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an online version of the magazine Winter 2005
Circling the Dome
This is a scientist?
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This Is a Scientist?

Talmesha Richards has been leading a double life for months now, but lately her secret has been exposed. By day, Richards is a mild-mannered budding researcher clad in a simple white lab coat that comes down to her knees. But off-duty, she is a rockin' Baltimore Ravens cheerleader, sporting a purple miniskirt and a bare midriff while gyrating before 70,000 screaming fans at the M&T Bank Stadium.

The only clue to her secret life might have been found in the name tag on her lab coat: The lettering is purple, Ravens purple. “Otherwise,” she confesses, “I didn't really tell anyone about it.”

As a second-year student in the Graduate Program in Cellular and Molecular Medicine, Richards spends long hours learning the complexities of a basic science discipline that links trainees early on with clinical medicine. And so, the recent revelations of her moonlighting habit on the football field have prompted some comical reactions among unsuspecting colleagues. A lot of what she's been hearing is something like: “You do what?!”

Of course, similar reactions come from the people she meets during special public appearances she makes in her full Ravens regalia, as happened in November when she visited with injured U.S. troops convalescing at the Walter Reed Army Medical Center in Washington. Something about the cheerleader outfit is hard to reconcile with the image of a serious research scientist.

But to Richards, her purportedly opposing personas have lived comfortably together since early childhood. As a precocious elementary school student growing up in the shadow of Hopkins' Homewood campus, she was always drawn to neighborhood dance contests in which she routinely outperformed the older boys and girls. That led to her taking dance classes in high school at The Bryn Mawr School, where she excelled academically.

Her mastery of the academic world gave Richards entrée to all seven of the colleges to which she applied—including full scholarships at Princeton and Hopkins—but she felt most comfortable heading to the University of Maryland Baltimore County, which offered her a post in its ballyhooed Meyerhoff Scholars program. The chance to pursue her doctorate in the lab of breast cancer researcher Nancy Davidson at the School of Medicine was the perfect next step.

Recently, we sent Richards an e-mail to ask about her academic focus. She picked up our query on her computer in a cubicle in the Bunting Blaustein Cancer Research Building, where she's lately been seen toiling away, and responded quickly. Her current hands-on project, she said, involves “the potential effect that interference with the polyamine metabolic pathway has on the human epidermal growth factor receptor-2 (HER2) signaling pathway.”

That should take care of anyone who thought the science might be getting shortchanged.


Ramsey Flynn


Academic Tribal Councils

Fourth-year med student David Grelotti with his new mentor anesthesiologist Theresa Hartsell.
> Fourth-year med student David Grelotti with his new mentor anesthesiologist Theresa Hartsell.

When a promising medical student gets in over his head with a tough course, who does he turn to? When another student needs to chart a path in research, who will advise her on which scientist might best match her interests? Such dilemmas might typically be handled by an advisor, but the 450-plus students in the School of Medicine have traditionally relied on a hope and a prayer to find the right faculty member for that role. Up until now, the School has asked faculty to volunteer to act as advisors, but the pairings with students were random and there was no incentive to sign up for duty.

Now that will no longer be left to chance. Administrators have created a new structure that will match students with faculty mentors who can guide them through medical school. To create the new system, the SOM has divided the school into four separate colleges—each with its own tribal council of sorts. The four colleges are not yet named, but groups are already forming. Each college will have 120 students, 30 from each class. Twenty-four select physicians will oversee the schools, each assigned to five students in each medical school class. And backed by a $1.1 million budget, the new system will compensate the faculty members who agree to spend 20 percent of their time in this mentoring role.

“This represents a substantial and tangible investment in the development of our students as physicians,” says David Nichols, vice dean for education.

For fourth-year medical student David Grelotti, a better-organized mentoring system is long overdue. “There's this obvious wealth of resources here,” he says, alluding to the school's 2,333 full-time faculty members. “But we had no structured way to find these people. We figured it out by word of mouth.”

Anesthesiologist Theresa Hartsell, who will be a faculty leader for one of the unnamed colleges, hopes to develop a network of other faculty members “so students can have at their fingertips the richness of Hopkins.” Each college held its inaugural reception in November. Hartsell is now looking forward to inviting her students to her home as well.

“When we asked second-year students what they were hoping to get from the advisors,” Hartsell says, “they wanted to know what we were like outside the hospital, why we went into medicine, things like that. This is an opportunity to get to know people on a different level.”

 


Night-time Clout

The Hopkins Hospital dome at night

Hospitals are no one’s idea of fun. But the thought of coming in at night through the emergency department and then having to wait for hours on a gurney for a bed can make anyone cringe. A year ago, Hopkins Hospital was not immune to such problems. Even Hospital president Ron Peterson found himself personally receiving complaints from clinical directors about “a lack of smoothness and efficiency” in the transfer of patients from the ED to beds during evening hours. But Peterson, who’s been around this place for years, knew what to do—reactivate an old position.

As a young administrative resident at Hopkins in 1972, Peterson had shadowed the then full-time evening administrator. Cost cuts did away with that evening slot, but he never forgot his nocturnal travels through the wards with the after-hours administrator. A similar position, the Hospital head decided, provided the perfect answer to the mounting traffic.

Enter Stacy Sanders, the evening administrator, who came on board last winter. Since then, she’s become intimately familiar with all of the challenges that might bedevil the facility after dark. Chief among them, she says, are the maddening logjams that slow down a patient’s transfer from the emergency department to the intended hospital floor. But she’s learned how to quickly remove bureaucratic obstacles.

“That’s been the bulk of my work,” says Sanders, who spent months of her 3:30 p.m. to 11 p.m. shift roaming the floors, making hourly visits to the ED and dropping in on clinical units. As she roamed, she asked nurses, physicians, shift coordinators, admissions facilitators and housekeepers such questions as, How many patients are in the waiting room? How many have come up to your unit? How many are waiting to be discharged? She also asked if she could help resolve any problems or disputes. “I recognized that this position couldn’t operate in isolation,” she says.

After commanding the post for over 12 months, Sanders knows that moving patients through the ED and into a bed on a Hospital floor takes about 100 different steps. “A hold-up at any one step can delay a patient’s flow through the system for hours.” She says she’s gotten a pretty good sense of where the typical bottlenecks occur and how they can be avoided— or at last how to lessen their consequences.

Neil A. Grauer

 


In Search of Tranquility

Everyone who's spent time in a hospital gives some version of the story—the blaring loudspeakers, beeping monitors, and raucous hallway conversations. In a couple of units in Hopkins Hospital, all that din (which can affect patient safety and contribute to stress) finally got to Stephanie Reel.

Reel, the University's chief information officer, contacted a team of Hopkins acoustical engineers and asked them to attack the noise in the intensive care units in pediatrics and oncology. Now, that single step has brought greater tranquility to patients and potentially also to clinical spaces under construction.

The acoustics engineers, Ilene Busch-Vishniac and James West, both from the Whiting School for Engineering, agreed that a daytime average of 35 decibels—like a loud whisper—would be ideal for their noise-level goal. They then identified the major disturbers of the peace on both units and attacked.

On the pediatrics unit, the klaxon sound of the unit's loudspeaker paging system won the noise contest. And so, the engineers equipped each staffer with a silent handheld device similar to a cell phone. The number of loudspeaker pages quickly plummeted from 12 times per hour to just one.

In oncology's ICU, the engineers discovered that traditional sound-muffling acoustic tiles had long been banished as hotbeds of bacterial growth. The team's solution was to invent a new form of sound-absorbing material by wrapping anti-bacterial fabric around panels of fiberglass insulation and suspending them from walls and ceilings with the aid of Velcro. “That treatment reduced the reverberation time by almost a factor of three,” West reports.

Needless to say, patients and staff are elated with their new-found solace. Only the expertise of these specially trained engineers could have conquered our noise, says Sharon Krumm, the director of nursing for the Kimmel Cancer Center.

 


Saturdays in the OR

For the first time in as long as anyone can remember, surgeons at Hopkins Hospital are performing non-emergency operations on Saturdays. Weekends, of course, have always been business as usual for trauma surgery, transplants and other such emergencies, but most planned-for procedures took place Monday through Friday.

As the number of patients scheduled for necessary surgical procedures has continued to grow, however, administrators decided that implementing a Saturday operating schedule simply was logical (at least until new clinical buildings open and make more operating rooms available). Saturday hours made good sense in other ways, too. They maximize available resources, for example. With each operating room containing over $1 million worth of equipment, extending the use of that technology beyond 44 hours a week just seemed more fiscally responsible.

In fact, “the Saturday schedule is a win-win for everybody,” says Judy Reitz, the Hospital's executive vice president. Clinicians can smooth out their cramped and hassled Monday-to-Fridays, and patients coming in through the door find it easier to get a time slot for their surgery.

And so, after a modest beginning in early December when just one service—thoracic surgery—was using one operating room for three consecutive cases (an esophageal dilation, a bronchoscopy and a mediastinoscopy), the Saturday schedule is growing robust. Soon it's scheduled to involve four ORs and specialties like neurosurgery, urology, and orthopedics. Two more ORs will be reserved for emergencies, which continue rolling in through the door.

To staff the Saturday schedule, OR nursing coordinator Brenda Nack at first called for volunteers. “The response was pretty good,” she says. But with nurses and techs looking to their weekends for family life, no one dreamed that system would work forever. New recruits are now being hired with an understanding that they'll work on Saturdays. Anne Bennett Swingle



The Bow Tie Club

Eighty and thriving: Sol Permutt and Ken Zierler
> Eighty and thriving: Sol Permutt and Ken Zierler

A recent eyeballing of neckwear on physicians around the medical campus has turned up a curious trend: Bow ties appear to adorn the necks of a disproportionate number of senior physicians. And many of them aren't just passing through; they're still on the job.

“I can tell you where I got the habit,” says Ken Zierler, an endocrinologist still active in research at 87. “When I came home from overseas duty in the Army, I was working in a lab. I was afraid my long ties would fall into a beaker. So my wife bought me a bow tie, and one of my neighbors taught me how to tie it.”

Zierler says he's noticed bow ties on about a half dozen other senior physicians around the institution, and he's not sure if their sartorial tendencies share the same origins. He also suspects future generations of senior physicians will be less inclined to maintain the tradition. “I think there's more acceptance among young people for not wearing ties at all,” he says.

Zierler, who's lately been focused on glucose uptake and experiments on the mechanism of insulin action, celebrates his 60th consecutive year on the faculty in February. He shares this tendency for longevity with close colleague Sol Permutt, a pulmonologist who, at 80, looks up to Zierler as a mentor.

Like Zierler, Permutt has remained active. He still works in the pulmonary function laboratory, trains fellows and conducts clinical research on asthma and immunology. And he, too, is a committed devotee of the bow tie.

“I've been wearing them since I was a teenager,” Permutt says, adding that his favorite specimen is a hand-crafted number from a dear medical colleague, who's married to another pulmonologist. “Her husband and I,” Permutt explains, “just happen to share a passion for very big bow ties.”

 


Popular Needles

Needle therapy

Longtime faculty members in this bastion of scholarly medicine probably never thought they'd see the day when acupuncture would become an accepted treatment here. But with peer institutions like the Mayo Clinic, Duke, Stanford and UCLA already offering the popular needle therapy, it was only a matter of time. And now the ancient Chinese treatment has made its modest debut here, too.

Practiced by a clinical nurse specialist who's a licensed acupuncturist, the therapy is currently available only to cancer patients and eventually is projected to be used on about 15 of them a week. Most will be outpatients, and all will need a written referral from a medical oncologist here.

What finally managed to sway medical conservatives here to allow the ancient treatment to enter Johns Hopkins were the results of several clinical trials. Smartly placed needles, the studies found, really can reduce pain and nausea following surgery or chemotherapy.

Sponsored by a Sidney Kimmel Foundation grant, the acupuncture service here is just one of several “alternative” offerings the foundation makes possible for cancer patients. Others include a six-week mind-body course and a consultation service on complementary therapies.

ABS



What about the Animals?

mouse

The School of Medicine may have come a long way since the dark days in 2001, when regulators criticized its care and housing of lab animals (read mice and rats), but its animal overseers are still wrestling with dilemmas.

The current challenge comes from the growing demand for more animals, which means that even the new state-of-the-art vivarium and other facilities will soon be bursting at the seams if the issue is left unattended. It seems that 80,000 rodents and 25,000 cages are not enough in an era in which the bulk of research involves genetic studies with lab animals.

Authorities have not yet devised the optimal solution for the looming space crunch—lab directors are discouraged from sheltering rodents within their own quarters—but they report progress in other key sectors. Animal health, for instance, always a key concern at universities housing large groups of mice for research, has improved dramatically.

“We developed a concerted effort to eliminate all the infected animals on campus,” says Chris Newcomer, who came from a senior lab animal post at NIH in 2003 to become Hopkins' associate provost for animal research and resources. “Now we've pretty much eradicated all the infectious disease.”

 


Towering Inflation

With two new clinical towers—a children's hospital and a cardiovascular and critical care center—now in the final stages of planning, Dean/CEO Ed Miller has lately been spending inordinate hours on planes, trains and automobiles trying to keep generous donors attuned to the need for these buildings. “That's what I've been focusing on for the past two years,” he says. “I haven't had much time to focus on anything else.”

And as if persuading people to support buildings (not just research for new treatments) weren't hard enough, Miller's mission has been accelerated by cost estimates that refuse to sit still. Just in November, trustees approved $725 million for the construction, $190 million more than the previous estimate. Part of what Miller is striving for, he says, are “no surprises” down the road in the amount of money it takes to construct the desperately needed two buildings, along with no compromises on building quality.

Originally, the project's budgeteers had tracked the rate of construction inflation at 2.7 percent over 10 years, and thought they'd hedged their bets by planning for three percent. But inflation has spiked to eight percent annually since 2003, with Hurricane Katrina's construction demands causing the final jump.

By planning for the destabilized construction costs, Hopkins hopes to avoid the scenario that recently afflicted UCLA. After going over budget with its hospital building costs, the West Coast school is straining to afford to equip it.

Says Miller: “I don't want to leave the next generation with high debt, bad bond ratings or limited clinical programs to pay for those towers.”


The Emergency Virtuoso

Gabor Kelen

“Controlling chaos,” says Gabor Kelen, is the essence of emergency medicine. He should know. The soft-spoken Toronto native who is chief of the Department of Emergency Medicine—and was recently elected to the National Academy of Sciences' Institute of Medicine—has spent his professional life gaining a firmer grasp on managing the unwieldy.

As director of the Office of Critical Event Preparedness and Response (CEPAR), created here shortly after 9/11, Kelen oversees institutional planning and reaction to all catastrophes, whether man-made (terrorist attacks) or natural (blizzards, floods, hurricanes).

It was Kelen, for instance, who oversaw a Labor Day weekend CEPAR telephone marathon that rounded up more than 600 members of the medical community here prepared to go to the storm-battered Gulf Coast after Hurricane Katrina struck. “It was like the Jerry Lewis telethon,” Kelen says. Ultimately, CEPAR dispatched 32 volunteers to set up and operate an emergency clinic near New Orleans that treated more than 300 patients over a 16-day period. Later it arranged for a Hopkins team to help assess medical needs in Pakistan following the earthquake there.

Kelen's leadership was a key reason for the Department of Homeland Security's decision in December to award Hopkins a $15 million grant. The funding makes CEPAR the headquarters for a nationwide, 20-institution consortium to study all aspects of preparing for and responding to national emergencies. A key goal will be developing ways to train tomorrow's scientists and health care professionals to handle disasters.

Kelen's attraction to emergency medicine dates back to his med student days, but he came to Hopkins in 1986 for his residency, he says, because “the whole concept of promoting emergency medicine didn't have the same impetus” in Canada as it did here.

“I just liked the excitement of the ED,” he says, “and I've never really lost it.”

Neil A. Grauer 


Swimming For a Lost Hero

Peter Attia
Photo by Allen J. Schaben, L.A. Times

With his arms rhythmically slicing the dark water of Catalina Bay, shortly after midnight last Oct. 11, surgical resident Peter Attia completed a feat achieved by only 119 others—swimming the 20.2 miles between Santa Catalina Island and the Southern California coast. But rather than focusing on his own accomplishment, Attia spoke about the person who had inspired him: Terry Fox.

As a Toronto grade schooler in 1980, Attia was transfixed by photos of the boyish, curly-haired Fox, a 22-year-old British Columbian who had lost his right leg to bone cancer, but then ran a 3,339-mile “Marathon of Hope” across Canada on his artificial limb to raise money for research on the disease that would kill him a year later.

In the quarter-century since, Canadians have voted Fox their nation's greatest hero; issued two stamps and a commemorative coin in his honor; and bestowed his name on a mountain, a highway, a coast guard cutter, annual charitable marathons and a foundation that has raised $360 million for cancer research.

At 32, Attia made the swim to raise $10,000 in pledges for the Terry Fox Foundation. With the help of his wife, Jill, a nurse practitioner, he swam 20 to 30 miles a week in a health club pool and a Northern Virginia lake. He studied how fish move and diagrammed the physics of his stroke and how best to balance his body in the water. The young resident also discovered parallels between surgery and open water distance-swimming. “Swimming is really a technically driven sport,” he says. “And surgery is very technical. You're always practicing technique.”

Averaging a planned 48 strokes per minute, Attia completed the swim in 10 hours, 34 minutes, 51 seconds. “I'm irrelevant,” he insists. “The Terry Fox runs are important.”

Neil A. Grauer


One Step Forward for Faculty Women

Lisa Heiser

For now, Lisa Heiser’s focus is on women. Appointed to the new position of assistant dean for faculty development, Heiser is setting out to make sure that Hopkins’ professional opportunities for its faculty are available equally to both genders throughout their careers. In addition, she will undertake an annual analysis of faculty salaries and help department directors work toward the equal treatment, promotion and retention of women in the School of Medicine.

The reasoning behind Heiser’s new job stems directly from the data. In 2002, the school’s Women’s Leadership Council reported that despite a decade’s worth of significant increases in the number of faculty women in lower ranks, few had eventually attained full professorships. And even though the number of women moving up the ranks has increased significantly since then, last June a committee reported on other inequities: Promotion of women takes longer than it does for men; the total salary for female faculty is, on average, 6.3 percent lower than that of men; a large majority of women—80 percent—believe men and women are not treated equally in their departments.

The dean’s office has created Heiser’s position to remedy such impediments. An Ohio native, she spent 13 years as director of the career management program for the university. About her new focus, she says, “It will take a community to create a more equitable culture.”

Neil A. Grauer

 

 
 
 
 
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 The House that Sol Built
 Time Clocks in the Trenches
 Beyond the Abyss
 The Sum of All Fears
 
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