Lois Ence and her husband, Bill

Lois Ence, mother of eight, grandmother of 37 and great-grandmother of nine, faced a difficult decision after her left eye began to tear uncontrollably and the lid began to droop.

An MRI test at the Brigham confirmed what Ence, 76, suspected: For a third time, a tumor was growing in the front of her skull, just behind the forehead, and pressing on the top of her eye.

In 2001 and 2016, doctors removed a noncancerous brain tumor known as a meningioma. Even with successful surgery, some meningiomas may recur. The tumor itself is not deadly, but when it grows in crowded, crucial regions of the skull, it can cause serious health problems.

This time, tests showed a new, grape-sized tumor that likely was pushing on the muscle that holds up the eyelid and on the gland that produces tears, causing her symptoms.

Omar Arnaout, MD, of the Department of Neurosurgery, explained that if the condition was left unchecked, she could lose use of her left eye as the muscle eventually failed to hold up the lid. Alternatively, she could consider surgery to remove the tumor.

After two previous and lengthy brain surgeries, followed by challenging recoveries, Ence was willing to risk her left eye to avoid a third invasive surgery.

Upon carefully studying her case, Arnaout proposed using a new, minimally invasive “keyhole” technique. Working through a small incision in her eyelid, known as a transpalpebral approach, he would be able to remove the tumor — forgoing the need for surgeons to go through the bone in her skull to reach the mass.

Although initially still skeptical about any additional brain surgery, Ence changed her mind after meeting with members of her multidisciplinary care team, which included providers from the Division of Plastic and Reconstructive Surgery, who would partner on the procedure.

She liked how her providers spoke directly and clearly with her about her condition and the benefits of the keyhole approach. Their teamwork and trust in each other were apparent.

“They had my complete confidence after that,” she said.

‘This Looks Perfect’

Each keyhole surgery is unique and custom-designed for the individual patient. Neurosurgery and plastic surgery teams prepare extensively to plan the safest route to the tumor, with minimal scarring and tissue disruption.

Ence’s surgery was performed in early June. The team approached the tumor from below instead of from above, making a small incision in her upper eyelid. Inserted through this “keyhole” opening were instruments used to remove the tumor and affected bone. “We were able to sneak in behind the eyeball to the roof of the skull where our target was,” Arnaout said.

Once Ence’s eyelid healed, the incision was no longer visible within the folds of her eyelid.

“The surgery took half the time than the doctors expected,” Ence said. Afterward, she was alert and well enough to safely avoid a stay in the Neuroscience Intensive Care Unit. After just one night in the hospital post-surgery, Ence returned to her Worcester home.

“The recovery was so easy. I was on my feet the next day,” she said. “I immediately started to do word puzzles to stretch my brain and to go for walks.”

As her eye cleared of excess fluid, she returned to reading. Within weeks, she was back to driving, volunteering and preparing for a late summer trip to California to attend her granddaughter’s wedding, visit Yosemite and spend additional time with her family.

“I’m kind of a miracle,” Ence said. “The stitches blend into my eyelid. I’ve earned my wrinkles. To me, this looks perfect.”

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From left: Daniel A. Solomon and Christin Price participate in a panel discussion in Bornstein Amphitheater.

Not only has the Brigham Health Bridge Clinic been providing timely care for patients with opioid addiction and other substance use disorders since opening last year, but it’s also inspiring innovation to combat the region’s opioid crisis.

During a Quality and Safety Grand Rounds, “Opioid Epidemic Solutions Panel,” on Sept. 12, speakers discussed what they and their colleagues are doing to help patients, particularly those with concerns related to injection drug use. This event, which was led by Scott Weiner, MD, MPH, of the Department of Emergency Medicine and director of the Brigham Comprehensive Opioid Response and Education (B-CORE) Program, was one of several events hosted this month at the Brigham and BWFH to celebrate National Recovery Month and educate our community about the Brigham Health services available to those in need.

Daniel A. Solomon, MD, a physician in the Infectious Disease Clinic who also cares for patients in the Bridge Clinic, spoke about a pilot at the Brigham that is examining whether it’s safe and effective for patients who inject drugs to receive IV antibiotic treatment at home for infections caused by injection drug use.

Even though patients who inject drugs are prone to recurring infections and often need prolonged antibiotic therapy, they historically have not been considered good candidates for a peripherally inserted central catheter (PICC) line — a tube that is inserted into a vein and remains accessible for patients who need ongoing IV treatments. Providers are often reluctant to discharge patients who inject drugs with PICC line out of concern for them using the catheter to inject illicit drugs.

As a result, these patients often undergo long-term inpatient stays to receive IV antibiotics. Patients who inject drugs are referred to the Bridge Clinic — where they receive individualized care plans that may include addiction treatment medications and psychosocial services — and those who meet certain criteria can now successfully complete their course of antibiotics at home.

Since April 2018, 20 patients with a history of injection drug use have been discharged from the Brigham to home with a PICC line to complete a course of IV antibiotics with close follow-up care in the Bridge Clinic. During the Quality and Safety Grand Rounds, Solomon reported that all the patients have completed their antibiotic course and experienced no PICC line complications. Three patients relapsed while on IV antibiotics, but none used the PICC line for illicit drug use. Collectively, 570 inpatient/rehab days were spared for these patients.

“Here is an example of one program that was made possible because of the existence of the Bridge Clinic,” Solomon said.

Continued Progress

In addition to the discussion about the home pilot, panelist Christin Price, MD, administrative director of the Bridge Clinic and clinical director of the Brigham and Women’s Medicaid ACO, provided an update on the Bridge Clinic.

More than 400 patients have been referred to the Bridge Clinic since April 2018, and 75 percent of them came to at least one appointment. The average duration of care in the clinic is two and a half months. There is a cohort of patients that has remained with the Bridge Clinic for a longer period of up to 10 months, given their ongoing high acuity. Price said she’s thrilled with the progress that has been made in the clinic to help patients in need. In particular, the Bridge Clinic’s 83 percent retention rate — representing patients who continue to receive treatment at the clinic or in longitudinal care after six months — outshines national averages for similar programs, which rarely reach 50 percent.

“We’re here not only to treat our patients’ addiction, but to also care for them as people,” Price said. “Our goals are to get our patients into treatment, aid them on a path to recovery and help them with other things going on in their lives, such as homelessness or food insecurity, which can often impede recovery. We’re here to support each of them in many ways.”

For more information about recovery month, and to view a calendar of events, visit BWHPikeNotes.org.

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From left: Stephen Conway, Sharon Conway, Sarah Conway, Baby Sophia, Nomi Conway, Adam Kaye and Jake Conway

Sharon Conway, LICSW, was 26 weeks pregnant in 1987 when she and her husband, Stephen Conway, MD, saw the meticulously laid-out plans for the next chapter of their lives take an unexpected turn. It also marked the beginning of a heartwarming, multigenerational story in which the Brigham would play a central and recurring role.

At the time, Stephen was completing a neuromuscular fellowship at Lahey Clinic. He had accepted a job in Connecticut, and the young couple began preparing to move to Hartford.

Sharon, then a social worker at Beth Israel Deaconess Medical Center, was approached by a concerned nurse colleague who observed that she looked a bit swollen and offered to take Sharon’s blood pressure. It was dangerously high, and Sharon was quickly admitted at Beth Israel with preeclampsia before being transferred to the Brigham for the advanced care available in its Neonatal Intensive Care Unit (NICU).

Their daughter, Sarah, was delivered two days later, weighing just 1 pound, 14 ounces.

Stephen and Sharon Conway celebrate their granddaughter’s birth at the Brigham.

Despite her uncertain start, Sarah grew and thrived without complications, thanks to the lifesaving care she received in the NICU. Nearly three decades later, she would return to the Brigham — not as a patient but following in her father’s footsteps as a neurologist-in-training in the Harvard BWH-MGH Neurology Residency Program, in which she now serves as a chief resident.

“Who would have ever imagined as we sat anxiously around her isolette in the NICU that she would be back so many years later?” Sharon said. “We had so many worries and fears back then. We couldn’t even dare to dream an outcome like this, but the care that we received at the Brigham was phenomenal. I can’t say enough about how grateful and privileged we feel.”

And just this May, the Conway family added another cherished chapter to their Brigham story when Sarah (now Sarah Conway, MD) and her husband, Adam Kaye, MD, celebrated the birth of their daughter, Sophia, at the hospital.

“How could I not have her here?” said Sarah, who is currently on rotation at Massachusetts General Hospital. “Over the years, my parents imparted on me how thankful they were for the care that I received at the Brigham when I was little, and we’re all so appreciative for the care Sophia and I received more recently. I’m happy to work in medicine and have an opportunity to give back in some way.”

‘Held Our Hands and Our Hearts’

As an infant, Sarah stayed in the Brigham’s NICU for seven weeks, at which point she was healthy enough to be safely transferred to a Connecticut hospital closer to the family’s new home. During their first experience at the Brigham, Sharon and Stephen said the care team’s extraordinary kindness was an immense comfort.

Sharon and Stephen Conway hold their daughter, Sarah, in the NICU for the first time.

“We were particularly attached to Sarah’s primary nurses, who held our hands and our hearts through the whole thing,” Sharon said. “They really gave us the confidence that Sarah was getting what she needed, and they were honest about things that were complicated and potentially scary. I felt like I always had somebody with me.”

Stephen — an alumnus of the Brigham, Beth Israel and Boston Children’s Hospital’s neurology residency program — said his familiarity with the Brigham as a trainee assured him that Sarah would receive world-class medical care. Even so, as an anxious new father, he gained a deeper appreciation for the exceptional compassion and seamless communication their Brigham care team practiced daily.

“Even though I had been to the NICU as a resident, it’s just another world as a patient,” Stephen said. “Everyone made us feel very comfortable, and knowing the hospital as I did, I felt we were in very competent hands.”

A Special Connection

Years later, when it came time for Sarah and her husband to apply to residency programs, Sarah said the Brigham-Mass General program was a natural choice for her — not only for its academic excellence but also its connection to the hospital that was so meaningful for her and her family.

“Match Day was one of the most exciting days of my life,” said Sarah, who will continue her training at the Brigham next July as a neurology fellow. “When I opened the envelope and saw the Brigham-MGH program inside, I burst into tears.”

For her loved ones, it’s heartening to know that Sarah is still being cared for at the Brigham, albeit in a different way.

“She’s had the opportunity to get the most incredible and sophisticated medical training from the best of the best, and we felt that she and Sophia got the highest-quality care possible when our granddaughter was born,” Sharon said. “We are indebted to those who provided her with a miraculous start.”

Home | About the NICU

From left: Jessica Lambert and research fellow Mayra Pinilla Vera collaborate in the lab.

At Princeton University, rising sophomore Jessica Lambert found no shortage of opportunities to advance her studies and gain experience as she pursues a career in public health and indigenous studies. But as she considered her options for internships earlier this summer, one stood out above the rest: the Four Directions Summer Research Program.

Part of the Brigham’s Center for Diversity and Inclusion, Four Directions aspires to train the next generation of Native American health care leaders through an eight-week research internship with mentoring, networking and hands-on experience at the Brigham and Harvard Medical School. The program connects students with a faculty mentor, whom they work with on a basic science or translational research project, culminating in a final project presentation.

Celebrating its 25th anniversary this year, Four Directions has trained more than 200 students to date.

Lambert, an enrolled citizen of Choctaw Nation and a first-generation descendent in the Eastern Band of Cherokee Indians, said Four Directions surpassed all her expectations — offering not only a phenomenal learning opportunity but also a rare and meaningful chance to connect with other American Indian students.

“At Princeton, I’m only one of a handful of Native students, so the sense of community this program offered made it really special,” she said. “You’re able to talk about your experiences, and everyone will know what you’re going through. There was also an incredible support system beyond the students. Everyone was so welcoming and wanted to see us succeed.”

Four Directions is open to undergraduate rising sophomores, juniors and seniors from around the U.S. In addition to research, students participate in clinical shadowing, professional development workshops, weekly discussion groups, social activities and more.

Lambert, one of eight students in this summer’s cohort, interned with Rebecca Baron, MD, of the Division of Pulmonary and Critical Care Medicine, and contributed to research about respiratory disorders. On the clinical side, she shadowed Stanley Ashley, MD, of the Division of General and Gastrointestinal Surgery, and observed a hernia repair in the Operating Room.

Through activities like these, participants gain skills, experience and knowledge they can draw from to empower themselves, their communities and future generations of all Native Americans, said Thomas Sequist, MD, MPH, director of Four Directions.

“By advancing the representation of Native Americans in medicine, biomedical science and public health, this program is an essential part of addressing both diversity and equity in these fields,” said Sequist, who is also a physician at the Phyllis Jen Center for Primary Care and chief quality and safety officer at Partners HealthCare. “In addition, our faculty and staff are exposed to cultures and viewpoints different from our own while being challenged in new and thoughtful ways. Together, it makes us all better at what we do.”

Baron, who has served as a Four Directions mentor for 20 years, said it’s a joy to welcome the students into her lab each summer.

“I have always loved participating in this program, as I feel we benefit as much, if not more, than the students do. We have the unique opportunity to learn about their background and culture, and it is inspiring to see them grow and develop in our environment,” she said. “I have longstanding relationships with many of the students whom I’ve mentored over the years, and it is a true privilege to see them thrive and to see their careers develop.”

Home | Brigham Values | Four Directions Summer Research Program

Marianne Weiler displays a radiation therapy mask for pediatric patients painted to resemble Spider-Man.

Every superhero undergoes a transformation. Clark Kent turns into Superman. Peter Parker becomes Spider-Man. Diana Prince changes into Wonder Woman. And with a little help from Lead Radiation Therapist Marianne Weiler, MBA, RT(T), pediatric cancer patients who are undergoing radiation therapy at the Brigham have the option to transform into superheroes, too. 

Any patient receiving radiation therapy targeted to the brain must wear a special mask to keep their head in place during treatment. The material looks a bit like a fencing mask, covering the face with mesh or lattice-like holes that allow the patient to see, hear and breathe while being kept in place for their radiation treatment. To help make pediatric patients more comfortable wearing these masks, Weiler has started painting them with some familiar, friendly faces — depicting comic-book characters, for instance — so they look more like something you would find in a costume store than a hospital. She was inspired after seeing similar projects at other hospitals on social media. 

“It hit a chord with me,” Weiler said. “Even if it offers these kids a little bit of comfort, it’s worth it because they go through so much already.”

After talking to her supervisors and co-workers about the idea, Weiler and her colleagues worked together to offer these decorated masks to their pediatric patients. 

“When Marianne asked if we could paint the masks, I thought it was an exceptional idea,” said Todd Vivenzio, MBA, RT(T), director of Radiation Therapy Services at Dana-Farber/Brigham and Women’s Cancer Center. 

The department has created a book of templates patients can choose from, and they welcome requests for custom designs. While superheroes have been the most popular choice, others have included one modeled after Boston Bruins goalie Tuukka Rask’s hockey mask.

“I just love what the kids come up with. They are so creative,” Weiler said. “One girl was talking about her love of chocolate, and that’s how we ended up with a mask depicting the M&M’s characters.”

Marianne Weiler paints a radiation therapy mask.

‘Truly Uplifting’

Weiler usually receives requests via care team colleagues, including Pete Meagher, OCN, RN, a radiation oncology nurse, and Courtney Audet, a child-life specialist. Once she knows what the patient wants, Weiler makes a sketch, outlines it on the mask and then uses a combination of paint and markers to fill in the design with vivid colors. The process can take about an hour, but some requests, such as the Bruins mask, require more detail and can take almost twice as long. 

The art supplies are safe to use on the masks and don’t interfere with treatment. Patients who would like to keep the mask can safely do so.

In the few months since Weiler started the project, she has painted fewer than a dozen masks, but she believes even this seemingly small-scale effort has made a profound difference for patients and their families. When patients are comfortable wearing their masks, it can make them feel more at ease during treatment, which means they might be able to avoid the need for sedation — something often used with pediatric patients undergoing radiation therapy, as it can be difficult for small children to lie still for an entire treatment session. 

According to Weiler’s colleagues, the tangible difference the masks make for their young radiation patients is undeniable. 

“Seeing a child smile and run to their nurse or therapist with excitement as they show their custom design is truly uplifting,” Vivenzio said. “Moments like this, when the patient and their family have forgotten, even for a second, about why they are at the hospital, make what we do well worth it.”

Home | Radiation Oncology Care for Children

Sumaira Ahmed

Five years ago, Sumaira Ahmed noticed a small black circle partially obstructing vision in her right eye. It expanded over the next two days, and soon she was unable to see out of that eye at all.

The development caught her off guard; Ahmed was in her mid-20s and otherwise healthy. But her loss of vision quickly escalated. One day at work at a previous job, she walked into a wall she hadn’t seen and collapsed.

“I got rushed to the hospital. I couldn’t really feel my hands, and I was experiencing burning and tingling sensations in my feet,” recalled Ahmed, who now serves as director of Strategic Marketing and Business Development at the Neil and Elise Wallace STRATUS Center for Medical Simulation.

After a battery of tests, Ahmed was diagnosed with neuromyelitis optica (NMO), a rare autoimmune disease that creates inflammation throughout the central nervous system — causing the immune system to misidentify healthy cells in the optic nerve and spinal cord as foreign invaders. NMO patients can experience vision loss, eye pain, paralysis of the arms and legs, and bladder or bowel incontinence, among other symptoms. Its cause is unknown, and it has no cure. For patients with severe forms of the disease, it can be fatal.

Despite the challenges of living with a chronic illness — which include receiving over 200 chemotherapy infusions since her diagnosis and undergoing surgery every six months to assist with the disease’s peripheral symptoms and side effects of treatment — Ahmed has kept a positive outlook. Since the beginning, she has believed there was a greater purpose behind her diagnosis.

It didn’t take long for her to find that direction. Two months after being diagnosed, she established The Sumaira Foundation for NMO.

Growing from a two-person operation to a 28-person, volunteer-based nonprofit, The Sumaira Foundation for NMO aspires to raise awareness of NMO and build a global community for patients and caregivers. The organization also fundraises to advance NMO-related research through two grant programs: the Spark Grant and Joannie’s Unicorn Grant, a pediatric-specific award named in memory of Joannie Rios, a 6-year-old NMO patient who died earlier this year. In June, Tanuja Chitnis, MD, of the Department of Neurology, was named the inaugural recipient of the Joannie’s Unicorn Grant, which will support her study evaluating the effects of NMO treatments in pediatric patients.

Bright Lights, Big Smiles

On a personal level, Ahmed hopes to inspire positivity among patients and their loved ones. The foundation’s social media presence and website are purposefully adorned with bright colors and cheery graphics, which frame its mission statement of “illuminating the darkness” around NMO.

“I want everything we put out there and everything we do to pick these people up and make their lights brighter and their smiles bigger,” Ahmed said. “There is a lot of heart in our organization. We genuinely just want to help.”

To keep the conversation going, Ahmed developed a multimedia platform called “Voices of NMO,” which enables people affected by the disease — including patients, caregivers and clinicians — to chronicle their experiences. In addition to raising visibility and providing an outlet for those who feel isolated, Ahmed hopes the project will help scientists and clinicians recognize new patterns related to the disease and possible therapeutic targets.

To date, the platform has shared more than 60 stories. Some include patients who were misdiagnosed with multiple sclerosis (MS), which manifests in similar ways to NMO but is a much different condition. Common treatments for MS can be detrimental to NMO patients, something Ahmed believes is crucial to increase awareness of within the medical community.

“I want the foundation to be a pillar of hope and support for patients, showing that there is a light at the end of this tunnel,” Ahmed said. “I hope that our work eventually leads to a cure so that people don’t have to live in darkness.”

‘A Place Where You Belong’

In her work at the STRATUS Center, Ahmed says she is inspired every day by people who share her personal vision: to save lives.

“I have been able to apply a lot of what I learned at the Brigham to the foundation, and things are just flourishing because I’m fortunate to have both of them in my life,” she said.

Meanwhile, Ahmed’s colleagues at STRATUS are equally moved by her commitment.

“Sumaira is creative, bright, savvy and warm. She is one of the major reasons for STRATUS’ success,” said Charles Pozner, MD, executive director of the STRATUS Center.

Looking to the future, Ahmed hopes to one day open a physical center in Boston targeted to the medical and community needs of NMO patients.

“As a patient, you have no idea why this happened to you, and it’s hard to connect with other people,” she said. “I think building a brick and mortar that signifies a safe place of belonging, togetherness, understanding and hope would be a dream come true, especially at a place like the Brigham.”

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From left: Terri Gorman, Karen Cashman, Corinne Cyr-Pryor and Katherine Gregory

In the four decades since Karen Cashman was a patient in the Neonatal Intensive Care Unit (NICU) at the Boston Lying-In Hospital, one of the Brigham’s predecessor institutions, much has changed. Most visibly, the environment of care for premature and sick infants is now the Mary Horrigan Connors Center for Women and Newborns (CWN). Yet, as Cashman was heartened to see during a recent visit to the Brigham, the exceptional warmth and compassion of those caring for the babies has remained the same.

To celebrate her upcoming 40th birthday and honor her beginnings, Cashman returned to the Brigham last month to mark a lifetime of gratitude for the excellent care she received for three months following her premature birth. She said coming back was an unforgettable experience and one made especially memorable when she reconnected with a Brigham nurse, Corinne Cyr-Pryor, RNC, MSN, IBCLC, who had cared for her at the Lying-In so long ago.

“This visit provided me with the gift to not only celebrate how far I’ve come but also to recognize and thank the providers who invest so much of themselves in the care of the Brigham’s tiniest patients,” said Cashman, who lives in Maine with her husband and two daughters.

Cashman said it was an honor to meet with Cyr-Pryor, who continues to work in the NICU as a staff nurse and lactation consultant, and express her appreciation for her commitment to patients and their families. For Cyr-Pryor, seeing former patients like Cashman thrive and live happy, healthy lives is what has kept her working in the NICU for so many years.

“Babies are awesome, and the proof was in the wonderful woman, Karen, standing before us that day,” Cyr-Pryor said. “Helping these tiny patients and their families is a passion and a privilege.”

An Enduring Influence

During Cashman’s trip to the Brigham, she toured the NICU with Katherine Gregory, PhD, RN, associate chief nursing officer for CWN; Terri Gorman, MD, NICU medical director; and Lynne Blech, administrator for Patient/Family Relations.

Cashman learned about the evolution of the NICU and advancements in care that have taken place there throughout the years, including the installation of the first NICU-dedicated MRI in the country in 2018 and the recent NICU renovation and expansion.

Reflecting on her visit, Cashman said everyone she met welcomed her and made her feel she has always been a part of the Brigham family.

“Forty years ago, the Brigham made my family feel reassured, like we were in good hands, and that we had the best care on our side,” she said. “I believe no matter if you had a healthy start, have met great adversity or are somewhere in between, it’s beneficial to pause and reflect on your life, celebrate who you have become and acknowledge those who’ve helped to get you where you are today.”

As an infant and throughout childhood, Cashman and her mother participated in Harvard Medical School studies. Cashman was surprised to find out much later in life from her mother that her baby teeth did not go to the “tooth fairy” but to research. Today, her family still believes in the importance of improving care through discoveries.

“While I know I am just one of many babies who contributed to the advancement of care, it’s amazing that somehow my contribution helped with the progress of medicine, in particular premature births,” Cashman said. “I like to think what I was a part of at the time helped to create a more promising world. I believe my care, possibly my life, could have been much different if I did not end up at the Brigham.”

Her experiences as a patient also inspired her to pursue a career in the health care industry, most recently as public relations director for Northern Light Health, an integrated health care system in Maine. Through her job, she enjoys paying her gratitude forward.

“I use my love of words and communication to uplift others and help them find hope and reassurance when they may need it most,” she said. “Having a career in health care is an important piece of who I have become.”

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Nurse Louise Payen and medical interpreter Ana Hoffman meet on Braunwald Tower 14A.

When Sigfredo Salguero began working at the Brigham five years ago, he was struck by the professionalism and enthusiasm of each member of the Interpreter Services team.

“The work they do is unmeasurable,” said Salguero, operations manager for Interpreter Services. “I am grateful we have such dedicated and talented individuals who love coming to the Brigham to help our patients and their families.”

Last year, the Brigham’s Interpreter Services team, a department within Patient Care Services, assisted roughly 90,000 patients and their families with language barriers and hearing impairments across inpatient and ambulatory areas — more than doubling in volume over the past decade. Yilu Ma, MS, MA, CMI, director of Interpreter Services, broke into a wide smile just thinking about this number.

“I am so proud of our team and what we accomplish every day,” Ma said. “We are part of our patients’ care teams, and it feels great for all of us to know that Interpreter Services is a valued and respected resource at the Brigham, delivering the highest-quality, safest, most compassionate and professional care to our limited-English proficiency patients and their families.”

In the past few years, the department has expanded its offerings to distributed campus locations and works with a vendor that provides phone and video interpreter services around the clock when Brigham interpreters are unavailable.

A Part of the Team

Nearly 40 years ago, Interpreter Services at the Brigham had one staff member. Now, the department is one of the largest hospital-based interpreter services teams in Boston. Currently, the team has 21 part and full-time certified staff interpreters and 50 certified per-diems, providing interpretation and translation services in over 40 languages, including American Sign Language (ASL), Cantonese, Cape Verdean, French, Haitian Creole, Italian, Korean, Portuguese, Russian, Somali and Spanish. At the Brigham, Spanish and ASL interpreters are available in person 24 hours a day, seven days a week, and Spanish requests account for more than 70 percent of Interpreter Services’ total volume.

In addition to offering direct support, the team works with departments across the institution and provides translation services for various projects, campaigns, trainings and written materials.

Each day is different for interpreters at the Brigham. They might come in for their shift and have one or two simple translation requests, such as interpreting what a patient wants for breakfast. Later in the day, they might need to facilitate a conversation with a patient and provider about end-of-life care.

Ana Hoffman, a Spanish-language interpreter who works primarily in the Braunwald Tower, has been at the Brigham for 10 years. Throughout that time, she has gotten to know many patients and their families and enjoys the variety that comes along with her job. While some days are filled with challenging cases, she’s grateful that she can be there for patients, as well as her colleagues, when they need her the most.

“There is no work more rewarding than to convey different languages into one,” Hoffman said. “I am grateful to be able to contribute as part of the medical team in the Braunwald Tower and collaborate with our providers to help enhance the world-class care patients receive here at the Brigham.”

Janet Abrahm, MD, of the Division of Palliative Medicine, and her palliative care colleagues rely on interpreters each day to help them relay important, sensitive messages to patients and their families. In addition, Abrahm said interpreters act as cultural brokers in health care delivery and help providers work more productively with patients from diverse backgrounds.

One demonstration of the invaluable relationship the two teams have forged over the past few years has involved a collaboration among Abrahm, Ma, Jessica Goldhirsch, LICSW, MSW, MPH, of Care Coordination, and Marta Solis, MBA, BACHA, CMI, the service’s educator and a Spanish-language interpreter. They have worked to develop a series of dialogues designed to empower interpreters to strengthen their role on the care team. They also used a glossary of terms to help interpreters understand important language used in palliative care.

“The Interpreter Services group is so professional, responsible and skilled,” said Abrahm, former chief of the Division of Adult Palliative Care at Dana-Farber Cancer Institute. “I couldn’t be luckier as a clinician in palliative care, and for whom communication is key, to have a partner who understands the nuances and subtlety of what I’m talking about.”

Leo F. Buckley Jr., executive director of Business Operations in Patient Care Services, said interpreters at the Brigham play a vital role ensuring that patients receive the highest-quality care.

“Our interpreters are central members of the patient care team and collaborate with nurses, physicians, therapists, nutritionists, chaplains, managers and many others by bringing diverging cultures together through interpretation for patients and their families,” Buckley said.

Salguero looks forward to continuing to help patients and their care teams communicate.

“The Brigham is a great place to work and receive care, and I believe we have some of the best interpreters in the world here,” he said. “I am glad to be able to call this hospital home. It’s an awesome place all around.”

“Behind the Scenes at the Brigham” is a monthly series in Brigham Bulletin that provides a glimpse of the people whose everyday contributions help make the Brigham a world-class institution. Is there an individual or team you’d like to see featured? Send your ideas to bulletin@bwh.harvard.edu.

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The World Health Organization defines health equity as the fair opportunity everyone should have to attain their full health potential and articulates that no one should be disadvantaged from achieving this potential.

Brigham Bulletin invited all faculty, staff and trainees to reflect on how they are addressing health equity in their own work and their suggestions for advancing health equity at the Brigham. We hope you enjoy these thoughtful contributions, and we invite our employees to add their own and keep the conversation going by following the instructions below.

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Andrew Green

Since Andrew Green, M.Eng, was a senior in high school, he’s considered the Brigham’s Department of Biomedical Engineering his second home. Now a clinical engineer with the team, Green said he would not have landed his dream job if it weren’t for his experiences with the Student Success Jobs Program (SSJP) and endless support from his mentors here.

“It has all been a blessing to me,” Green said. “SSJP is the program that essentially set up my career, and my mentors guided me and believed in me every step of the way. I am so grateful.”

After a high school classmate at Boston Latin Academy encouraged him to apply to SSJP, Green was ecstatic when he learned that he had been selected to work in Biomedical Engineering, a team that inspects, tests, installs, maintains, repairs and replaces approximately 26,000 devices used in patient care and research throughout the Brigham. (That supportive classmate and fellow SSJP alumna, Jennifer Herrera Cordones, BSN, RN, eventually became not only part of the Brigham family as a nurse on Braunwald Tower 15CD, but she and Green also formed their own family when they married in 2018.)

A program of the Brigham’s Center for Community Health and Health Equity (CCHHE), SSJP works with departments across the Brigham to pair students from select Boston-area public high schools with mentors and internship opportunities in various fields.

“Andrew is our pride and joy,” said Michael Fraai, executive director of Biomedical Engineering and Device Integration and one of Green’s mentors for the past nine years. “Words can’t express how proud we are of Andrew and everything he’s accomplished so far in his life.”

Michelle Keenan, director of Community Programs in the CCHHE, met Green when he first joined SSJP in 2010. She said his experience reflects the lasting value of the program for students, the local community and the Brigham at large.

“We know that the investment in eager and committed young people in our community creates a pathway to higher education and careers for students,” Keenan said. “SSJP is predicated on the understanding that young people in our local neighborhoods are a vital asset for the future of our local neighborhoods and, importantly, the future of the Brigham and the health care sector.”

‘A Very Special Place’

Since he was young, Green has had a passion for math, science and engineering. He said it was a dream come true as a high school student to get exposed to a field where he could combine these interests and receive hands-on experience in the hospital setting.

As an undergraduate at Syracuse University, he returned to Biomedical Engineering each summer as a college intern through the SSJP. The program offers paid summer internships to students who have successfully completed SSJP during high school, are enrolled in a college or university and are pursuing a medical, science or health degree. He graduated from Cornell University with his master’s in biomedical engineering, and he began working full time at the Brigham shortly after completing graduate school in 2017.

Throughout his education, he hoped that he’d one day return to the hospital’s Biomedical Engineering team. He was drawn to the Brigham from the first day he interned here because of the encouragement he received from his colleagues.

“I felt, and still feel, valued here,” Green said. “I hope that every student can find that kind of support system that pushes you for success. This department definitely embodies the SSJP values.”

Kerrie-Ann Jack, a business manager in Biomedical Engineering, said two words come to mind when she thinks of Green: caring and persevering. Jack and her colleagues worked closely with Green throughout his time in school to help him identify his career goals and develop a path to get there.

“Andrew has thrived working with our team,” Jack said. “Everyone saw his dedication and passion from the very start, and we were all committed to helping him succeed.”

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The Patient and Family Relations team

As Lynne Blech reflects on the most rewarding points of her nine years in Patient and Family Relations at the Brigham, there are larger, community-centric events that certainly come to mind. But it’s the smaller, more private moments — sitting beside a patient or family member and listening to their concerns with kindness and empathy — that warm her heart the most.

“I feel that it is a gift when a patient is willing to provide us their feedback because it’s always a learning opportunity,” said Blech, an administrator on the 12-person team. “We always say we lead with curiosity and not judgment. When a patient comes to us to say that something about their experience fell short of their expectations, we want to know so that we can improve how we communicate and provide care.”

The Patient and Family Relations team, based in the Bretholtz Center for Patients and Families, partners with patients, families, faculty and staff to address positive or negative feedback about care quality and communication — working collaboratively with multidisciplinary teams to obtain diverse perspectives and improve the experience for all involved.

“At the Brigham, we strive to deliver the best care experience for our patients. But health care is big and it’s complex — and it is a human system — so while we most often exceed expectations, sometimes we fall short,” said Nivetha Paterson, interim senior director for Patient and Family Relations in Patient Care Services. “We want everyone to have an exceptional experience, and only by listening with compassion to patients, families and staff can we achieve the best outcomes.”

When patients and families share positive feedback about their experience, staff in the center also pass those comments the relevant care teams to ensure their contributions are recognized.

In addition, the Patient and Family Relations team provides training in effective communication and conflict de-escalation for clinical and nonclinical departments across the Brigham. The center also oversees the hospital’s Patient and Family Advisory Councils (PFACs), dedicated groups of patients and family members who provide feedback on various programs and initiatives.

Fueled by Collaboration

Although based at 75 Francis St., the small but mighty team covers all inpatient and outpatient sites across the Brigham’s main and distributed campuses. In addition to Blech and Paterson, the team consists of five patient/family representatives, three service coordinators, a project manager and a senior patient adviser.

In an average month, patient/family representatives manage more than 300 cases, which represent instances where Patient and Family Relations staff work to address a specific concern or support a request tracked in the team’s shared database.

But that number only tells half the story. Paterson and Blech estimate they and their team collectively field an additional 300 inquiries each month — connecting patients and families with the right resources when they call, email or walk into the center with questions about parking assistance, lost belongings, notary services and a large variety of off-the-cuff requests.

On any given day, the team might be helping a family member advocate for their quality of care concern or a former patient looking to reunite with a care team member with whom they had formed a special bond.
With such a wide range of service areas and tasks, collaboration with others across the Brigham is an essential ingredient in the team’s success, Paterson said.

“I don’t think you could do this job without collaboration,” she said. “We’re only one of many touch points a patient might have, so we try to make sure we interact with everyone on that patient’s or family’s journey.”

Katie Fillipon, MS, RN, OCN, FNP, associate chief nursing officer for Oncology and Medicine, said she has learned so much about mediating and resolving challenges from working with Patient and Family Relations. From her early days as a new nurse director a decade ago to her current role, Fillipon said she tries to model their “consistently impressive” approach in her own interactions with others.

“They are consummate professionals, they are the voice for patients and families who feel lost in our system, and they are tireless supporters of the care we provide,” she said. “Navigating a complex health care system is challenging for anyone, and I feel so assured that I can call on these colleagues to help guide our patients and families in times where they feel overwhelmed.”

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From left: Kate Gasparrini listens to Melinda, a patient at Brookside Community Health Center, during a recent visit.

Melinda, 54, a longtime patient at Brookside Community Health Center, said the clinic’s recent addition of walk-in hours for behavioral health counseling has been a lifeline during a devastating time for her family.

Following her son’s murder in 2013, she spent the next several years battling grief and housing insecurity. For a while, she suffered in silence. That changed about five months ago. During a routine appointment, Melinda’s longtime Brookside primary care physician, Robert Hartley, MD, MSc, gently encouraged her to take advantage of the center’s behavioral health services. She was touched by his compassion.

“I didn’t really trust anyone but my doctor. Dr. Hartley showed so much concern for me, and he kept me going until I was ready,” said the Dorchester grandmother of five.

Since then, Melinda has been using the Integrated Behavioral Health Services pilot program to see a clinical social worker for counseling.

Launched in January through a collaboration between Brookside leadership and its behavioral health team, the program initially enabled any patient seen in the Medical Department to be connected to an Integrated Behavioral Health provider. Since then, the pilot has expanded to include weekday walk-in hours for patients who need immediate support. In addition, patients who need a referral to a psychiatrist can obtain an appointment within one week of the walk-in visit.

Connecting Body and Mind

After observing the roadblocks that prohibited patients from following through with their scheduled behavioral health appointments — such as lack of transportation, busy schedules or long wait times — the team wanted to create a program that would provide rapid access to care and allow patients to visit when it was most convenient for them.

In addition to walk-in hours, the behavioral health team maintains flexible availability for impromptu visits. For example, if a patient expresses interest in behavioral health services during a routine medical visit, a member of the team could be available to see the patient — a departure from the traditional model of providing a referral and having the patient come back later for an appointment.

“Sometimes, we can even do a really quick introduction if the patient doesn’t have time to sit with us that day,” said Kate Gasparrini, LICSW, a clinical social worker at the center. “We can talk with them about what we do and the services we offer and help them feel comfortable about coming back to see us at a later time during a walk-in visit.”

Katherine White, LMHC, a mental health counselor at Brookside, has worked closely with Gasparrini to launch the pilot. Newer to the Brookside practice, White said getting the program off the ground has helped her learn more about all the services available at the center and collaborate more often with providers.

“Through this pilot, we are reminding patients that your body and mind are connected,” she said. “Having behavioral health be integrated into their care routine is important.”

Victoria Hill, NP, an adult-geriatric nurse practitioner at Brookside, said the pilot has been extremely important in allowing medical providers to comprehensively serve patients.

“Many of our patients have been coming to Brookside for decades,” Hill said. “They trust Brookside and the people who work here. Therefore, it’s important that we are available to our patients to work with them through those difficult times when they need us. Having access to behavioral health providers in the moment is an example of how we can meet patients where they are and address their specific needs.”

Melinda said the walk-in model is well-suited to her needs, as it means she can receive care when she needs it most.

“The walk-ins are more accessible, and that availability is imperative, especially when you need to see a therapist,” she said. “Just having someone be available to listen is so important. I feel I’m in a much better, much stronger place today because of these services.”

Integrated Behavioral Health is open to current Brookside primary care patients. To learn more, call Mimi Jolliffe, executive director, at 617-983-6039. In the event of an imminent safety concern, such as suicidal or homicidal ideation, call 911 or go to your local emergency room.

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From left: Erin Lyons Matiello visits Kerry Bergeron after a recent Easter celebration for VAD patients.

When Brigham patient Kerry Bergeron received an invitation from a member of her care team to attend a get-together with other patients last month, her eyes lit up. Having been hospitalized in the Shapiro building for more than 60 days following surgery, Bergeron said this gathering was just what she needed to help lift her spirits.

“It made my day,” said Bergeron, who has been recovering from heart valve replacement surgery followed by a procedure to implant a pacemaker. “I appreciated being able to talk with other cardiac patients and hear their stories.”

Since 2016, physician assistant Erin Lyons Matiello, PA-C, of the Heart Transplant and Mechanical Circulatory Support Program, has run the Boston Athletic Association’s (B.A.A.) 10K each June with the Brigham LVAD Warriors. The team’s fundraising efforts support patients who have a left ventricular assist device (LVAD) implanted as a result of heart failure.

Three years ago, Lyons Matiello used some of the donations to create personalized luggage tags for patients’ “VAD bags.” The VAD, a mechanical pump that supports heart function and blood flow in patients with heart failure, has both internal and external components. LVAD patients must carry a backup controller and batteries in these bags at all times.

In advance of this year’s 10K on June 23, Lyons Matiello launched a new project, VADFest, to lift the spirits of VAD patients hospitalized during year-round holidays. She hosts small celebrations in the Shapiro Cardiovascular Center for patients and their families and recently kicked off the series with an Easter gathering. She uses the Brigham LVAD Warrior funds to purchase food and decorations for the informal socials, which will also include secular holidays, such as Memorial Day and Fourth of July.

Working at the Brigham since 2015, Lyons Matiello said she wanted to create these events to bring together VAD patients who are currently staying in the hospital for care. She said each of her patients are like “family” to her, so to do something special for them means everything.

“I love all of my patients, and I want to be there for them and make their lives better,” she said. “I hope these small but meaningful celebrations help to brighten their days.”

Lyons Matiello thanked her multidisciplinary colleagues in the Advanced Heart Failure program for being a source of both inspiration and encouragement with hosting VADFest celebrations, and she greatly values their ongoing support of the LVAD Warriors team and the projects its fundraising sustains.

Come race day, Lyons Matiello said she’ll be thinking of all her patients, including those who are no longer with us.

“They’re the reason why I wanted to create this team,” she said. “I know they would be out on the course running beside me if they could, so this race is dedicated to them.”

David Bell, an admitting officer in Patient Access Services, is participating in the B.A.A. 10K this year as a member of the LVAD Warriors. After receiving an email about the team from a colleague, Bell instantly knew that he wanted to participate.

“I want to do everything I can to help our patients,” Bell said. “Erin is a fantastic person, and her efforts to go the distance for her patients touch my heart.”

Bergeron, who had an LVAD implanted in 2014, praised Lyons Matiello for “going above and beyond” to bring a smile to her patients’ faces. A Brigham patient for many years, Bergeron has enjoyed getting to know Lyons Matiello and appreciates her thoughtful care.

“Erin is a sweetheart,” Bergeron said. “I’m proud of her and what she’s doing to help her patients. I absolutely love the Brigham. It’s my most favorite place to be aside from being home.”

If you or someone you know would be interested in running the B.A.A. 10K to support the Brigham, visit give.brighamandwomens.org/events/baa-10k.

Foreground, at right: Gary Levine and Jane Brock meet with pathologists in Myanmar.

Although their work takes place behind the scenes, pathologists are on the front lines when it comes to diagnosing and, by extension, treating cancer. But in much of the world, experienced pathologists are in short supply. On a recent trip to Myanmar, one of many countries faced with the challenge of an increasing cancer burden and limited resources and infrastructure to tackle it, a Brigham team began bridging that gap through technology.

In April, Jane Brock, MB, BS, PhD, chief of Breast Pathology, and Carrie Robinson, MD, clinical fellow in Obstetric/Gynecologic Pathology, spent several days in Yangon, the country’s largest city, collaborating with pathologists from across the region to support and expand their capabilities. 

“Improving access to high-quality cancer treatments in low-resource settings is a global health challenge, and making a significant difference at the country level requires coordination of efforts by many organizations working together and pooling resources, knowledge and skills,” Brock said. 

Two of these groups are the American Society for Clinical Pathology (ASCP) and C/Can 2025: City Cancer Challenge, part of the Union for International Cancer Control. ASCP’s Center for Global Health aims to implement innovative methods of improving laboratory practice in a sustainable way across the globe, and C/Can 2025 is committed to reducing premature deaths from cancer by 25 percent by 2025, primarily by uniting governments, the donor community, nonprofits and the private sector to launch sustainable, comprehensive cancer solutions.

The Brigham’s Department of Pathology has supported global health initiatives for many years, with pathologists and laboratory staff donating their expertise to benefit patients in Rwanda and Haiti. 

Technology is making it simpler than ever to support these efforts. Biopsy tissue on slides can now be imaged digitally with a slide-scanning device. Providers in a low-resource setting can upload these images to a web-based system to be viewed by an expert pathologist at the Brigham — or anywhere in the world. 

“We no longer need to have glass slides shipped at high cost and with significant time delay around the world to be able to assist with diagnoses,” Brock said. “Our goal is to use telepathology to improve the quality of all cancer diagnoses made in a country that lacks subspecialty expertise and is struggling with providing high-quality education to its pathologists.” Through telepathology, it’s also possible for the Brigham to provide feedback that can help to improve laboratory procedures.

Following a private donation of a slide scanner to Myanmar, the country can now link into ASCP’s Motic telepathology platform, which currently serves countries in Africa. 

“We will shortly be able to offer a Brigham-based telepathology service to Myanmar — the first in Southeast Asia for ASCP,” Brock said. 

To ensure that Myanmar hospitals can take full advantage of this technology, Gary Levine, program manager for the Brigham’s Business Development and Strategic Initiatives group and an expert in the IT infrastructure needed for telepathology, also traveled with the team to Yangon. Levine, who has been instrumental in establishing telehealth connectivity between the Brigham and a partner institution in China, provided guidance through multidisciplinary lectures and meetings. 

By facilitating access to the deep expertise that lies within the Brigham and other academic medical centers, telepathology is positioned to improve cancer care in Myanmar and beyond. 

From left: Linda Van Marter, Kyle Wilcox and Maria Conley

Kyle Wilcox spent the first 81 days of his life in the Brigham’s Neonatal Intensive Care Unit (NICU). Eighteen years later, he’s a healthy high school senior who is preparing for graduation and college. Inspired to give back to the hospital that he and his family called home for nearly three months, Wilcox visited the Brigham on April 18 and donated gifts to parents whose babies are currently in the NICU.

“I wanted to do something special for the Brigham — the place where my life began,” said Wilcox, who was born prematurely, weighing 1 pound, 15 ounces. “The NICU team helped my family so much when I was a patient here.”

A senior at Millis High School, Wilcox was required to complete a community service project before graduation. When he received his assignment at the beginning of the school year, he knew right away he wanted to do something with the Brigham’s NICU to enhance the experiences of families whose infants are being cared for here.

“Having a newborn in the NICU can be a very stressful time for parents,” Wilcox said. “My parents still talk about those early days often and the miracle that the NICU provided for me.”

For the last several months, Wilcox has raised close to $1,700 to provide NICU parents with gifts, including baby clothes and gift cards for meals and parking at the Brigham. Last Thursday, he delivered 20 care packages to the unit and met two families who received his donations.

Wilcox said coming back to the Brigham and saying thank you to the hospital that helped him thrive was special.

What made the experience even more meaningful was he had the opportunity to work on this project with neonatologist Linda Van Marter, MD, MPH, vice chair of the Department of Pediatric Newborn Medicine, who cared for Wilcox when he was a patient in the NICU in 2001.

Van Marter said Wilcox’s gifts were chosen to help parents with some of the challenges with having a baby in the NICU, making life a little easier for families and honoring his own parents’ journey in the process.

“I can’t help thinking that the greatest gift Kyle has given each of them is his presence with them in the NICU,” Van Marter said. “Here we have a young man, formerly a tiny preemie, offering not only material gifts but also the hope and inspiration to parents that their babies might someday grow up to be as healthy, smart, kind and generous as he is. Kyle’s project touches the hearts of all who knew him when he was a patient in our NICU.”

Patrice Droney and her husband, Brian, were spending time with their daughter, Maggie, in the NICU when Wilcox stopped by to deliver a basket of items to them.

Droney said it meant a lot to her family that Wilcox donated these gifts to NICU families. She plans to tell her daughter about Wilcox someday and what he did to help others.

“Kyle is an inspiration,” she said. “We’re so grateful to him and everyone at the Brigham for everything they’ve done for us.”

Wilcox’s mother, Kris, and father, Reg Wilcox, III, PT, DPT, MS, OCS, executive director of Rehabilitation Services, also came to the NICU and watched their son deliver the packages. They couldn’t help but smile as he interacted with NICU staff and families.

“It was definitely one of those times when I was a proud dad,” Reg Wilcox said.

Jasmine Sealy-Norvin receives tips on résumé writing from a volunteer during Bridges to Moms’ recent Career Day event.

Shortly after Jasmine Sealy-Norvin, 28, learned she was pregnant with her second child, she gathered her courage, her 4-year-old son and whatever the two of them could physically carry — and they escaped.

Home was no longer a sanctuary due to domestic violence. When she made the difficult decision to go, Sealy-Norvin was unsure she and her children would find refuge, but she knew their lives depended on them leaving.

They landed in a mice-infested shelter and were assigned to a room on the third floor without elevator access. It was an especially difficult placement for Sealy-Norvin, who is legally blind with some residual vision. Her pleas for a new room went unanswered. About four months into her pregnancy, she suffered multiple falls going up and down the building’s stairs.

Although she felt vulnerable and alone, the mother-to-be persevered. She held down two part-time jobs and continued pursuing her master’s degree in mental health counseling. But try as she might, she couldn’t outrun the overlapping medical, emotional and financial challenges that come with homelessness, single parenting and a high-risk pregnancy.

“When you don’t know where you’re going to be able to rest your head, your first thought is not about scheduling your next prenatal appointment,” Sealy-Norvin said.

Still, more than anything, she wanted to ensure her children would be safe and healthy. During an outpatient visit at the Brigham, she shared her concerns with a social worker, who referred her to a program called Bridges to Moms. Operated in partnership with a local nonprofit, Health Care Without Walls (HCWW), the program connects homeless expectant mothers with a breadth of services during pregnancy and through the first year of their child’s life.

‘A Shocking Revelation’

Founded in 2016 by Roseanna Means, MD, of the Division of Women’s Health, Bridges to Moms provides free prenatal, peripartum and postpartum care while seeking to address the unique needs of homeless women during and after pregnancy. To date, it has served 120 patients, many of whom are referred to the program by their Brigham care providers.

“For most patients who have a baby, being discharged from the hospital is a happy moment. They take you down to the front door, and usually you have a loved one waiting there with a car to bring you home. Someone stops by with a casserole. Everyone wants to help you out,” Means said. “But we saw that our homeless patients were getting in a cab and going directly to a government housing office to ask for shelter for themselves and their newborns. It was just a shocking revelation.”

In addition to its clinical work, Bridges to Moms focuses on addressing social determinants that make it difficult for homeless women and their babies to access care.

For example, the program provides patients with taxi vouchers for all their medical appointments; similarly, mothers whose babies are hospitalized in the Neonatal Intensive Care Unit (NICU) receive free transportation to and from the Brigham each day until their infant is discharged so that they can bond with their newborn.

In addition, moms receive vouchers to enjoy a meal at the Garden Café whenever they’re here for an appointment or visit. For many women, it might be the only meal they eat that day, Means said.

Unstoppable Drive

Providers and staff also help patients navigate public assistance programs for daycare, food, clothing and housing. Sealy-Norvin recalled how the Bridges to Moms team advocated for her placement in a cleaner shelter with appropriate accommodations for her medical needs as one of many examples of how the program has helped her overcome hardship.

Today, Sealy-Norvin and her two sons, now 5 years old and 7 months old, continue to live in a shelter. Even so, she is filled with hope for the future. In addition to work and graduate school, she is juggling an internship and pursuing an early-childhood education certification.

“My kids give me strength. They gave me the strength to leave. They give me the strength to go on. I just want a better life for them and to be a role model,” she said. “Having Bridges to Moms in my corner, I know that I have people supporting me so that I keep pushing forward.”

Bridges to Moms also works closely with patients to set them up for future success, connecting them with career development and job training opportunities. On April 9, the program hosted a four-hour Career Day event in the Hale Building for Transformative Medicine. Volunteers from BNY Mellon and Deloitte provided free résumé counseling, job interview training and related services. The event — spearheaded by HCWW volunteer Elizabeth Decker — also featured representatives from Found in Translation, a local nonprofit that assists bilingual, low-income women with medical-interpreter certification training and job placement in the field.

Wendy Figueroa meets with a volunteer during the Career Day event

Wendy Figueroa, 33, a mother of five who was referred to the program during her most recent pregnancy, attended the event to polish her interviewing and personal finance skills. Figueroa, a native Spanish speaker, learned about Found in Translation through Bridges to Moms and recently underwent her second round of interviews for entry to the program — hoping to become a medical interpreter and, one day, a nurse.

“If I can learn more, I’m going to do it, and thanks to Bridges to Moms, I’m meeting a lot of people who can help me in different ways,” said Figueroa, who currently lives in a shelter.

Means said she is continually in awe of her patients’ unstoppable drive to make life better for their families.

“These women are warriors,” Means said. “We see so many instances of bravery and resilience. I don’t know that I could last a day in their shoes.”

Carla Monteiro

When Carla Monteiro learned a few months ago that she would receive the Future of Social Work award from the National Association of Social Workers (NASW), she burst into tears.

“I thought back to 20-year-old me,” Monteiro said. “I was a new and single mom. I didn’t have a car. I wasn’t working. I didn’t have a degree. Receiving this award meant so much to me because it has allowed me to reflect on where I was then and where I am now.”

Since she was young, Monteiro has been driven to help others. Growing up, she witnessed violence and substance use disorder in her Dorchester community — experiences that would have a profound influence on her career and fueled her dedication to alleviating suffering.

“The things I saw when I was younger brought me to want to become a social worker and help people who are struggling with mental health and substance use,” she said. “It’s truly my calling.”

Today, Monteiro is working hard to achieve these dreams.

She’s a care transition specialist in the Bridge Clinic and completing a social work residency in the Emergency Department (ED). In addition, she’s an advanced standing student at Boston College and will graduate next month with a master’s degree in social work.

Outside of work and school, she is the founder and president of the Cape Verdean Social Workers Association and serves on the board of directors at Nos Di Tchada i Amigos — a nonprofit organization focused on improving a local community in Cape Verde, Africa, and its residents. In addition, she is involved with the Greater Boston Association of Black Social Workers and is a “big sister” with the Big Sister Association of Greater Boston. Most recently, she was appointed as one of 277 elected delegates for the National Association of Social Workers Delegate Assembly slate for Massachusetts.

Although most of her days are packed, Monteiro says she wouldn’t trade her schedule for anything in the world.

“When I walk through the doors each day when I come to work, I still feel the same excitement as I did on my first day here,” she said. “The Brigham has truly exceeded my expectations of what I thought it would be like to work in a hospital setting.”

Trancy Escobar, director of Care Continuum Management and one of Monteiro’s supervisors, said her team is thrilled Monteiro is part of the Brigham family.

“Carla exemplifies the true definitions of advocacy, empathy, compassion and dedication toward the patients and their families served in the Bridge Clinic, Emergency Department and Brigham community,” Escobar said. “We are excited to watch Carla progress through the next stage of her career.”

Invaluable Experience

The experiences Monteiro has had in her career have shaped her path to becoming the social worker she’s always aspired to be.

Last year, she completed a social work residency in the Department of Neurology at the Brigham. Earlier in her training, Monteiro pursued internships that gave her the opportunity to work with at-risk youth and incarcerated men and women.

Working at the Brigham for a year now, Monteiro said it has been a blessing to continue doing what she loves in a health care setting. In the Bridge Clinic, she works with patients grappling with addiction and facilitates continuity of their care and connection with community resources. In the ED, Monteiro performs assessments on patients and provides emotional support to them and their loved ones.

Christin Price, MD, program administrative director in the Bridge Clinic, said Monteiro has been a critical part of the clinic since it opened last year.

“Carla is not only dedicated to serving our patients, but she also has such a tremendous set of skills and community connections that truly bring her service to a new level,” Price said.

Monteiro is grateful for her Brigham mentors and colleagues who’ve supported her. She hopes she can be an example for other women and show them that anything is possible if you set your mind to it.

“What I love about the Brigham is that we all work together, every day,” she said. “Everyone’s opinion matters.”

Jeffrey Robbins, LICSW, clinical social worker in Neurology, mentored Monteiro when she worked as a resident in the department. He said her commitment and work ethic set the bar not only for students seeking a career in social work but also for experienced clinicians.

“Carla is the quintessential ambassador for the ideals and principles of social work practice,” Robbins said. “Her dedication to her work with individual patients is matched only by her steadfast efforts on behalf of the communities she represents.”

‘We Made It’

When asked what keeps her motivated, Monteiro didn’t hesitate to answer: her 17-year-old son, Mesiah, whom she calls her “mini social worker” because of his supportive and empathic nature. For eight years of his life, Monteiro raised him as a single mom — they did everything together and became inseparable.

“I’m so proud of him and the person he has become,” said Monteiro. After accepting her recent award, she sent a text to Mesiah, thanking him for being such an important part of her life.

“I said, ‘Baby, we made it,’” Monteiro said. “He replied to me and said, ‘Yes, we did, Mom. I love you.’”

From left: Michelle Morse, Paula Chatterjee, George Karandinos and Paul Farmer

When an uninsured, 44-year-old Latino patient arrived at a Philadelphia clinic to seek help for severe back pain, neither he nor his provider was prepared for the complex web of structural barriers that would ultimately affect his care.

Presented as a case study to a panel of Brigham physicians, the patient’s story sparked a lively discussion about how providers could address the challenges this man and his care team encountered. The event kicked off The New England Journal of Medicine (NEJM)’s new “Case Studies in Social Medicine: Seeing Patients Through a Social Lens” series. The case presentations, which complement a monthly NEJM “Perspective” feature by the same name, explore social medicine concepts and their clinical implications.

The Brigham event, held March 29 in a packed Zinner Breakout Room with overflow via webcast in Bornstein Amphitheater, was co-sponsored by the Residents’ Social Justice Committee and NEJM’s case series editors.

As told by George Karandinos, a student in the Harvard/MIT MD-PhD Program at Harvard Medical School, who co-authored the original case study and presented it to the panel, the Philadelphia patient was attempting to manage several chronic medical conditions, including diabetes and asthma, in addition to his back pain. He also had a history of incarceration and poverty, and nearly a lifetime of emotional and physical trauma.

Over the course of his life, the patient had spent 10 years in prison, in which time he suffered a weight lifting injury and was beaten by a prison guard. After his release, his back pain continued to flare up due to heavy lifting required by his job. In the clinic, the patient disclosed to his provider that he occasionally purchased oxycodone illicitly on the street to help manage his pain.

Hoping to help his patient begin to heal, the provider gave him ibuprofen and a five-day prescription for oxycodone, enrolled him in the clinic’s diabetes and hypertension programs, and booked a follow-up appointment. But fearing rearrest after his earlier disclosure about obtaining painkillers illegally, the patient refrained from filling his prescription and did not return for his next appointment.

Understanding Structural Violence

In a conversation guided by Paula Chatterjee, MD, MPH, a chief medical resident in Internal Medicine, panelists Paul Farmer, MD, PhD, chief of the Division of Global Health Equity, and Michelle Morse, MD, MPH, a hospitalist and assistant program director of Internal Medicine Residency, examined how issues around structural violence can intersect with patient care. Structural violence refers to the ways in which large-scale inequities in social, political, institutional or economic systems — such as racism or the criminal justice system — can cause physical harm.

“As clinicians, one of our jobs is to understand the embodiment of structural forces as disease,” Farmer said. “Social forces get in the body as specific pathologies.”

A patient from a poor neighborhood might be suffering breathing problems due to asbestos exposure in dilapidated housing, panelists noted. Similarly, a patient who was recently incarcerated may be experiencing chest pain due to tuberculosis, which has a much higher incidence in prisons.

Acknowledging that these are difficult issues for providers to navigate in everyday patient interactions, speakers offered attendees a framework for different scales of intervention, ranging from individual patient encounters to large-scale social change. For example, when treating a patient who has a history of opioid use disorder, a provider can prescribe medication-assisted treatment, such as buprenorphine, or refer them to the Brigham’s Bridge Clinic, Chatterjee said.

As for the case study patient, he later obtained reliable access to health care after Pennsylvania expanded Medicaid in 2015. Karandinos noted that while he began regularly seeing a primary care physician and improved some aspects of his health, he also continued to face setbacks due to complications related to existing chronic illnesses and his family’s precarious economic situation.

“I don’t think it’s enough to simply be nicer to patients or more culturally sensitive, or to look for magical screening questions, even though being kind, sensitive and attentive are critical in a case like this,” Karandinos said. “For our most vulnerable patients, well-meaning clinical care has to be paired with a structural imagination to envision interventions that are proportional to the challenges our patients face.”

From left: Kidney Pal team members Josh Lakin and Kelsey Killeen discuss a case with nephrologist Ernest Mandel in the Dialysis Unit.

Since he began working more closely with the Division of Renal Medicine over the past several months, palliative care physician Josh Lakin, MD, says one thing has become abundantly clear: Patients with kidney disease face a complex constellation of medical complications, psychosocial concerns and quality-of-life issues.

In addition to dealing with the symptoms of kidney failure, patients with end-stage renal disease are often managing other serious, related illnesses and disorders, including cardiovascular disease, depression, diabetes and malnutrition. On top of that, dialysis — the only treatment for kidney failure besides an organ transplant — tethers patients to a machine for about four hours at a time, multiple days per week, to clear toxins from their bloodstream.

“I have not met a single patient yet whose only health issue is kidney disease,” Lakin said. “These patients spend a lot of time in the health care system.”

Treating a serious illness like kidney failure requires a delicate balance that can be challenging to navigate not only for patients and families but also the multidisciplinary teams that care for them. While attending to the disease itself is of paramount importance, so is preserving a patient’s quality of life and ensuring end-of-life care plans are consistent with his or her wishes.

This is the crossroads at which faculty and staff across several divisions are hoping to make a difference by reimagining the way palliative care is delivered and expanding access to these important services through two new, novel programs: Kidney Pal and Heart Pal.

Expanding Access

Developed in collaboration with their respective clinical partners, each Pal program embeds a three-person team of palliative care specialists — consisting of a physician, nurse practitioner and social worker — directly in inpatient units, with plans to expand to outpatient settings. Kidney Pal supports patients with end-stage renal disease. Heart Pal, which grew out of an existing collaboration with several teams in the Division of Cardiovascular Medicine, supports the Advanced Heart Disease program in the Heart & Vascular Center.

Launched in January, the programs stem from a broader strategy to extend the reach of palliative care services throughout the Brigham, explained James Tulsky, MD, chief of Palliative Medicine. “We wanted to align with specialty areas where need was high and create integrated models through which we could not only provide those services but also train local providers in palliative care skills and competencies,” Tulsky said. “We hope Heart Pal and Kidney Pal will be models for future Pal programs across the Brigham.”

Members of the Pal teams participate in their respective unit’s daily rounds, huddles, and patient and staff meetings to proactively identify and address any palliative care needs.

“We know palliative care and hospice are very underutilized by heart failure patients, and that’s part of the reason we’re targeting this population,” said Kristen Schaefer, MD, medical director of Heart Pal. “We’re really trying to lead the charge to figure out how to help people live well with whatever serious illness they have and prepare for the final periods toward the end of life.”

Apart from these two programs and a specialized Intensive Palliative Care Unit at Dana-Farber/Brigham and Women’s Cancer Center, palliative care at the Brigham primarily operates as a consult service.

“One of the things that’s been really nice about being integrated with the team is we’ve had the opportunity to see patients earlier than we normally would,” said Lakin, who serves as medical director of Kidney Pal. “Now, a nephrologist or nurse will point us to patients they’re concerned about but who aren’t yet at end of life, giving us time to get to know them and learn about their priorities before we push on the more difficult conversations.”

Powered by Teamwork

Pal team members emphasized that the programs’ strength is a direct result of its multidisciplinary model.

“We each have such a different lens,” said Kate Sciacca, MSN, the nurse practitioner for Kidney Pal. “If the three of us walk into a room to see a patient, we’re each thinking about different aspects of care. The ability to consider nursing, medical and social needs together in the context of palliative care is invaluable.”

Schaefer agreed: “Palliative care is built as an interdisciplinary practice,” she said. “Without that model, it’s like practicing with one hand tied behind your back.”

The partnership has been mutually beneficial for the clinical specialties that the Pal programs support.

“Over the past several years, I have learned a tremendous amount from Dr. Schaefer while caring for heart failure patients as they make very difficult decisions about advanced therapies or palliative and hospice care,” said Joanne Weintraub, APRN-BC, a nurse practitioner in the Center for Advanced Heart Failure. “I look forward to collaborating with the new Heart Pal team, including Stephanie Cassone, MSN, FNP-BC, and Tracy Ng, MSW, to give our Advanced Heart Disease patients the very best care.”

Southern Jamaica Plain Health Center

According to the Centers for Disease Control and Prevention, more than 30 million Americans have diabetes, and one in three are unaware of their diagnosis. Latinos face an above-average risk for developing the disease and are about 50 percent more likely to die from diabetes than white U.S. patients. A program at Southern Jamaica Plain Health Center (SJPHC) is working to change that.

Comunidad en Acción, which translates to “Community in Action,” provides free services and educational resources for Spanish-speaking patients with diabetes or pre-diabetes to help them better manage their overall health.

SJPHC physician Liliana Rosselli-Risal, MD, founded the program in 2012 to help patients navigate the health care system, communicate with their care providers and understand their health needs.

To date, the program has served 182 patients, primarily consisting of women over age 55. Most participants are immigrants from Spanish speaking countries who experience social isolation and financial challenges in addition to managing other chronic health conditions, such as high blood pressure and high cholesterol.

“Managing diabetes can be a lifelong and difficult task,” Rosselli-Risal said. “For our Spanish-speaking, low-income diabetic patients, this task is made even more difficult due to inequitable access to health knowledge, exercise opportunities and healthy food choices. The Comunidad en Acción program at SJPHC was founded on the belief that it is as important to empower these underserved patients as it is to provide them with the right advice.”

Culturally Relevant Programming

After receiving an initial grant from the Massachusetts League of Community Health Centers to help launch the program, Rosselli-Risal began to experiment with different types of educational health programming to see what would be most effective and culturally relevant for her patients.

For example, knowing that going to a commercial gym isn’t a big part of her patients’ culture, Rosselli-Risal looked for other opportunities for increasing physical fitness that would resonate better. When a yoga studio next to SJPHC closed and was then rented by the Brigham, she advocated for using the space to host Zumba and Spanish-language yoga classes for Comunidad en Acción participants.

The program also hosts healthy-cooking classes at SJPHC — often using ingredients common in Latin American kitchens — and organizes weekly group walks around Jamaica Plain.

At the heart of Comunidad en Acción is a two-hour class at the center, held Thursdays at 11 a.m. For the first hour, a nurse educator or social worker leads a weekly discussion about diabetes, weight management or mental health. During the second half, participants eat lunch together and socialize.

Finding a Second Family

As the program progressed and participants grew closer to each other, their conversations evolved. Rosselli-Risal saw patients begin to feel comfortable speaking candidly about personal challenges, including discussing what it’s like to lose a loved one, familial hardships and the difficulties that come with living away from their home countries.

Soon enough, these friendships extended beyond the doors of SJPHC. When one patient was hospitalized for a terminal illness, several participants visited her. During this time, the patient’s Comunidad en Acción friends became her second family.

In addition to strengthening community bonds, the program has led to tangible health benefits for participants, including weight loss, reduced blood pressure and lower rates of depression.

Rosselli-Risal, an SJPHC physician for 20 years, said it has been immensely gratifying to see the program blossom.

“My happiest day of the week is Thursday,” she said. “It is a beautiful thing as a physician to be so close to my patients.”

While participants are not required to attend the program’s weekly Thursday meetings, Rosselli-Risal says 20 to 30 patients show up every week to participate in the many programs Comunidad en Acción has to offer. Her dream for the program is to expand it to community centers around in the country.

“I want to publish the results of this program so that people can see the effect of culturally relevant programming,” she said. “Giving patients the tools they need to learn about healthy living and prevention in their native language allows them to connect to the information.”