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Extreme Medicine Orthopaedic surgeon Michael Karch (M’95, R’02) on meeting the patients where they are, even when it’s tough to get there
FROM THE ARCHIVES: Disaster Prep In 1956, 100 second-year medical student victims of a â€œhypothetical explosionâ€? in McDonough Gymnasium poured into Georgetown Hospital, as part of a disaster simulation designed to test the response of medical personnel. Nursing students joined the mayhem as distraught relatives. The event was covered in the Washington Post and in Georgetown University Alumni Magazine, shown here.
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Meeting the patients where they are, even when it’s tough to get there
Not for Oneself but for All Lessons learned in disaster medicine
Reflections on 9/11 Medical care in the chaos In fatigues, scrubs, or habit,
Sister Dede Answers the Call
The Doctor Is Out Teaching wilderness medicine at Georgetown From Afghan outpost to the Caribbean
A Mission to Serve
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Reader Feedback Check Up News & Research
Student Voice On Campus Alumni Connections Reflections on Medicine with Kimberly Henderson (C’91, L’95, M’00)
READER FEEDbACk I enjoyed the fascinating article on the proposed new curriculum for Georgetown’s medical students. It sounds like an excellent idea. For 10 years, I have helped teach the Patient-Physician Communication course to brand new medical students. Understandably, they always love being introduced to patient contact from their very first week at Georgetown. As a footnote, Duke University School of Medicine began their current “experimental” curriculum in 1966. It compresses the required pre-clinical courses into the first year, puts the required clinical rotations into the second year, devotes the third year to pre-clinical electives and research, and the fourth year to clinical electives. As a 1973 graduate of Duke, I found that approach highly effective. Richard M. Waugaman, MD Clinical Professor of Psychiatry, Georgetown University School of Medicine
A publication for alumni and friends of Georgetown University Medical Center
Editor Jane Varner Malhotra
Contributors Daniel Coleman (M’17) Jeff Donahoe Allan Hutchison-Maxwell (S’14) Michael Karch, MD (M’95, R’02) Melissa Maday Patti North Kate Potterfield (C’04) Camille Scarborough Carolyn Zimmerman
Design Director Robin Lazarus-Berlin, Lazarus Design
University Photographer Phil Humnicky
Executive Vice President for Health Sciences Edward B. Healton
I just read Camille Scarborough’s article on Dr. Allan Goody. I did not realize he had passed away. I have such fond memories of Dr. Goody’s morning report at VHC, both as a third year and Sub I. He was a sweetheart of a man and an incredible clinician-teacher. His passing is truly a loss for the Georgetown community. Thank you for article. Mark C. Markowski, MD, PhD (C’01, M’09, G’09) Clinical Fellow, Medical Oncology Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital
Wellsworth DeZeng arc perimeter
Glancing at your marvelous photograph of the School of Medicine Class of 1933, I noticed an unusual medical device on the lab bench. This is a Wellsworth DeZeng arc perimeter, used to test patients for visual field defects from about 1920 to 1950. The invention of the bowl perimeter by Hans Goldmann in 1945 rendered it obsolete. I recognized the device because a senior colleague gave me his arc perimeter when he retired. Using it took a bit of skill and training which ophthalmology residents, but not medical students, would have learned as part of their education. It is unclear why the medical students in this group picture chose to feature the device, or if they even knew what it was. Perhaps it just looked impressive and seemed like a suitable prop. Jonathan C. Horton (R’89)
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Dean for Medical Education Stephen Ray Mitchell (W’86)
Georgetown Medicine is published by the Georgetown University Office of Advancement Communications. Visit the magazine online at gumc.georgetown.edu/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 Contact alumni records for address changes: email@example.com or 202-687-1994. For up-to-date information on Georgetown events and alumni news on campus and around the world, visit Georgetown Alumni Online: alumni.georgetown.edu. © 2016 Georgetown University Medical Center
On the cover: Michael Karch (M’95, R’02) stands in an upper field of his farm in Virginia with the “go-bags” that he takes when deployed on a medical mission. Packed and ready at all times, they contain basic medical supplies, demolition and set-up tools, and a small amount of personal gear such as food, a sleeping bag, and ropes. Karch keeps a second set packed in California where he works part-time. Photo: © Ashley Twiggs Photography
ChECk Up News & Research
Global health Experts Join Georgetown
ebecca Katz, PhD, MPH, a specialist in global health science and security, has joined the Medical Center faculty along with her research partner, Julie Fischer, PhD, and four other members of her research team, who were recruited from the Milken Institute School of Public Health at George Washington University. For more than a decade, she and her team have worked to help design systems and implement ways to facilitate a coordinated response to potential microbial outbreaks and pandemics in 22 countries—many lowresourced and developing. “We analyze policies and practices used throughout the world to prevent, detect, and respond to emerging health threats before they become international crises,” says Katz. “The better a country’s public health systems are, the sooner it can recognize that something abnormal is happening, the faster they can do something
Katz (left) and colleagues Aurelia Attal-Juncqua and Julie Fischer consult on emerging global health threats.
about it, and the more lives they are able to save. “We ask and answer questions like: What kind of systems do you need in place to have countries working together? How do you think about the types of capacity that will be required at the municipality level? What does this mean for travel and trade? Are there international agreements that should be in place to facilitate mitigation
and response, and how do countries implement the ones that are already in place?” These are the challenges that can lead to advances— or breaks—in broader international diplomacy. Katz says she was attracted to Georgetown because it offers the opportunity to approach the issues through a multidisciplinary lens, engaging faculty and students
across the Medical Center as well as with the Law Center, the School of Foreign Service, and other parts of the university. Before the end of the year, Katz and Fischer will launch the Center for Global Health Science and Security at Georgetown University Medical Center. The new center will connect global health efforts already happening across Georgetown. n
“The better a country’s public health systems are, the sooner it can recognize that something abnormal is happening, the faster they can do something about it, and the more lives they are able to save.” — Rebecca Katz
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There’s an App for That!
omen who want to track their fertility are increasingly turning to smart technology. But can they count on it for accuracy? Maybe not, say researchers in a recent study of nearly 100 fertility awareness apps. The authors found that most do not employ evidencebased methodology. The study, published in July in the Journal of the American Board of Family Medicine, also found that many apps include a disclaimer discouraging use for avoiding pregnancy. The study was led by Marguerite Duane, MD, MHA, FAAFP, adjunct associate professor at Georgetown
Are you fertile?
University School of Medicine and executive director of Fertility Appreciation Collaborative to Teach the Science (FACTS). The report lists just six apps with either a perfect score on accuracy, or no false negatives (days of fertility classified as infertile). “When learning how to track your fertility signs, we recommend that women first receive instruction from a trained educator, and then look for an app that scored 4 or more on mean accuracy and authority in our review,” says Dr. Duane. Now where’s the app that changes diapers? n
pancreatic Cancer Meets precision Medicine
“I am certain we will learn a lot about what drives pancreatic cancer, what we can use in our medical toolkit, and what we need to develop as novel treatments.” — Michael J. Pishvaian pancreatic cancer and have stable disease as determined by screening may be eligible. Half will be randomly assigned to receive standard of care chemotherapy regimens—two are in use today—and the other half will have their tumors
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analyzed using state-of-theart laboratory tests designed to match treatment to the genes and proteins making their cancers grow and spread. “In the molecularly tailored group, we will be harnessing any and all available resources to provide patients with the
right drugs to treat their tumors,” says Georgetown Lombardi oncologist Michael J. Pishvaian, MD, PhD, principal investigator of the clinical trial who sees patients at MedStar Georgetown University Hospital. For example, if a patient’s
he first clinical trial to compare standard of care chemotherapy with molecularly tailored therapy (also known as precision medicine) for metastatic pancreatic cancer began enrolling patients at Georgetown Lombardi Comprehensive Cancer Center this summer. The phase II study, which involves four other cancer centers around the country, will enroll about 60 patients. Patients who have been treated with one round of chemotherapy for metastatic
tumor reveals molecular pathways found in breast or ovarian cancer, drugs for those tumor subtypes will be used. “We may find that some patients do better with standard of care therapy because their tumors use pathways for which we do not have a targeted therapy, and that other patients respond well to targeted treatments for which we have an agent,” Pishvaian
says. “I am certain we will learn a lot about what drives pancreatic cancer, what we can use in our medical toolkit, and what we need to develop as novel treatments.” The $1 million study is being funded by the American Association for Cancer Research (AACR) and the Pancreatic Cancer Action Network (PanCAN). The other co-leading institution is
Thomas Jefferson University in Philadelphia, which will molecularly model individual tumors. The study is also being funded or supported in part by Caris Life Sciences, Inc.; Guardant Health, Inc.; and Theranostics Health, Inc. Pishvaian has been a paid scientific consultant for Caris Life Sciences. Margaret Foti, PhD, AACR chief executive officer,
underscores the urgent need for research into the deadly disease. “Pancreatic cancer is one of the few cancer types for which death rates are steadily increasing,” says Foti. “It is projected to become the second leading cause of cancer-related death in the United States by 2030.” n
Gut Check: Groups Align to Fight GI Cancers
rogress has been too slow for patients with gastrointestinal cancers,” says Craig Lustig,
United States committed to work together to fight against gastrointestinal cancers, which represent many of the leading
“We believe this unique collaboration will strengthen the voice of our community and improve outcomes for patients.”
— Craig Lustig associate director of the Ruesch Center for the Cure of GI Cancers. Part of Georgetown Lombardi Comprehensive Cancer Center, the Ruesch Center became founding member and academic center for the new GI Cancers Alliance. In June, the coalition of 20 groups from around the
cancer killers. These include cancers of the esophagus, gallbladder, bile duct, liver, pancreas, stomach, small intestine, bowel (large intestine or colon and rectum), and anus. “We believe this unique collaboration will strengthen the voice of our community and improve outcomes for
patients,” Lustig says. “We share a common core belief that a unified patient voice is central to addressing unmet needs in screening, awareness, and treatment.” The mission of the GI Cancers Alliance is to raise awareness, provide education, and advocate for the prevention, treatment, and cure of gastrointestinal cancers through a collaboration of advocacy organizations, industry stakeholders, and institutional partners. Since the group’s founding this summer, progress has already been made by aligning purposes, as the group works to create resources and tools to help fill the gaps for patients seeking help. “There has been tremendous momentum amongst GI cancer stakeholders, in a
short period of time, through the Alliance,” notes John Hopper, executive director of the Fibrolamellar Cancer Foundation, board director of the National Pancreas Foundation, and Alliance co-chair. n
For more information visit www.gicancers alliance.org
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Ethical Questions Around Marketing to people With hemophilia
ow do pharmaceutical companies reach people who have hemophilia? How do they interact with consumers? What drives a patient to choose one drug over another? When does a drug product’s promotion go too far? Some of the pharmaceutical companies’ direct-toconsumer marketing methods are unprecedented and should be examined by regulators, say researchers in a recent study, who reviewed documents, including consumer-oriented materials, produced by the makers of hemophilia treatment products. The study in the PLOS Medicine “Policy Forum,”
“We know companies focus promotional efforts on people with hemophilia because patients specifically tell their physicians which products they want to use.” — Adriane Fugh-Berman published June 14, was written by Adriane Fugh-Berman, MD, director of PharmedOut, and two physicians who were graduate PharmedOut interns. PharmedOut is a Georgetown University Medical Center project involving physicians, researchers, students, and other volunteers who promote evidence-based prescribing and educate health care professionals about pharmaceutical marketing practices. Fugh-Berman, an associate professor at Georgetown University Medical Center, and co-authors Phillip Kucab, MD, a resident at Detroit Medical Center, and Katelyn Dow Stepanyan, MD, a resident at UCLA, say the marketing takes place against a
background where optimal strategies for hemophilia treatment and prophylactic regimens remain uncertain. Marketing directly to people with hemophilia, the report says, begins when patients are young—through camps, school scholarships, internships, awards, and career counseling—and continues into adulthood with gifts, grants, and jobs. The authors note that people with hemophilia often make their own choices about which product to use, and that personal relationships are key in the companies’ marketing strategies. While it is common practice for physicians to serve as spokespersons for the pharmaceutical industry, in the case of hemophilia it is often taken a step further. Manufacturers of clotting factors enlist patients and their families to help market the product, recruiting them for employment, consulting roles,
Fugh-Berman directs PharmedOut, a Georgetown University Medical Center project to advance evidence-based prescribing.
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or advisory boards, the study says. “We know companies focus promotional efforts on people with hemophilia because patients specifically tell their physicians which products they want to use,” Fugh-Berman says. “The companies make a great deal of money from their clients, and spend millions on individual promotion to foster brand loyalty.” The U.S. regulates pharmaceutical industry marketing strategies that target physicians, note the authors. The study calls on regulators to review how pharmaceutical companies directly market to and interact with consumers. To move the purchase decision away from brand loyalty and towards evidence-based medicine, they also suggest that the federal government require research that has not been done before, comparing the benefit of different blood agents (which vary considerably in price) and different regimens. n
Cancer Research Explores paternal Obesity
bese male mice and normal weight female mice produce female pups that are overweight from birth through childhood, and have delayed development of their breast tissue as well as increased rates of breast cancer. These findings, published June 24 online in Scientific Reports by researchers at Georgetown Lombardi Comprehensive Cancer Center, come from one of the first animal studies to examine the impact of paternal obesity on future generations’ cancer risk. Obesity can run in families, and the same is true for
those big babies grow to adulthood, they may have increased risk of breast cancer. While much of the focus has been on the maternal side, few if any studies have looked at the influence of dad’s obesity on his offspring’s cancer risk. The researchers found evidence that obesity changes the microRNA (miRNA) signature—epigenetic regulators of gene expression— in both the dad’s sperm and the daughter’s breast tissue, suggesting that miRNAs may carry the epigenetic information from obese dads to their daughters. The miRNAs identified
the hypoxia signaling pathway. “This study provides evidence that, in animals, a father’s body weight at the time of conception affects both the daughter’s body
“This study provides evidence that, in animals, a father’s body weight at the time of conception affects both the daughter’s body weight both at birth and in childhood, as well as her risk of breast cancer later in life.” — Sonia de Assis some breast cancers. Maternal obesity is believed to influence both conditions in humans—a woman who is heavy in pregnancy can produce larger babies, and when
regulate insulin receptor signaling, which is linked to alterations in body weight, and other molecular pathways that are associated with cancer development such as
weight both at birth and in childhood, as well as her risk of breast cancer later in life,” says the study’s lead investigator, Sonia de Assis, PhD, an assistant professor
in the department of oncology at Georgetown Lombardi. “Of course our study was done in mice, but it recapitulates recent findings in humans which show that obese men have significant epigenetic alterations in their sperm compared to lean men. Our animal study suggests that those epigenetic alterations in sperm may have consequences for next generation cancer risk.” The next step, de Assis says, is to see if the same associations regarding breast cancer risk hold not just for mice but for humans, too. n
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A Real knockout in Gene Editing
Georgetown Professor Recognized for Historic Breakthrough
o celebrate the 75th anniversary of Cancer Research, the journal’s editors picked 50 landmark studies that were scientifically significant and influential at both the time of publication and today. This was no easy task, as the journal has published approximately 50,000 papers since its founding in 1941. One of the selected landmark studies presented a breakthrough in gene editing by Todd Waldman, MD, PhD, a professor of oncology at the Georgetown Lombardi Comprehensive Cancer Center and director of the Georgetown MD/PhD
study—“p21 Is Necessary for the p53-Mediated G1 Arrest in Human Cancer Cells”— says it all. It found that the p53 tumor suppressor gene, the “guardian of the genome,” interacts with another gene, p21, to arrest growth of stressed cells. p53 is a big deal. In 1989, Bert Vogelstein, MD, a titan in the field of cancer genomics, discovered that p53 acts as a tumor suppressor. p53 is mutated in half of all human cancers. Waldman was beginning his PhD research in Vogelstein’s lab at Johns Hopkins when he asked if he could try to “edit” genes in human
It found that the p53 tumor suppressor gene, the “guardian of the genome,” interacts with another gene, p21, to arrest growth of stressed cells. Program. Twenty years ago, he published the study that led in part to earning his own MD/PhD degree at the Johns Hopkins School of Medicine. For those in the field, the title of the November 15, 1995
cancer cells. He wanted to “knock out” specific genes in these cells to find out how they function when compared to cells with the gene. He had thought about it as a high school intern at National Institutes of Health.
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Oncology professor and researcher Waldman created a landmark technique to better understand gene function in cancer cells.
He thought about it again as an undergraduate at Yale. At Hopkins, he decided to do it. Yeast, bacteria, worms, and flies had long been used for gene knockout studies, and mice with knockout genes had just been developed before Waldman began his experiments. But it hadn’t been done in humans. “Everyone had just figured knockout studies in human cells couldn’t be done,” Waldman says. They were wrong. It took some laborious tweaking of the method used to create knockout mice, but it worked in human cells.
“My method was trial and error,” he says with a laugh. He and his co-authors, Vogelstein and Kenneth Kinzler, PhD, revealed how, through the p53 and p21 genes, cancer cells stop dividing after being exposed to damaging anti-cancer treatments. This major finding was not possible without Waldman’s gene editing technique. Other groups in England and Japan were also working on creating gene knockouts in human cells, targeting other genes. “It is fair to say ours was among the first few knockouts in human cells,
© Wikimedia Commons
but not the very first,” says Waldman. Still, the findings about p21 and the methods used were electric. Other researchers adopted the technically difficult process for about four years, until a simpler system surfaced. That method stayed in use until 2013, when CRISPR, the “easy” gene editing technique, was developed. CRISPR is now the subject of news reports, Nobel Prize speculation, and ethical musings the world around. Compared to Waldman’s procedure, it is more efficient and can more easily be applied to entire organisms. However, the ultimate outcomes are the same— modified genes. Waldman continues to study cancer gene function in his Georgetown lab, and has recently identified a new cancer gene called STAG2 that is among the most commonly mutated genes in cancer, involved in causing bladder cancer, pediatric bone tumors, leukemia, brain tumors, and other tumor types. Although Waldman now uses newer techniques, he remains committed to using human gene editing to study human cancer genes in human cancer cells themselves. “Studying gene function in cancer cells is now a lot more straightforward and will continue to get easier as even newer technologies are developed,” says Waldman. n
Report Reveals Major D.C. health Disparities
frican Americans in Washington, D.C., are six times more likely than whites to die from diabetes-related complications, according to a recent Georgetown report being submitted to a mayoral commission. This sobering finding is one of many in the report, which looked at health disparities in the nation’s capital. The study was requested by Georgetown history professor Maurice Jackson, chair of the District of Columbia Commission on African American Affairs, and carried out by Christopher King, an assistant professor in the School of Nursing & Health Studies (NHS). The report includes the fact that African American men live 15 fewer years than their white counterparts, and are 3.5 times more likely to die of prostate cancer. African American families are also three and a half times more likely to live below the poverty line. The greatest health disparities take place in the southeastern part of the city, where African Americans make up approximately 90 percent of the population. “We have to think about the root causes of these racial differences in health outcomes,” explains King, author of numerous scholarly articles on health equity and
disparities. “Historically, we’ve placed more emphasis on the health care system as a means of addressing the problem, and less emphasis on complex social factors. “So in addition to health outcomes, this report focuses on the socioeconomic conditions that drive health,” he adds. Those drivers include stark differences in unemployment rates (19 percent in African American majority Ward 7 versus 3.4 percent in majority white Ward 3), median household income ($40,000 for blacks versus $115,000 for whites), and education (less than 25 percent of blacks 25 and older hold bachelor’s degrees versus 50 percent for all residents). While access to culturally tailored, high-quality health care is important, the report presents a number of recommendations that address social, economic, political, and environmental factors. “Historically, our culture has had a medical focus on health disparities and relied on the health care sector to close the gap,” King explains. “But improvements have been
marginal. An expanded ecosystem of players must be at the table.” NHS Dean Patricia Cloonan praised the report, and notes that her school works to “translate Georgetown’s Jesuit values into action in the important domain of health.” “Leading efforts to develop this significant report on critical health disparities in D.C. spotlights our commitment to community-based engagement and promoting health equity,” she says. “Professor King and his team, including our students, have done a great job in underscoring areas of focus and offering key recommendations.” n
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eorgetown alumni meet the patients where they are, ideally in a fully staffed, well-equipped clinical setting. But many step out to find themselves caring for the whole patient in nontraditional, resource-limited environments. In war zone field hospitals, along mountain trails, at large public gatherings, in remote settings, after disasters around the globe or down the streetâ€” wherever the need. Meet a few of the physicians practicing austere medicine, pushing the limits of patient care, and awakening the boundless expanse of human hope.
Not for Oneself but for All Lessons Learned in Disaster Medicine
to survive. The one caveat: they’d have to carry him back up the mountain. Karch and his colleague took turns lifting the patient over their shoulders, fireman-style, carrying him 50 paces, and then trading off. In the midst of this crisis and grueling physical work, Karch admits to asking himself how they would make it out—and in fact, could they. Then something miraculous happened. One by one, young men and boys from the village started arriving. They saw that their elderly neighbor now had hope, and they wanted to help. “First there were two guys helping us,” Karch recalls. “And then four guys, and pretty soon a stretcher showed up. We no longer had to carry him on our shoulders.” The larger team of locals and international volunteers eventually arrived at the helicopter, helping load the injured man on so he could be transported to medical care. By giving one man a chance, Karch and his team helped to mobilize an entire village at a time otherwise marked by trauma and despair. Their aid and example inspired a community to push through the disaster into hope and resilience. Karch calls this the “force multiplier” effect—an essential part of disaster medicine. Through his work in disaster medicine, he seeks to not only help communities prepare for crisis before it happens and cope with its immediate trauma, but also to help
When a 7.8 magnitude earthquake struck Nepal in the spring of 2015, survivors faced shock and fear in isolated villages throughout the Himalayas. Disaster aid arrived from around the world, including Michael Karch (M’95, R’02) and the International Medical Corps. He and his emergency response team helicoptered from village to village, assessing needs, treating patients, and putting communities literally “on the map” for additional aid and supplies.
When they landed near the small mountain town of Laprak, an elderly woman approached them about her husband who had suffered a stroke, and was now paralyzed and injured. He was fifteen minutes down the hill, she explained. The aid workers had a limited window of time before they had to helicopter back to their camp, likely not enough time for a search and rescue. Disaster medicine is full of split-second decisions like this, when pragmatism and humanity might be at odds. But Karch and a team member, a volunteer EMT, decided they would try to find and help this man. They ran down the hill, dodging rubble and the ravages of the earthquake. About an hour later, they found the elderly man. He was paralyzed and in need of immediate medical care
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Photos p. 10-12 © Sara B. May, MD. Photo p. 13 Jocelyn Ortiz/International Medical Corps
By Kate Potterfield (C’04)
affected communities build capabilities to strengthen and rebuild after relief teams exit. “When you’re a team leader in a mass casualty event,” he says, “you forfeit your right to get caught up in the emotion, fatigue, or starvation of the circumstances. If your team sees you getting tired or overtaken by emotions, they will, too— because they’re scared. It’s hard to put into words how scary such an environment is, especially when there are aftershocks or gas explosions or terrorist attacks.” He seeks to empower through example. “The force multiplier effect of the team leader is huge—the team leader can dictate how poorly or well a team functions. And then the team itself has a force multiplier effect on the village or city it’s treating. The community carries their energy forward.” By demonstrating a path forward past trauma, the force multiplier effect sets off a ripple of hope and action. While
helping the victims of a mass casualty situation is most immediately about basic physical and medical needs, it also has psychological, emotional, and spiritual elements. Karch finds that the most powerful way to attend to these needs of an affected community is leading through example. By providing support and demonstrating that there is reason for hope, he seeks to provide an example that is both instructive and inspiring—an example that can jumpstart a community and region’s resilience and recovery. Karch’s brand of hope is a bold hope—but also grounded and pragmatic.
The Georgetown Ethic Karch grew up in Kutztown, Pennsylvania, and knew since high school that he wanted to become a surgeon. He was drawn to its combination of science, service to others, and hands-on technical skill. After college, when applying to
medical school, he also knew that he wanted to attend Georgetown University School of Medicine. “It was always number one on my list,” he recalls, noting Georgetown’s ethic of cura personalis—treating the whole person “mind, body, and soul,” caring for those at the margins, putting others before yourself, and training rigorously. “The four years of med school were the best four years of my life, without question.” He relished the training. “Every day, we were taught to do the right thing,” he says. In times of emergency and split-second decision-making, this sense of integrity helps propel him forward. The principles and ethics taught at Georgetown go beyond professional life, he says. His formation in medical school and residency helped him become both the physician and the person he is today. By being educated as a whole person, he learned to care for others in the entirety of their beings—body, mind, and soul. Karch points out that this is about “not just the patient, but also your small community, your family, your spouse, your children—it goes on and on. That’s the ethic of Georgetown and it’s carried me into my practice. “It can be easy to get caught up in the selfishness of modern society, but when you are given this base ethic as you’re being formed, it’s a stronghold you can always go back to.” After graduation, Karch completed a surgical intern year in Southern California at Loma Linda University Medical Center, and then returned to Georgetown Pages 10-11: In the wake of Typhoon Haiyan in 2013, the Philippine town of Tanauan faced major destruction and welcomed the swift arrival of Karch and his team of Mammoth Medical Mission volunteers. Page 12: Karch and his crew arrive in the Philippines just 48 hours after the storm hit. Left: Karch attends a victim of the 2015 earthquake in Laprak, Nepal. The paralyzed man will need to be carried back up the mountain to receive care.
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race on a cold, dark morning. While he had second thoughts, they didn’t linger long. He remembers thinking, “It’s Karch. Karch got us out here—let’s just do the best we can.” He laughs, adding, “I never ran harder in my whole life.” Karch has since gone on to run 53 marathons, six Iron Man Triathlons, and two Badwaters, a 135-mile footrace through Death Valley. School of Medicine Dean for Medical Education Ray Mitchell encourages Georgetown students to cultivate a mindful state of being, understanding their comfort zones, talents, and interests. “And sometimes part of reflection and formation is to journey up to your own limits,” he adds. Karch, he says, exemplifies this principle.
An Inflection Point While Karch always knew he’d become a surgeon, he never considered disaster medicine until the seventh year of his residency at Georgetown. Specifically, on September 11, 2001. For Karch, the date became an inflection point, both for himself personally and for disaster medicine.
Medical volunteers meet with Karch to organize the care of hundreds of typhoon victims pouring into their ad hoc aid station in Tanauan’s converted town hall.
As he walked through the hospital hallways with his team around 9 a.m. that morning, he wondered why everyone was glued to the television. Shortly after that, he heard the massive explosion of the plane hitting the Pentagon, just a few miles down the Potomac. This is when it all changed—not just for him but for the field of disaster medicine. (He recounts this moment firsthand in a reflection on page 18.) Karch wanted to go where he could have the biggest impact, so later that day he took a train to New York and volunteered at Ground Zero. Thinking himself well prepared to help, after a grueling 48 hours at the disaster site, he realized that there was a lot he wished he knew going in. Not typically provided in medical schools and residency programs, training for mass casualty situations would unfortunately need to be an increasing priority. In the years that followed, as doctors and medical professionals returned from Afghanistan and Iraq, they brought
© Sara B. May, MD
for a residency in orthopaedic surgery. He looks back on this time fondly, noting the program’s caliber and the impact of the mentorship he received, “not just in medicine but in life too.” One such mentor, John N. Delahay (M’69, R’74), serves at Georgetown as the Peter Cyrus and Rose Dignan Rizzo Professor in the department of orthopaedic surgery and pediatrics, vice chair of the department of orthopaedic surgery, and program director of orthopaedic surgery training. He recalls Karch’s compassion and energy in all he pursues, along with his excellent surgical technique. “He is a pioneer in developing protocols used today, creating structure in the delivery of healthcare in these completely chaotic settings.” Karch’s classmate, Joseph McQuade (M’95), similarly recalls Karch’s drive and hard work in medical school. He calls Karch someone who makes those around him better through his example, and someone who brought this tenacity to his free time. While students, the two friends ran the JFK 50-mile ultramarathon in Maryland. McQuade recalls arriving at the
© Ashley Twiggs Photography
reports of treating patients in mass casualty situations. The nature and pace of combat in these wars proved to be different than previous conflicts—and faster. As a result, it demanded new approaches to combat care and treatment, breeding innovation in mass casualty medicine. For example, a one-handed tourniquet was invented, allowing a soldier to selfapply it. Battlefield dressing technology improved, reducing significant blood loss, and pain management options advanced. Such innovations and adaptations, Karch says, impacted a generation of surgeons and physicians. Karch spent the next decade educating himself in mass casualty medicine, drawing largely from the expertise of his military colleagues. He also participated in Tactical Combat Casualty Care (TCCC) and combat extremity surgery courses led by the military. He wanted to take the lessons learned in combat situations and apply them to civilian mass casualty events—an approach that would make him a pioneer in the field. He continued his official surgical training after Georgetown through a fellowship in sports medicine and trauma at the Taos Orthopaedic Institute in New Mexico, and the study of advanced and masters AO trauma techniques in both the United States and Europe. He became a team physician for the United States ski and snowboard team, and eventually set up practice as an orthopaedic surgeon at Mammoth Hospital in Mammoth Lakes, a small mountain town near Yosemite National Park in central California. In the remote town, Karch quickly noted the community’s vulnerability in the event of a disaster such as an earthquake. To prepare Mammoth Lakes to take care of itself should crisis strike, he developed a course to train both medical and nonmedical professionals in the
protocols and best practices for a civilian mass casualty event. He applied many of the military’s lessons to civilian scenarios. The successful program grew into the annual International Disaster and Austere Medicine Course, offered in Mammoth Lakes to medical professionals from around the world. Growing from this program, the Mammoth Medical Missions (MMM) is a nonprofit organization providing general medical and healthcare relief and education to underserved rural and mountain communities around the world. It also deploys emergency response teams to mass casualty events.
In November 2013, Karch and a group of 15 MMM volunteers were on their way to Los Angeles International Airport
When they arrived in the Philippines, they learned of Tanauan, a town about 15 miles south of Tacloban that had been devastated. They went directly there and found chaos—no power, no running water, extreme medical needs, and another storm moving through. With the exception of the basic supplies they brought, their entire setup was ad hoc. They turned the town hall into a field hospital and rationed their supplies. Over the course of four days, hundreds of patients were triaged and treated. Babies were born, some via C-section, and 157 surgeries were conducted—most on the town mayor’s desk, which had been converted into an operating table. Frequently in disaster situations, whether natural or manmade, large aid organizations such as the Red Cross or
for a routine medical mission in Chiapas, Mexico, when plans changed. They learned that Super Typhoon Haiyan— the strongest recorded tropical cyclone ever to hit land—had struck the Philippines. Karch and his team discussed the situation. “We asked: where is the greatest need for us and our supplies?” Karch recalls. They decided to reroute.
Doctors Without Borders can’t mobilize to arrive until 72 to 100 hours after the first mass casualty event. But by studying military medical tactics, Karch had developed a model for closing this gap between disaster and the provision of medical care: the immediate deployment of small, nimble teams. “Knowledge gained in wartime medicine can be directly applied to the
Military as Model
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The CMFST model is now employed in mass casualty events around the world.
Preparing for Disaster Karch has learned from his experiences in the field—and he wants his story to beget others’ stories of crises met and lives saved. How does a medical professional prepare for mass casualties? First, hospital systems need to be ready to receive large numbers of trauma patients all at once. “Have we preemptively thought about this problem and told our workers the simple things— where to show up, who to report to—so that our response can be organized and not add to the chaos?” asks Karch. Preemptive thought also applies to triage, he says. How will medical teams agree to triage victims and categorize them as needing care now, in 15 minutes, or in two hours? He believes it’s also important for all physicians to have a basic technical skill
set for mass casualty medicine. While general surgery, orthopaedic surgery, emergency medicine, and anesthesia might be especially well-suited to disaster scenarios, Karch believes that every physician should be able to treat gunshot, explosion, and crush victims, for instance —all who may be arriving nonstop. “In disaster medicine, you have to be able to practice outside your comfort zone,” he says. “Disaster medicine forces us back to where we should be as physicians: on some level, we should be able to take care of the whole body. In disaster medicine, there are no specialists. So it’s good to have a refresher on general medicine, on the things we learned in medical school.” With recent mass casualty events around the world, he adds, “This is where medicine is going to need to go— to evolve into—in the next decade.”
What’s Next? Karch’s next chapter includes spending more time with his wife Kim, a pediatrician, and their children, ages 8, 10, and 12. Two years ago, they bought Sweet Meadow Farms in the Shenandoah Valley of central Virginia. All family members work on the 200-acre operation, where they raise grass-fed, organic beef cattle, goats, and mixed poultry. Nearby farm-to-table restaurants in Lexington, Virginia, are their clients. While the family is now based at the farm, Karch still spends about 10 days per month performing surgeries in Mammoth Lakes. He is also co-inventor of innovative surgical tools, and co-founder of Smart Medical Devices, Inc. His main focus now, however, is teaching—specifically, providing trainings in mass casualty medicine to In Nepal, locals work alongside International Medical Corps volunteers to help hoist the earthquake victim into the helicopter for transport to medical care.
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Jocelyn Ortiz/International Medical Corps
civilian mass casualty setting,” explains Karch. “The statistic and treatment principles are the same.” During the Gulf War in the 1990s, the military developed a new forward surgical team (FST) concept. The old mobile Army surgical hospital (MASH) unit, designed for Korea and Vietnam, was not suited to this kind of military operation with a fast-moving front. Combat teams needed a way to conduct surgery and provide care that was lighter and quicker than the 200,000-pound MASH unit. The FST was designed for rapid transit, with capabilities to perform lifesaving, damage-control surgeries. Karch decided to apply this model to civilian mass casualty situations. He and MMM developed the civilian mobile forward surgical team (CMFST) and put it to work for the first time in the Philippines. As a result, they provided life-saving medical care in those first critical days before larger aid organizations could arrive.
physicians and medical students. A primary vehicle for his teaching is Mammoth Medical Missions’ International Disaster and Austere Medicine Course, a mix of didactic training and hands-on simulations geared toward preparing trainees to think under fire. By replicating the myriad stressors at play in a real disaster situation, the result is chaos. On the ground, such chaos may last for days at a time. But, as McQuade notes, one of the most important skills Karch teaches is being able to establish some order. “He teaches you to think under fire and focus on one thing at a time.” Karch recognizes his strengths in high-stress, disaster situations, and is committed to the role he can play to meet the patients where they are, even when the setting is remote or dangerous, or both. “There’s a strong spiritual element to this work. I believe that my purpose on earth is to help people.” This belief is reflected in the phrase he calls his North Star during trying times: Non sibi sed omnibus. “Not for oneself but for all.” In 2015, when he, his colleague, and villagers from Laprak, Nepal, were carrying the paralyzed elderly man to safety—and when the physical and mental challenge felt like too much—this phrase, like a mantra, centered him and pushed him onward. “That’s what drives me. If things are getting tough physically, mentally, emotionally, I just say, hey, someone’s got it worse than I do. Anyone who’s in medicine believes on some level that they have some given talents and some learned talents. The combination of the two puts them in a position where they can reach down and pull people up. It’s these talents and learned skills that are valuable and you don’t want to abuse. When things get tough, Non sibi keeps me going and helps me push forward.” n
Emergency and Disaster Management at Georgetown By Allan Hutchison-Maxwell (S’14) When disaster strikes, people turn to emergency management leaders—qualified professionals who have the skills to guide mitigation and recovery efforts. In an unstable world, emergency managers are becoming a valuable commodity. Without an infra-
structure to train these professionals, where can they gain the experience they need? Created in 2013 to meet a growing demand, the Georgetown Graduate Program in Emergency & Disaster Management (EDM) is focused on preparing emergency management professionals for success through applied learning and experience. The Executive Master of Professional Studies program consists of hybrid courses that include seven weeks of online work and one week of onsite residency. Students meet in places that have endured serious disasters, Georgetown EDM students and San Francisco such as New Orleans, where they hear from police discuss marine preparedness efforts for both survivors and the emergency managers the San Francisco Bay. who led the response. Through 54 hours of class and exercise time during the week, students gain insight from the experiences of people who lived through the disaster. The program attracts students from a variety of fields, including health professionals such as epidemiologists, physicians, and nurses. Students from the health professions bring a unique perspective, says program director Joelle Miles. Cooperation and understanding between the medical professions and emergency managers is becoming increasingly important. The EDM program trains students in everything from dealing with tactical field situations to coordinating infectious disease response, weaving public health elements into courses. Georgetown’s School of Continuing Studies has focused on meeting demand for applied learning programs that help build skills for practitioners working in the field. Prerequisites include six years of experience in a related field and current work in a leadership position. By bringing together experienced practitioners and faculty, the program fosters a spirit of collaboration and allows students to learn from one another. The disaster program is more than just an avenue into traditional emergency management jobs and government agencies such as FEMA, says Miles. More and more industries and sectors need emergency management skills. The EDM program is helping to train new generations of leaders who return to their fields ready to meet challenging disasters head-on. n
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Medical Care in the Chaos Does it seem that the flags are always flying at half-staff these days? With the recent upward trend in large-scale, violencerelated injury patterns from Orlando to Nice, the ability to organize, manage, and treat mass casualty victims, whether in man-made or natural disaster, should now be paramount in every physician’s mind. For Americans, this “awakening” occurred on the morning of September 11, 2001. Something fundamentally changed in all of us. On that day, we realized both individually and as a nation that we were vulnerable. On that day, those of us who practice medicine realized that we had much to learn about the emerging field of civilian mass casualty medicine. On that day, I was chief resident on the Georgetown Orthopaedic Surgery Service, in my PGY-7 year of surgical training and full of confidence, and knowledge... or so I thought. On that day, within minutes of the explosion at the Pentagon, we were told to be prepared to receive 200 patients in the next five minutes. It was a high-voltage moment. In reality we received only one, a man with severe burns who was transferred to Washington Hospital Center’s Burn Center. The others couldn’t get to us from Virginia. Bridges into Washington, D.C. were quickly shut down as part of the preestablished disaster plan to protect the inner core of the nation’s capital. It made sense, at least on paper. However, when a disaster occurs on the other side of the river, as in the case of the Pentagon, Georgetown and virtually all of the city’s major trauma centers were immediately out of reach. Like everyone in medicine that day, I felt empty, paralyzed, and incredibly frustrated. It was as if we had trained for that specific moment our entire lives, and when it did occur, we couldn’t help. My high-voltage electricity had been shut down. I then did something very impulsive... out of character and irrational in every sense of the word. I left the hospital and went home.
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I stuffed a backpack full of dressings and sutures, food, a water purifier, a headlamp, and a sleeping bag. I took a cab to Baltimore since the Washington train station was closed, and jumped on a train headed to New York City. Within hours, I was in the heart of it. My thought was that in some way I could help the surgeons there, possibly rotate them out when they were tired. The city was in chaos. Hot fire, eye-burning smoke, and choking dust everywhere. It was impossible to see. Deafening wails, of sirens and of people, made it impossible to hear. Clear senses became quickly fogged. Water from fire hoses made dangerously slick mud out of the ash, and gas and electrical lines tempted one’s fate along a hopscotched path through debris. It was hot when it should have been September cool and dark when it should have been afternoon light. There were thousands of papers floating through the financial district—life savings, mortgage statements, stock portfolios just drifting aimlessly in the wind. And shoes—hundreds of shoes everywhere. And bodies. So many bodies in the street, with no shoes on at all. I was told that the greatest immediate need was to organize the growing pile of bodies; for most, it was too late for my surgical skills. I assigned myself to an ice skating rink nearby, where we set up to triage live patients if they came, but also to unload bodies and body parts onto the ice for later preservation and identification. Ground Zero was austere in more ways than the destruction, with no precedent, no assigned leaders, no chain of command, no sign-ins, no registration and, most importantly, no directions. We had to take the initiative. We had to make things happen on our own. An ice rink-turned-morgue seemed strangely logical. At one point in the early evening, I went to the bathroom and noticed a set of fireman’s clothes on a hockey bench. When I got back to my job, there was an announcement that there had been a request for doctors to go up to the front in order to establish a triage unit; there was new hope of finding injured survivors. The only requirement was that physicians would need to secure fire gear, as it was dangerously hot in “The Pit.”
© FEMA / Alamy Stock Photo
by Michael M. Karch, MD (M’95, R’02)
Up to this point in my life, I had never stolen anything. Within seconds, I was wearing someone else’s fire gear from that hockey bench. I became one of the first physicians on site at Ground Zero and spent the next 48 hours directing a selfmade, onsite MASH unit performing search and rescue, body recovery, and damage control mass casualty medicine. This was an “into the frying pan” moment. To say that I was prepared for this experience would be a gross misstatement. I was humbled and then humbled again many times over. I walked away from that experience admitting to myself that I knew nothing. Knowing what I know now after 15 years of studying, practicing, and teaching disaster and mass casualty medicine, I must have made errors upon errors in the simple act of trying to help. Did I do no harm? At that time virtually no one received formal training in civilian mass casualty medicine. A decade-long course in late night, home research and self-directed study helped me understand how to do it better the next time. The prolific writings of our military colleagues serving in Iraq and Afghanistan provided volumes of material to learn from over the coming years. Could their knowledge be translated into civilian mass casualty events? The 9/11 experience put me on a different career and life trajectory than expected, allowing me to respond to, practice, and instruct civilian mass casualty medicine in the far corners
of the world. And through this privilege, I have seen both the best and the worst of humanity. I continue to be humbled by the destructive power of a super-typhoon or an earthquake or a bomb or bullet—or for that matter, the rejuvenating energy of an innocent baby that is randomly born into the chaos of it all. But also, I am inspired by the force multiplier effect—the impact that those who “march toward the sound of gunfire” have on others who are in need. The simple act of helping, or just being there, lifts people up and allows them to stand again. At the core, far deeper than the DRGs and the CPTs and the EMRs, I believe these selfless acts remind us of why we went into medicine in the first place. Is it truly our responsibility to care for our communities? Is it our role to be leaders? If being prepared is what we naturally do as physicians, regardless of our specialty, then, in this changing world, it is our obligation to learn about civilian mass casualty medicine. People depend on us to do so. n
On September 15, 2001, Dr. Karch wrote to friends and colleagues reporting what he experienced and learned as a physician at Ground Zero, including 27 practical tips for future mass civilian casualty events. The email went viral. Read the full text at gumc.georgetown.edu/magazine.
In Fatigues, Scrubs, or Habit, Sister Dede Answers the Call The life and career of surgeon Sister Deirdre Byrne, MD (M’82, R’97), has included the political tensions of war and conflict, as well as deep inner peace. She has performed surgery under challenging conditions in Afghanistan, and provided care to returning soldiers as she rose to become colonel in the U.S. Army Medical Corps and as a reservist. She has served as a missionary surgeon responding to natural and man-made crises in Kenya, Sudan, Haiti, and Iraq. And on September 11, 2001, she made her way on foot to Ground Zero to bring supplies and support to firefighters in the smoke-filled air during the first two days of the tragedy. Throughout these experiences and more, Byrne was on a personal journey to discern her calling and to profess her vows as a woman religious. She is now a sister of the Little Workers of the Sacred Hearts in Washington, D.C., where she serves as medical director of their pro bono Physical Therapy and Eye Clinic at their convent, as well as volunteer surgeon at the Catholic Charities Medical Clinic (formerly of the Spanish Catholic Center). Whether in military fatigues, in scrubs, or in her habit, she says she’s there to work hard for her patients.
A life of medicine, service to the poor, religious vocation, and a Georgetown education now seem that they were all but inevitable for Byrne. She grew up in the Washington suburb of McLean, Virginia, in a large, devout, go-todaily-Mass, Roman Catholic family. Byrne quotes her mother that her call to serve others as a religious sister “started in utero,” simultaneously laughing and serious as she shares the story. Mother Teresa was her high school hero. If the life of a religious was a calling, so too was the life of a physician. By “a miraculous event,” as she calls it, Byrne was accepted to Georgetown School of Medicine. Georgetown was a family tradition: her father, thoracic surgeon William Byrne, was medical class of 1948 and completed a residency at Georgetown in 1956, in addition to her brothers Kevin (M’79) and John (M’87). By Jeffrey Donahoe
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Sister Deirdre Byrne
Serving the Country Through Army Medicine
Byrne was accepted into an Army general surgical residency With seven siblings, Byrne knew that money was tight. program and deferred this to do surgical training beginning in The military offered a scholarship program, so Byrne joined 1990 and ending at Georgetown in 1994. the Army in 1978 as a medical student, and received a military “I was thrilled to get into the program,” she says. Work medical scholarship. Her military service of family medicine weeks of 100 or more hours are grueling for any surgical resiand surgery would last nearly 30 years. dent, but Byrne also remembers the excitement. “The Army After a three-year family medicine residency at the U.S. had boosted my confidence, and I really flourished in those Army hospital at Fort Belvoir, Virginia, Byrne began the days.” scholarship “payback” period. As a full-time military officer, For someone with less she served 13 months in the pluck and inner strength, Sinai Peninsula, Egypt as entering a residency proliaison between the Army gram eight years after and the monks of St. graduating would have Catherine’s Monastery. made for more than a few One of the oldest surviving uncomfortable situations. Christian monasteries, it is Her brother John, five years located at the base of Mt. her junior, was already an Sinai, an area sacred to all orthopaedic resident at three Abrahamic faiths. Georgetown; medical After the Sinai, Byrne classmates were already volunteered to serve in attending physicians. “It Korea to practice family was a bit humbling,” she medicine and emergency admits. medicine. Running the ER “But humility is good gave her the opportunity to for people,” she says with a scrub in to assist surgeons. smile. “I was thirsty for hands-on Residency and fate also experience and was already brought her two callings toying with the idea of together. In 1996, as chief doing general surgery,” she surgical resident, Byrne says. was the first assistant when “The military was pretty Byrne served in Haiti in 2010 after the devastating earthquake. Cardinal James Hickey, hard core, but I don’t regret Archbishop of Washington a minute of it,” says Byrne. from 1980 to 2000, had open-heart surgery, and she also cared Her time in the service was more than just a payback for for him daily post-op. In 1997, her last year as senior resident, her. “I always wanted to be there to help our country,” she Byrne was freed up to be on-site and on-hand to deliver medsays. “The Army—this country—gave me a free medical ical care when her hero Mother Teresa visited Washington education, and I am grateful.” for five days. Note: Byrne is especially thankful that Mother Teresa was in good health. A Grueling—and Humbling— Surgical Residency After residency, Byrne practiced in Ventura, California, After completing a seven-year commitment of full-time medical training missionary doctors for two years. In 2000 she comservice in the Army Medical Corps, in 1989 Byrne spent a year pleted her board certification in surgery. “People sometimes doing missionary medicine. During part of that year she worked think, ‘Oh, you do missionary medicine over there somewhere, in India with a surgeon named Sister Frederick, who had done you serve the poor. You must not be able to hack it in private her surgical training at Georgetown. The friendship and menpractice’,” she says. torship strengthened Byrne’s dual vocations, but the call to be a They would be mistaken, because this is a physician who religious was put on hold for the call to be a surgeon. does not settle for good enough. Byrne brings not only top
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to live out the life of a fictional hero— Army surgeon Hawkeye Pierce from the TV show MASH. “I was a great fan of Hawkeye. I just loved his humor.” When she returned from Afghanistan in 2009, she finally retired from the Army for good and professed final vows with the Little Workers two years later.
Byrne brings hope, joy, and medical care to Sudan in 2009.
professional training—she is board certified in family medicine and general surgery as well as a fellow of the American College of Surgeons—but also brings years of invaluable experience in resource-limited settings to her practice. “I wanted my patients to know that they were getting the best care I could give them.”
Finding a Religious Home Also in 2000, Byrne came back to Washington to begin an intense discernment process, finding and joining the Little Workers of the Sacred Hearts, an Italian order more than 120 years old, made of both teachers and health professionals. It was a natural and immediate fit. “It’s a very traditional order,” Byrne says. “We pray together every day, including daily Mass and Adoration. We live in community. We’re old-fashioned girls.” Finally finding a religious home,
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Byrne took her formal formation in 2002 and professed first vows in 2004. But, once again, the Army would interrupt. “I had one foot in the religious life and one foot in with Uncle Sam,” says Byrne. In 2003, the Army brought her back as a reservist after she made first vows and deployed her three times over the next six years: twice in the United States and once for three months in Afghanistan. This meant trading in her habit for scrubs and fatigues. In Afghanistan she took care of wounded citizens. “We were just six miles from the Pakistani border, so we could hear the missiles overhead,” she remembers. “The hospital was one of the few safe zones on the base as it was bomb proof, so our patients were protected from further harm.” She chuckles when she admits that Army medicine gave her the opportunity
Wearing a black veil and full-length white habit, Byrne enters an office at the Catholic Charities Medical Clinic in D.C.’s Mount Pleasant neighborhood with apologies for running late. A minor but emergent surgery had presented a few hours earlier. She performed the surgery in a small but well-equipped room down the hall; for more complex surgeries, she works out of a number of affiliated hospitals. The modest clinic, a convent until it was renovated in the 1980s, resembles any private practice suite. A tour of the first floor reveals a closet-sized but wellstocked pharmacy, a lab, an ultrasound, three exam rooms, and a patient counseling room. Upstairs, there’s a wellappointed dental clinic and a light-filled chapel. There are two full-time doctors in addition to Byrne, several nurse practitioners, and rotating medical students, including some from Georgetown. It’s clear that Byrne knows everyone in the building and everyone knows her. She’s a bit of a wisecracker, genially answering questions from colleagues and patients, quick with a touch and a greeting. The work of a surgeon and former medical director includes holding doors open for patients, helping to carry a baby stroller down stairs, and directing UPS deliveries. It’s an informal atmosphere, seemingly lacking in hierarchy. “They all call me Sister Dede,” she says.
Sister Deirdre Byrne
Meeting Medical Needs at Home
Byrne estimates that most of the clinic’s patients live well below the federal poverty line (about $24,000 for a family of four and about $12,000 for an individual). About half are undocumented. Few patients have insurance, but many pay what they can. “It helps with their dignity,” Byrne says. Byrne pauses the tour to point out a plaque honoring her old friend and former patient, the late Cardinal Hickey, who founded the clinic. His memory is dear to her: they shared a deep faith and a concern for social services, immigrants, and charity.
mission for two weeks. She’s also on the board of medical advisers. “Sister Dede provides her unique skills to those refugees who need it the most,” Epstein says. “The Kurds that we serve absolutely love her and always ask when she is coming back again.” “She brings a credibility to our efforts that only a former U.S. Army surgeon turned sister of the Church can—and I think there is only one person like that in the world,” Epstein says. “She is unique,
and courageous beyond all measure.” Byrne says she is blessed. “I’ve had the education and surgical training to be prepared to work with difficult cases in poor communities and in areas of great conflict.” “I entered Georgetown knowing what I wanted to do,” she adds. “It’s what I am doing now: I’m a religious sister and a surgeon. I am able to serve Christ in the poor and was able to care for our incredible soldiers.” n
A Model of Courage Byrne, who’s staring age 60 in the eye (a fact that she dismisses with a wave of the hand), says she’s content to stay home, treat patients, and be Mother Superior of the Washington Little Workers sisters. “Mostly I fix the leaky toilets in the house and make sure the bills get paid,” she says modestly. But she’s been lured back into extreme medicine a few times lately to deliver care in the Kurdistan region of northern Iraq. The Global Surgical and Medical Support Group (GSMSG), founded in 2015 by Georgetown alumnus and current medical student Aaron Epstein (G’12, M’18), provides medical care in war-torn regions. Sites like Kurdistan can have medical infrastructure and resources but often lack the medical professionals to run them. The program provides not only care—from front-line medics to advanced cardiothoracic surgery—but also training for local doctors. To date, the GSMSG has had six trips to Iraq. Epstein says that Byrne was one of the first to believe in him and back his ideas, volunteering to go with him to Iraq and recruit other U.S. doctors. She went on the first GSMSG medical
At Washington, D.C.’s Catholic Charities Medical Clinic, Byrne consults with her colleague, nurse practitioner Laura Shaw (MS’11).
Serving at Ground Zero On September 11, 2001, Byrne found herself in New York, having transported a fellow religious sister for medical treatment the prior day. The towers fell in the morning, and by evening Byrne and two sisters had been sent to the base of the towers, with instructions to answer the call to dispense supplies and support to the firefighters. “We could barely see through the smoke,” she remembers. The three finally made it on foot to the police barriers near 10th Street. “We probably shouldn’t have gotten through, but between the sisters’ habits and my medical license, it opened the door for us.” Byrne worked in a first aid tent and dispensed care, support, and supplies. n
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The Doctor Is Out Teaching Wilderness Medicine at Georgetown By Patti North
The School of Medicine’s wilderness medicine elective includes hands-on training through mountain rescue simulations.
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hen they first dissect a frog, or maybe first peer through a microscope, many doctors-to-be begin to dream about a career in medicine, long before they ever apply to medical school. Not Matt Wilson. “I wanted to be a park ranger,” he says with a touch of nostalgic good humor. As a young boy growing up in Virginia, Wilson participated in myriad outdoors clubs and wilderness leadership activities. As an adult, his career plans evolved and he decided on a career in medicine, attending medical school at the University of Virginia. But he never forgot his first love—the outdoors. Remarkably, he has found a unique way to pursue both passions simultaneously, teaching the wilderness medicine course offered since 2013 at Georgetown School of Medicine. During the two-week elective, Wilson complements daily lectures with regional outdoor recreational activities run by local professionals. For example, the altitude and climbing emergency lectures are coupled with a trip to the climbing gym, where students participate in supervised climbing with exposure to mountain rescue techniques. The marine and whitewater lectures are followed by a trip to the river rescue station in Cabin John, Maryland and an optional kayaking excursion with a local boat outfitter. Extreme outdoor recreation is more popular than ever. More than 40 million
tourists visit recreation areas above 7500 feet in the American West each year. Hundreds of thousands participate in adventure travel in central and south Asia, Africa, and South America, many traveling to altitudes above 13,000 feet. Most of these activities are enjoyed without injury, but when someone does get hurt, they are a significant distance away from a hospital or clinic. Wilderness medicine, also known as “austere medicine,” is about caring for people in a resource-limited environment. That may be the wilderness, but the term may also apply to disaster relief, terrorist incidents, or international medical missions. Wilson’s course is accessible to fourth-year students, as they have nearly completed medical school and have largely acquired the skills needed to provide most kinds of care in a typical hospital setting. “They know how to use state-of-theart treatments and diagnostic tools. Now it’s time to step out of the box,” Wilson says. “We try to get the students to think in a different way. What do you do when the situation is less than ideal? There are things that happen every day in medicine that defy textbook answers.” “The students learn what is important to do and in what order,” Wilson notes, applying what they already know but in new conditions. In a wilderness or austere scenario, the challenge is not only diagnosing and treating a problem, but often finding a way to get the victim to a clinical setting in time to prevent further damage or death. A high-angle rescue, for example, requires skills common to mountaineering, not medicine. And in many cases, rapid and safe evacuation is more effective than treatment in the field. Some of Wilson’s students want to go into emergency medicine (he himself is
In addition to teaching wilderness medicine at Georgetown, Wilson works for the National Park Service as operational medical director of the National Capital Region, helping coordinate medical aid preparations for events like July 4 on the National Mall.
“We try to get the students to think in a different way. What do you do when the situation is less than ideal? There are things that happen every day in medicine that defy textbook answers.” — Matt Wilson a board certified emergency medicine physician at MedStar Washington Hospital Center), others envision themselves participating in disaster relief or medical mission activities at some point in their careers, and still others just enjoy outdoor sports and see these skills as a natural complement to pursuing them. Students complete the course with a capstone group exercise that involves the simulation of various injuries in a wilderness setting. Occasionally the activity brings unplanned excitement, such as when the student acting out a twisted ankle encountered a sizable but
non-venomous snake. In the past three years, the course has been offered in warmer months, so activities have included hiking, rock climbing, and canoeing, with simulated heat stroke and drowning. This year the course will be offered in winter, and will include skiing with simulated fractures, frostbite, and hypothermia. Some of the students come to the class with great confidence, having participated in outdoor activities most of their lives. Wilson says that they quickly learn how the stress of an injury coupled with the remote setting creates a significant challenge. They may not
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realize, for example, how quickly cardiac arrest following a lightning strike can be reversed in the field with CPR. And they may hold to the same myths that many do: that the victim remains electrified after the strike and cannot be touched. This is not true and delaying resuscitation in order to triage less severely injured victims can rapidly diminish the chances of successful resuscitation. Techniques also change over time. The best course of action for a poisonous snake bite, for example, is now to evacuate the victim to a place where antivenom can be administered as soon as possible—not to cut or otherwise compromise the wound in an attempt to extract the poison. Wild animal attacks, fortunately, are rare and are best prevented in the first place by not engaging a defensive action from an animal, to the extent possible. Indeed, the most effective strategies focus on prevention: packing a good emergency kit, watching for signs of dehydration, postponing outdoor activities when a thunderstorm is forecast. But enjoying the great outdoors brings a certain amount of risk with it, though probably not, as Wilson points out, “as much as driving on the Beltway.” In the true Georgetown spirit of women and men for others, Wilson also offers his skills to the National Park Service as operational medical director of the National Capital Region, at the recommendation of Bill Rogers, MD, who preceded him in the position for many years. The area covers Harper’s Ferry in West Virginia to Prince William Forest in Virginia, and everything in between including Rock Creek Park and the National Mall. This means that every year on the Fourth of July, he is downtown coordinating a team to provide care for a million people who
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gather on the Mall to celebrate and view the fireworks. Known as “mass gathering medicine,” the volunteer crew is prepared to address everything from a drug overdose to a terrorist incident. Wilson and several Georgetown
previous night and the carefully planned emergency response staging, he shrugs. “It’s really the safest day of the year to be down on the Mall.” A fleet of air conditioned Metro buses stands by to ameliorate the most
Wilson meets with MedStar Georgetown University Hospital residents to review protocols before the Independence Day parade.
residents help implement National Park Service protocols, working with representatives from the Park Police and a variety of state and federal agencies. Hours before the Independence Day parade along Constitution Avenue begins, Wilson stands calmly between a red truck labeled “Mass Casualty Unit” and a big white school bus labeled “Medical Ambulance.” Noting the thorough security sweep beginning the
common ailment for parade viewers and marching bands: heat stroke. To Wilson, it’s a reminder that “You don’t have to be all that far from a hospital to be in an unusual setting requiring the care of many people at one time.” Wilson and the multiple medical teams are standing by, ready to assist as the crowds gather to celebrate freedom. And on this day, fulfilling a boyhood aspiration, he takes his place alongside the park rangers. n
From Afghan Outpost to the Caribbean
A Mission to Serve At the conclusion of an accomplished military career, Gerard Antoine (M’98) reflects on his time at a combat outpost and turns to the challenges of health care in the Caribbean.
ieutenant Colonel Gerard Antoine, MD (M’98), retired last month from the U.S. Army after 24 years of active duty service which bookended his time at Georgetown University School of Medicine. For Antoine, the inexorable bond between his military and medical careers propels him into his next endeavor, and leads him back to his childhood home. The doctor’s end goal is to build the Rehabilitation Hospital of the Caribbean (RHC) in Trinidad. RHC will be the first comprehensive inpatient and outpatient rehabilitation hospital in the English-speaking Caribbean, with an aim to reduce cardiovascular and stroke morbidity and mortality in Caribbean nations. The company is registered, and the hospital’s name is in place; Antoine is now focused on making it a reality. “It’s like the Cleveland Clinic, or the Mayo Clinic,” he says with a confident smile. “They started off as ideas in somebody’s head, too.” Using the model of MedStar National Rehabilitation Hospital in Washington, D.C., Antoine plans to open RHC’s outpatient offices this year, followed by the construction of an inpatient facility. The teaching arm of the institution will be the Caribbean Medical Providers Practicing Abroad
Antoine coordinates medical conferences and care in Trinidad and throughout the Caribbean.
(CMPPA), a non-profit founded by Antoine in 2006. The growing volunteer organization hosts annual conferences and training for medical and rehabilitation professionals throughout the Caribbean. CMPPA collaborators from around the world attend the program, including members of the vast Caribbean medical diaspora.
‘A Shot at a Dream’ Born in Trinidad, Antoine holds the Caribbean close to his heart. He hopes to improve health care in his birthplace, and he understands from personal experience the impact that better medical resources and training can offer. When he was 10 years old, his mother, Lucille S. Antoine, died during routine
childbirth in a Trinidad hospital. “Even today, there is a significant shortage of physicians and nurses in Trinidad and Tobago,” he notes. “In addition, there continue to be high incidences of stroke and other noncommunicable diseases. This is my way to give something back to the community that gave me the best and most memorable years of my life.” His family emigrated to the U.S. when Antoine was 14. He enlisted in the Army at 17, beginning a remarkable career that would combine medicine and the military, service and leadership. Unlike many future physicians, Antoine did not dream of being a doctor. “I wanted to work in electronics and be an engineer,” he explains. “The recruiter told me engineering required a six-year commitment, and I just wanted to do three years in the military to secure funding for my education.” The recruiter suggested Antoine sign up as a medic, based on his time constraints and admissions scores. Twenty-five years later he was still in uniform—and still in medicine. Antoine stayed as an enlisted soldier in the Army for 10 years, climbing to the rank of Sergeant First Class. He served in many roles. “I was an infantry combat medic in the 101st Air-Assault Airborne Division, an ambulance driver, a hospital
By Melissa Maday
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attendant, and a platoon sergeant in an evacuation hospital—I covered the gamut, and I enjoyed it,” he says. “The military taught me perseverance and leadership. I learned about teamwork, and what it’s like to be involved in something far bigger than myself.” The exposure to so many aspects of health care during his enlisted service changed Antoine’s career path. He pursued health care, becoming a respiratory
dream,” Antoine enrolled in medical school at Georgetown, a community he credits with truly embracing him, in addition to providing him with an outstanding education and wonderful resources. The friendships Antoine developed on the Hilltop have endured, and many of his Georgetown friends now contribute their time and talents to CMPPA. One friend, Nigel Scott (C’95), an undergraduate ten years his junior, had
clinics or facilities to give back to communities in need,” Taylor explains. “Dr. Antoine is one of the few doing just that. “ Antoine’s Georgetown lessons went beyond the classroom. “I received the right exposure and learned to become an active, lifelong learner. I also learned to serve. I think the whole education process at Georgetown prepares students for service to humanity, and challenges them to keep learning so they can better serve their patients and communities.”
CMPPA volunteers conduct blood pressure screenings in Tobago in 2015.
therapist working with spinal cord injury patients in VA hospitals. One of his patients became his mentor, pushing him further in his medical ambitions. “This man, Mr. Bryant, not only served as a mentor, but he became my friend. Even more than that, though, he encouraged me,” Antoine continues. “That’s when I was first exposed to physical medicine, rehabilitation, and spinal cord injuries. I’d been an enlisted soldier for 10 years, and like so many in the military, I’d attended five different undergraduate schools to earn my bachelor’s degree. Medical school seemed like an unlikely dream. But Mr. Bryant believed in me. He nurtured and encouraged my growing desire to become a physician.” And so, in what he calls “a shot at a
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attended the same high school in Trinidad. They met on the basketball court during a pick-up game on campus. All these years later, Scott, now an attorney in Philadelphia, provides pro bono legal services to CMPPA. “Georgetown brought us together, and we bonded over our shared experiences— in Trinidad and on campus,” Antoine says. He formed another lifelong friendship with David L. Taylor, Associate Dean for Student Learning and Director of the Georgetown Experimental Medical Studies (GEMS) Program, whom he considers a mentor. Their admiration is mutual. “In my 27 years at Georgetown, I’ve interviewed thousands of students aspiring to medicine, and many express their heartfelt interest in establishing healthcare
The commitment to service he learned at Georgetown built upon Antoine’s military training and gave him inspiration and direction for the next step in his career. After completing his internship in family medicine at Howard University Hospital and his residency training at MedStar National Rehabilitation Hospital, Antoine chose to stay in the military. “The model of service and leadership at Georgetown is important in the military—especially when things change so fast. It tied in really well with what I was doing. It was an easy decision for me to stay on,” he said. “I’ve been a soldier since I was 17. I enjoy taking care of the men and women who serve—whether on a deployment, or in my work as a rehabilitation physician at the VA hospital. I enjoy wearing the uniform and taking care of the families.” The military values resonated with him. “It’s amazing to watch, really. Even when they get hurt, the first thing young soldiers ask in the hospital is ‘How are my buddies?’ and the next thing they say is ‘I want to get back out there.’ They want to stay with their units, their fellow soldiers. I believe that’s why people join the service: to serve something bigger and greater
Lessons in Service and Teamwork
than themselves.” A veteran of both the Iraq and Afghanistan wars, Antoine recalls his service with deployed troops on combat outpost (COP) McClain in Afghanistan as a rewarding time in his military medical career. “I was the only physician, serving with four combat medics and two special forces medics. While I worked in the safety of an aid station, the young medics made daily trips into harm’s way—‘outside the wire’—which were often eventful.” The remote mountain aid station served as a trauma bay, a family practice clinic, a recreation center, and on occasion a chapel. “I was the oldest guy there—a 50-year-old lieutenant colonel. The aid station was the only location on the COP where young soldiers could come and relax when they had a free moment. I made sure they always had lots of hot coffee and video games.” “Our trauma patients always presented in groups of three and four,” he says. “Our goal was to stop the bleeding, stabilize, and evacuate them. The one variable in the equation we could not control was evacuation: we had to manage severely injured patients sometimes for a few minutes, and sometimes for up to an hour. It all depended on our helicopter medevac support on that day.” “Practicing in a combat zone without the support of another physician or nurse alongside you teaches teamwork at the deepest level,” he explains. “You learn to trust the young medics who work in the aid station with you. And in that extreme setting, I took every opportunity to train them for the worst case scenario, because I knew it was going to happen—we just didn’t know when. Training went beyond the medical staff. We trained the infantrymen to care for their buddies; we trained every soldier to assist in mass casualty situations.”
Antoine and the CMPPA partner with local care providers in Tobago to offer cancer screenings.
Giving Back to Trinidad As he retires from the military, Antoine now turns his passion for service to the land of his birth. “All my best memories of life were in Trinidad. I feel obliged to give something back. There are challenges with health care in the Caribbean, and I have something to offer.” Through CMPPA, he asks Caribbean colleagues who currently practice in the U.S., Canada, and Europe, as well as other medical and non-medical volunteers, to give their time, money, and expertise. The growing network held its first conference in Trinidad in 2014, with about 150 attendees, including 50 international volunteers. At the 2015 conference in Tobago, over 250 people, including more than 70 international participants, attended. In 2015, CMPPA partnered with the Trinidad and Tobago Cancer Society to perform pap smears, breast exams, and cancer screening in Tobago. The next conference is scheduled for June 2017 in Barbados. Taylor sees Antoine’s unique, motivating form of servant-leadership as the
driving force behind the success and growth of CMPPA. “The reason everyone is excited about CMPPA and the Rehabilitation Hospital of the Caribbean is Dr. Antoine, and the reason he can motivate and inspire people to help him is because he serves first. This gift in him was groomed by the military and nurtured at Georgetown. You hear the same theme all the way through his career,” says Taylor. As he prepares to move from Hawaii to Trinidad, Antoine is excited for this next chapter in his life. “For the last 15 years, I’ve spent my time taking care of one patient at a time, every 30-45 minutes, then going home. But I’ve realized that I can help many more patients through CMPPA. We can help thousands at a time by securing resources for treatment, education, and outreach. I want to contribute to the little part of the world that I can change. I am just doing what I know: rehabilitation medicine, physician leadership, and community service.” n
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A Jedi in training...or a first year medical student on a mountain rescue mission By Daniel Coleman (M’17)
he guy was not in a good way: two miles from the closest road, a steep 1500-foot trek separating him from the valley floor. Before I even got close, I could see the laceration—a six-inch oblong cut that looked like it was splitting his right forearm in half. Caitlin called out to let him know we were coming. We downclimbed a short stretch of gently graded cliffs, then tread carefully, because there was another 20-foot drop to the left. Up close, he was remarkably calm.
His name was Jed Knight, but his friends called him Jedi. I asked if I could be his padawan, but he didn’t laugh and I could sense my stock plummet even further. Jedi also had 10-out-of-10 pain under his left knee. He couldn’t bend it and there was a decent amount of dried blood, enough so his pants were sticking to the skin. Caitlin went to work, cutting away the pant leg as I irrigated the forearm and firmly dressed the wound. We removed the pant leg, and looking
During that time, my job was to make sure he was still alive, which is a tall order for some kid who had spent the last year memorizing the Krebs cycle and figuring what Brodmann area 4 really was. “Sir, my name is Dan Coleman.” “Hi,” he answered. “I’m a first year medical student working with the mountain rescue group,” I explained. But the way I said it, I think it sounded more like an excuse, absolving myself from any soon-to-be-made mistakes. The guy raised his eyebrows, maybe wondering if he should roll off the edge and save himself several hours of pain and amateurish fumbling. I checked his pulses and made sure he wasn’t thirsty. He hadn’t hit his head or blacked out, and he was adamant that he had “just slipped.”
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down at that mess, I thought a bad word. There was a jumble of bones erupting through the skin, like when continents collide to form mountains. A compound tibia-fibula fracture. Help was on its way, but I didn’t think they would make it in time. Wild places have always intrigued me. Places where you can smell eucalyptus, sweet and oily, and feel a carpet of dried pine needles beneath your feet. Places that are far enough away to make things like email and texting obsolete. I look for the high points, promising vistas of rock and snow, with an incom-
parable sunset if you can wait just long enough. And I’m not the only one. The outdoor recreation industry is booming. The latest report on outdoor participation from the Outdoor Foundation shows Americans engaging in an estimated total of 11.7 billion outings in 2015. But as more people go outside, more accidents will happen outside, whether due to poor preparation, ignorance, or just bad luck. That may mean more twisted ankles and skinned knees, a few more hapless hikers walking into camp delirious and dehydrated, or lost in the middle of nowhere with a compound tibia-fibula fracture. Jedi had been hiking along a ridgeline in the Massanutten Mountains of Virginia, across the valley from Shenandoah National Park. He enjoyed wildlife photography and had seen a deer, a young buck, off in the woods. He told his two friends that he would catch up further down the trail. They separated and Jedi wandered through some thick underbrush to get into position, but took one step too far, slipped, and fell. That was almost 18 hours ago. Looking down at it, I wondered what to do. I had recently finished gross anatomy, so I knew about the bones and their connections. I knew which nerves and arteries might be injured. I even knew about compartment syndrome and its symptoms. “My foot feels kind of tingly.” I felt his foot. It still felt warm with good pulses, but he had a lot of pain
Patrick Coleman (M’06), Daniel’s brother, demonstrates the use of a SAM (Structural Aluminum Malleable) splint during a workshop as Kimberly Johnson (M’18) looks on.
whenever I moved it. For all of that preclinical knowledge I had, none of it was going to help. Even if I knew then what I know now, I think there is little precedent for a fourth year medical student attempting a backcountry fasciotomy. We had to get him down the mountain. Caitlin and I thought about supporting him between us, using a bit of tubular webbing I had in my pack, but discarded the idea because we were still going to have to scramble up a few gentle cliffs to the trail. We would have to wait for the litter to arrive from base, load Jedi in, and haul him up using a system of ropes and pulleys. In the meantime, we splinted the injured leg to the good one and waited. During that time, my job was to make sure he was still alive, which is a tall order for some kid who had spent
the last year memorizing the Krebs cycle and figuring what Brodmann area 4 really was. So I just kept talking to him, taking what vitals I could every so often, and wishing that I really knew what to do. When people get injured in a city, they are a short ride from a well-equipped emergency room and a team of specialists, ready to tackle whatever comes their way. Wilderness medicine, however, is about using the accoutrement you can fit in a backpack to keep someone stable for hours, pending slow transport to a proper healthcare facility. It’s this improvisational aspect of wilderness medicine that I find fascinating. Flipping through Auerbach’s compendium on the subject, there are pages upon pages of unique solutions for when that first, best option isn’t available. In place of a knee immobilizer, use a tightly wrapped sleeping pad. No sling? Just pin up the bottom of the shirt to create a cradle. And for a compound tibiafibula fracture…splint the leg and get to definitive care. Great. Finally, the litter arrived, along with dozens of other rescue denizens. I checked in with Jedi and then we loaded him in and strapped him tight. “Hey, I can’t really feel my foot anymore.” We were making slow headway. The semi-technical team had rigged their pulleys and the rest of us were helping to pass the litter up the rocks. I tried feeling the pulses in Jedi’s foot, but it was difficult because the litter kept moving around. It took over an hour to move Jedi up the rock. After that, the rescuers had to pass the litter hand-tohand over uneven terrain, but once we
got to the trail, they attached a single large wheel and we started down at a (slightly) faster clip. “Man, I don’t know, my leg feels, like, dead now. It’s like it’s not attached.” There was no point in stopping. We were only about halfway down. There was an ambulance in the parking lot, but the closest medical center was almost an hour away. By that time, it had been nearly 24 hours since the accident. Jedi was going to lose his leg. And then our team leader went to the front of the line, blew a whistle, and announced that he was ending the mission. We unstrapped Jedi, and he hopped down on both feet, full strength, no pain. A miracle? The Force? In fact it was a training exercise, not a real search and rescue. The injuries were painstaking moulage. Jedi was (thankfully) not his real name. But my nerves were real. I had been unsure of myself the entire time, unsure if what I had done was correct. There wasn’t an attending to consult, no one was double-checking my work, and I barely knew anything about managing a patient, let alone a patient in the middle of nowhere when I only had a few bandages to my name. I had been in the backcountry plenty of times, but this was my first real experience with wilderness medicine. When we go outside, the chances are slim that something bad will happen. Most likely, the hike will go according to plan, and we’ll walk across that snowfield without incident, snapping a picture of an incomparable sunset before tucking into camp for the night. But what if some kid nicknamed Jedi slips off a ledge two miles from anything and ends up with a compound tibiafibula fracture? For future medical professionals who enjoy venturing outdoors, it would be prudent to be ready for anything. n
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better bystanders By Melissa Maday
This ear-catching line is the motto of Heroes for Hearts (H4H), a non-profit organization whose mission is to teach compression-only Cardiopulmonary Resuscitation (CPR), Automated External Defibrillator (AED), and first aid training to the general public. After learning about the increasing number of heart attacks and low rates of bystander CPR in the United States, School of Nursing and Health Sciences undergraduates Brandon Ferrell (NHS’17) and Heroes for Hearts instructors in action training members of a global non-profit headquartered in D.C. Nirmal Maitra (NHS’17) founded H4H during their freshman year. around the world to be prepared to safely Milzman, MD, professor of emergency Compelled by the lack of CPR training and efficiently act in any situation in medicine and associate dean for inforoutside healthcare communities, the which CPR is required,” Ferrell explains. matics and research at GUMC, serves human science majors devoted them“Compression-only CPR can be taught as the group’s medical advisor. selves to making a difference. in less than 20 minutes and is free-ofSince 2008, the American Heart “We were inspired to take something cost. Immediate compression-only CPR Association has recommended that relatively simple—CPR—and come up performed by a bystander has also been bystanders use the hands-only method with an innovative delivery system to shown to improve survival in out-ofof CPR rather than the previously taught increase the number of people reached, hospital cardiac arrests compared to CPR combination of compression and mouthtrained, and ready to perform it. We with mouth-to-mouth resuscitation. to-mouth resuscitation. The compreswanted to begin by reaching our immeWhile many people are hesitant to sion-only method was developed and diate community first, but we have a perform mouth-to-mouth resuscitation, staunchly advocated by Georgetown vision of expanding to the greater nation compression-only CPR has allowed as well as underserved global zones in the fellow and former faculty member H4H to extend CPR training to just Gordon Ewy, MD (W’65), and his team long run,” Maitra explains. about anyone.” What resulted is Heroes for Hearts, an at the Sarver Heart Center at University The group’s simple structural model of Arizona. Although Ewy, who himself international non-profit with chapters in complements its straightforward goal. studied under W. Proctor Harvey at Washington, D.C., and India. Maitra is Students form the backbone of H4H, Georgetown, retired in 2012, his work currently president and Ferrell is vice and Georgetown’s global reach amplifies continues to impact the Georgetown president. International health majors the impact. community today. Michaela Hitchner (NHS’19) and May“We recognize the power of the “The mission of our organization is to Linh Huynh (NHS’19) serve as secretary students around us at Georgetown,” empower and better equip communities and financial director, respectively. David
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20 minutes. Let’s save a life.
Maitra explains. “Students are the key to efficiently and cost-effectively bringing this life-saving training to everyone. Not only does the student population regenerate each year, but most students travel from campus during the summers, too. We want to train and send them out into the respective communities they touch. We believe students can be utilized as a powerful force for constructive change.” As of August, about 50 Georgetown students were involved in H4H, which met its goal of training 1,300 people by the end of the summer. The group hopes to expand nationally and internationally and train at least 10,000 community members by the end of 2017. “In addition to training businesses, we are training families,” Ferrell says.
“When an entire family learns CPR, you have prepared an entire household for an emergency. Kids too young to perform compressions can learn how to dial 911.” The student group is gaining notice. Ferrell, Maitra, and Milzman have
Maitra and Ferrell, who are both pre-med, feel grateful for the opportunities they have on the Hilltop. “We are very privileged to attend Georgetown, but it’s also a mandate to take what we learn and give back to the
“The mission of our organization is to empower and better equip communities around the world to be prepared to safely and efficiently act in any situation in which CPR is required.” — Brandon Ferrell testified at D.C. Council hearings on two CPR-related bills. The second student-run chapter will open soon at another local university.
community,” Maitra says. “Heroes for Hearts enables us to put the Jesuit ideal of men and women for others into practice on a daily basis.” n
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White Coats On for the Class of 2020
hey come from across the country and around the world. Many have a military background. Some come from families with a long tradition in medicine. No matter the path they were on, the 196 students that make up the Georgetown University School of Medicine Class of 2020 are now moving forward on the same journey, with cura personalis at the core. They began their walk together August 5 at the annual White Coat Ceremony held in Gaston Hall. While many view the ceremony as the beginning of medical school, Georgetown educators stress that it marks the beginning of a medical career. “What comes with the white coat is transformational,” said Stephen Ray Mitchell, MD (W’86), dean for medical education. “This is not graduate
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school. You will be part of the medical profession.” Donald Knowlan, MD (R’60, W’82, H’04), emeritus professor of medicine, delivered a powerful keynote speech, as he has for many years.
Generations of Georgetown Medicine With his Georgetown Medicine alumni parents proudly looking on, Timothy DeVita (C’14, M’20) was coated by his alumna grandmother, Marie DeVita (M’54). One of only four women in her graduating class, she passed the torch on to the third generation in what she describes as a wonderful and very emotional ceremony. Much has changed since she was at Georgetown, including the class makeup: this year’s cohort is comprised of more women than men. The DeVitas were not the only
Georgetown family at the event. Krista Roberts (M’20) was drawn to Georgetown all the way from Sacramento, California to follow in her family’s footsteps. Her mother graduated in 1986, and her aunt, uncle, and other extended family also graduated from the School of Medicine. “I come from a family of physicians, so I had a lot of exposure to it,” said Roberts. “I made an effort to branch out and try different things, but nothing else had the feel of the patient-doctor interaction. I chose Georgetown because all of my family members had such great things to say about it.”
Different Journeys, Common purpose No two students have walked the same path. Stephen Pineda (M’20) describes his journey to medical school as “slightly
unusual,” but says that every step solidified his conviction to become a physician. After graduating from West Point in 2008, Pineda served as an infantry officer for five years in Iraq and Afghanistan. Upon returning to the U.S., he worked as an EMT in Baltimore, often operating in underserved areas of the city. He later joined a research lab at Boston Children’s Hospital before coming to Georgetown. “My experiences in the army made me realize that I wanted to work in a profession that would allow me to care for others,” says Pineda. “Georgetown’s emphasis on care of the whole person really spoke to the type of doctor I wish to be.” n
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Biomedical Graduate Education
pursuing a phD for the Love of Science How does someone with a degree in electrical engineering spend a career in finance, retire, and then head to Georgetown for a master’s in biotechnology, eventually pursuing a PhD in pharmacology? Georgetown Medicine sat down with Kimbell Duncan (MS’15, PhD’22) to find out. Tell me about your early career in the investment field.
What made you decide to study biotechnology?
Do you have a specific research interest?
I graduated from Yale with a Bachelor of Science in electrical engineering, but I had taken a summer job on a trading floor between my junior and senior years and fell in love with the markets. I joined Goldman Sachs out of Yale and within a short period of time became a trader. I worked in finance for 17 years and retired in 2004. During that time, I was fortunate to be on the front lines of a few financial innovations. My time in the investment business taught me that learning never stops, and one needs to continuously expand the number of tools in his toolbox in order to be nimble and prepared for unforeseen opportunities.
Following retirement, I began to invest in startup companies as an angel investor. Several of those early investments were in biotech. In addition, my personal life was consumed with healthrelated matters. My mother suffered from mastocytosis and my first wife was diagnosed with breast cancer at the early age of 29. Understanding disease and possible new treatments became an obsession. Many of my friends were either bioscientists or medical professionals, and I sat on the boards of five biotech companies. Ultimately, both my mother and my wife died of their diseases. When I decided to move to Washington, D.C. from London, I explored the possibility of going back to further my biosciences education more formally. I obtained a master’s degree in biotechnology from Georgetown in 2015 and then gained acceptance into the PhD program in pharmacology here. You might say that I am backfilling my education to support the work I have been doing as an investor and philanthropist, but I hope I might contribute through research as well.
I am interested in the gut-brain axis as it relates to diseases of the central nervous system. I plan to focus on Parkinson’s disease.
As investor, philanthropist, and pharmacology PhD student, Duncan is not your average retiree.
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Will you use your phD to change careers or add a new layer onto your current skillset? My “career” has been over for more than a decade. I study and research for the love of science and the search for ideas that make a difference. I contribute as an investor and board member to support the activities of brilliant scientists and entrepreneurs, and I have seen how my own studies enrich the conversations I have with them. But their ideas are their own and my contribution marginal. Of course, my graduate education informs my activities as an investor and my charitable aspirations, but it is too early in the PhD journey to see what opportunities will arise upon obtaining that milestone.
Last year you represented Georgetown at the Leaders of Tomorrow Summit, meeting with current and future regional biotech leaders. how was that experience? I was grateful to have the opportunity to participate in the summit. The most rewarding aspect was forming a team with students from other universities in the region to solve a problem and submit a proposal. Gaining insight into
the work others are doing in fields that are not directly related to the work I am doing was interesting and rewarding. I continue to remain in contact with one or two of my Leaders of Tomorrow colleagues and follow their advancement.
American Medical Association
You sit on a number of biotech boards and charities. how did you get involved with them? I first began to invest in start-ups in 2006 and, generally, I accept board positions with those companies. Each of the companies was founded by a scientist/entrepreneur who discovered or created an invention with the aim of improving the health of its ultimate beneficiaries. It is inspiring to work with people who tirelessly work to solve problems and advance technologies. In 2010, I started the Rush Foundation, a charity focused on HIV in sub-Saharan Africa, having become familiar with the science and human toll of the virus through one of my angel investments. I wanted to help make a potential vaccine candidate accessible to the poorest countries that are most affected by the pandemic. The vaccine is currently in phase II trials. We subsequently expanded the activities of the foundation to help those living with HIV. We provide start-up funding for income-generating activities, fund pilot prevention programs for youths, and fund a self-sustaining medical services delivery operation for fishing villages in Uganda. In addition, we have supported academic research aimed at improving the policy response to ensure the long-term provision of HIV interventions in sub-Saharan Africa. It has been challenging but rewarding work. n Interview by Camille Scarborough
Georgetown Student Takes Seat on AMA board
ourth year Georgetown School of Medicine student Omar Z. Maniya (C’11, M’17) has been elected to the American Medical Association’s 21-member Board of Trustees. The AMA announced the results of its election on June 21. “I am honored to be elected a trustee of an organization that has been tirelessly striving to improve the lives of physicians and patients for over 150 years,” said Maniya. “But health care is changing dramatically, and as the youngest member of the AMA’s Board of Trustees I am excited to bring a unique perspective.” Maniya has dedicated his research to health systems innovation. He recently graduated with an MBA from Harvard Business School, where he studied how to lower health care costs through disruptive innovation and the impact of alternative payment models on costs and efficiency of care. He also gained experience in health care consulting and finance at McKinsey & Company and RBC Capital Markets. “At the end of the day, all our policy proposals, technological advancements, and innovations have to help doctors be doctors and improve the lives of our patients,” Maniya said. Maniya and other members of the Board were elected by physicians and medical students representing more than 190 state and specialty medical societies. The mission of the AMA Board of Trustees is to foster the promotion of the art and science of medicine and the betterment of public health.
As the youngest member of the AMA Board of Trustees, Maniya hopes to improve the work of doctors and the lives of patients.
An active member within the AMA, Maniya served for two years on the AMA Council on Long Range Planning. For their biennial “Health Care Trends” reports, he helped conceptualize emerging health care delivery models, health care information technology, changing medical education, and the blurring line between payers and providers. He has received multiple awards and recognitions including the AMA Foundation Excellence in Medicine Leadership Award, and has been named a McKinsey Emerging Scholar, a Georgetown Science in the Public Interest Fellow, and a Georgetown University School of Medicine Sweeny Scholar. Born in New York City and raised in Princeton, New Jersey, Maniya earned a bachelor of science in biology and minor in economics from Georgetown University. n
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historic Campaign Exceeds Goal
hanks to the support of the entire Georgetown community, on June 30 the 10-year campaign For Generations to Come came to a successful close, raising $1.67 billion for four key pillars: Scholarships, Academic Excellence, Student Life, and Transformative Opportunities. In addition to surpassing the $1.5 billion goal, Georgetown raised more for student scholarships during the campaign than in the preceding 217-year history of the university,
confirming and expanding its commitment to needblind admissions and meet-full-need financial aid. The number of new Georgetown University Medical Center scholarship funds grew to 39 over the course of the campaign— 34 endowed, and five current use. For the entire university, the campaign saw 530 new scholarship funds, of which 490 were endowed. In addition to substantial investments in facilities
across the university campus, such as the Healey Family Student Center, the W. Proctor Harvey Clinical Teaching Amphitheater, Regents Hall, and the Dahlgren Chapel renovation, donors funded 79 new endowed chairs and professorships, 11 new research centers, and $153 million directed to groundbreaking research. n
Learn more about giving opportunities at giving.georgetown.edu.
Saturday, October 29, 2016 n
6:30 p.m. Washington Hilton benefits Georgetown Lombardi Comprehensive Cancer Center
0 Raffle of a 2016 Lexus NX200t F Sport Automobile $100/ticket. Do not need to be present to win. Honorary Chair: DeMaurice Smith
Anniversary Co-Chairs: Paul Tagliabue William R. Roberts Jeanne Ruesch
Gala Co-Chairs: Brian Katz Jill Kirkpatrick Paul Schweitzer Evening Emcee: David Hill, Producer, 2016 Academy Awards & American Idol
For information call 202.687.3866 0 www.lombardigala.georgetown.edu
G E O RG E TOWN MEDICINE
This year Georgetown University Medical Center students, faculty, parents, alumni, and friends shared past and current White Coat Ceremony moments on Instagram (@georgetownmedalumni)Â and Twitter (@HoyaMedAlumni). Follow us and add your photos and memories to the conversation.
GU MEDICAL CENTER
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Reflections on medicine with
Kimberly Henderson (C’91, L’95, M’00) Balancing work as a medical consultant and practicing doctor, this triple Hoya keeps cura personalis at the center of it all. She is an emergency physician at Mount Sinai Beth Israel Hospital in Manhattan, regional medical director for CVS MinuteClinic, and medical director for health systems alliances at CVS Health.
A MinuteClinic is not a medical home. We support the medical community. After we see patients, we always
My path may not be the typical beaten path. But every day I get up and see my patients and do the best I can for them. It’s something I’m passionate about. You read a lot about
At CVS Health, we’re involved in making sure
I was drawn to emergency medicine because it fits with the way I think and function. I like the variety: seeing a 90-year-old patient with congestive heart failure in one room, checking a pregnant patient with a complication in room two, reducing a shoulder for a kid who fell playing football in room three. I’m a hands-on doc. I like to do my own procedures, my own central lines. And I like communicating with subspecialties. The emergency department is the front door of the hospital. A lot of times it’s the only experience a patient has with our medical center. I started with CVS seven years ago as a collaborating physician for MinuteClinics, located inside the pharmacies. I supported nurse practitioners who work alone there, if they wanted to review a dosage or go over a case. Over time, I got a full swath of the country to manage, which blossomed into NP education. I work on quality assurance and chart review in different states. I provide guidelines and training for the care of patients that I may never see, but am ultimately responsible for. MinuteClinics are not urgent care but retail medical care, when your doctor isn’t available. It’s the brave new world of medicine. We’re not delivering babies in there, but why wait a week to see your primary care physician because you have a sore throat? I think we fill a need.
G E O RG E TOWN MEDICINE
patients are optimally adherent to their medications, because as a population, patients who take their medications the way they’re supposed to do better. We have programs like multi-dose packaging for complex regimens. Instead of having to negotiate 15-20 vials on the kitchen table, patients receive prepackaged combined medications in cellophane wrappers for morning, afternoon, and evening. I work with a new app for home health visits called Pager. You call for a doctor like ordering an Uber. Sometimes we have to meet patients where they are.
I am “Jane Hoya”—Georgetown undergrad, law school, and medical school. I met my husband at Georgetown, and we were married in Dahlgren Chapel. Georgetown made me the kind of physician that I am. You’re taught that it’s not just about numbers on a screen, tests you’re running, medications you’re prescribing. It’s taking care of the whole patient—a living, breathing person with concerns, beliefs, and questions, in addition to medical problems they may have. During training, one of my attending physicians at Georgetown told me that with every patient, before you do or say anything, make sure it’s the same sort of care you’d
give your own family. To this day, I bring that into every room that I enter. n
physician burnout. I don’t have that.
send a visit summary back to the primary care physicians, so they know we’ve taken care of them, and so they can continue to manage their care.
“I give to Georgetown because I am grateful for the scholarship support I received.” —Dick Nasca (C’60, M’64)
At Georgetown School of Medicine, besides the great learning environment and reputation for turning out solid clinicians, we had an outstanding faculty. They knew us by first name, invited us to their homes for dinner, and challenged us to the highest academic standards. They were determined to see us succeed. I give to Georgetown because I am grateful for the scholarship support I received, and because I want to ensure that the academic excellence and Jesuit traditions continue. As I approached my 50-year reunion, my wife Carol and I decided to give back through a charitable gift annuity to support the medical school’s scholarship program. I hope you will consider joining us in supporting and preserving the Georgetown medical experience for our future graduates. Carol and Dick Nasca (C’60, M’64)
You too can help future generations at Georgetown, through a charitable gift annuity or other giving methods. To learn more, please contact the Office of Gift Planning at 202-687-3697 or email GiftPlanning@Georgetown.edu.
NON-PROFIT ORG. US POSTAGE Georgetown University Office of Advancement Communications University Box 571253 Washington, DC 20057-1253
SOCIAL WORK Medical students find a quiet spot to meet outside Dahlgren Memorial Library. Read more about the incoming Class of 2020 on page 34.
PAID PERMIT NO. 3901 WASHINGTON, DC