re learning more as an increasing percentage of the population is living seven, eight, nine decades.

As the global COVID-19 pandemic reminds us so acutely, age is a gift. Aging is living, and to find the grace in it is our opportunity and our challenge.

What does a wrinkle or silver hair signify in our culture? How can we better understand and care for one another in our different stages of life? A child’s transformation is marked in predictable phases of maturity. Adults move through these evolutions, too, though some are more physically visible than others.

In the following pages, read about Georgetown’s continuing contributions in the field of aging: long-term brain research, expanding knowledge about health and aging in society, and ethics and patient care for life’s beginnings and ends.

Pause for three personal reflections on the process of growing older—for teenagers, for retirees, for all those seeking balance.

When we see ourselves as aging works in progress, always unfinished and in transformation, perhaps we free ourselves to live more fully but with ease, like a flower bud emerging, unfolding. Each blossom is part of the larger, interconnected system—the thorny leafy stem, the entire sweet-scented rose bush, the garden, the dirt, the forest. All creation, renewed in spring.

AGING & TRANSFORMATION

The Silver Lining Georgetown trains the next generation of health leaders in the field of aging

By Lauren Wolkoff (G’13)

Three years ago, with two graduate degrees and nearly 25 years of experience in higher education administration under his belt, one law school dean had his eye on retirement.

In his mid-50s at the time, attorney Scott Foster (L’93, G’21), then a senior administrator and assistant dean at Georgetown Law, was looking to recharge his batteries and possibly pivot to a new career.

Equipped with a good sense of his strengths, Foster wasn’t certain how he wanted to apply them. He was pleased and not entirely surprised when an aptitude test surfaced the field of assisted living and nursing home management. Wth his background in administration, and the knowledge that the field of aging services was becoming prominent, the results resonated with him immediately.

Foster recognized he would need more specialized education. Georgetown’s new Master of Science in Aging & Health, launched in 2018, fit the bill perfectly.

Now 57, Foster is the oldest person in his cohort. Proudly so, he notes, despite feeling somewhat rusty in terms of writing academic papers and adjusting to being back in a classroom.

“The program was actively looking for a range of ages, so the fact that I was in my mid-50s was a plus,” Foster says. “I believe that the expertise I gain in the program, coupled with my long career as a senior-level administrator, will ideally position me for a new career in the field of aging.”

Dreamstime.com

Reframing the Aging Process The topic of aging has enormous implications for our society.

In the next four decades, the number of Americans aged 65 or older is projected to nearly double, from 52 million in 2018 to 95 million, according to the Population Reference Bureau. This means that nearly one in four Americans will be 65 or older by the year 2060.

This impending demographic transformation has garnered nicknames such as the “silver tsunami,” evoking the image of a massive wave of senior citizens on the horizon.

Yet when we frame aging as a looming problem, we miss the opportunity to engage people of all ages in a more productive, positive way, according to Pamela A. Saunders, PhD. An associate professor in the departments of neurology and psychiatry at Georgetown University Medical Center (GUMC), Saunders is founding director of the new graduate program.

“We have a unique challenge to address a population that’s going to have a lot more older people than it has in the past— and that's a good thing. We’re living longer. We’re healthier,” Saunders says. “Modern medicine has helped us to reach an older age, but these population changes affect all of society, so we need to consider what they mean for all of us.”

The aging population raises myriad economic, workforce, housing, and health care questions and opportunities, and Saunders hopes the new program will help prepare students to respond to them.

Intergenerational Dialogue Now in its second year, the graduate program is attracting students from a wide variety of backgrounds and experience levels, cultivating a “dialogue between multiple generations,” says Vi Nguyen, the program coordinator.

“They’re learning from each other. The program naturally attracts people from different age groups, so it leads to intergenerational collaboration,” Nguyen says.

Some, like Foster, are attempting a career pivot or reinvention, while others are just starting out.

At 24, Darya Rahbar (G’20) is the second-youngest person in her cohort. She says she has always had a “soft spot for older adults.” After realizing early on that a career in primary care wasn’t for her, she enrolled in the Georgetown graduate

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program, ultimately deciding on a concentration in Health Care Economics and Policy.

While she was initially intimidated by a multi-generational classroom, Rahbar now says it is one of the aspects of the program she values most.

“I’m benefitting from it immensely. I’m learning from those people who have a different life perspective that comes from more experience, but I also feel like I am bringing something to the table,” Rahbar says. “I feel more empowered than I expected to step up and meet people where they are and have them meet me where I am.”

She adds that she and her colleagues share an “underlying curiosity and a profound respect for older adults and the process of aging.”

“A lot of people are scared of aging, but in this class there is a genuine fascination. People are not afraid to ask questions and push boundaries in terms of their respect for one another and for this population,” says Rahbar.

Another strength is the program’s interdisciplinary approach, notes Foster. Faculty members bring expertise from departments across the university, including the School of Medicine, the School of Nursing and Health Studies (NHS), the Law Center, and the McCourt School of Public Policy. A highlight for Foster has been an elective in elder law, which connected to his legal roots.

A monthly seminar series features speakers from various university departments, as well as local and national experts.

From GUMC, speakers from the spring semester have included NHS Interim Dean Carole Roan Gresenz, PhD,

that, rather than seeing older adults as a one-dimensional “problem” to deal with, students view them as people with lived and living experiences who bring complexity and richness to the world.

“Older adults tend to get discriminated against, but we want to reframe that so we begin to think and talk about the accumulated wisdom and knowledge and experience, and how to put it to good use rather than putting it on a shelf,” she says.

Teaching Aging in Medicine Beyond the MS program, Georgetown’s efforts to teach students about aging are woven throughout the medical and nursing curricula.

According to Mary Furlong, MD (MS’91, M’95, R’00), senior associate dean for curriculum at the School of Medicine, the topic is not broken out as a separate unit, but rather is fully integrated into the preclinical curriculum, for example in the central nervous system module and pharmacology course. The aging lens can be applied to almost any disease or condition.

The School of Medicine also places a heavy emphasis on bioethics, where medical students learn about issues related to palliative and end-of-life care.

Furlong is an advocate for exploring how the topic of aging can be better represented across students’ four years. “I feel very strongly that we need to be educating our medical students about this topic in a variety of ways. Anyone who has a parent or relative who is aging or dying can tell you how crucial it is,” she says.

Geratrics OSCE (objective structured clinical examination) in progress: Third-year medical student Wilton Robinson (M’21) visits with actor Lona Livingston, who plays a standardized geriatrics patient struggling with sleep disturbance (left). Professor Pamela Saunders observes from the Control Room (center). Afterwards, participants gather to debrief (right).

discussing the effects of early-stage Alzheimer’s disease on household financial outcomes, and R. Scott Turner, MD, who directs the Memory Disorders Program (see story on page 18 for more on these researchers).

Saunders says the interdisciplinary approach helps ensure

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Once students begin their clinical training, they encounter aging across several different compulsory clerkships, including family medicine, neurology, internal medicine, and obstetrics/gynecology.

In addition, approximately 20 third-year medical students

each year choose to do a two-week geriatrics clerkship. The goal of this elective is to have students see older people not just as patients in need of care once they are sick, but also as people who have needs while they are well.

“To study the aging process is really just to study people,” says Saunders, who directs the geriatrics clerkship in addition to the masters program. “Geriatrics focuses on a range of health-related issues for people in mid to late life.”

As with many clerkships, the geriatrics one culminates in what is known as an objective structured clinical examination (OSCE), a simulated exercise in which an actor presenting as a standardized patient tests competency in areas such as clinical skills, communication, examination technique, and other facets.

“We do one case with an older adult who has problems sleeping, and the student has to talk to the patient to find out what’s going on and come up with a plan. Then the older adult gives them feedback based on their communication skills,” Saunders says.

On top of these efforts, the School of Medicine is using virtual reality software at its Dahlgren Memorial Library that provides students a sense of what aging patients experience—by enabling them to virtually enter the body of a patient who is experiencing age-related conditions such as macular degeneration or hearing loss, cancer and end-of-life issues, or memory loss (see story on page 16).

The Value of Home Health At NHS, aging is threaded throughout the various undergraduate and graduate degree programs as a part of overall care.

One standalone course, available to undergraduate as well as some masterslevel nursing students, is devoted to studying older adults. In one assignment, which is premised on the District’s Department of Aging and Community Living Safe at Home Program, students conduct hypothetical assessments of home environments.

The goal is to determine if they would be safe for older adults to return to after being treated in the health care system.

“Nursing students are usually doing clinical care in an acute care setting such as a hospital, so they are not in people’s homes. Therefore they don’t really appreciate all the issues in the home that can contribute to or impede someone’s health and well-being,” says Margaret Granitto, ANP-BC, CNL, an instructor in the department of professional nursing practice and coordinator for the course on older adults.

“This drives home the point that you might be taking care of someone in the health care delivery system, but you are going

Donna Cameron enjoys connecting students and seniors through the School of Medicine’s community-based learning course.

to be transitioning them somewhere else that might be fraught with danger,” says Granitto. “If you need to discharge someone with a broken hip, what does their home look like? Do they need to go up and down stairs? These are the types of issues we want students to be thinking about.”

NHS also offers an advanced distanced-based degree in aging, the Adult-Gerontology Acute Care Nurse Practitioner specialization, as part of the Master of Science and Doctor of Nursing Practice programs. This curriculum prepares registered nurses for leadership roles as providers through case studies, standardized patient experiences, and high-fidelity simulation, according to Kelly Thompson-Brazill, DNP, RN, assistant professor at NHS who directs the program.

“Complicated psychosocial issues, such as an acutely ill older adult patient signing out of the hospital against medical advice to care for a terminally ill spouse, are built into each learning activity,” Thompson-Brazill says. “Students are expected to competently manage each patient’s clinical condition using current medical evidence and guideline-based care, while providing patient- and family-centered care.”

Building Community Connections An education in aging at Georgetown often means getting out of the classroom and into the community.

All first-year medical students at Georgetown take a community-based learning (CBL) course, where they can choose from an array of initiatives in the DC area to gain a deeper understanding of a specific population—typically one that is medically underserved. Each year, about 40 students out of nearly 200 choose a CBL related to older adults, where they design and lead activities with older adults and staff at various sites.

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According to Donna Cameron, PhD, MPH, professor of family medicine in the School of Medicine who has run the CBL course for the past 20 years, these experiences resonate deeply with students year after year.

Students are often surprised by how connected they feel to the older adults through these visits, notes Cameron.

“This is the kind of exposure we want our medical students to have and to receive. We want them to experience bringing joy to people who are not sick and to learn about the lives of older adults before they become ill and seek medical care,” Cameron says.

“That patient in Exam Room 2 has a family, a life, a career,” she adds. “All of those influences can impact your diagnosis and plans for treatment. One of the objectives of the CBL course is to understand the factors of one’s everyday life that help to determine a person’s health status before they become a patient.”

At IONA Senior Services, a CBL site located in northwest DC, a small group of first-year medical students collaborate

with staff to devise activities for folks in their memory disorders day program.

“What’s so important for the participants is that they are being challenged, and their senses are being stimulated through different types of art-based activities,” says Julia Langley, who brings the students there each year. In addition to teaching at the medical school, Langley is the faculty director of the Arts and Humanities Program at Georgetown Lombardi Comprehensive Cancer Center.

“For different but related reasons, the time the students and the participants share together is an amazing gift,” Langley says. And even though they may not remember the students’ names each time, the seniors eagerly anticipate their visits with Georgetown medical students.

“The students who work with the participants are learning the importance of being present,” notes Langley. “They don’t have to be talking, they don’t have to know everything, they just have to pay attention and be there.” n

Georgetown University Aging-Related Programs and Resources AgingWell Hub at the McDonough School of Business

Senior Citizen Non-Degree Audit Program

A collaborative of diverse organizations focused on research, partnerships, open innovation and shared frameworks to improve products and services for the aging population and their caregivers

School of Continuing Studies offers people over 65 the opportunity to audit undergraduate level courses chosen from the regular course offerings

Mini-Medical School Virtual Reality Training at Dahlgren Memorial Library Immersive technology that allows students at the School of Medicine to step into the aging patient’s experience using a headset and software (see story, page 16)

A twice annual community-oriented 8-week lecture series that allows area residents (including but not limited to retirees) to explore various areas of the basic and clinical sciences that mirror Georgetown medical school topics

Association of Retired Faculty and Staff

Doctors Speak Out

A group that supports emeriti members’ professional endeavors, facilitates social ties, and provides volunteering and community outreach opportunities

Quarterly luncheon series inviting local residents (including but not limited to retirees) to hear directly from university experts about advancements in biomedical science and implications for medical practice

Georgetown University Learning Community Program Series of non-credit mini-classes for individuals 55 or older taught by volunteer retired faculty and others on topics such as politics, art, literature, and science

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ROMEOS: Retired/Retirement-Approaching Old Medics Eating Out Informal social group of physicians who meet monthly for lunch and lectures, and who are trained by or connected with the School of Medicine and MedStar Georgetown University Hospital

A Spiritual Retirement Plan

By Myles N. Sheehan, SJ, MD

In my years practicing geriatric medicine, along with my experience as a Jesuit priest, I have noticed how carefully many plan for their retirement and older years.

There are needed and prudent decisions about finances and savings, consideration given to moving and downsizing, along with the happy planning of what possibilities aging might open. People look forward to travel, the ability to have more time for leisure and hobbies, as well as simply relief from some of the pressures that work and raising a family can bring. But it is worth taking the time to consider a spiritual retirement plan.

tennis, golf, cruises, and continuous entertainment. An Ignatian spirituality of aging looks at aging as a gifted time to find God’s presence in a new period of life, time to reflect on the experiences of one’s life as well as savor the present, and, in a way that is real and honest, prepare for the fact that life comes to an end and that there may well be hard times before the journey is over.

In the Principle and Foundation which begins the Spiritual Exercises of St. Ignatius, Ignatius posits that our lives have a purpose and a goal: relationship with God that is meant for eternity. All of creation, everything we experience, provides us with an opportunity to find God and discover God’s plan for us.

Per Ignatius, it does not matter if we are rich or poor, have good or bad health, a short life or a long life. All the circumstances of our lives provide the opportunity to find God. Given that many of us live so much longer, what is God’s invitation? Answering that invitation in our older years is a great way to build a spiritual retirement plan.

How do we do that? Take the time to think about prayer, our relationship to a worshipping community, and the opportunity to find someone who could serve as a spiritual guide. These are important parts of the response.

But a good place to start is to daydream, like Ignatius, on what we desire in our older years and reflect on our hopes and fears. Then simply talk to God. n

Bottom: iStock

Given that many of us live so much longer, what is God’s invitation?

Ignatian spirituality takes our daydreams and desires seriously. Indeed, St. Ignatius’s conversion began as he reflected on his experience while recovering from a badly fractured leg, caused by a cannonball! Our daydreams and desires can point to where God is calling us, no matter what stage of our lives.

The notion of finding God in all things, another central part of Ignatian spirituality, is still vital and compelling with advanced years. When one considers that many people are living 20 to 30 more years than they might have expected when they were young, it is clear that God is giving a gift to be appreciated with the years of aging.

What might God be calling us to in retirement and older age?

Aging certainly has its challenges. It can be presented in a lurid manner as a time of feebleness, decline, memory loss, and horror. Equally inaccurate is pretending that aging is all about

Myles Sheehan is a Jesuit priest, an ethicist at Georgetown’s Pellegrino Center for Clinical Bioethics at Georgetown, and a former specialist in geriatric medicine.

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Building in-person empathy with

Virtual Reality

By Kate Colwell

This frustrating and confusing experience is a learning tool designed to help medical professionals understand the perspective of a patient with Alzheimer’s disease. Georgetown University School of Medicine has partnered with Embodied Labs to bring immersive VR experiences to students in the geriatrics clerkship, and to incoming students in the new Master of Science in Aging & Health program.

CEO and founder Carrie Shaw created Embodied Labs after becoming a caregiver at age 19 to her mother, who had early-onset Alzheimer’s disease. Now, the modules she developed are being used to help Georgetown students step into the perspective of patients experiencing her mother’s condition, as well as macular degeneration, Lewy body dementia, Parkinson’s disease, and end of life. VR users can move the animated hands of the patient persona and also see, hear, and speak with actors who were filmed for the simulations.

“These virtual reality experiences put you in the body of the patient,” says Linda Van Keuren, assistant dean for access and resource management at the Medical Center’s Dahlgren Memorial Library. “Each patient has a name and people will talk directly to you.”

VR is not new to medical education, and Georgetown is making investments to expand offerings, says Jett McCann, director of Dahlgren Memorial Library and senior associate dean for knowledge management.

A growing movement for more empathy training also matches the Jesuit values that attract medical students to Georgetown. “We have a responsibility here to explore things,” says McCann. “Teaching empathy underscores cura personalis.”

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Brian Stauffer

In the lower level of Dahlgren Memorial Library, Beatriz is chopping a potato. No matter how many times she lifts the knife, she can’t seem to wield it properly. She looks up in her kitchen, and sees her family singing happy birthday to her. Then the kitchen fades away and she is in a field of flowers. When the kitchen returns, her family stares at her with worried faces.

The simulation ends, and the Georgetown medical student takes off his virtual reality (VR) headset.

Third-year student Lorrane Kabert (M’21) experienced simulated vision and hearing loss through the macular degeneration module during her geriatrics clerkship. “It was so difficult to hear what people were saying to me, which was very upsetting,” she notes. “I felt ignored. I was even more upset with the physician's interaction with me.

He wanted me to take an exam, but the instructions were not clear and even though it was obvious that I did not understand, he proceeded with the exam without making sure I understood what to do.”

The VR lesson also reminded Kabert how important it is to check in with patients when delivering instructions, to make sure they understand everything. She’s determined to be a better physician as a result. “I was left with some feelings of guilt, appreciation, and desire to become an even more considerate and empathetic doctor,” she adds.

VR-based empathy training is one strategy to address systemic challenges facing caregivers who serve a rapidly aging patient population. Longer hours, more compressed

with heavy debt loads to choose other, more lucrative paths.

When presented with these concerns, the School of Medicine Parents Council made a $27,000 gift to convert an old staff lounge in the library into a VR lab with enough space for safe movement while wearing headsets.

The new lab space will open in the fall, equipped with Oculus Rift equipment, six individual computer stations, and one group experience screen.

Saunders is hopeful that the lab will offer more educational opportunities for students. “VR allows us to expand the number of experiences a student can have,” says Saunders. “Not everyone who rotates in geriatrics will work with a patient suffering from Alzheimer’s in those two weeks. This could be a great way of introducing geriatric medicine to the entire student population. If we could give every third-year student a chance to do those modules, that would be really powerful.”

The modules expose students to a diversity of patients, demonstrate how doctors work in teams with nurses and social workers, and teach more techniques. With increased funding, New simulation software offers the library could medical students the virtual purchase modules experience of a person with related to orthopedics, assessments conditions such as Alzheimer’s of gait and funcdisease or macular degeneration. tional ability, treating a patient after a fall, and many surgical applicatime with patients, and higher stress are all taxing on tions. All such applications would maximize students’ doctors’ empathy in modern medicine. Research shows in-person learning opportunities with real mentors and that empathy in medical students declines from firstpatients. year to third-year, says Associate Professor Pam Saunders, “In all medical fields, we’re really trying to teach empaco-director of the geriatrics clerkship, and director of the thy, compassion, and understanding of other perspectives,” Master of Science in Aging & Health program. says Saunders. “VR would never replace working with In addition, medical education about aging populations patients one-on-one, but it is a nice supplemental strategy. poses an access issue. “Geriatrics is one of the poorest It’s one tool in our toolkit to help support those goals of paid specialties,” says McCann, leaving medical students caring for the whole person.” n

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Six-month-old Elliott Barnes Tomasek offers a gentle reminder that aging starts early, and continues every day throughout our lives. He is pictured here and on the cover with his friend Rochelle Jaffe (82), a retired bookstore owner, who lives with memory loss.

Slowly Breaking Ground in Alzheimer’s Like the disease itself, the study of Alzheimer’s takes time and patience. Georgetown researchers walk the long road to uncover the mysteries of memory and cognition in the aging brain.

By Michelle Andrews

Lisa Helfert

M

edical researchers have found the keys to cure many maladies that cause sickness and suffering, but Alzheimer’s disease has for decades remained a stubbornly resistant foe.

The Food and Drug Administration last approved a drug to treat the disease nearly two decades ago, and all four of the currently approved drugs provide, at best, a modest improvement in symptoms for a while.

Family members feel helpless as they struggle to provide care for their loved one, who seems to fade into the persona of a familiar-looking stranger.

Meanwhile, the number of Americans living with Alzheimer’s continues to grow, and now approaches six million. With no way to prevent it and no cure in sight, it is the sixth leading cause of death.

These troubling statistics haven’t deterred researchers at Georgetown University Medical Center, several of whom are engaged in groundbreaking research on different aspects of this complex disease.

Alzheimer’s is the most common cause of dementia. It is characterized by abnormal levels of beta-amyloid proteins and accumulations of neurofibrillary tangles in the brain that disrupt how nerve cells communicate and result in a loss of neurons. These changes gradually affect people’s ability to think and reason and remember. Eventually, they can no longer perform daily tasks or live independent lives.

Aging is the most common known risk factor for Alzheimer’s disease. After age 65, the number of people with Alzheimer’s doubles every five years. By the time someone is 85, the likelihood of having Alzheimer’s “is almost a coin flip,” says G. William Rebeck, professor of neuroscience at Georgetown, who heads the university’s Laboratory of Aging and Neurodegeneration.

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Family history and genetics can also increase the odds that someone will develop Alzheimer’s disease. The APOE gene is associated with significantly higher risk; if someone has one copy of the APOE4 variant of the gene, their risk of developing the disease is pushed forward by five to seven years, Rebeck says.

Cancer Treatment and Cognition The APOE4 gene figures prominently in the work of some Georgetown researchers. Jeanne Mandelblatt, a professor of oncology at Georgetown’s Lombardi Comprehensive Cancer Center, is investigating the interaction between cancer and cancer therapy and cognition in older breast cancer patients, including those with the APOE4 allele.

Mandelblatt didn’t set out to study Alzheimer’s. She spent much of the past 30 years conducting research on the intersection of cancer and aging, with an early focus on breast and cervical cancer screening. Mandelblatt’s research helped pave the way for Medicare to cover Pap smears to screen for cervical cancer, the first preventive benefit that the program covered.

She continued to advocate for health care for older women at risk for or with cancer.

Mandelblatt was curious about older women with breast cancer, a little studied group whose aging brains, she theorized, might be more vulnerable to cognitive decline after cancer and its treatments.

Mandelblatt’s research demonstrated that older women with breast cancer wanted similar treatment options as those offered to younger women, including aggressive therapy regimens. Her work led to an interest in the long-term cognitive effects of chemotherapy and hormonal treatments, the foggy thinking now referred to as “cancer-related cognitive impairment.” She was curious about older women with breast cancer, a little studied group whose aging brains, she theorized, might be more vulnerable to cognitive decline after cancer and its treatments.

What she and her colleagues learned, in a large study of older women with breast cancer aged 60 to 98, was that most women did not suffer long-term cognitive ill effects after chemotherapy or hormonal treatment. But there was one conspicuous exception: a small group that had the APOE4 genetic variant. Two years after completing chemotherapy, with or without hormonal treatment, women with one or two copies of the APOE4 gene had significantly lower cognitive scores

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related to attention, processing speed and executive function than those with other APOE genotypes.

(About 25% of people in the United States have at least one copy of the APOE4 gene, whereas roughly 65% have only the APOE3 genetic variant, which doesn’t affect the risk of developing Alzheimer’s. Approximately 10% of people have the APOE2 gene, which actually reduces a person’s risk of developing Alzheimer’s disease.)

How to explain what was happening in these women?

Cancer and cancer treatments probably don’t themselves cause Alzheimer’s disease. “Is what we’re seeing an unmasking of neurodegenerative disease in women who were already on a course of developing dementia?” Mandelblatt wondered. “Or are they suffering cognitive declines as a result of cancer and treatment for the cancer, which may have accelerated their aging process?”

The Role of Genetics Mandelblatt approached Rebeck, who works with animal models, to discuss collaborating on this research. Rebeck, a well-known expert on the link between APOE and Alzheimer’s, uses mouse models to try to understand why inheriting different forms of the APOE gene affects people’s risk of developing Alzheimer’s so markedly.

Rebeck and his colleagues in the lab set out to see if they could replicate the results in mice that Mandelblatt had observed in people. In a recently published study, Rebeck, Mandelblatt, and Georgetown colleagues reported that, like their human counterparts, mice with human APOE4 genes showed markedly impaired learning after receiving a common chemotherapy drug compared to APOE3 mice that were given the same drug. After treatment, APOE4 mice that were placed in a maze had much more difficulty locating the escape hole, compared with APOE3 mice that received the same treatment.

The results pave the way for researchers to explore the interaction at the genetic and molecular level between the APOE genotype and other chemotherapy drugs in mice. These experiments aren’t feasible to conduct in humans, but they could help researchers glean information about the potential effectiveness of different drugs in individual patients.

Ultimately, the research could provide clues to preventing Alzheimer’s disease altogether, says Rebeck.

“Could I treat the APOE4 mice with something before they were given chemotherapy that would prevent the cognitive impairment in the first place?” he wonders.

Rebeck didn’t plan on a career in Alzheimer’s research. After receiving a bachelor’s degree in chemistry and then a PhD in toxicology from Harvard University, he got a Fulbright fellowship and took a post-doctoral position at a lab in Germany that specialized in Alzheimer’s disease. It was the early 1990s, and

not much was known about it.

“Since I started out kicking around in different areas, I think I always imagined I would kick around more, but I never did.

This stayed interesting and productive,” he says. Rebeck has been at Georgetown since 2003.

Rebeck, who also has a master of fine arts in writing, occasionally explores science from a completely different perspective: he writes plays. His subjects have ranged from a play about the life of Dr. Alois Alzheimer, a German neurologist whose research led to the identification of Alzheimer’s disease, to a 10-minute dialogue between a pair of placebo control lab mice who are dealing with existential angst.

Trials of the Long Road Another key locus for studying the impact of Alzheimer’s disease and other types of dementia at Georgetown is the university’s Memory Disorders Program, which provides clinical care for patients with Alzheimer’s disease and recruits patients for and oversees their participation in several national and international clinical trials to test drugs to prevent or treat the disease. Last year, the program celebrated its 20th year.

Though he acknowledges that progress in key measures to combat the disease has been disappointing, program director R. Scott Turner remains optimistic.

“We’ve been persistent, and I think we are going to develop new treatments eventually,” he says. He points to incremental advances over the past several years that have greatly enhanced researchers’ ability to understand the disease and identify predictive biomarkers decades before the disease appears. For example, PET neuroimaging scans that can detect beta-amyloid plaques in the brain can now be performed on living patients, opening the door to treatment in the disease’s early stages.

Turner is also optimistic about the prospect of new drugs in development, particularly Biogen’s immunotherapy drug, aducanumab, which harnesses the body’s own defenses to fight disease and which has shown promise in slowing cognitive decline in patients with early-stage Alzheimer’s.

“It looks like we may have arrived at a whole new way to treat the disease with monoclonal antibodies,” Turner says. “It’s a crack in the door.”

The drug testing process has been a rollercoaster, however.

Georgetown was one of the sites in a multi-center phase 3 clinical trial of the drug. But that trial and another identical one were halted last spring when the drug failed a key test. After conducting a new analysis of a larger dataset from the trials, Biogen determined that the drug is effective at the highest dose and has submitted it for approval to the Food and Drug Administration.

Turner points to other significant studies led by Georgetown, including successful phase 2 trials of resveratrol

and nilotinib, both of which also take aim at amyloid plaques in the brain. Neuroscientist Charbel Moussa uncovered the new use for the repurposed cancer drug nilotinib, and along with Turner, recently completed a study in people with Alzheimer’s disease. Results are expected soon.

The Memory Disorders Program is also involved in clinical trials of experimental drugs that could prevent Alzheimer’s disease. Results of those trials are expected in the next two to three years, according to Turner.

Gresenz has explored how the disease plays out in people’s financial lives, particularly in the years immediately before diagnosis when neither they nor their families may realize that their financial decision-making and judgment may be impaired.

A neuroscientist, Turner has spent his career researching Alzheimer’s disease, first conducting animal research and then transitioning to human clinical research. He took over the Memory Disorders Program in 2008.

One of the biggest challenges the Memory Disorders Program faces is finding enough people to participate in the clinical trials that are crucial to testing drugs that are in the pipeline, Turner says. Some of that stems from a failure to diagnose the disease in the first place.

“One issue is that the medical community doesn’t like to bring up the topic of dementia,” he says. “It may never be discussed with patients, and even if they do develop cognitive problems, there’s a reluctance to bring up Alzheimer’s.”

Clues from the Bottom Line Where her colleagues focus on understanding the biology and genetics of Alzheimer’s disease at the cellular level, Carole Roan Gresenz’s research examines Alzheimer’s from a behavioral perspective. The health economist has explored how the disease plays out in people’s financial lives, particularly in the years immediately before diagnosis when neither they nor their families may realize that their financial decision-making and judgment may be impaired.

Gresenz and colleagues merged Medicare claims data with data from a large, longitudinal survey of Americans over age 50 that asks them about their financial assets and liabilities, among other things.

The researchers found that in the two to three years before

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people received an Alzheimer’s diagnosis, they and their families faced a heightened risk of experiencing a reduction in their net worth, especially in liquid assets like savings and checking accounts.

As their cognitive abilities falter in the early stages of Alzheimer’s disease, people may lose the ability to handle routine financial tasks like balancing their checkbook and paying bills on time. They may also make inexplicable purchases as their memories fail, like a woman who bought the same pair of blue jeans over and over, says Gresenz, the interim dean for Georgetown University’s School of Nursing & Health Studies.

The problems can be compounded because in the early stages of the disease, many families don’t yet realize that their parent or spouse is sick and needs help with these tasks.

“One of the things that is so significant is that these expenses are happening right around the time of diagnosis, just when people are going to need to spend money on their care,” says Gresenz.

Gresenz is beginning work on a related study that will link Medicare claims data with credit card data to get a more granular picture of people’s spending in the early stages of the disease.

Inspired by Family The issue resonates personally with Gresenz, whose mother developed dementia similar to Alzheimer’s several years ago, in her late 70s. Years before her diagnosis, her mother, who’d been widowed decades earlier and had capably managed her own financial affairs for years, inexplicably hired an unlicensed, uninsured contractor to put a new roof on her house. It ended poorly, and the financial repercussions were significant.

“Looking back, it might have been a canary in the coal mine,” says Gresenz. “In the early stages of the disease, people’s family members don’t have a strong signal that there’s a problem. They’re not aware of the deficits that are occurring.”

As the number of people with Alzheimer’s grows, many people have personal and painful experiences with loved ones who have the disease. Alzheimer’s researchers are no exception.

Like Gresenz, over the last 10 to 15 years Turner’s mother’s Alzheimer’s disease has slowly progressed.

“It’s been hard to watch,” he says. Knowing that in addition to age, family history is one of the strongest risk factors for developing the disease, Turner decided to find out if he had the APOE4 genetic variant that significantly raises the risk for developing Alzheimer’s. He swabbed his cheek and sent a sample of saliva to a consumer genetic testing company.

Happily, he learned that he does not.

The increasing ease with which people can learn their APOE status with at-home tests makes the quest to find

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answers all the more urgent for some researchers.

“What we’re witnessing now is that people are learning their APOE genotype, and there’s nothing they can do about their risk of these really serious conditions,” says Rebeck.

Not yet, anyway. But the search for solutions continues.

“A lot of people run the other way when they hear about or see Alzheimer’s,” says Turner. “But one of the largest unmet needs in all of medicine is the treatment or prevention for Alzheimer’s.”

Stay tuned. n

Living in the Present An avid reader and traveler, Rochelle Jaffe founded Washington, DC’s renowned Travel Books & Language Center in 1984, as well as libraries in Sierra Leone and in her Maryland retirement community in memory of her beloved daughter, Eve. “I’m a senior now, living with memory loss. But it doesn’t scare me. It’s a new experience, and I live one day at a time,” she says. Jaffe recommends a few favorite books Elliott and Rochelle from her collection on aging: contemplate their intergenerational friendship. n

Redeeming Dementia: Spirituality, Theology and Science

by Dorothy Linthicum and Janice Hicks

n

Dancing with Elephants: Mindfulness Training for Those Living With Dementia, Chronic Illness or an Aging Brain

by Jarem Sawatsky

n

Caring for a Person with Alzheimer’s Disease

by National Institute on Aging and National Institutes of Health

n

The Gift of Years: Growing Older Gracefully

by Joan Chittister

n

The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Other Dementias, and Memory Loss

by Nancy Mace and Peter Rabins

Teens and Aging

By Anisha Abraham, MD, MPH

What memories do you have of being an adolescent?

Do you recall becoming more independent and trying new things? Or do you remember having bad acne, feeling awkward and worried about what the future held? Adolescence can be a profoundly exciting time of change, growth, and maturity in the life span. In fact, many wonderful and intense things can happen, such as falling in love. Experiences that occur during the teen years can also have a profound impact on adulthood and aging.

community to another or have parents from different cultural or ethnic backgrounds. This brings unique strengths like adaptability and multiple languages but also challenges related to identity and belonging. Other hot topics that teens struggle with include eating disorders, media use, anxiety, and depression.

I find working with teens so important because adolescent health has a significant impact on adult health and well-being.

In fact, nearly 70% of premature adult deaths connect to conditions such as obesity and substance use that started during adolescence. As such addressing teen risk behaviors early on is critical. The good news is that caregivers and educators can do a lot to help positively shape teens’ lives.

As a pediatrician and adolescent health specialist, I see the value in making a strong connection with teens. Ask them what they are concerned about, what they are doing in their lives, plus give them the ability to speak confidentially and listen without judgment to stories about their personal life. In our adolescent clinic at MedStar Georgetown University Hospital, we support teens through the many issues that can occur during adolescence but also ensure that teens build on their natural strengths to handle life’s challenges (such as living during a global pandemic) and build resilience.

Adolescence is a powerful period of transformation. I am continually awed and inspired by the teens that I work with and the wondrous changes that they undergo. Looking to the future, I feel incredibly optimistic for what the next generation has in store for us and how much they will improve the world we know. n

Sujith Abraham

I am continually awed and inspired by the teens that I work with and the wondrous changes that they undergo.

Adolescence is defined as ages 12-20 years by the World Health Organization. What is fascinating is that the teen brain is only 80% developed, and all the parts of the brain are not fully connected until the mid-20s. These changes and connections make teens adept at learning new skills like speaking another language. However, there is also a constant tug of war between the brain’s reward center and the prefrontal cortex which regulates logical thought and organization. As such, it may be difficult for teens to fully regulate their behavior and put on ‘the brakes’ when needed. Young people are also more vulnerable to addiction or changes in brain development if they are exposed to drugs (such as vaping) or alcohol at early ages.

Young people today face unique issues. For example, the coronavirus pandemic has brought homeschooling and social distancing to the forefront and is completely transforming how teens study, work, and communicate. The current generation is also more diverse compared to previous generations. More young people have grown up as immigrants moving from one

Anisha Abraham is a pediatrician and teen health specialist on faculty at MedStar Georgetown University Hospital and Amsterdam University Medical Center. Her book Raising Global Teens: Parenting in the 21st Century will be released in fall 2020.

For more information, see dranishaabraham.com.

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A Mother’s Gift Accompaniment, acceptance, and love as the end draws near

By Beth N. Peshkin

Brian Stauffer

T

he room was dotted with balloons and party décor.

Glittery cards and flowers adorned the windowsill, and the “birthday girl,” my mom, had a soft smile on her face as friends and family visited. Being Charm City natives, we brought in our favorite Baltimore crab cakes for a celebratory dinner. I felt a cushion of love surrounding her that day: January 3, 2016. When she blew out the “8” and then the “7” candle on her frosty cake, I knew what I wished for. I wonder what she wished for.

But there’s another important detail in this montage: Mom was in her hospice bed. We celebrated her birthday and mourned her death in that bed. Just thirty days before, a neurosurgeon in the emergency room delivered her shocking diagnosis: four brain lesions from metastatic lung cancer. She had not been recognizably symptomatic or diagnosed prior to that.

On January 20, just two weeks after our birthday celebration, my sister called to tell me that Mom was “transitioning.” That morning, she had eaten a hearty breakfast, conversed lucidly with her caregiver, and she even stopped fussing about getting her nails buffed and filed—so the sudden downturn was unexpected. Panic stricken, I hurried from my home in Arlington, Virginia, imploring my sister to keep telling Mom that I was on my way: “Tell her to hang on—don’t stop telling her I will be there. Tell her to wait for me.”

When I arrived about an hour later, Mom’s eyes were closed but she nodded responses to my questions. She would smile; she squeezed my hand. I told her a terrible storm was in the forecast, and that if she opened her eyes in two days, she would see a thick white blanket from the impending Snowzilla.

Mom, ever practical, probably reasoned that she needed to get on with her transition if we were to have a funeral in 24hours and then hunker down. Indeed, within a couple of hours, her breathing slowed and rattled, and her cold fingers lay upon mine under the blanket. Our rabbi, whom I had called to her bedside, recited the deathbed Vidui, a Jewish confession prayer.

The second he finished, an eerie silence cushioned the room.

I leaned in to her and whispered in her ear, “I love you, I love you, I love you,” as she took her last breath.

Death as Life-Affirming What did I wish for? Actually, I suspect in one way or another my mother and I wished for the same thing. Interestingly, I don’t think either one of us wished for more time together, because we worried that would bring suffering to us both. I think what we wished for was a “good” death. At that point, what this meant to me was that she would continue to be comfortable, that she would depart this world tranquilly, and that there would be no hard decisions to make. I imagine she would have said she didn’t want to be a burden. I also knew that I wanted to be with her when it happened. To this day, I can sleep at night because I have great peace with her death—I saw and I felt her gentle passing. I don’t consider myself to be a religious person, but hers was a deeply spiritual passing. She had a good death.

Since then, I have thought about what that really means.

The notions, ironically, seem inexorably tied to living well before we die. If we are lucky, many of us live well in our later years.

But I wondered, why does it seem so hard to continue to live well right before we die? What is it that we hope for?

There are no easy answers to these questions. However, I have come to appreciate that two things are key: acceptance and communication.

For me, I was never in denial; I had accepted my mother’s fate weeks before in the ER. Maximizing the likelihood of a good death then meant lots of listening, talking, and sometimes battling to communicate well within our family and with the health care team. Our six-week trajectory, and all of its lessons, was our story. Indeed, it’s striking to me that people who have been on the end-of-life journey with a loved one usually have a unique story to tell about the end. Few passings are unremarkable.

Telling and listening to these stories, processing them,

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Caring Relationships What are some ways that health professionals can help their patients who are facing a life-limiting illness?

“Make the time to elicit patients’ hopes, worries, and even regrets,” says Myles Sheehan, SJ, MD, ethicist at the Pellegrino Center for Clinical Bioethics at Georgetown University and former specialist in geriatric medicine. Integrating the biopsychosocial model of care, he emphasizes not just medical concerns at the end of life, but other needs as well. “Yes we can provide excellent pain and symptom control. But for so many people, they worry about the loss of dignity as they lose independence. The good news is that dignity is inherent in our existence. Everyone deserves care and respect.”

Prior to joining the Jesuit community at Georgetown University this year, Sheehan developed “Recovering Our Traditions,” a curriculum aimed at improved end-of-life care in the Catholic community. Previously he practiced geriatric medicine at Beth Israel Hospital in Boston and Loyola University Medical Center in Chicago. In this capacity, he served as primary care physician for many patients. He cultivated a

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relationship with them, and in many instances, got to know them over a long period of time. He initiated discussions with his patients about their goals, recognizing that as they age or face illness, those goals would need to be revisited and would likely change.

Building and maintaining a relationship with a physician early on can be key to facilitating trust and decision-making at the end of life, notes Sheehan. “Relying on your lawyer about the specifics of your advance directive is like getting marriage counseling from your banker,” he says. “Take the time to talk with your doctor, and your family. Let somebody speak with your own voice if need be.”

Many of us are not so lucky to have this bond with our doctors. My mom had been with her internist for decades, yet he was not involved in her care during these last weeks of her life. For some patients, that’s when working with a palliative care team can be especially important. These specialists aim to improve the quality of life for people with acute or chronic illnesses, regardless of whether they are life threatening.

“We walk into a moment of crisis and find hope, peace, and connection,” says Michelle Milic, MD, assistant professor of clinical medicine at Georgetown’s School of Medicine in the Division of Pulmonary, Critical Care and Sleep Medicine, and member of the Division of Palliative Care team at MedStar Georgetown University Hospital. “This puts us in a blessed and privileged position.”

“Palliative care is about living well,” she adds.

Engaging with the team early, in some cases soon after diagnosis, can be very beneficial.

“Palliative care is interprofessional care focused on symptom management and maintaining quality of life. It is appropriate at any stage of a serious illness, and can be provided along with curative treatments,” Milic explains.

The majority of patients who qualify for palliative care do not receive it, she says, in some cases because trained providers are not available since the field is relatively new. Other times, people just don’t know to ask for it, or confuse it with hospice.

“It’s not the same as hospice care, when people are no longer receiving active treatment for their disease,” Milic explains.

“Our social worker describes palliative care as the umbrella, and hospice care is one of its supporting spokes.”

Treatment Versus Care The quality of death is closely tied to the quality of life. It is indeed a circle. Enter the doulas.

You may have heard of birth doulas. They are health professionals who provide support to women before, during, and after their pregnancies. Similarly, end-of-life doulas provide support to dying individuals and their families. From the Greek word for servant, a doula may help an individual create a life legacy or plan a funeral. Doulas tend to the needs and wishes of the

Michael Heckman

learning from them, contemplating our own mortality, making our wish lists—these activities are healthy. It’s not the stuff you talk about at cocktail parties, but it is exactly what you talk about at events like Death Over Dinner or Death Cafés.

These intimate gatherings—launched in the last decade and gaining popularity around the world—proffer comfort food and drink as people engage with each other over difficult subjects.

Neither support groups nor grief counseling sessions, they are facilitated conversations designed to increase awareness and open discussion about death and dying. The meetings forge connections and thoughts that become life affirming.

Coincidentally, I attended my first Death Café right around the fourth anniversary of my mom’s passing. It turned out that, relative to some of the other discussions we tackled that night, conversation flowed easily when the participants described what a good death meant. I was struck by how many of us talked about the fear of being in pain and wanting to avoid that. We also talked about what would provide comfort: The author with her mom, saying goodbye to our loved ones, Vivian Peshkin, in 2014. surrounding ourselves with music, nuzzling with our fur babies. So much of our conversation centered on what we will want in our last days and hours. Making our wishes a reality takes some planning. But the best-laid plans can easily get derailed unless we have a health care team who knows our preferences and works with us to attain our goals.

client and family as they arise, offering time and a supportive presence.

A possible and positive consequence of talking and thinking more about death might be living better, both mentally and physically. It may also mean that we consider and express what we value, what we want—and perhaps more importantly, what we don’t want—at the end of our lives. We may attempt to infuse more control into this scenario, but what happens when our intentions and plans do not materialize?

“When you gaze up at the starlit heavens, remember, the light once mine still shines within you.

Think of me, remember me, and my light will shine on through you.”

— Excerpt from the poem “Remember Me”

by Elizabeth Tragash, read at the author’s mother’s funeral

While there’s so much in between, consider the two ends of the spectrum. What happens if we want “everything” to be done, but treatment simply will not mitigate the disease or restore health, and may in fact hasten death? “Fighting” disease is part of the fabric of society. When it comes to cancer, we’re in it to win the “war.” Doctors often have the mindset that continuing to treat despite a dismal prognosis is what they are supposed to do.

But stopping treatment is not tantamount to stopping care.

“We’re not giving up,” Milic reminds us. “There’s always something we can do to support our patients and their families.”

“No matter what, I never abandon patients during their experience with illness,” Sheehan adds. “They always receive care.”

In some extreme cases of illness and despair, a person wants to abandon their life. Beyond refusing treatment, the patient wants to hasten the end of suffering. This person’s fight becomes a fight to die the way they want to, and the ethics around it are murky territory.

As for physician-assisted suicide, there’s no question where Sheehan stands.

“A good death never happens if I take that person’s life,” he says.

Sometimes in the final days or hours, heavy pain relief is offered for maximum comfort, but an unintentional consequence is that death ensues.

Some people remain alert and aware, although they are ready to die. Their mind and soul have prepared for the end, but the body isn’t there yet. It can be an agonizing time. When faced with what they perceive as the only option, some people carry out their own wishes by voluntarily ceasing to eat or drink.

Sheehan questions whether there is a better way, a response that aims higher. “In these situations, I would always wonder if there was more that could be said or done to affirm the value of the person’s life, and if there has been sufficient imagination and effort to mobilize resources that would allow someone to avoid such a tragic step.”

A Light Shining On For my mother, I knew she would accept her death when and how it came, but somehow it would still happen mostly on her terms.

During the week after the diagnosis, the oncologist informed me that she wanted to seek an ethics consult, because my sister and I would not consent to a risky lung biopsy. My mother’s wishes were clear, and she had made them known to the doctors in no uncertain terms: no chemo, no systemic treatment. Possibility of a chest tube if her lung collapsed? No way.

When the doctor persisted in scheduling the biopsy, she reported to me that my mother had agreed to the procedure— that she had indeed “consented” to it. However, at the time they had this discussion, the swelling in my mother’s brain had caused disorientation and confusion, so as I pointed out, she was not capable of truly consenting to this procedure.

With a shaky voice, I firmly told the doctor, “We’re not having an ethical problem. We’re having a communication problem.”

With that, we changed course and both doctor and daughter voiced their acceptance that there was little we could do to alter the inevitable. We pursued palliative treatment only, and I don’t think my mom felt an ounce of pain, at least not the physical kind. In the end, my mom gave her two daughters the gift of a good death.

For Milic, her work with patients and families, plus her own experiences with death and dying, help put everything in perspective. “I don’t take things for granted. Plans can dissolve in a heartbeat.”

For me, the illness and death of both my parents taught me to finally appreciate how to live in the moment, and to experience joy in the little things. Both personally and professionally, I now have a deeper understanding of the Ignatian ethos of what we espouse at Georgetown, cura personalis, care of the whole person, throughout the life cycle. n Beth N. Peshkin, MS, CGC, is a professor of oncology and director of genetic counseling at Georgetown Lombardi Comprehensive Cancer Center. This year she celebrates 25 years at Georgetown.

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Ends and Beginnings For hospice and labor and delivery nurse Nicole Heidbreder (NHS’13), standing with patients at the two threshholds of life gives meaning to all that’s in between.

It’s hard for Nicole Heidbreder (NHS’13) to casually answer that quintessential DC question, “Well, what do you do?”

The hospice and labor and delivery nurse usually says she works in birth and death in the medical setting, and then waits for the thousand-yard stare, the furrowed eyebrows, the confused “oh.”

It doesn’t help the conversation that, as a nurse for seven years, Heidbreder has developed an allergy to small talk and prefers asking the tough questions.

“Hospice and birth are phenomenal to me because you go straight to ‘Tell me how you’re doing?’ I would much rather have those conversations than go out to happy hour,” Heidbreder laughs.

A graduate of the School of Nursing & Health Studies accelerated second degree Bachelor of Science in Nursing program, Heidbreder has brought her unique blend of calm rationality and deep empathy to her hospital work, and to patients in need of endof-life or palliative care at hospices in the Greater Washington area.

Shutterstock

By Lora Strum

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Comfortable working in birth and death, Heidbreder considers the two events to be life’s great equalizers.

“When you’re in that much physical discomfort, it’s really hard to have a fake personality,” Heidbreder says. “You are the essence of you. I love being around people in that space.”

Heidbreder has gravitated towards those spaces for decades. Prior to attending Georgetown, she trained as a birth doula in California, where her mentors encouraged her to embrace the overlap between birth and end-of-life care.

Inspired, Heidbreder began to offer her own doula workshops in 2009, and in 2017, applied those principles to what she calls her “death work.” This includes a podcast (“The Magical Deathcast”), a death meditation series, and bi-monthly Death Cafes—salon-style meetings where strangers share coffee and cake, and discuss death.

Providing these services to her community felt natural to Heidbreder, who, as a young girl in Quincy, Illinois, used to wake before the sun to ride around with her dad in his pickup truck to register their neighbors to vote.

“I was raised by a father who instilled in me that it’s one thing to take care of yourself and pay your rent, but if you’re not serving the community you live in, what are you doing?”

To better serve her patients, Heidbreder fuses her experiences with life’s endings and beginnings as a teacher with the International End of Life Doula Association. She works to help reframe how the American health care system approaches life, death, and the in-between.

“Our medical system treats birth and death as medical events. I find that incredibly reductive,” Heidbreder explains.

“It misses the beauty and nuance of those life transitions.”

Landing at Georgetown The opportunity to explore those transitions through a public health and social justice lens attracted Heidbreder to Georgetown. But, already carrying a heavy student loan debt from a prior masters and bachelor’s, she couldn’t afford another degree.

So she tried her luck at the Nurse Corps Scholarship Program offered through the U.S. Health Resources & Services Administration. It covers full tuition plus costs for two students from any state, and Heidbreder was selected as a 2011 recipient.

“It was a gift to my life,” she says simply. “And with great gifts comes great responsibility.”

Heidbreder enrolled in Georgetown’s 18-month program and relished going back to school as an adult. Taking anatomy, physiology, and pathophysiology in her early 30s, when she had a deeper understanding of her body, provided greater perspective and purpose, she remembers.

Moving from New York City to DC and downsizing parts of her life to prioritize her studies was difficult. She’d spent her 20s working in music promotion, where she regularly rubbed elbows with Lou Reed, Patti Smith, and Alicia Keys.

But after three or four years her passion had waned. “I realized that being cool is actually about doing meaningful work, not hanging around with famous people,” Heidbreder says.

She was ready for a change and eager to invest more time in a serviceoriented profession but took some time finding her way to Georgetown.

“My life has been more about hitchhiking in Africa and shaving my head at 25,” Heidbreder laughs.

“When I didn’t have a plan, I’d wing it.”

Nicole Heidbreder She discovered her passion for birth work and, later, nursing while “winging it” in Indonesia. There she met an American midwife who invited Heidbreder to shadow her while she assisted local births in remote villages.

Just 10 months earlier, the 2004 tsunami ravaged the region and limited access to prenatal care. Births were fraught, including the first one Heidbreder attended where a woman delivered a baby who wasn’t breathing. While that baby’s life hung in the balance, the mother gave birth to another child. No one knew she was carrying twins.

The shock reminded Heidbreder how little space there is between birth and death. Her thinking was only reinforced in Uganda when, shadowing another doctor, Heidbreder remained to hold a new mother’s hand as she hemorrhaged shortly after giving birth.

“I didn’t have any medical training, I didn’t know what I was doing, but I just knew I couldn’t leave her. That was the moment I knew I was going to be a birth worker,” Heidbreder says.

She returned to the states and applied to Georgetown with a determination to improve women’s health and reproductive

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rights in her own country. Her emphasis on non-traditional care, however, sparked tension in some conversations.

Differing views on patient experiences and a nurse’s responsibility enriched class discussion and debate, recalls Margaret Nolan, assistant professor at NHS. She and Heidbreder shared divergent perspectives on the benefits and risks of home birth, for example. Despite their differences, the two remain close today.

“She’s been an amazing mentor of mine,” Heidbreder says.

“When I’m having my own career existential crisis, she has been a rock for me.”

Authentic and on the Bright Side Nolan nominated Heidbreder for the Sigma Theta Tau Nursing Leadership award and, after graduation, also selected her to serve as a preceptor for nurses at another hospital. While managing her own busy shifts, Heidbreder mentored earlycareer nurses as they shadowed her and learned on the job.

Victoria Yedlin had just graduated from Georgetown when she was assigned to Heidbreder in a labor and delivery unit.

Yedlin found herself and the other nurses struggling to balance the demands of patient care in a complex hospital system.

But, shadowing Heidbreder, Yedlin saw how negativity didn’t have to pervade her long shifts. “Nic never seemed jaded,” Yedlin says. “She stayed extremely positive when it came to her patients. No matter what was going on in her life, she came to work ready to provide the best care possible.”

Heidbreder enjoys helping nurses like Yedlin find the silver lining in the profession’s toughest moments. It’s something that she had to do when she became discouraged early in her career.

In clinical rotations, she observed patients with feeding tubes, unaware of their surroundings, caught between this life and the next. It deeply upset Heidbreder, and she considered quitting nursing school.

Heidbreder stayed in nursing, but made the transition to palliative and hospice care, focusing on how her experience with life’s beginnings could ease its endings. But her new role came with its own brand of heartbreak. While hospice is designed to be a six-month journey, many of Heidbreder’s patients are referred to her care with just weeks to live.

To forge trust quickly with patients, Heidbreder avoids small talk and embraces conversations at their hardest points. Asking about adult diapers is as commonplace as letting a daughter or husband know their loved one is expected to die soon.

Sugar-coating the realities of death and dying is ineffective in these moments, she says. Patients facing devastating medical events can easily sense when a healthcare professional is lying to save their feelings. If they feel patronized, they often shut down and rebuff any caregiving offered.

“If you say to someone ‘You’re going to be okay,’ and they know they won’t be okay, they won’t be vulnerable anymore,”

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she says. “There’s no room for b.s.”

Other than telling the truth, Heidbreder finds that rarely is there a “right thing” to say to someone in crisis. “People just want to not feel alone, and they want to feel heard, validated, and honored,” she says.

To recognize this need in her patients, she engages in active listening—normalizing emotions, being open to questions, providing guidance—while refusing to become cynical or enamored of misery.

A Grounding Spirituality Heidebreder’s Georgetown theology and ethics professor Ridgeway Addison notes how well Heidbreder straddles the line between life and death, especially in regard to spirituality and faith. She now guest lectures in his Problem of Suffering course.

“I appreciate how her own Buddhist-based spirituality continues to ground her nursing practice and her work as a caregiver and educator,” Addison says.

Heidbreder understands that gaps exist between theory and practice. It’s why she mines her professional experience to provide students with real-world examples of how to ease the burden of suffering for patients. She also draws upon her doula training to suggest more spiritual or emotional approaches to help people cope.

“Her blend of traditional and non-traditional health care experience makes her a unique voice to balance the more codified voices that traditional textbooks, nursing experts, and even creative theologians bring to the syllabus and weekly discussion in the course,” Addison says.

Approaching mortality from diverse perspectives has helped Heidbreder address what she considers our constant “low-grade anxiety” around death. When we’re anxious, Heidbreder explains, we’ll pursue anything that gives our life meaning. This stress often manifests itself in a relentless busyness and, eventually, burnout and resentment.

Healthcare workers, working long hours in professions that constantly grapple with life and death, can be particularly prone to this anxiety, Heidbreder observes. To temper that feeling in herself and make sense of the 15-hours days, the guilt and the constant pressure, Heidbreder makes a point to step back and examine what good she’s done and has yet to do.

Whether she’s embarking on a new journey teaching online workshops, dancing more, buying a house or starting a family, she refuses to do anything that doesn’t feel true to herself.

“Everything—money, sex, good looks—is a total illusion,” she says. “The only thing that is real is being authentic in each and every moment.”

It’s why when people ask her what she does, Heidbreder forgives the small talk and explains. It’s a chance to be honest with herself, in hopes that others will be honest, too. n

Balancing Effort and Ease in Aging

Jim Vecchione

By Mercedes Santos

As an athlete I learned that acceptance was defeat.

I powered my way through competitive tennis with grueling practice sessions. Backpacked across alpine passes, limping with blisters, barely able to move with fatigue, but powering on through all manner of nasty weather. I rode my bike against 20 mph headwinds determined to make my way up the California coast, to reach my self-imposed destinations. For decades I had taken a “no pain, no gain” approach to just about everything in my life, and by my mid-40’s my body began to rebel with injuries.

Then I discovered Hatha yoga. I soon learned that this intensely personal practice required far more than my well-honed steel will. Over time, as humility began to replace my pride, there emerged a sometimes brutal clarity about who the “I” was that inhabited my body. The two yoga trifectas of bodybreath-mind and balance-flexibility-strength taught me something new: the value of patience, compassion, and ease.

With my early retirement came the opportunity to become certified to teach the practice to others. Each week for the last eight years, I’ve met with 60- to 80-year-olds to teach my eclectic style of Hatha yoga. When I began teaching these classes I was in my mid 60s, and in Boomer fashion told myself that 60 was the new 40. I believed that I had some important things to share: to help others deepen their body awareness; to introduce them to the power of the breath; and to lead them in an in-the-moment experience. My overarching goal was to help them discover greater functional comfort with their aging bodies.

The acceleration of aging that seems to appear in the 6th and 7th decades of life can be dizzying. My own journey with aging, in addition to the run-of-the-mill aspects of physical aging, has also included neurological challenges, cancer, and two shoulder repairs. My yoga practice and community brought me through each of those difficult times.

I’ve also watched my students face illness and loss, witnessed their frustrations as they push against the inevitable. I’ve seen them land (sometimes bruised) into a place of surrender and

transformation, carrying on with grace into a place of peace and ease. The meditative aspects of yoga help us to find and maintain equilibrium through times of accelerated change.

The deepening of self-knowledge that is a part of the yoga practice helps us to find and sustain purpose in our lives, as more familiar things from our past fade into the background.

Through yoga, I’ve found a loving and fun-loving community of friends. The community that forms around the shared yoga practice is deep and enduring. The profoundly intimate practice that we engage within ourselves is often done mere inches away from the person next to us. We hear the grunts, the groans, and the sighs. Sometimes we bear witness to our and others’ tears. Many of the students I teach have been practicing together for over 10 years. Side by side they’ve navigated not only the changing landscape of their own bodies, but also the shifting circumstances of their lives. At the time when we’re most at risk for increased isolation, strong community arises where there otherwise might be a void.

For all of its benefits to our aging bodies and mind, Hatha yoga is also a deeply spiritual practice. The qualities that we practice while on the yoga mat—kindness and compassion, self-study and honesty, patience and surrender, self-discipline and discernment—are at the heart of yoga. Whatever spiritual beliefs we hold, we carry with us into this practice the desire to be strengthened and more deeply understood.

Yoga teaches surrender and the value of letting go of expectations. Just when I think I’ve found a place of stasis, something else in my life or my body changes and I’m called upon to adapt, again. I can practice the change on my yoga mat, and when I step off my mat and into the world I am a better person for it. n Mercedes Santos, E-RYT, has been teaching Hatha Yoga for 17 years in Washington, DC, and nearby communities. Her focus on alignment and yoga therapeutics contribute to her interest and development of yoga programs for a variety of age-related conditions.

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Tied Up With a Bow New Mitchell Scholars Fund launched to honor Dean’s commitment to diversity, access, and affordability

A

s Stephen “Ray” Mitchell, MD, closes his 22-year tenure as Dean for Medical Education at Georgetown University School of Medicine, we look back on just a few of the many achievements that took place under his visionary guidance. A beloved teacher, a champion of diversity, a community builder, and a caring clinician, Mitchell would be the first to say he did not establish any of these programs alone. But we celebrate the leadership he demonstrated and environment he created that allowed good ideas to take hold and flourish.

As Georgetown University President John J. DeGioia states, “Ray’s efforts and leadership have helped shape the course of medical education at Georgetown

Launched during Dean Mitchell’s tenure: 1997 Medicine-Pediatrics program 2001 CIRCLE innovative medical education grants 2002 Mind-Body Medicine program 2005 Integrated Learning Center 2007 HOYA Clinic 2014 Learning Societies 2015 W. Proctor Harvey Amphitheater 2016 Journey(s) Curriculum 2018 ARCHES pipeline program

for more than 30 years, and for his extraordinary dedication to his teaching, the practice of medicine, his colleagues, and his students, we are deeply grateful.

Our university is fortunate to continue to benefit from Ray’s membership in our community as Dean Emeritus, and we

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look forward to his contributions as part of our medical education faculty for years to come.”

Born in southwest Virginia, Mitchell was the first in his extended family to attend college—an achievement made possible by his parents’ commitment to ensuring better educational opportunities for their children. After advancing through medical school, he realized that were it not for barriers to education access, his mother might have become a physician before him. This inspired Mitchell to advocate for broader access to medical education for first-generation students and others who are underrepresented in the field of medicine. He has since devoted much of his career to expanding educational opportunities, championing his belief that “future physicians must learn in diverse classrooms that resemble the populations they will be serving.”

Dean Mitchell has made financial aid a top priority under his leadership.

“Twenty years ago, financial aid was needed—but insufficient—and in response, donors, alumni, and parents opened their wallets and hearts to help us transform the school,” Mitchell says.

“We are not finished, but we have grown endowed scholarship funds from approximately $15 million to $37 million and have seen the amount of student debt decrease for the first time ever in a three-year trend. We are moving in the right direction, but more is needed.”

As a tribute to his leadership and in honor of his deep commitment to improving medical education access, as well as diversity and inclusivity, the university is launching the Mitchell Scholars Fund.

The Dean in his trademark bow tie

Once established, the Mitchell Scholars awards will be granted to students with demonstrated financial need and whose holistic background and experience suggest they are uniquely able to contribute to the diversity of the Georgetown community, as well as the communities that they will serve during their careers. The fund will help ensure that financial considerations do not dictate whether or not these students will enroll at Georgetown, leading to a more diverse student body and improving the experience of all students.

“My dear Mother read the Bible cover to cover more than once, and one favorite verse was from the book of Micah: Be just, be kind, be humble.

Hopefully I have made late Mom happy with my time here,” he says. n

To learn more about contributing to the Mitchell Scholars Fund, please contact Sumana Chatterjee at Sumana.Chatterjee@georgetown.edu or 202-236-3616

Inclusion Leader Welcomed New director offers support for growing diversity at medical school

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ith a background in higher education, personal experience as a first-generation college student, and extensive work with diverse student populations, Isela Melendez-Carpio brings expertise and passion to her new role as the School of Medicine’s director of diversity and inclusion.

In January, Melendez-Carpio began overseeing the growth of the Office of Diversity and Inclusion’s pipeline programs: the Academy for Research, Clinical, Health Equity Scholarship (ARCHES) and the Gateway Exploration Program (GEP), in partnership with DC Public Schools.

“This position encompasses all of my background,” she says. “I’ll be working with high school, undergraduate, and medical students, staff, and faculty. I’m most excited about having a diverse group of people that I get to work with directly.”

Originally from El Salvador, Melendez-Carpio moved to the United States when she was 6 years old. She was raised in Arlington, Virginia, and attended the University of Richmond, where she studied political science and government.

After college, Melendez-Carpio dedicated a year to the AmeriCorps program, guiding high school students in underserved communities through the college application process. It was during this time that she became passionate

about working with students on issues of equity and access.

“For somebody who is new to this country, the system is not intuitive.

Especially if you’re still trying to grapple with a new language, coupled with so many other factors—citizenship status, socioeconomic background, familial support—it can be very challenging to navigate,” she says.

Her continued work to support immigrant education and professional development led her to pursue a master’s degree in higher education administration at the University of Virginia.

“During graduate school, I really focused on honing in on my diversity and inclusion experience. Having worked with so many different student populations and families, I wanted everything to come together—which ultimately brought me here,” Melendez-Carpio says.

As a first-generation college student, Melendez-Carpio understands the unique obstacles that students with diverse backgrounds and experiences face. She credits mentors and family in helping her achieve her goals, and hopes to provide the same support through her role at Georgetown.

“Growing up, I had a lot of people who told me ‘no’ but a lot of people told me ‘yes’ and have supported me along the way. Those types of leaders, teachers, and mentors are the reason why I’m here.”

Isela Melendez-Carpio brings professional and personal experience to the role directing the School of Medicine’s Office of Diversity and Inclusion.

For Melendez-Carpio, the key to helping students thrive is centered on relationship-building and being open to others’ diverse experiences.

“Relationships are so important. It’s critical to understand where people are coming from in order to be an informed ally and advocate,” she says.

In her personal life, Melendez-Carpio has seen firsthand how support can make a difference in someone’s life.

“As a child of immigrants, it gives me so much pride and joy to see everything my parents sacrificed for me and my siblings come to fruition. I attribute my successes to their continued love and support. They inspire me every single day,” she says. n

Matched Online This year’s Match Day was like no other! Speeches were livestreamed from campus as members of the Class of 2020 connected virtually, sharing their posts with joyful photos and comments from their physically distanced, socially connected celebrations. Congratulations to this innovative and flexible new cohort of compassionate Georgetown physicians!

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Life in the NASH Lane

By Martha Dee Gay, PhD

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he world offers plenty of advice on how to live a healthier, safer, and fuller lifestyle. So why are we still riddled with diseases and health disparities? The answers can sometimes lie beyond genetic makeup or “healthy� social norms; it can merely be a result of our choices. Often our quick-paced living can demand a faster response towards

syndrome, and type 2 diabetes can increase the incidence of developing NAFLD, although liver disease can affect those of any age, including children. Nevertheless, people are more likely to develop NAFLD as they get older.

Many patients with NAFLD will initially experience few or no physical

Above, author and 2020 Science Writer Fellow Martha Dee Gay is an NIH TL1 post-doctoral scholar and translational scientist at Georgetown University Medical Center in the Division of Gastroenterology.

food consumption, for example, which may not present us with healthy or lowcalorie options.

According to the National Institutes of Health, today 30-40% of adults in the U.S. live with chronic liver disease unrelated to alcohol consumption. The condition, Nonalcoholic Fatty Liver Disease (NAFLD), results from fatty deposit buildup in the liver. Health conditions such as obesity, metabolic

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symptoms. However over time it may progress to a more serious condition called NASH, or Nonalcoholic Steatohepatitis. NASH is a combination of fat, inflammation, and liver cell damage.

Having a life in the NASH lane is the road beyond NAFLD, and it will soon be the leading cause of cirrhosis and liver cancer in the U.S. Although it occurs in individuals of all races and ethnicities, I am particularly interested in

NASH research because it is most common in the Hispanic community.

This inflammatory liver condition, which may lead to fibrosis or tissue scarring in the liver, can develop into cirrhosis and possibly progress to hepatocellular carcinoma. Except for weight loss and physician-monitored vitamin E therapy, especially for diabetic patients, there are very few treatments that are useful in reversing fibrosis of the liver, which is a hallmark of NASH. Presently I am an NIH GeorgetownHoward Universities Center for Clinical and Translational Science Post-Doctoral Scholar performing research in the lab of Jill P. Smith, MD. Our novel publication in Digestive Diseases and Sciences in January 2020 showed that the drug proglumide could prevent NASH and development of hepatocellular carcinoma in mice fed a high-fat diet. Furthermore, proglumide successfully reversed the histology or the tissue architect by significantly decreasing the amount of fibrosis or tissue scarring, and improved certain liver biomarkers of NASH. Although no medications are approved to treat NASH, the Smith lab is currently conducting a phase 1 STOPNASH clinical trial to test the safety and dose of proglumide along with observing its anti-fibrotic effects in selected NASH patients. Our goal is to repurpose proglumide, initially used to treat stomach ulcers, for future studies as a potential therapy for NASH. As we strive to develop novel methodologies and enhance our understanding of this disease, life in the NASH lane is progressively getting better for patients. n

Throwing Light Into Circuits to Prevent Seizures

By Irene Sanchez Brualla, PhD

The Franklin Institute

W

hen the museum curators of the Franklin Institute Science Museum created an exhibition based on the brain, they used a giant Neural Climb (pictured above) to represent it, instead of a solid brain model (as they had done before, with their nationally famous giant heart that hosted even weddings in one of its ventricles). The structure’s nets and flashing lights emphasized the nature of the brain as a web of connections.

The brain works thanks to the connections between different areas inside of it. The organ that allows us to perceive our surroundings and interact with them needs a connection between our senses, our conscious mind, and the areas dedicated to movement in order to do its job and keep us alive.

The brain suffering an epileptic attack works in a similar way to the healthy brain, however in this case, when one area starts to have a seizure, it transmits it to other areas it has connections with.

These areas may activate other areas, and in this way the seizures can propagate and amplify around the brain, like a mine going off in the middle of a minefield, setting off more mines.

There is a small, dark brain area,

sitting in our brainstem, called substantia nigra (black substance), which is known for containing a very important compact part (pars compacta), which has most of the neurons that produce dopamine on the brain. The degeneration of these neurons is what causes Parkinson’s disease. But the substantia nigra also contains another part with more scattered cells (pars reticulata), which for more than 30 years has been known to reduce seizures when it is inhibited. However, the reasons why it works this way have remained mysterious for many decades.

Last December, though, the laboratory of Patrick Forcelli, PhD (G’11), assistant professor in the department of pharmacology, published the mechanism behind this mystery. They described that inhibition of the substantia nigra pars reticulata neurons could stop four different types of seizures in lab rats. This area has two main projections: the superior colliculus, and the pedunculopontine nucleus.

The way Forcelli’s lab silenced the substantia nigra neurons was using optogenetics, a technique that allows the activation of specific neurons using light.

To inhibit the substantia nigra pars reticulata, they injected a virus in it.

This virus contains DNA with genes that code a membrane protein that would allow negative ions to enter the neuron when illuminated. This mechanism inhibits the neurons. The researchers found that silencing the neurons projecting to the superior colliculus avoids the four types of seizures described. However, silencing the neurons projecting to the pedunculopontine nucleus only inhibited one type of seizure, and even exacerbated others.

These results from Forcelli Laboratory have been published in the journal Proceedings of the National Academy of Sciences.

Of course, as any good scientific discovery, it offers a lot of questions and possible venues to follow now. Are the neurons that project to the superior colliculus different from the ones that project to the pedunculopontine nucleus?

Could they be a pharmacological target?

Optogenetics is not an approved therapy in humans yet, but the things we learn with it can help us understand the brain better and, perhaps, help find a cure for seizures and epilepsy one day. n The author is a post-doctural research fellow in the Forcelli Lab.

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Health Justice for Immigrants In January, students, faculty, and staff from across the university gathered at the School of Medicine to reflect on defending immigrant health and human rights as part of Georgetown’s MLK Initiative “Let Freedom Ring,” in honor of Dr. Martin Luther King, Jr. Medical student panelists who are first-generation Americans spoke about their personal experiences with health care in the U.S. One shared a story that resonates with many immigrants.

His parents came to the country seeking better educational and professional opportunities, making many sacrifices to ensure the children flourished in their new environment. As he grew up, they went from one visa to the next over many years, until eventually they became undocumented.

Health care was a constant worry for his uninsured family.

He recalled that the only times his parents expressed regret about immigrating to the U.S. was when family members fell ill. One day his mother exhibited signs of a stroke, which they later learned was a Transient ischemic attack. Rather than risk the expense of a hospital visit, they called the pastor to their home to support the family with prayer.

After the panel, small groups discussed how to overcome the legal, financial, language, and cultural barriers in order to provide more equitable health care for immigrants.

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At the close of the event, Dean David Taylor, director of the Georgetown Experimental Medical Studies (GEMS) program, called for continued action, working together across fields to better address the needs of those on the margins.

The program was organized by the medical school’s Health Justice Scholars Track, the Office of Diversity and Inclusion, and the Latino Medical Student Association. n — Rhea Bhatt (G’22)

Georgetown Lombardi Marks 50 Years In 1969, a seed was planted at Georgetown when iconic NFL coach Vince Lombardi arrived for an urgent diagnosis and treatment for an aggressive form of colorectal cancer. Though his life was cut short only months after his diagnosis, Lombardi’s legacy and the contributions of his team of Georgetown doctors lives on through the Georgetown Lombardi Comprehensive Cancer Center.

Since its establishment in 1970 by John F. Potter, MD, Georgetown Lombardi has transformed thousands of lives affected by cancer through compassionate patient care, meaningful community engagement, life-changing service, and innovative research and education.

A leader in cancer care and research, Georgetown Lombardi is the only Comprehensive Cancer Center to hold the National Cancer Institute designation in the Washington, DC area.

The academic medical center supports groundbreaking cancer prevention and treatment methods to enhance health and quality of life.

Almost 20 years ago, a group of researchers led by Georgetown’s Richard Schlegel, MD, PhD, made discoveries that were critical to the development of the HPV vaccine—the first cancer prevention vaccine. As a co-inventor of the technology, he helped prevent millions of people from becoming infected with the virus which can lead to cervical cancer.

Today’s efforts from world-renowned researchers focus on understanding the mechanisms of disease, targeted therapies, immunotherapy, early detection measures, and other advanced strategies to improve cancer prevention, care, and survival. Georgetown Lombardi also proudly champions community-based partnerships and programs such as the Capital Breast Care Center (CBCC) that provides community outreach, cancer education and resources, and patient navigation services for cancer prevention and early detection.

Louis M. Weiner, MD, director of Georgetown Lombardi, says celebrating the center’s 50th anniversary signifies a key moment to reflect and progress toward the goal of eradicating cancer.

“Georgetown Lombardi has made significant contributions to the way the world approaches cancer research, community outreach, and patient care. We are excited to commemorate this hallmark moment in our history and we thank those who continue to support our remarkable work, which will change lives for the next 50 years.” n

Top photo of John F. Potter, MD. Bottom photo, taken in the Spring of 1969, shows Vince Lombardi on the Georgetown University football field with the hospital in the background.

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ALUMNI CONNE CTIONS

The Enduring Spirit of Cura Personalis Warwick Evans Society founder Joe Riggs is remembered for his legacy of service

By Samantha Poremba

L

ast November, I traveled up to Haddonfield, New Jersey to attend services in memory of beloved alumni leader Joseph Riggs, MD (C’55, M’59). Outside the church on the night of his Friday night wake, the air was humming in a way not often felt in moments of solemnity. I joined the long line slowly shuffling in.

“Joe always reminded us that people don’t care how much you know, unless you show them how much you care,”

Longtime friends from the Class of 1959, Riggs and Pelletier enjoyed being back in the classroom together at their 55th reunion in 2014.

whispered his friend Anthony Caggiano, MD (M’64), as we waited to greet the Riggs family.

I saw a glimmer of Joe in each grandchild as they welcomed us in. I saw the impact of Joe’s care as the church filled with patients he helped deliver, with loved ones whose cancer he helped cure, with members of the vast community whose lives he touched. We could hear Joe’s laughter as the church chuckled, during the Saturday morning funeral

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service, when the priest shared how Joe presented his funeral mass script to him decades ago.

Back at Georgetown the following day to my regular work running School of Medicine engagement events, I felt the spirit of Joe everywhere. In conversation with a group of med students hosting a bake sale for a classmate in need, one of my favorite Joe stories came to mind. Bright and vivacious, he was equally a quiet do-gooder. Every five years, for a total of 11 medical school reunions, Joe collected funds to finance Medical Mission Sister and classmate Fernande Pelletier’s (M’59) return from Ghana back to Georgetown.

He ensured she also went back with contributions to support her underresourced hospital.

Joe’s work represents generations of Hoya doctors committed to one binding concept: cura personalis. Latin for care of the whole person, the Catholic, Jesuit value becomes a unifying compass for our diverse body of students and alumni.

Because Joe loved Georgetown, he also saw how we could improve it. As he noted in 1991, “The lack of grants at Georgetown University School of Medicine is discouraging to the student drawn to low-compensation public service and altruism—just the kind of student the school attracts.” So he helped establish the Warwick Evans Society, a giving circle named for the first graduate of Georgetown’s Medical Department, who was also a scholarship recipient. In recent years, Warwick Evans leadership gifts, at $1000 or more, frequently on an annual

basis, have constructed the backbone of transformative funding that helps support scholarships for our service-oriented medical students.

I often think about the moment I had after his funeral, chatting with hopeful, purposeful medical students. At first, I couldn’t discern why I felt like Joe was with us. I had never met him in person, just by phone as he prepared for his twelfth medical school reunion. I asked myself what it was about Joe that made me feel like I had known him all my life.

Then it hit me. It’s cura personalis.

When a group of people believe in caring for each creature they come across deeply and wholly, their response has ripple effects. It’s the compilation of small acts of good creating an always renewing, improving community.

Outside the physical walls of the School of Medicine, the Warwick Evans Society is another way cura personalis extends its reach. With over a million dollars raised thus far this fiscal year, the impact continues to be powerful and beyond what we can measure. Many lives have been changed for the good by the scholarship dollars raised.

To know Joe continues to be a blessing. Every morning I head into work, I am warmed by the thought of spending my day with incredible people, who in many ways are an extension of Joe, the university’s mission, and the spirit of cura personalis. n

To learn more about the Warwick Evans Society, visit giving.georgetown.edu/warwickevans.

Telemedicine and COVID-19 In late March, Georgetown Medicine magazine caught up with Yalda Jabbarpour, MD (M’08), a Washington, DC, family medicine physician, about changes taking place in the early phase of response to COVID-19.

What has changed in your medical practice?

Overnight we went to seeing primary care patients nearly 100% virtually, via telehealth. We were able to mobilize our resources, and think creatively and quickly to meet the needs of our community.

We looked at our patient list to figure if we really needed to see them in the office. This challenged some of our ways of practicing medicine, needing to be face-to-face in the same room, touching the patient, doing the physical—and there is something sacred about that—but it’s nice to see how we could quickly meet the patients where they needed to be met: in their homes.

How are DC’s vulnerable populations impacted?

Although our clinic is in an affluent area, we serve vulnerable elderly patients. Loneliness can be hard on the elderly who may not be able to do grocery shopping on their own, go to the bank, etc. Social distancing can bring about anxiety and depression.

A lot of our providers do precept at the family medicine residency in Prince George’s County, and there it’s a different challenge. Patients may not have access to a cell phone, computer, or internet for televisits. The providers are still seeing patients in person, but they’re changing how and where they screen.

What drew you to family medicine and health policy?

I was born and raised in San Diego. My parents came from Iran. I went to UCLA, then taught fourth grade on the south side of Chicago. The experience shaped me to care for vulnerable populations.

I saw the importance of public health in education. My students had a hard time staying in school because of health issues like asthma, or their parents had poor health. We had a school-based medical program because kids couldn’t get to the doctor’s office easily. I decided to study medicine at Georgetown, and really meshed with the idea of taking care of the whole person, and with family medicine’s emphasis on vulnerable populations.

Today I’m the medical director at the Robert Graham Center, a health policy research center under the American Academy of Family Physicians. Our research informs evidencebased policies, insurance impacts, primary care outcomes and

spending, and how we pay for and access primary care.

We are doing a qualitative study on women in the primary care workforce. Data shows female physicians, especially younger ones, are burning out at higher rates than males. At the same time, more women are going into family medicine and primary care in general. With a large proportion going in but then burning out, what does that mean for the future of primary care and the physician shortage?

What gives you hope and joy in this difficult time?

A big positive is the ability for MedStar Health and the medical community in general to come together, be flexible, open up the telehealth rules and get everyone quickly switched over to them. I’m hoping we can see innovations like video visits continue. It’s going to expand what we can do.

Personally, our kids are home from school and all their activities are cancelled, so we suddenly have a ton of time as a family. We’re eating dinner together every night. I’m helping them with homework. They’re hanging out together. With the busy schedule taken away, they have a chance to just be children.

I’m finding little rays of sunshine every day, watching the kids work on a puzzle, my colleagues being so caring, and a system as big as MedStar finding ways to move things quickly to meet the needs of our patients. n

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Reflections on medicine with

Edmund Duthie, MD (M’76) I was at Georgetown from 1972-1976 and had no idea what geriatrics or gerontology was. The curriculum on aging was sparse. I followed the internal medicine track.

My Georgetown role models include Dr. John Collins Harvey and Dr. Don Knowlan, who I worked alongside during my second year as a med student—a gift of a lifetime. A great clinician, and I remember him going to patients’ bedside, and teaching us the fundamentals.

Working as a student at DC General had a big impact. It was grounding to care for disadvantaged populations who needed the support. The social determinants are so impactful in being able to manage illness. People were grateful for the interest shown in their well-being, and I was making a difference.

After graduation, I went to the upper midwest with my wife to look at programs like DC General, and chose Milwaukee County Medical Hospital. From the environment to the supervision with the faculty, I knew this was where I wanted to be.

During my third year of residency at the Medical College of Wisconsin, a rheumatologist said he was starting a geriatric program, but it didn’t resonate with me.

A few months later, the college sent me to a conference in geriatrics and gerontology.

Lo and behold, I crossed paths with Dr. Harvey, who insisted that I think seriously about entering the field. Seeing a mentor so excited about this work... well, I caught the fire.

Organizations like the Donald W. Reynolds Foundation and the John A. Hartford Foundation are committed to improving care for older adults. With grants allotted to geriatric education, we recruit students out of medical school into the specialty.

Being in geriatrics, there’s a certain amount of caring for the underdogs. A little bit of care and interest for older patients goes a long way and is appreciated on a different scale compared to general family practice.

The field has not grown in the way that it needs to. About 50% of positions in geriatrics and gerontology are vacant.

In the field, we talk about The 4 M’s.

Matters, as in what matters the most to the patient, what are their goals and priorities. Medication, polypharmacy and the appropriate use of medication in older people. Mobility, not just the wellness and exercise component, but the issue of falling as well. And mentation, or mental activity.

In many families, older adults say they don’t want to be a burden, and want to maintain a sense of dignity, independence, and ability to shop, get dressed, and housekeep for themselves.

People are also shaping their careers and being driven by the hope to spend time with their grandchildren and have multigenerational households.

Students’ motivation to go into geriatrics often starts with their own grandparents. They say ‘My grandparents mean the world to me and seeing them get frail makes me want to do better for others like them.’

This July, I am stepping down as division chief, which means for the first time since 1983, I won’t be in a major leadership role, and will transition to faculty and scholarship. I’m looking forward to getting back to the education aspect of the field.

Beyond the long-hour days, I’m ready to get more exercise alongside Jersey Boy, my Golden Retriever, golfing when I can, tackling some yard work, and enjoying one of my favorite pastimes: reading. I’m currently reading Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life by Louise Aronson. n

Alamy, Shutterstock, iStock

Division Chief, Geriatrics and Gerontology, Medical College of Wisconsin; Clinician Educator

To our Georgetown health workers behind the scenes and on the frontlines, thank you for tending to the world with cura personalis.

NON-PROFIT ORG. US POSTAGE Georgetown University Office of Advancement Communications University Box 571253 Washington, DC 20057-1253 USA

A MOMENT OF GRATITUDE As a way to honor their first patients—the anatomical donors— first-year medical students began gross anatomy in January with the cadaver blessing, led by Georgetown chaplain Tom Buckley, SJ.

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