Faced with too many kids with heart problems in Ireland, one surgeon devised a transatlantic solution.
When cardiac surgeon Mark Redmond returned to his
native Ireland in 2000 after 12 years of training at
Johns Hopkins, he found a country blessed with a robust
new economy. The hospitals were clean, well equipped
and smartly staffed. But Redmond also noticed a disturbing
overflow of patients in need of life-saving cardiac
The problem was especially acute among children: With
150 patients waiting for heart surgery, only one hospital
in a nation of nearly 5 million could handle their
care. Meanwhile, an ongoing surge in population meant
that the need for these vital heart operations was
Redmond didn’t blame his country’s system
of socialized medicine for the backlog, but he was
determined to expand Ireland’s ability to take
care of these desperately ill children. Yet even as
he began forming plans for a modern new hospital outside
Dublin, the waiting list of young patients continued
to grow. Where could they go for help? For Redmond,
the answer was straightforward.
Three times a year since the fall of 2000, Mark Redmond
has been quietly selecting up to eight children to
accompany him on a 10-day pilgrimage to Johns Hopkins,
where he retains a faculty appointment. His fellow
travelers range in age from just weeks old to teenagers.
Usually, the children’s parents come along.
If all goes well, Redmond operates on two children
each day for the next week. For many, he performs time-sensitive
valve replacements. In some of the most pressing cases—as
with the infant in the photograph at left—he
repairs holes in the hearts of babies suffering from
Down syndrome, where the procedure’s optimal
surgical window closes after six months. Once the patients
are out of surgery, Redmond presides over their postop
recovery and then flies them back to Ireland by the
end of the week.
Typically quiet affairs, Redmond’s transatlantic
medical tour draws little public notice in the Emerald
Isle. Still, with his most recent round of seven operations
here in November, he has repaired the hearts of nearly
100 Irish children in Baltimore over the last six years.
During that time, the number of Irish babies and young
people waiting for heart surgery has dramatically declined—from
150 at the start to just 40 patients now.
With a new 183-bed hospital now opening outside Dublin—for
which Redmond will serve as medical director—he
hopes the taxing voyages will soon become a thing of
the past. “I think this will be my last mission
here,” he said to medical colleagues while visiting
his most recent patients in their recovery suites. With
all seven of the children looking pink and animated,
Redmond was ready to depart for his return flight within
the hour. “Of course,” he concluded, “that’s
what I said last time I was here.”
An Icon Turns 100
Backstory of an artistic medical masterpiece
The Four Doctors have turned 100. Putting it more
precisely, John Singer Sargent’s portrait of
the School of Medicine’s four founding physicians—certainly,
the University’s most prized artistic possession—has
reached a century.
Unveiled here on the evening of Jan. 19, 1907, the
painting shows William Welch, William Halsted, Sir
William Osler and Howard Kelly looking like vaunted
European academics instead of practicing American physicians.
Attired in black robes, they pose before a massive
Venetian globe and an El Greco painting. Nearby lies
a 1515 edition of Petrarch.
Welch, who was on hand for the portrait’s unveiling,
described the sittings in the artist’s London
studio during the summer of 1905. All four physicians
were there—a scheduling feat that had taken two
full years to coordinate. As work began, Sargent was
distinctly not pleased. “It won’t do,” he
had declared. “It isn’t a picture.” Then
he brought in the globe, and by the next sitting, happiness
reigned. “Now,” he pronounced, “we
have got our picture.”
Hopkins treasured “The Four Doctors” from
the start. Although it was soon loaned to the Corcoran
Gallery in Washington and then sent to the Carnegie
Institute in Pittsburgh, it was never loaned again.
Its immense size (10 feet 9 inches by 9 feet 1 inch)
and construction on four separate canvasses made moving
it too risky. In 1938, as World War II began in Europe,
the painting’s protective glass was removed and
it was covered instead with a screen. If bombs fell
on Baltimore, everyone wanted the great work to come
“The Four Doctors” has been restored three
times, most recently in 2001. Before the last cleanup,
Halsted had appeared lost in the shadows—some
believed because Sargent didn’t like the surgeon
and intentionally obscured his features. As layers
of grime and dirt fell away, though, Halsted emerged
in all his glory. Today the Four doctors look just
the way they did when they were unveiled 100 years
Anne Bennett Swingle
Hearts of Steel
Who says a working heart has to beat?
Artificial hearts may have finally arrived. With healthy
donor organs in chronic short supply, surgeons here
are gaining confidence in high-tech answers for patients
with late-stage cardiac failure. Consider the HeartMate
II device in the photograph at right. It’s a
major leap forward from its first generation from five
years ago—smaller and more reliable. Doctors
implanted 15 of them here in 2005, with promising results.
At a cost of $65,000 each (with “implant kit”),
surgeons think they herald a new frontier. Though John
Conte would typically refer to one of these as a “left
ventricular assist device” (LVAD), he sometimes
tells patients unfamiliar with the pumps to “think
of it as an artificial heart.” Conte and cardiologist
Stuart Russell say the device provides a continuous
flow of blood rather than the “pulsatile” quality
normally associated with a human heartbeat. It’s
expected to extend the lives of end-stage patients
by up to seven years. Five years out, they say, Hopkins
will implant up to 75 such devices. And it gets better:
A new device that will have no metal-on-metal contact
whatsoever (no ball bearings to wear out) has just
entered phase 1 trials. The “Rotary VAD” uses
magnetic levitation to drive its moving parts. They
could extend lives by up to 10 years.
A Talk Before Cutting
Surgery now starts with introductions
It typically takes about two minutes. The operating
team gathers around an anesthetized patient and the
head surgeon begins. “My name’s Rich Schulick.”
“I’m Ryan Katz, resident,” comes
the next person, followed by “Adriana Schwent,
nurse.” From behind their surgical masks, one
by one, all seven give a name and a role.
So begins the ritual that is unfolding with growing
frequency in ORs nationwide: Surgical teams have adopted
a protocol devised by the aviation industry—the
preflight safety check. In two specialties here—surgery
and anesthesiology—those practices have come
to include establishing an accord among the team members
before a procedure begins. For today’s operation,
for instance, Schwent reads from her checklist: “We’re
doing an exploratory laparotomy, a distal pancreatectomy
and a splenotomy.”
“I agree,” says Schulick.
“I agree,” says Katz.
On Schulick’s signal, Schwent takes the group
through a list of 16 points concerning the coming procedure—which
medications the patient is currently using, the estimated
time of the operation, the blood supply that should
be on hand—all details that must be taken into
account before the first incision is made.
Under increasing pressure to reduce medical mishaps,
the Joint Commission two years ago ordered these formal “time
outs” before every surgery. But at Hopkins, adaptation
was spotty at first. The guidelines, many believed, failed
to include issues that could afflict cases as complicated
as those seen here.
Enter Lisa Rowen, director of surgical nursing, who
made a series of revisions to the mandated checklist
based on discussions with surgeons, nurses and anesthesia
providers. The expanded tool, which debuted May 1,
blends the Joint Commission’s list into one quick
series of checks amid a more comprehensive process.
It’s been embraced from the top down.
Besides introductions—seemingly common sense,
but until recently rarely practiced—the process
includes a post-op debriefing before the surgeon leaves
the room. It reviews issues that arose during the operation
and goes over steps that could increase safety. It
also reviews plans for immediate post-op care.
“The linchpin of the process,” Rowan says “is
the attending surgeon. The surgeon needs to show buy-in.”
Rich or poor, the care’s the same
Talk to faculty physicians here about why they put
up with the pressures and smaller paychecks that can
define academic medicine and you’ll often get
this response: “There’s something about
Hopkins that’s different.”
Some say it’s the unusual comradeship among
colleagues that characterizes clinical practice here.
For others, it’s the thrill of being part of
the intellectual firmament of this place. For Ted DeWeese,
director of radiation oncology, it’s those things
DeWeese, a specialist in urologic malignancies, loves
the idea that he’s able to offer similar treatment
to all of his patients."No matter their financial
status or where they come from,” he says, “they
get the same care." He even cites the ultimate
pair of cases to demonstrate what he means.
Three years ago, two men from opposite ends of the
social spectrum came to him almost simultaneously with
nearly identical stages of prostate cancer. One was
the head of a major European conglomerate, the other
a gravedigger from Orleans Street in East Baltimore.
DeWeese, who’s known for his proficiency in delivering
subtle doses of radiation into malignant tumors, treated
the men identically.
Today, the corporate titan is 65; his medical fellow
traveler is 68. DeWeese has given both the “all-clear” signal. What’s
really interesting, though, is that during their prolonged
series of treatment visits, the two men struck up a
relationship in the waiting room of DeWeese’s
department. Like other patients in similar circumstances,
they bonded with each other after repeated encounters.
(A local businessman and a dockworker, even meet for
lunches several times a year.)
“A little club starts to take shape,” says
DeWeese. Some relationships even become “very spiritual
on that level.”
Technology has unleashed torrents of possibilities for saving lives. But when the heat is on, it takes a wunderkind to sort it all out.
> Click to see the instruments described in detail
Residents once spent hours manually compiling data
for patients’ daily progress notes. Lehmann
co-authored a program that compiles it all
in less than five minutes.
For pediatric patients, physicians once used
an error-prone technique to make drip calculations.
This team’s automated calculation program
has reduced errors by 90 percent.
When antibiotics are called for, time is key.
One Lehmann program accelerated the approval
process, reducing the risk for resistant bacteria
and saving $400,000 annually.
chemotherapy requires delicate measurements.
Lehmann’s team assessed high-risk procedures
and created an order-entry tool that reduced
In a noted breakthrough, the group standardized
calculations for delivery of continuous medications.
In collabora-tion with safety experts, Lehmann
designed a better system for ordering medications,
nutrition, tests—and phototherapy levels.
For “old style” nutrition infusers
like this one, the Lehmann team crafted a calculator
that reduced dosing errors by 89 percent.
Online CPR Guide
When a heart stops, the
team must think fast. This “CPR card” is
automatically tailored to the patient’s
metabolic particulars and weight.
The call came in on Friday night. A 2.2-pound preemie
with a failing heart, failing lungs and failing kidneys
was inbound to the Hopkins NICU. Neonatologist Chris
Lehmann dispatched a fellow to oversee the transfer
and warn the parents their baby could die within hours.
At 10 p.m., as the infant boy arrived in the neonatal
intensive care unit, six specialists descended. Each
set about negotiating fast-moving medical details and
equipment. “For two hours,” says Lehmann, “this
room was pandemonium.”
With so many of the baby’s vital systems in
peril—and some 50 different medicines and dosing
levels to choose from against a loudly ticking clock—the
team faced its ultimate test. Which drugs? How fast?
Which doses? Luckily for this newborn, the physician
in charge—Lehmann—had personally overseen
the programming of nearly all the technology in the
room. These machines had answers.
Chris Lehmann came here in 1995 for a neonatology
fellowship and quickly got bored. He found himself
gravitating toward the “informatics nuts” who
toil at computers trying to devise smarter and safer
ways to govern the minutiae of lab values, contagions
and pharmaceuticals that affect outcomes. Quickly encountering
the glitches in programs, he began tailoring them to
the particular needs of his colleagues in pediatrics.
Then he began writing software programs from scratch,
rolling them out, debugging them as he went along.
The tools turned mountains of scut work into manageable
molehills; his programs helped avert medical mistakes.
In one feat, Lehmann programmed the machines in neonatal
suites to send alerts to busy residents whenever their
patients’ lab values slipped into the abnormal
range. When residents complained that the alerts set
off their pagers unneccessarily, Lehmann made adjustments.
Soon, pagers were beeping but a few times in a 12-hour
shift. Without the “noise,” outcomes improved.
Lehmann’s colleagues began extolling the virtues
of his systems to co-workers over lunch.
presides over five servers from his office. “All
of my servers monitor each other,” he quips. And
though the technology allows him to multitask with the
best of them, Lehmann makes clear “it’s
not for the love of gadgetry that I do this. It’s
all about these babies.” The infant boy in this
case, for example, was transferred to a lower level of
care less than two weeks after checking in. “He’ll
Years after his cold arrival as a refugee, our vice dean for research reaches a pinnacle in American medicine.
|>Chi Dang in his office, flanked by a 1967 photograph of his brother and him with their new American family. (He’s front left.)
One of his first memories of life in America was watching
the mist his breath created in the cold Michigan air
every time he exhaled. In the 39 years since that chilly
beginning as a fresh-faced 12-year-old refugee from
Vietnam, Chi Van Dang has engineered a much warmer
reception in his adopted country: In October, the School
of Medicine’s vice dean for research was welcomed
into the National Academy of Sciences’ Institute
of Medicine, one of the most respected honors in his
For Dang, such prospects might once have looked like
a long shot. One of 10 children of the late Dang Van
Chieu, Vietnam’s first neurosurgeon and dean
of the University of Saigon’s School of Medicine,
Dang was shipped off in 1967 with his brother to live
with an American family in Flint, Michigan. His parents
wanted to spare the two boys from the war that was
raging in their country.
Chi Dang took quickly to the American ziggurat. After
obtaining his undergraduate degree at the University
of Michigan and a doctorate in chemistry from Georgetown,
he arrived at Hopkins as a medical student and—except
for a couple of years at UCSF as a fellow—has
never left. Today, in addition to his vice dean responsibilities,
Dang is a noted hematology researcher whose work on
the MYC cancer gene is considered pathbreaking. He
serves on the editorial boards of several scholarly
journals and mentors Ph.D. candidates and postdoctoral
Still, few colleagues knew of Dang’s refugee
story until last July, when a feature about that long-ago
chapter began circulating on the news wires. “My
friends find this history interesting because I have
no Vietnamese accent,” he says. “I tell
them I have a Michigan accent.”
A knowledgeable coterie of Dang’s fans have
figured out, however, that he is now the highest ranking
physician of Vietnamese descent in academic medicine—not
just in the United States, but in the world. In 2005,
his proud expat countrymen honored him at the Vietnamese
American National Gala with their Gold Torch Award
for medicine and education.
Still, if he were not in the higher reaches of medicine
at Hopkins, what might he have become?
“Deep in the crevices of my mind,” Dang
told the writer of a Vietnamese-American lifestyle
magazine, “I dream of the serenity and bucolic
existence of a country doctor. Like my father, I wish
to be remembered first and foremost as a teacher and
Neil A. Grauer
New physiology chief pursued childhood fascination.
David Hellmann might strike some as looking not much older than the medical
students he teaches, but those students know that behind those boyish looks
they find an unforgettable mentor. That trait was also recognized last fall
by the American College of Physicians, which named Hellmann—a rheumatologist
and director of the Department of Medicine at Johns Hopkins Bayview—its
Distinguished Teacher of the Year. The citation, which will be presented at
the College’s national meeting in San Diego this April, states that Hellmann’s
renown as a teacher has been proven “by the acclaim and accomplishments
of former students,” many of whom have gone on to become leading medical
More Alpha Docs
Deborah Armstrong, associate
professor of oncology, gynecology and obstetrics,
has been awarded the first annual Health Breakthrough
Award from the Ladies’ Home
Journal. The award recognizes her work on delivering
chemotherapy through a catheter directly into the abdomens
of ovarian cancer patients.
Dietz, Victor A.
McKusick Professor of Genetics and Medicine, has
received the American Society of Human Genetics’ Curt
Stern Award for his ground-breaking research on Marfan
syndrome and other genetic diseases.
Todd Dorman, associate professor of anesthesiology,
surgery and medicine, and vice chair for critical care
services in Anesthesiology and Critical Care Medicine,
is president-elect of the American Society of Critical
Joel Gallant, professor of
medicine and assistant director of the Hopkins AIDS
Service, has received the Emerging Leader in HIV
Clinical Education Award from the HIV Medicine Association.
Besides his reasearch and a well-known text, he’s
known for Web-based additions to patient education.
of oncology and pathology, has received the National
2006 Outstanding Specialized Programs of Research Excellence
(SPORE) Investigator Award for her work in pancreatic
and breast cancer vaccine development.
Sean Leng, assistant professor of geriatrics, has
received the Paul Beeson Career Development Award in
Aging Research, one of the most prestigious in the
field of geriatric research.
David Nichols, professor of
anesthesiology, critical care medicine and pediatrics,
and vice dean for education, has received the American
Academy of Pediatrics’ Critical
Care Distinguished Career Award.
Arnall Patz, director emeritus
of the Wilmer Eye Institute, has been elected to
the American Printing House for the Blind’s
Hall of Fame for Leaders and Legends of the Blindness
Richard Rubin, associate professor
of medicine and pediatrics, has been elected president
of health care and education for the American Diabetes
Association. He’s author of the Johns Hopkins
Charles Silberstein, associate
professor of orthopedic surgery, has received the
American Orthopaedic Society for Sports Medicine’s
Thomas Brady Award, recognizing his exceptional treatment
of local athletes, including members of the Baltimore