Pulse Magazine Spring/Summer 2020

SPRING/SUMMER 2020

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New Strategies to Manage Physician Burnout Cutting-Edge Liver Research Saves Lives

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PULSE SPRING/SUMMER 2020 RUTGERS NEW JERSEY MEDICAL SCHOOL

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Dean Robert L. Johnson, MD, FAAP’72 The Sharon and Joseph L. Muscarelle Endowed Dean Rutgers New Jersey Medical School Interim Dean, Rutgers Robert Wood Johnson Medical School Chief Operating Officer Walter L. Douglas, Jr. Director of Marketing and Communications Tiffany J. Cody Senior Editors, Pulse Mary Ann Littell Tiffany J. Cody Contributing Writers Ty Baldwin Merry Sue Baum Maryann Brinley Amanda Castleman Katherine Gustafson Genene W. Morris Nancy A. Ruhling Lina Zeldovich Design www.MarcoCammayo.com Principal Photographer Keith B. Bratcher, Jr.

ng KEEP IN TOUCH Pulse is published twice a year by Rutgers New Jersey Medical School. We welcome letters to the editor and suggestions for future articles.

Send all correspondence to: Marketing and Communications Rutgers New Jersey Medical School ADMC Building 11, Suite 1110 30 Bergen Street Newark, NJ 07107 or via email to njmsmarketing@njms.rutgers.edu ON THE COVER COVID-19 virus concept photo by Adobe Stock.

A MESSAGE FROM THE DEAN On Dec. 31, 2019, as New Year’s Eve revelers prepared to usher in the new decade, the World Health Organization Country Office in China received a report concerning a pneumonia of unknown cause detected in Wuhan, China. This report marks the event that would lead to the identification of a novel coronavirus (COVID-19) and put the sprawling city of Wuhan on the map as ground zero of a worldwide pandemic.

In the months since, with millions infected in more than 200 countries, areas, and territories and more than 100,000 deaths in the U.S. alone, life as we know it has been significantly altered by COVID-19.

Handshaking is practically taboo and terms like “social distancing,” “remote learning,” and “self-quarantine” have entered our vernacular.

In this issue of Pulse, we highlight the Rutgers New Jersey Medical School researchers and physicians who are working to battle COVID-19 and other ailments that compromise lung health, including a world-renowned doctor who had a pivotal role in the development of an innovative test to rapidly detect the virus.

Additionally, on the pages that follow, you will read about other remarkable advances

that NJMS physicians are spearheading in health care, including the doctors who are using game-changing point-of-care ultrasound to quickly access vital information to get critically ill patients the treatments they need in a timely manner, and a surgeon whose work to develop ex-vivo perfusion devices helps to protect donor livers from damage as they travel to their intended recipients.

While a lot has changed since the COVID-19 outbreak, at least one constant remains: NJMS’s resolve to be at the forefront of defeating diseases that threaten the health and well-being of people, not only in New Jersey but around the globe. We will do our part to help end this scourge so that life can return to some degree of normalcy.

In health,

Robert L. Johnson, MD, FAAP’72 The Sharon and Joseph L. Muscarelle Endowed Dean, Rutgers New Jersey Medical School Interim Dean, Rutgers Robert Wood Johnson Medical School

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“IT ALWAYS SEEMS IMPOSSIBLE, UNTIL IT’S DONE.” –NELSON MANDELA

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Physician Burnout, Wellness, and Resilience

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A CLOSER LOOK

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NJMS PEOPLE

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ALUMNI FOCUS

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16 Tackling Liver Disease

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Excellence in Health Care Awards

NOTABLE Recognition from one’s peers is among the highest benchmarks of success. Two NJMS faculty members, Jean Anderson Eloy, MD’02 (left), professor and vice chair of otolaryngology – head and neck surgery, and James K. Liu, MD, professor of neurological surgery, recently received such recognition.

Eloy and Liu were among five Saint Barnabas Medical Center (SBMC) physicians selected by the SBMC medical staff and Physician Collaboration Committee to receive the prestigious 2019 Physician Excellence in Health Care Award. The physicians were honored for embracing the organization’s mission of compassionate, excellent care and superior service.

Brazeau Named Chief Wellness Officer Chantal Brazeau, MD, professor of family medicine and of psychiatry at New Jersey Medical School, and assistant dean for faculty vitality at NJMS and Robert Wood Johnson Medical School, has been named chief wellness officer for Rutgers Biomedical and Health Sciences (RBHS).

She will work to develop and implement wellness initiatives for RBHS faculty, health care providers, and team members.

For more on the medical school’s focus on burnout and well-being among students, residents, and faculty, see page 14.

Lamba Appointed Vice Chancellor of Diversity/ Inclusion Sangeeta Lamba, MD, MSHPEd, has been appointed the inaugural vice chancellor for diversity and inclusion at RBHS. She was chosen for the position after an extensive search. Lamba’s primary responsibility will be to lead and implement a fully integrated strategy for diversity, inclusion, and health equity initiatives across RBHS, with special emphasis on academic, faculty, and trainee advancement.

Nominations for this award are made by clinicians and leaders serving on patient safety collaboratives, performance improvement committees, and other initiatives.

Thanks to a group of dedicated and compassionate NJMS students, no patient at University Hospital will have to fear dying alone. A program now in place, known as No One Dies Alone (NODA), offers companionship and empathy for terminally ill patients who—for whatever reason—are alone at the end of life.

Depending on the patient’s wishes, a student may hold the individual’s hand, massage it, quietly read, play soothing music, or even offer appropriate prayers.

Sometimes simply the presence of another person is all that’s asked.

writing reflection papers. They also spend 20 hours in the classroom. It takes a great deal of dedication.”

The program, based on the national model of the same name, was the brainchild of NJMS student Julie Thormann, who approached University Hospital chaplain Helen Kurczynski, MDiv, with the idea.

The chaplaincy team partnered with the Healthcare Foundation Center for Humanism and Medicine to develop the training, which is specifically designed for medical students.

The support they provide patients is invaluable, but this effort also enriches the students’ lives, giving them a new perspective on death and dying. “At some point, all of them will respond to a Code Blue and see a patient die,” says Kurczynski. “For them it won’t be just another patient who died. The NODA program has taught them that it is a sacred moment when someone dies.”

“The training is intense,” says Kurczynski. “The students prepare for about 15 hours outside the classroom doing reading, watching videos, and

The chaplain says it was an emotional experience for the first eight students who completed the training in January. She asked them a number of deep personal questions, including why they wanted to support dying patients. “There were so many heartfelt stories,” she says. “And some were also the stories of what led them to medical school. These students are all quite remarkable. It was beautiful to watch how much effort they put in.”

For more information on the NODA program, call 973-972-1943.

New Conference Room Named for Kenneth G. Swan, MD A newly refurbished conference room in the Department of Surgery has been named in honor of the late Kenneth G. Swan, MD, a professor of surgery at NJMS for more than 40 years. Swan, who died in 2014, specialized in trauma, vascular and thoracic surgery, and served as combat surgeon for multiple tours in Vietnam and the first Gulf War. The room was dedicated at a ceremony in January, with about 40 members of the Department of Surgery on hand, along with members of Swan’s family.

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In the room are portraits of Swan and Benjamin Rush, MD, who was chair of the Department of Surgery for 25 years. A display case contains artifacts belonging to Swan and Rush. Memorabilia from Rush includes his microscope and ophthalmoscope and several of his papers. Rush served in the Korean War as a surgeon in a M.A.S.H. unit.

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ED UCATI ON

By Amanda Castleman

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ven the thought of an MD program can be daunting, with long hours of classwork and rigorous study. But New Jersey Medical School graduate and future neurosurgeon Nicole Silva, MD’20, still finds time to slip away each year, flying to the Brazilian Amazon. There she researches how socialized medicine serves residents in less affluent regions with low resources and transport challenges.

When Silva graduated this year, NJMS acknowledged this extracurricular work.

Her diploma reads, “Doctor of Medicine with a Distinction in Global Health.”

This year some 40 NJMS students dove into advanced projects and received mentorship through the Distinction Programs, tracks which include Global Health, Urban Health, Medical Education, Service to the Community, and Medical Innovation and Entrepreneurship.

“We started the programs about five years ago,” says Mercedes Rivero, assistant dean for admissions. As a result of the Association of American Medical Colleges’ projected physician shortage, medical schools increased class size and 26 new medical schools opened in the last decade. Enrollment

is up 20 to 25 percent, but the number of residencies has remained roughly the same, so candidates need to stand out from the pack.

“With an increasingly competitive residency application process, it is our collective responsibility to provide opportunities for students to grow their interests and develop more innovative approaches to learning,” says Rivero.

“The Distinction Programs give students unique skill sets that position them for success.”

Associate dean of admissions George Heinrich, MD, adds, “They’re an opportunity to use talents that aren’t typically part of the curriculum. They also allow students to expand on things that are important to them and have those interests acknowledged. It adds another layer of prestige and shows they’re experts in focus areas.”

Heinrich oversees the Medical Innovation and Entrepreneurship (DiMIE) track, which encourages students to evolve new technologies— from apps to devices and novel molecules—and even bring them to market. “There is so much enthusiasm,” he says.

Nicole Silva, M

D’20

“I have to remind them, ‘Don’t forget your day job, medical school!’”

While the entrepreneurs are inventing new apps, Aditya Uppuluri, MD’20, is expanding the use of existing ones via the Medical Education Distinction Program. This future ophthalmologist hopes to “someday teach students, residents, and patients.”

Uppuluri’s project looks at the role of Facebook in medical education outside formal curricula. “My class created a private group to share notes, resources, a calendar of academic events, and Grand Rounds, etc. For us, it provides a centralized way to communicate… and a freer flow of ideas and information than conventional methods like emails, assemblies, and conventions.”

uluri, MD’20 Left: Aditya Upp hite, MD'21 Right: Darius W

He’s exploring how social media tools could expand to include faculty and administrators—and whether they should. “Do students really want professors to know what they’re doing on Facebook and vice versa?” he asked.

Darius White, a fourth-year student in the Urban Health Distinction Program, is starting a project that will extend through a master’s in public health and into his residency. He grew up in Newark and sees the city as an extension of his family. White wants to give back by doing health literacy outreach to urban adolescents, especially black and Latinx males.

“At some hospitals or clinics, the staff roll their eyes at patients who are incarcerated or suffering from addiction or think, ‘Typical!’ But I see them as people who made mistakes,” he says. “I see a father, brother, or cousin, because I’ve been in that situation. That’s what pushed me into medicine and why I pursued this distinction in urban health. It’s great when your medical school cares about these issues too—and gives you the tools to help in areas you’re passionate about.”

Watch Aditya and Darius answer questions about the Distinction Programs at bit.ly/pulsesummer2020.

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or Stephen Alerhand, MD, and Ilya Ostrovsky, MD’12, both assistant professors of emergency medicine at New Jersey Medical School, the “old days” were not so long ago. Using point-of-care ultrasound (POCUS) at the bedside has given them more rapid, dynamic information about their patients than they ever imagined when they were in medical school just a few years ago. Unlike the big, bulky, expensive ultrasound machines of the past, a portable touch screen on wheels or a handheld tool called a Butterfly IQ transducer that fits into a pocket are game-changers in caring for patients, especially the critically ill.

The co-directors of Emergency Ultrasound know they are onto something almost wizardly. A Harry Potter wand?

A Wonder Woman belt? Definitely in the Star Trek and Back to the Future realm. Alerhand and Ostrovsky even play with the idea of heroes’ magic to teach POCUS to students, residents, and others. At this point, the Butterfly

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IQ is only being used in teaching, but the plan is to apply for permission to use this smaller tool for clinical care as well.

“The residents love POCUS because it supplements the physical exam for making diagnoses,” Alerhand says.

“Today we looked at a gallbladder and immediately identified the cause of the patient’s pain—gallstones.

“Remember the little handheld devices in Star Trek?” he asks. “Now we have them.”

At the monthly Ultrasound Rounds for residents and students, the group shares, discusses, and provides feedback on patient cases and images. The fun part comes when a lucky winner gets to wear a superhero belt for producing the best image. “Here’s the belt,” Alerhand says, pulling out a black, red, wide, and totally Rutgersembellished hero’s belt. “Everyone feels excited and inspired by this technology.”

In the old days? “Well,” he admits, “a patient might come into the ED with abdominal pain and after the physical

exam, we might send him or her for a CT scan. That would take this patient down the hall to the radiology suite, away from the care of an ED doctor and nurse. It would cost money and valuable time, and we’d end up with a static image. In contrast, POCUS lets us see what’s going on in the abdomen right away. It offers diagnostic accuracy, dynamic imaging, patient safety, cost reduction, and decreased ED length-of-stay. Ultrasound doesn’t replace the physical exam, but rather supplements it.”

For Ostrovsky, whose passion is resuscitation, “This is essential technology. Our patients are very sick. Using ultrasound at the bedside of critically ill patients has made me realize how powerful this tool can be. It’s not feasible to have a radiologist or a cardiologist physically in the ED 24/7 to perform bedside ultrasounds, and sometimes my patients are too sick to move to radiology.

In the past, we just wouldn’t quickly know the diagnosis and in some cases, we’d never know. Now we can diagnose right away and without the danger of adding worsening complications from intrusive tests.”

Top left: Stephen Alerhand, MD (white top) Bottom right: Ilya Ostrovsky, MD’12 (Black top, pointing to screen)

By Maryann Brinley Alerhand agrees. “For evaluating for cardiac tamponade…instead of trying to evaluate the heart by listening with a stethoscope in a loud room, and wondering whether the heart sounds are muffled, we can visualize the heart in real time using dynamic imaging to see if there is fluid around the heart. We can answer questions, make decisions, and guide procedures, and the level of patient safety has improved.”

Though it sounds simplistic, the ultrasound team is also finding that not all bodies fit textbook anatomy. Ostrovsky gives an example: “When we treat patients with cardiac arrest, we are taught to compress in the same exact place for all patients.

But in looking at hearts with ultrasound, we find that everyone’s heart is a little different and locations can vary.

“Residents are doing amazing things right at bedside,” he continues, crediting the ability to see anatomy in action. “When I was a resident, a patient might come in critically ill and I would guess about the underlying physiology. Now I can see: Do they need fluids? A surgeon?”

The two are working toward building a division to grow the use of POCUS throughout the medical school and University Hospital. “We have been pushing this technology everywhere,” Alerhand says. “Our residents and students are already pioneers because of their ultrasound skill. No matter what field of medicine the students enter for residency, they will be able to bring this advanced skill set and develop into POCUS leaders.”

A true believer in this technology, Alerhand arrived at Rutgers in June 2018 with a 15-page resume full of awards, accolades, research studies, and publications, many devoted to bedside ultrasound. “I first used it in residency,” he recalls. “My medical school didn’t have it.”

Learn more about bedside ultrasound from Drs. Alerhand and Ostrovsky at bit.ly/pulsesummer2020.

POCUS was introduced into the NJMS curriculum in 2019 as a pilot program. The then-associate dean of education, Sangeeta Lamba, MD, was wholeheartedly behind it. She says, “We’ve developed a comprehensive bedside ultrasound curriculum led by Dr. Alerhand and the emergency department faculty and residents.

Students are introduced in Year 1 and use the handheld transducers to practice their skills and perform exams on standardized patients. All of Year 4 graduating medical students practice how to place an intravenous line using POCUS, a very useful skill as they become residents.”

One of the black-and-white images Alerhand and Ostrovsky use in their teaching shows a man sitting in a tub in 1954 when the first ultrasound was invented. “The idea behind it was that sound waves travel well through water,” Alerhand explains. “Looking at this outdated photo now and how far the tools of medicine have come, it’s easy to imagine those practitioners in the ’50s laughing about the idea of putting an ultrasound in your pocket. That would be as silly as traveling through time, going back to the future in a DeLorean automobile.”

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R ES EAR CH

By Katherine Gustafson

In

2015, a 49-year-old man began having headaches and seizures after being stung by wasps. His doctor diagnosed him with allergic encephalitis with gelastic status epilepticus, the fourth incidence worldwide of allergic encephalitis induced by a wasp sting.

“Our diseases have been changed,” says Ming. “Two decades ago it was infectious disease. Many people have allergies now. We have so many immunerelated and inflammation-related disorders. It’s also changed our gut microbiome. Your body’s responding to the atmosphere.”

development of allergies and diseases including encephalitis, cancer, and neurodevelopmental difficulties.

New Jersey Medical School professor of neurology Xue Ming, MD, has seen an increasing number of patients presenting with encephalitis, a rare brain inflammation usually caused by a viral infection.

It is unclear how they contracted the virus, but Ming suspects that our changing global climate is to blame for increased transmission, whether via wasps or other vectors.

Ming and Ray are undertaking a series of studies, reviewing findings on possible linkages between environmental change and human health. They began with a paper about the relationship between changes in human microbiome and the increasing prevalence of neurodevelopmental disorders like autism and ADHD, published in the journal Child Neurology Open in 2018. They are currently working on another study that will delve deeper into the effect of climate change and ecosystem disruption on allergic disease and the gut microbiome.

Ming says her goal is not only to elucidate new areas of exploration for health care but also to bring some urgency to the discussion of climate change by demonstrating the immediate effects it is having on people’s lives.

“Unusual causes of encephalitis such as this could become more prevalent in a time when the ecosystem is undergoing dramatic change,” she and co-author Carly Ray, MD’20, write in a study of environmental effects on neurodevelopment, published in the International Journal of Environmental Research and Public Health last December.

Ming treats the encephalitis patients she sees with immune suppressants. This usually leads to full recovery. However, they relapse more frequently than expected. She attributes the increasing incidence and the greater relapse rate to the phenomena of molecular mimicry and autoimmunity, which is on the rise as the world’s environment shifts and antigens evolve with it.

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As climate change and human activity alter the plant species, insects, invertebrates, and microorganisms that are prevalent in ecosystems around the world, the types of pollen and other organisms we are exposed to also change.

The consequence is that “our bodies are bombarded with novel organisms,” write Ming and Ray. The human immune system sees the molecules in these organisms, called antigens, as foreign substances, and responds with a complex inflammatory reaction.

Inflammation originated in the body as a protective response, but when it is frequent and widespread it can be problematic, ultimately contributing to the

“We’re being exposed to novel antigens every single day, and our immune systems are not able to deal with that,” says Ray.

“There’s been a lot discussion of climate change’s effect on the environment, but not as much on the impact on the human body,” says Ray, who plans to become a neurologist. “Dr. Ming has become passionate about showing that climate change will affect the human body — the immune system, allergies, autoimmunity. She also thinks there could be a link between the effects of climate change on the gut, and on the gut and neurodevelopment. ” With all these changes affecting our health, Ming sees a very alarming new problem on the horizon that our health care system and society as a whole are only just beginning to grapple with: “Immunities are not possible now because it’s an ever-changing environment.”

The question remains whether our approach to medicine will change fast enough to meet this challenge.

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COM M UN I TY S E RVIC E

Teaching parents to ‘give up the ghost’ in the nursery

By Lina Zeldovich

In

the Nishtar University Hospital in Pakistan, Muhammad Zeshan, MD, associate professor of psychiatry, spoke soothingly to a distressed mother whose baby had been sick for a long time. “Hold your daughter and call her name,” said Zeshan, whose specialty is child and adolescent mental health. When she did so, the baby immediately turned her face toward the mom.

“See how smart she is?” Zeshan pointed out. “She’s only a few months old and she already knows her name. If you smile at her, she will smile back. And you both will feel happier.”

Adverse childhood experiences (ACEs) such as mental or physical trauma endured during early development can harm children’s brains for life.

Children who suffer multiple ACEs are 4.5 times more likely to develop depression, 11 times more likely to try intravenous drugs, and 14 times more likely to attempt suicide than typical youngsters. That’s why positive interactions between parents and children are very important. But in poverty-stricken communities where families live in crowded houses, battle sickness, care for relatives with mental illness, and endure other hardships, parents are often too stressed to devote time to these meaningful experiences.

They can be aloof, withdrawn or even violent in response to their infants’

cries or needs. When these children grow up and start their own families, they often act the same way towards their own youngsters, becoming the so-called “ghosts in the nursery” and perpetuating the problem.

Zeshan, who grew up in Pakistan and saw this firsthand, wants to break the vicious cycle and turn parents

into the “angels in the nursery.” After completing a child and adolescent psychiatry fellowship at Harvard Medical School, he travelled through his home country, teaching an infant-parent mental health workshop and demonstrating how responsive caregivers can buffer children’s adverse experiences stemming from chronic poverty.

“In the parent-child dialogue, 50 percent of the time the child initiates the interaction,” says Zeshan, “so if we

can help parents pick up those cues and be more responsive, we can change those ghost experiences into angel experiences.”

For Pakistan—a country of 120 million people with fewer than 20 child psychiatrists—this would be a fundamental shift in mindset. Within 10 days, Zeshan organized 12 workshops

at big academic institutions and small community hospitals in four different cities. With nearly 200 attendees at each, including parents, pediatricians, and lady health workers (a term used in this country to describe female community health workers), Zeshan brought smiles to many parents’ faces. When he shook a rattle next to a sleeping baby once or twice, the child stirred, but later slept through it. As Zeshan explained to the mother that the little smarty quickly learned to

ignore the noise, she beamed. “Good for him, because our household is noisy!” Moments like this can really change parent-child interactions, Zeshan says.

Now, Zeshan is setting up a similar workshop in Newark, where underprivileged communities face similar challenges. While disadvantaged American families are culturally different from those in Pakistan, many of them battle similarly crowded conditions, poverty, and mental illness.

In Newark, many families have access to counseling and health insurance, but they may lack the extended support network that large families in Pakistan offer. And postnatal depression affects mothers universally, leaving them “stillfaced,” unable to respond affectionately to infants in either language. “There’s a huge need to help the underserved population,” Zeshan says. “Luckily we have more resources here, so we can make a more significant impact.”

Zeshan’s work has attracted the attention of New Jersey’s First Lady, Tammy Murphy, who wants the state to be a national leader in maternal and infant health. “I’m excited people recognize the importance of this work,” Zeshan says.

“The more workshops we run, the more parents we can help switch from being ghosts to being angels.”

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By Nancy A. Ruhling and Lina Zeldovich

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It always seems impossible, until it's done. - Nelson Mandela At the height of the COVID-19 pandemic, waves of patients arrived at area hospitals so many that treating them all seemed impossible. But the NJMS health care team met this challenge, and continues to meet it.

In

February, the Centers for Disease Control and Prevention warned that the U.S. should brace for a coronavirus outbreak. Since then, the number of COVID-19 cases in this country has skyrocketed to nearly 2.6 million as of early July, and more than 128,000 have died.

Debra Chew, MD, assistant professor of medicine at NJMS, who heads the COVID-19 preparedness effort. “As patients began to arrive, the team was ready, carrying out testing, hospitalization and intubation when necessary.

We mobilized all efforts to save lives.”

No place in the country has been harder hit than the tri-state area, with New York as the epicenter. Across the Hudson, the Garden State has the second highest confirmed case count in the U.S. As of June 8, more than 12,000 have died from the virus and more than 160,000 have been infected. New Jersey’s busy streets and neighborhoods are now eerily quiet. With COVID comes a new vocabulary too: self-isolation, social distancing, flattening the curve. All this in an astonishingly short period of time.

Newark, the most populous city in New Jersey, is in the heart of Essex County, with a rate of infection that’s one of the highest in the state. During the peak period of infection, the medical team strived to maintain a sense of order amid the crisis. The entire hospital was turned over to COVID-19 care, and hundreds of patients were treated in the triage tent, emergency department, ICU, and more than 40 isolation rooms.

Throughout this crisis, a few things stand out. The first is the sheer volume of suffering: the critically ill patients, their anxious families, and the millions who are self-isolating. The second is the heroism of those who go to work while the

At varying points, nearly every patient who came through the hospital’s doors tested positive for coronavirus or was suspected of having it, pending test results. Through teamwork, expertise, and collaboration, clinicians were able to withstand the COVID-19 surge, saving lives.

“Through this difficult and unprecedented time, I’m very inspired by our teams and our staff,” says Chew. “We’re all working together to treat patients and save lives—and we will continue to do so.”

rest of the world shelters in place: emergency and sanitation workers, scientists, food producers, grocery store staff, public transportation workers, and others.

The most amazing heroes of all are the health providers who put their own lives at risk to care for those who are infected.

In Newark, just 13 miles from the epicenter, the New Jersey Medical School and University Hospital (UH) medical team is on the front lines. Showing creativity and innovation, they’ve stayed one step ahead of the virus to meet surging patient demand and save lives.

PROVIDING CARE: A MARATHON, NOT A SPRINT

As the COVID-19 threat approached New Jersey, the NJMS team began preparations. Elective surgeries were cancelled and ambulatory visits rescheduled. Resources were shifted and hospital space reconfigured to create new ICUs and isolation rooms for the anticipated wave of patients.

“From podiatry to OB/GYN residents, everyone was recruited to be on COVID-19 teams. It was overwhelming and humbling to see everyone so ready to help,” notes Mark H. Einstein, MD, MS, NJMS chair of obstetrics, gynecology and women’s health and UH interim chief medical officer. Many efforts were directed at training staff in the care of COVID-19 patients, including respiratory care and the use of personal protective equipment.

“We set up several tents outside the emergency department to triage and screen patients with respiratory symptoms,” says infectious disease specialist

New Jersey has turned the corner, but the battle is far from over. As COVID-19 has quickly become a leading cause of death, NJMS faculty are working to find new ways of diagnosing and controlling the disease.

DEVELOPING RAPID TESTING TOOLS

In late March, a team of NJMS researchers completed the first evaluation of a new rapid COVID-19 test that has received emergency use authorization by the Food and Drug Administration (FDA). The test, now being used in hospitals throughout New York and New Jersey, was developed in collaboration with molecular diagnostics company Cepheid. It is fast and easy to perform, without the need for a centralized laboratory.

SARS-CoV-2, the organism that causes COVID-19 disease, poses a huge diagnostics challenge. With limited supplies of testing, there were also no globally established testing procedures for diagnosing it. In some cases, tests had to be sent to remote labs, yielding results in five hours to five days—an unacceptably long time.

The ability to establish a diagnosis quickly is crucial for disease treatment and containment, says David Alland, MD, chief of infectious diseases and director of the NJMS Public Health Research Institute (PHRI). “Imagine 20 patients you have to hospitalize, some of whom have COVID, but others who have something else. To prevent the infection’s spread, one must separate those who have COVID from those who do not, so waiting five days or even five hours is too long.”

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Alland’s laboratory has many years of expertise in developing innovative diagnostic testing for infectious diseases. When the first U.S. COVID-19 case was reported in January, he and his NJMS colleagues Padmapriya Banada, PhD, and Sukalyani Banik, PhD, immediately went to work to create the new test, adapting a tuberculosis test they had previously developed. The scientists put in nine-hour shifts inside a Biosafety Level 3 lab, wearing the equivalents of space suits. Their efforts paid off, and the new test was approved by the FDA in record time.

“Our test delivers results in 45 minutes,” Alland notes. “Instead of taking your test to a lab, the lab comes to you in a form of a plastic cartridge.” The test must be processed

by Cepheid technology, which is currently in use in area hospitals.

David Alland, MD

Another COVID-19 rapid test that recently received FDA emergency use authorization utilizes molecular beacons technology invented by PHRI researchers. Molecular beacons provide powerful tools for imaging RNA in living cells, and can determine if COVID-19 is present in a clinical sample. The technology is being used as part of a COVID-19 test from global health leader Abbott Laboratories. A simple nose swab, it takes just 15 minutes to complete.

To coordinate Rutgers University’s research and public health efforts to combat COVID-19, Rutgers has created the Center for COVID-19 Response and Pandemic Preparedness. Alland serves as the center’s inaugural director.

EVALUATING BLOOD PLASMA AS A POTENTIAL CURE

While COVID-19 infections and fatalities continue to increase, many thousands of people have recovered from the infection. Their blood plasma contains antibodies that may help critically ill patients fight the virus.

NJMS and UH are collaborating on an FDA-approved study using blood plasma from patients who recovered from COVID-19 to treat new patients who are severely ill with the infection.

Marc Klapholz, MD, chair of the NJMS Department of Medicine, is the principal investigator. The researchers have treated a small number of patients with convalescent plasma and will study them closely over the next few months.

Padmapriya Banada, PhD

“This is a real team-based approach and requires a strong clinical assessment,” Klapholz says. “It involves our team for infectious diseases, critical care, our internal review board and, of course, partnering with our blood bank and our nurses and clinicians taking care of these patients.”

People interested in donating plasma must have had a confirmed positive test for COVID-19. For more information, call 973-972-5474 or email at covidplasma@uhnj.org.

CORONAVIRUS HOTLINE

The state’s Coronavirus Hotline (800-962-1253), has assisted more than 15,000 New Jersey callers throughout the pandemic. Operated by the New Jersey Poison Control Center at the NJMS Department of Emergency Medicine, it delivers up-to-date information about the pandemic 24/7, in any language, including best practices for prevention.

Sukalyani Banik, PhD

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NJMS INITIATIVES PROMOTING LUNG HEALTH

NJMS has long been a leader in research and clinical care for lung disorders, focusing on a broad range of conditions, from tuberculosis (TB) to pneumonia and vaping. Here is a look at some of this work.

TUBERCULOSIS

Debra Chew, MD

David Alland, MD, has collaborated with Cepheid for nearly two decades to develop innovative diagnostics, including a test for TB that was the first new test in more than 100 years to be approved by the World Health Organization. The test took 10 years to bring to market. This hard work paid off in other ways, proving crucial in the COVID-19 fight.

The NJMS Global Tuberculosis Institute is seeking ways to better diagnose and treat latent TB infection. One of only four Centers for Disease Control and Prevention TB Centers of Excellence in the country, it provides treatment, holds clinical trials, and collaborates with PHRI scientists to understand TB immunology.

Researcher Jason H. Yang, PhD, assistant professor of microbiology, biochemistry, and molecular genetics, and Chancellor Scholar, is developing machine learning methods to study the factors that play a role in treating TB. He uses mathematical models to simulate the biology of each specimen and then deploys machine learning to uncover bacterial mechanisms that might cause reinfection.

VAPING

Mark Einstein, MD

The dramatic rise in vaping, followed by a spike in associated lung injuries and deaths, made NJMS faculty focus on this new frontier. “Additives to vaping oils, such as honey and vitamin E acetate, can be lethal when inhaled,” says Andrew Berman, MD, NJMS professor of medicine and director of pulmonary medicine. “The problem will only get worse, since e-cigarettes are not regulated like traditional tobacco products.” NJMS faculty have launched a series of educational campaigns to increase awareness of vaping’s dangers. Vaping has also been incorporated into the pulmonary coursework for first-year medical students.

OTHER RESEARCH INITIATIVES Dane Parker, PhD, assistant professor of pathology, immunology, and laboratory medicine, Center for Immunity and Inflammation (CII), is investigating host-pathogen interactions with Staphylococcus aureus and other organisms.

Amariliz Rivera, PhD, assistant professor, CII, examines the significant health problems of pulmonary infections caused by fungal pathogens.

She’s developing a vaccine strain of Cryptococcus neoformans capable of conferring broad antifungal protection.

Marc Klapholz, MD NJMS residents share their experiences treating COVID-19 patients at bit.ly/pulsesummer2020.

Mark C. Siracusa, PhD, assistant professor, CII, Chancellor Scholar, is honing in on parasitic infections to help identify factors that regulate lung inflammation related to asthma.

William C. Gause, PhD, director of the Institute for Infectious and Inflammatory Diseases, is studying a possible treatment that would stem the progression of emphysema.

RUTGERS NEW JERSEY MEDICAL SCHOOL | 13

By Katherine Gustafson

U.S.

physicians are struggling. Every year, 400 doctors in the U.S. commit suicide, a rate twice that of the general population, and the highest of any profession. Around half of U.S. doctors show signs of burnout. Alarmed by the scope of the problem, medical schools and institutions have begun approaching this issue more as a systemic concern rather than an individual dilemma, as it has been framed in the past.

Among them is New Jersey Medical School, where a robust program focused on physician and student wellness and resilience is making strides in addressing the resident and physician burnout. In 2016, NJMS created an inaugural role for an assistant dean for faculty vitality, currently filled by Chantal Brazeau, MD, an NJMS professor of family medicine and psychiatry, and chief wellness officer for Rutgers Biomedical and Health Sciences.

To address this need among students and trainees, NJMS’s Graduate Medical Education (GME) Department launched a pilot program to build a culture of wellness and resilience under the purview of Rashi Aggarwal, MD, director of NJMS’s residency training program and associate professor in the Department of Psychiatry, and Neil Kothari, MD'00, associate professor of medicine and associate dean for graduate medical education.

“Burnout used to be viewed as something that was more individual; basically burnout was a problem for the individual to fix,” says Brazeau. “When this incredible level of burnout was identified, we realized you have to look at the environment as the source of the problem.”

A Systematic Problem

The classic symptoms of burnout in medical professionals consist of emotional exhaustion, loss of ability to connect personally with patients, and a reduced sense of accomplishment or personal efficiency.

The Mayo Clinic and the American Medical Association teamed up on a series of three studies—in 2011, 2014, and 2017—to assess the numbers of physicians who exhibit at least one of these signs. The results clocked in

1414||ppuullssee|| SPRING/SUMMER SPRING/SUMMER2020 2020

at 45.8 percent in 2011, 54.4 percent in 2014, and 43.9 percent in 2017.

These numbers are eye-opening. And it’s important to note that burnout not only results in distress among medical practitioners, it also affects quality of care and the efficiency of the system as a whole. Burnout among physicians costs the U.S. health care system around $4.6 billion a year in billings, according to a 2019 study.

“Medicine is very complex,” says Aggarwal.

“It’s a business, but physicians don’t think like businesspeople. Institutions are getting bigger and bigger, and are run like businesses. We’re doing a lot more every single day than we were in the past.”

To assess the levels of burnout among NJMS faculty, Brazeau led the NJMS Faculty Vitality Taskforce in conducting a survey among faculty and then helped each department name a Faculty Wellness Champion to sit on the taskforce, analyze the results, and lead wellness-related programming in their departments.

The taskforce presented the results of the survey to

each department, along with benchmarks for each specialty nationwide, then guided brainstorming sessions in which faculty discussed things their departments or NJMS could do to improve well-being at work. Faculty were tasked with selecting one intervention they could do in their departments to improve the culture of wellness or the efficiency of practice.

Meanwhile, Aggarwal and Kothari have been hard at work seeking ways to take corresponding action for residents and fellows. As chair of GME’s Wellness Committee, Aggarwal launched a pilot program that altered residents’ class schedule to create 15-minute slots dedicated to evidence-based wellness activities, such as mindfulness practice and cultivation of gratitude.

The program was so popular that the department expanded the time slots to 30 minutes and added activities such as yoga, trust exercises, skits, watercolors, and board games.

That is why even medical professionals need professional help to prevent and reduce burnout.

GME recently signed a contract with University Behavioral Health Care (UBHC) that allows all residents and fellows to get free, unlimited mental health consultations.

“Typically what we see is the medical student or resident or physician will demonstrate maladaptive perfectionism, a sense of needing to be perfect in all things,” says Mark Chernin, PhD, a psychologist and master clinician at UBHC. “We also see a high need for control, an exaggerated sense of responsibility, and a difficulty in asking for help. Across medical education in general, it’s not okay to ask for help.”

Providing more and better pathways for students and residents to ask for help and seek redress for concerns is key to changing this cultural dynamic.

In an effort to do so, GME is making it easier for residents to report any incidents of mistreatment or bias. Few people used the reporting system at first, but its usage increased as residents saw departmental leaders making sincere efforts to address complaints.

Kothari now gets an average of one report a month, which he sees as an indicator of positive change as medical students increasingly start to expect that their institution will have their backs.

“The term ‘resilience’ is a copout; burnout is a systematic problem,” he says. “We need to be focusing on changing the institution and the cultures. All of the onus certainly cannot be on the trainee to just be resilient and deal with it.”

Building wellness-enhancing activities into the workday serves to provide residents this outlet without burdening them further by making it “homework.” It is not only ineffective but unfair to ask people to take time outside of work to deal with workrelated problems.

“I learned from my work at a national level that I can focus on my wellness but if I come to work and it’s overwhelming, then the system of medicine in this country has failed in some way,” Aggarwal says. As a member of American Psychiatric Association’s ad hoc physician wellness task force, she helped launch a website for health care professionals to learn more about burnout, well-being, and resilience. The site seeks to reduce the stigma of burnout and emphasize the systematic nature of the problem.

Perfectionism and Stigma

Aggarwal knows from experience that residents need structured time to “just be human” during this overwhelming period of their medical education. She

became interested in this topic as a medical resident herself, when she was surprised by feelings of burnout and realized she wasn’t the only one struggling.

“As a first-year intern I saw myself turning into someone I didn’t like,” she remembers. “I came into medicine because I thought I was empathetic and cared about people. But I felt like all I did was do labs and order consults. I felt like a horrible human being.

I talked to another intern who said, ‘Me too.’"

Her experience wasn’t uncommon but many hid this painful reality. As medical professionals they felt societal pressure to appear in control and cool under pressure.

“The interesting thing is that people feel that physicians know what well-being means and how to get it,” Aggarwal says.

“I am a psychiatrist and I can tell you: We are not taught about well-being at all in medical school. We learn about diseases and how to treat the diseases.”

The work of addressing burnout must focus as much on community and institutional support as it does on helping residents develop individual skills around self-care and mindfulness. These efforts together create the supports to help residents develop into truly resilient physicians and for faculty to get the most out of their chosen profession.

Left: Rashi Aggarwal, MD Right: Neil Kothari, MD’00

The term resilience is a copout. We need to be focusing on changing the institution and the cultures.

- Neil Kothari, MD

RUTGERS NEW JERSEY MEDICAL SCHOOL | 15

Cutting-Edge Liver Research Aims to Save Lives Liver disease is now the 10th leading cause of death in the United States. Caused by cirrhosis related to viral infections like hepatitis B or C, fatty liver, and alcoholrelated liver disease, it claimed more than 40,000 lives in 2017. Patients with liver disease are also at high risk of developing liver cancer, which has only a 19 percent survival rate over five years. These worrisome numbers continue to rise. From 1999 to 2016, deaths from liver cancer doubled and deaths from cirrhosis increased by 65 percent.

Part of the problem is that unlike the heart or kidneys, there are no artificial alternatives for the liver. “If the liver fails, patients die,” says Keri Lunsford, MD, PhD, assistant professor, Department of Surgery, division of liver transplant and hepatobiliary surgery, New Jersey Medical School. “For late stage liver disease and liver failure, transplant is the only life-saving option.”

When transplants become available, they must reach

16 | p u l s e | SPRING/SUMMER 2020

patients quickly, before the organ is damaged from lack of oxygen and nourishment. With current standard of care, liver organs for transplant often travel long distances, from the hospital where the organ is obtained to the recipient hospital, in an ice cooler. This method preserves the organ only for a limited time, says Lunsford, who travels to organ donor hospitals to bring the precious cargo to her NJMS patients. “Once taken out of the donor body, the liver ideally needs be transplanted into the recipient patient within eight hours,“ she says.

This shortens the distances organs can travel, limiting patients’ options. It also increases the chances of post-operative reperfusion injury—the damage caused by the renewed blood supply to the oxygen-starved organ, resulting in surgical complications and failures.

With nearly 17,000 patients currently on the liver transplant waiting list, better alternatives are

By Lina Zeldovich necessary to protect the liver from damage while outside the body, and to extend the time the organ can be outside of the body.

James V. Guarrera, MD, professor and interim chair of the Department of Surgery, chief of the division of liver transplant and hepatobiliary surgery, NJMS, wants to change this suboptimal status quo. For more than 10 years, he has been working on developing ex-vivo perfusion devices in which livers can travel attached to pumps that perfuse them with oxygen, nutrients, antioxidants and vasodilators, protecting them from damage outside the body. Called LifePort Liver Transporter, this device is now being tested in a pivotal, randomized, controlled trial across eight transplant centers, including the NJMS center at University Hospital, the University of Cincinnati, the University of Virginia, and Intermountain Medical Center in Utah.

The LifePort Liver Transporter not only extends the amount of time the organ can travel, but also reverses the damage the liver sustains from being outside of the body. Machine perfusion before transplantation revitalizes the organ, compared to a liver preserved in an ice cooler. “Even a few hours make a difference in the transplant quality,” Guarrera says. “It recharges the organ and rejuvenates it. It is a little bit like having a spa day for the liver.”

Guarrera began working on the ex-vivo machine perfusion techniques and developing a prototype system while at Columbia University Medical Center, and was the first to publish clinical papers on the topic worldwide. He then collaborated with Organ Recovery Systems, a company focused on organ preservation products, to develop the first commercial device, the LifePort Liver Transporter.

vitamins or other nutritional factors, or choose to give susceptible patients lower doses of immunosuppressant drugs.

This personalized approach is important in transplantation success, Lunsford notes. “We are finding that one-size-fits-all methodology may not be the most successful. So we are moving toward the personalized medicine approach for liver transplants.”

There is still more exciting research related to liver health happening at NJMS. Associate professor of surgery Flavio Paterno, MD, MPH, is developing biomarkers for predicting liver cancer. His research focuses on microRNA—a special type of RNA involved in cells’ gene expression that can be elevated in cancer patients. In addition, Lloyd Brown, MD, assistant professor of surgery, is working on ways to detect and

treat fatty liver disease, a condition that is quickly becoming the leading cause of cirrhosis. Fatty liver is a condition common in those suffering from diabetes or living with obesity, but the damage is often silent until it becomes so severe that the organ fails. Finally, Nikolaos Pyrsopoulos, MD, PhD, MBA, professor of medicine and medical director of liver transplantation, leads multiple clinical trials aimed at prevention of end-stage liver disease.

Guarrera is excited about the new NJMS frontiers in liver research. “It has been a great opportunity to join NJMS and have the opportunity to build a large translational research program, further my own research, and launch new clinical initiatives. All of that makes a difference in patients’ lives—and that’s what every physician wants to see.”

Two years ago, Guarrera joined NJMS with the goal of growing the transplant center and developing a translational research program, and he quickly put the LifePort device to good use. In addition to the eight hospitals taking part in the LifePort Liver Transporter trial, two others are coming on board, Guarrera says.

The trial is in progress with excellent preliminary results. Guarrera’s prior clinical research showed that livers sustained significantly less damage when perfused. “Using this technique appears to increase the viability of the organ by more than 50 percent,” he says. That shows in the surgical outcomes—the transplanted livers graft much better by a variety of measures. “The results are outstanding, particularly for early graft function and reduction in post-operative complications.”

But assuring the transplanted organs’ vitality is only half the story. The other half is reducing post-transplant complications such as infections and deaths occurring within the first two years after transplant. To keep the body’s immune system from rejecting the transplant, patients are routinely put on immunosuppressant drugs. While this is generally effective at minimizing the chance for rejection, some patients develop recurring infections, some so severe as to be fatal. Lunsford’s research linked these inconsistent outcomes to the patients’ dysfunctional and depleted immune systems prior to liver transplant. “My research shows that when the immune system does not work correctly before transplant, the patient is at risk for multiple infections, and may ultimately die from them,” she says.

With support from the National Institutes of Health, RWJBarnabas Health, and the Association of Women Surgeons, Lunsford has identified several blood biomarkers that can be a sign of patients’ susceptibility to infections and risk of death after transplant.

With a simple blood test, physicians will be able to identify patients at risk prior to their transplant surgery, and work on boosting their immune systems.

Doctors may improve immune system function with

Keri Lunsford, MD, PhD

James V. Guarrera, MD Pictures of the LifePort Liver Transporter device.

RUTGERS NEW JERSEY MEDICAL SCHOOL | 17

N J M S PEOPLE

CL IN I CI AN

By Mary Ann Littell

Y

ears ago, a 7-year-old girl left her home in the Ivory Coast to live in the United States.

She was excited to join her loving parents, who had come here in hopes of a better life and new opportunities. But she wasn’t sure quite what to expect.

That little girl was Evelyne Goné, and her adjustment to this new life wasn’t easy. Her journey took her from New York City’s Harlem to St. John’s University and Barnard College, and ultimately to Harvard Medical School.

Through hard work and continual striving for excellence, she achieved her dream of becoming a physician.

Goné joined the New Jersey Medical School faculty in July 2019 as an assistant professor of anesthesiology and critical care. “Growing up where I did, I’ve always wanted to advocate for the most vulnerable,” she says.

“So I picked a profession which allowed me to do that. Patients who are critically ill, or under anesthesia, are probably at their most vulnerable state. It is a privilege to help in those moments.”

Back in the Ivory Coast, Goné had been raised by her grandmother and aunt. Coming from a tropical climate and slower-paced life to inner-city New York was quite a culture shock.

She spoke only French, so her mother gave her a crash course in English in preparation for school. Excelling in a placement test, Goné entered a fourth grade bilingual French and English class, the youngest child in the class.

The following year, she transitioned into an English-speaking class, where she was the top student. She continued to excel in New York’s public schools, noting that her parents expected her and her three younger siblings to understand the importance of education.

“We had far less freedom than our peers,” she recalls.

“Some kids would say, ‘Yeah, I can stay out until whenever,’ but that was not the rule in our house. Schoolwork came first.”

When Goné was in junior high, her father became ill. He struggled with severe headaches and developed vision problems, ultimately needing surgery. “This made me realize that health is at the root of all our well-being.

Without it, our entire life is paused,” Goné says.

“That’s when I decided I wanted to be a doctor.

My father’s surgeon was a French-speaking Lebanese immigrant. So I realized this was possible for me.”

18 | p u l s e | SPRING/SUMMER 2020

Goné’s excellent academic performance gained her entry into the prestigious Brooklyn Tech High School. Trying to adjust to high school and balance expectations, she went through a brief period of rebellion and her grades slipped dramatically. “This experience changed my outlook,” she says. “I realized that my life could have gone in a whole different direction.

I understood in that moment the power of mentorship and peers, and the complexity of the factors that influence success.” Goné refocused her efforts, having learned lessons that would later shape her career and passions.

Entering St. John’s University with an academic scholarship, she later transferred to Barnard College. After graduating, she tutored and did health equity work in New York City before entering Harvard Medical School. Her family remained a priority, and for the first two years, she took the bus home to New York every other weekend to help care for her siblings. “Immigrant families often don’t have the support of extended family nearby,” she comments. “My family needed my help, so that’s what I did.”

After a residency in anesthesiology and a fellowship in critical care, Goné joined the NJMS faculty as a board-certified critical care anesthesiologist. She divides her time between operating room anesthesiology and critical care medicine, and is interim medical director of the Post Anesthesia Care Unit. “I enjoy the variety that this setup provides,” she says.

At Harvard, Goné served as co-president of Women of Color in Medicine and Dentistry and was a board member of the school’s chapter of the Student National Medical Association (SNMA), an organization supporting underrepresented minority medical students.

At NJMS she is looking forward to becoming one of the faculty advisors for SNMA. She also serves as an interviewer for the medical school.

“Throughout my journey I learned the value of mentoring,” she says. “I always knew it would be a part of my career.”

Goné was drawn to NJMS by its commitment to education, diversity, and patient care, and its role in the city. She says, “Here I am able to do the things that are important to me: care for the most vulnerable patients, mentor students and residents, and serve the community. I am excited and blessed to have this opportunity.”

N J M S PEOPLE

STUD EN T

during my junior year, and that’s when I realized that I liked the hospital setting a lot more than programming at a computer.”

At The College of New Jersey, Hazim double-majored in biology and Spanish. “I wasn’t completely sure about being a doctor,” she says. “I considered being a Spanish teacher.”

By Ty Baldwin

M

atch Day can be exciting, sure. But it can also be stressful, anxiety-producing, even downright scary. For Nemesis Hazim, MD’20, March 20 was, well, just another Friday.

That’s because Hazim had already matched to a residency program in January. She’ll be doing her residency in orthopaedic surgery at Tripler Army Medical Center, in Hawaii. Perhaps not surprisingly, Hawaii was her first choice.

Hazim was born in the U.S. and spent her childhood in the Dominican Republic, where her mother worked as a dentist and her father as an electrical engineer. When she was 11, her parents separated, and she returned to the U.S. with her mother and brother. They settled in Passaic to be near family.

“I studied engineering technologies in high school,” says Hazim, who attended Passaic County Technical Institute. “I was interested in biomedical engineering and drafting. I started volunteering in the local hospital

Ultimately, Hazim credits the Northeast Regional Alliance (NERA) MedPrep Scholars Program at NJMS with encouraging her ambition to pursue medicine.

A partnership between NJMS and three other nearby institutions, NERA offers a free summer enrichment program for underrepresented college students interested in careers in medicine.

“I was in the NERA program for three summers, doing MCAT prep and research. That really helped me, not just academically but also being around role models.

Seeing Dr. Maria Soto-Greene, executive vice dean of NJMS, who’s so successful in her field, and being with other students whose situations were similar to mine, it kind of settled the idea in me that I could do this.”

By the time Hazim decided on medicine, it was a little late to focus on taking the MCAT and applying to enter medical school right after college.

“I took a graduate class in organic chemistry at Rutgers and did really well in it. I did some more research and clinical work. Then I applied early decision to NJMS.” Don’t imagine, however, that Hazim was all work and no play. During this time she was also getting pretty serious about beach volleyball, a sport she’d started the summer before college. Having challenged herself to go up a level each year, Hazim was now playing at the Open Level, just below professional. “At the Open Level you get paid if you win,” she explains. “I was playing in tournaments almost every weekend.”

Getting accepted to NJMS changed some things. Not beach volleyball. At least not right away. “I continued playing into my first year of medical school. I even flew to Florida for a tournament one weekend.” But, Hazim says, “Once I got that phone call from Dr. George Heinrich telling me I’d been accepted, I thought back to something I’d been asked during one of my interviews. Which was, basically, ‘How are you going to pay for this?’”

Hazim’s beach volleyball winnings were in the low four figures, so they wouldn’t help. Her family’s physician had gone to medical school as part of the military’s Health Professions Scholarship Program (HPSP), and he suggested Hazim look into it. HPSP offers aspiring physicians a paid medical education in exchange for service as a commissioned officer.

“I contacted recruiters from the Army, the Air Force, and the Navy,” she says. “After looking at all the options and requirements, I decided the Army was the best fit. It had the most residency spots. I figured if I was going this route, then I wanted to train within the military system.”

Hazim commissioned as a second lieutenant the day she joined HPSP. The Army paid her NJMS tuition and provided a small monthly stipend. Still, there wasn’t a lot of soldiering in Hazim’s day-to-day, at least not for the first two years of medical school. “That part began when I did my away rotations in orthopaedic surgery at military hospitals. One attending called me ‘Soldier’ and told me to put my hair up. That’s because, technically, when you’re in scrubs you’re in uniform.”

After her five years of residency at Tripler, Hazim will have a four-year commitment to the Army. “The deployments will range from four-and-a-half to nine months each year,” she says, “so you’re guaranteed at least some time at home.”

Hazim is looking forward to working with young active duty members. “It’s a demographic that I’ve been interested in ever since I started orthopaedics. Most of the research that really impressed me involved a lot of TMR work with amputees.” TMR, or targeted muscle reinnervation, involves reassigning existing nerves so that patients with amputated limbs can more easily control their prosthetic devices.

“My reasons for going into medicine always had a lot to do with how amazing I found anatomy,” Hazim says.

“I’m drawn to the idea of being able to use anatomy and repurpose it, reconstruct it, and make better outcomes for patients. That’s the cherry on top of medicine for me.”

RUTGERS NEW JERSEY MEDICAL SCHOOL | 19

N J M S PEOPLE

STAFF

In the Spirit of Service

Y

ou may not know his name, but if you’ve ever seen a doctor at New Jersey Medical School there’s a good chance that Esteban Santana, III, was an integral part of the process.

Meet the former football player, bodybuilder, and current pastor leading the Office of Managed Care

As manager of the Office of Managed Care, Santana and his staff of five are responsible for credentialing (and recredentialing) every health care provider at NJMS.

being offered a promotion to manager.

“Two weeks into the job, I got a call that United Healthcare was going to perform its annual audit for the department’s delegated contract,” Santana says. “I didn’t even know we had a delegated contract with them.” (A delegated contract, he explains, is one where an insurer contracts his office to perform the entire provider credentialing process on its behalf.)

“We oversee the actual primary source verification on all the degrees, licenses, and board certification approvals of our providers,” Santana explains. “Physicians, mid-level practitioners, everybody. Then we work with health plans to get our providers listed in their directories.”

Santana went through his former boss’s records and gathered up what he could.

“That first audit we scored 44 percent,” he says. “But we needed 85 percent to pass. I said, ‘This is my first month on the job, give me six months to get my ducks in order.’”

There are over 525 health care providers at NJMS. Each one participates with an average of 24 different health plans. That means Santana’s office is responsible for managing, and maintaining, over 12,000 separate managed care files.

Santana drew up a corrective action plan and went to Washington, D.C. for a week of classes on delegated credentialing at the NCQA headquarters. (The National Committee for Quality Assurance is the body that maintains credentialing standards.) “I came back and revamped the entire office. Six months later, we scored 85 percent. The next year we scored 99 percent.”

By Ty Baldwin

Santana lives in Piscataway, where he grew up, and where he and his wife of 27 years raised three children. Both his parents came to the mainland from Puerto Rico when they were young. His father worked as an industrial mechanic; his mother was a pick-n-packer at Revlon.

Since then, NJMS has gone from one delegated contract to twelve. In a nondelegated relationship, Santana explains, it can take an insurer three to six months to credential an individual physician. But with a delegated contract, Santana and his staff can get an NJMS provider approved and listed in a health plan’s directory in 30 to 45 days.

As an undergraduate at Rutgers, in 1989, Santana studied full time and also held down a full-time job as a billing technician in the Department of Medicine at UMDNJ. When he changed his major from accounting to psychology, he added a weekend job working in the Pediatric and Adolescent Unit at the Behavioral Health Center in Piscataway.

Even with this schedule, Santana still found time to play semi-professional football with the New Brunswick Panthers and to compete in Mr. Rutgers, a bodybuilding competition. “It was a challenge from one of my buddies,” he says. “I was a gym rat, so I decided I would compete, but I wouldn’t diet or anything.

I’d just keep lifting.” He placed sixth out of 106 in the lightweight division.

After graduating from college in 1994, Santana took a job at the Partnership for Youth in the Division of Community Health at UMDNJ, where he worked with both high-risk and gifted and talented youth. He then moved on to the

Eric B. Chandler Health Care Center at Robert Wood Johnson Medical School, where he started as a patient accounts clerk and, by 1999, had been promoted to program clinic coordinator.

Then Santana received a call to the ministry. “As clinic coordinator I was responsible for managing the front and back end operations,” he says. “It required some really long hours, so I began looking for a job that would be compatible with attending seminary.” That search brought

20 | p u l s e | SPRING/SUMMER 2020

Santana to NJMS, where he accepted a position as a managed care coordinator.

Santana graduated summa cum laude with his Masters of Divinity from New Brunswick Theological Seminary in 2007.

He currently serves as pastor of the Spanish language church at Cathedral International, a Historical Baptist Church, in Perth Amboy.

That fall, Santana returned from a vacation to find there had been a shakeup in the Office of Managed Care, and that he was

Santana says the Office of Managed Care is “a service oriented department,” and his spirit of service extends beyond his department to NJMS as a whole. Every year, for example, he volunteers at the NJMS Convocation, where, among other duties, he helps disabled guests obtain the proper assistance to their seats, or serves as a photographer so that medical students can get pictures with their family and friends.

Still, everyone has their pride, and Santana’s is evident when he talks about the changes he’s brought to managed care. “In the last five years,” he says, “we’ve scored 100 percent on our annual audits, with the exception of WellCare.”

Hey, nobody’s perfect. That WellCare score was only 99 percent.

ALUMNI FOCUS

Each One, Teach One

By Genene W. Morris

O

mar Bey, MD’83, was raised by his parents to believe that everyone has innate gifts. However, his father made it clear that to realize the full measure of one’s destiny, one must first do three things: recognize those gifts; develop them; and, finally, share the gifts.

The story of how Bey came to recognize, develop, and ultimately share his own gifts began decades ago, as he lay swaddled in his mother’s arms, just moments after drawing in his first breaths. “All of us were born at home right here in Newark,” explains Bey. “The doctor who delivered me was black, and he named me. And since he named me, my mother and father said, ‘Guess what? You’re going to be a doctor.’” This bold declaration would prove prophetic in the years to come and spur Bey to use his talents to uplift and empower.

Bey’s family moved from Newark to Gloucester County’s Williamstown in 1960. There he excelled as one of a few African-American students, singing in the school’s rock band and serving as class president during his junior and senior years.

Bey went on to attend Seton Hall University in South Orange and later enrolled at New Jersey Medical School, first as a student, then as an internal medicine resident where he developed his doctoring skills. It was at NJMS where he discovered his love for pulmonology, eventually completing a three-year fellowship in pulmonary critical care at Newark Beth Israel Medical Center.

In practice for more than 30 years, Bey has treated thousands of patients and whatever ails their lungs. But what has stood out for the pulmonologist, who completed a fellowship in nutrition at the Hospital of the University of Pennsylvania, is the role that weight plays in the worsening of patients’ conditions. Particularly troubling, says Bey, is the rate of obesity within the African-American community, especially among women. According to the U.S. Department of Health and Human Services’ Office of Minority Health, AfricanAmerican women have

the highest rates of obesity compared to other groups in the U.S. This prompted Bey to devise a multi-pronged approach to helping his patients lose weight, improve their health, and become better health care consumers. With an eye toward education, Bey wrote the book Eat One/Half—Make Weight Loss Easy and established a website, OBHealthy.com, where visitors can learn about weight loss and wellness. Furthermore, Bey hosts a weekly 30-minute cable show, A Moment in Medicine, which features in-depth discussions with other physicians concerning various medical topics. He also founded the Physicians Health Ministry, a network of volunteer African-American male doctors who visit community events, churches, and schools throughout New Jersey and New York to provide culturally sensitive answers to questions from their mostly black audiences. Bey says these events also represent an opportunity to plant seeds in the minds of younger audience members about what careers are available to them.

“If you’ve never seen a black doctor, or think they’re a million miles above you, will you aspire to be that?” Bey asks. “No. But if a guy like me says, ‘I’m just like you. There’s nothing special about me,’ maybe that will inspire others to become doctors.” It’s this altruistic mindset that garnered Bey the Weequahic High School Hall of Fame’s 2019 Humanitarian Award, says the organization’s founder Charles Talley. “I’ve known Dr. Bey for his community work for a long time. Every time I invite him to support anything that we do for the kids, he’s always there.”

For Bey, it’s simply a matter of heeding his father’s words.

“Life is finite,” says Bey. When people fail to share, “all that knowledge and information will die with you. I think the worst thing we can do is not pass it on.”

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high blood pressure and damage to other organs, most often the liver and kidneys. When doctors examined her, no fetal heartbeat was detected. After further tests, the OB/GYN team, overseen by Mark Einstein, MD, professor and chair of obstetrics, gynecology and women’s health, delivered heartbreaking news: the Rosenfelds had lost their infant.

In her weakened state, Rose nevertheless had to undergo labor and deliver her unborn child. “Thankfully the labor was quick,” says Moshe. “That was a blessing, one of many silver linings to this very difficult situation.”

Rose remained in the labor and delivery unit. Because she had lost so much blood, anesthesiology resident Somdatta Gupta, MD, was brought in to administer transfusions. With special training in critical care, anesthesiologists are frequently tasked with transfusing blood and blood products.

By Mary Ann Littell

T

he couple lives a busy life in Union, NJ, caring for their family of six children, who range from 2 to 10 years of age. Pregnant with her seventh child, Rose Rosenfeld’s water broke on a Friday afternoon in April 2019. It was four days before her due date.

“Through all of Rose’s pregnancies, her water had never broken before,” says Moshe. “So

right away, this was different.” They brought their children to a neighbor’s home and headed for Newark’s University Hospital, where Rose had received prenatal care. On the way, she became very dizzy and lost her vision.

At the hospital, Rose was diagnosed with preecclampsia, a life-threatening complication of pregnancy characterized by

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Later that evening, Rose’s condition deteriorated.

“Her blood pressure was unstable, her hemoglobin dropped, and her oxygen was dangerously low,” Gupta says.

“I feared she now had a condition we really dread: disseminated intravascular coagulation, or DIC. This complication of intrauterine death with preecclampsia results in the patient’s blood forming clots. There is another entity we had to watch for too: transfusion-related lung injury, where the lungs fill with fluid and it becomes extremely hard to breathe.”

Rose required several more transfusions, and her blood pressure continued to spike.

Through the long night, Gupta remained

by Rose’s side, conferring with Einstein, OB/GYN resident Dhaval Swaminarayan, MD, attending anesthesiologist Ferdinand Iannaccone, MD, respiratory therapists, and other specialists. Moshe stayed with his wife. “That whole night is a blur,” he says.

“All I could do was pray.”

Thankfully, these interventions had the desired effect. By Sunday evening, Rose’s condition had stabilized enough to transfer her to the ICU. A range of specialists cared for her, including Jean Daniel Eloy, MD’04, associate professor of anesthesia; Lisa Gittens-Williams, MD, professor of obstetrics, gynecology and women’s health; and Neelakshi Bhagat, MD, professor of ophthalmology. “We learned that Rose’s blood pressure was so high that it caused her retinas to detach,” says Moshe.

After eight days in the hospital, Rose went home, where she has continued to improve.

“Her vision has returned,” reports her husband. “She has her strength back and is able to care for the kids. It’s another silver lining.”

He says the medical team “was beyond amazing with their level of expertise and the compassionate care they gave my wife.

They explained everything so clearly. I don’t remember all their names, but we are so grateful to them.”

Rose continues to be carefully monitored.

In Newark for an appointment one day, the couple encountered Gupta in the hospital.

To Gupta’s surprise and delight, they ceremoniously handed her an envelope.

Inside was a poem they had written.

“We wrote this poem to give the doctors and medical staff our special thanks for their vigilance, compassion, and care,” says Moshe. “My sister helped us put into beautiful words how appreciative we are.

We brought it with us on our visit and gave it to Dr. Gupta.”

“This poem is the most precious thing I have from my residency,” says Gupta, who has since finished her residency and is now an attending anesthesiologist at Hackensack University Medical Center. “I’ll never forget this patient. I’m so glad I was able to help her. This is why we become physicians.”

“In childbirth, a billion things can go wrong,” says Moshe. “But so many times, a billion things go right, and my wife is okay. So how is it that some people do not believe in miracles?”

He adds: “Our loss was very hard. When people ask us how we deal with it, we answer that we are focused on the present, and the good that we have. Thank God I still have my wife.”

And They're Off! Match Day and Convocation Go Virtual

hile we could not gather in person this year to celebrate major milestones

Wwith the Class of 2020, we found a new way to celebrate. Our most special

traditions went virtual in response to the COVID-19 pandemic.

Our annual Match Day was a lively online experience with plenty of cause for celebration. For the third consecutive year, 98 percent of our graduating students matched to residency programs, exceeding the national average of 94 percent. They are off to train in prestigious programs at leading institutions such as Johns Hopkins, Columbia, Duke, Yale, and NYU. On the heels of this exciting day, NJMS students participated in a virtual convocation ceremony on April 13. Responding to the need for well-trained clinicians in light of the pandemic, NJMS was one of the first schools in the U.S. to accelerate its graduation date. Our graduates were able to begin their residencies early, providing much-needed services to overwhelmed health care systems throughout the country.

Close to home and the pandemic’s epicenter, 62 NJMS students matched to hospitals in New Jersey, and 58 matched to hospitals in New York, including 43 in New York City.

Though these virtual celebrations were a little bit different, they were filled with joy and excitement. We are so proud of our smart, talented students and all they have achieved, and will continue to achieve.

Non-Profit Organization U.S. Postage Paid Rutgers University Permit No. 5287 185 South Orange Avenue Newark, New Jersey 07103 njms.rutgers.edu