Posts from the ‘patient care’ category

Brigham Team Recognized for Role in Disaster Response

When a major flood caused by a burst pipe forced the closure of the labor and delivery and neonatal intensive care units at Boston Medical Center (BMC) temporarily last year, the Brigham and several other hospitals stepped up to ensure patient care remained the priority.

During a Quality Rounds presentation in Bornstein Amphitheater last month, BMC clinicians spoke about the flood and reflected on the disaster response and lessons learned. 

A critical piece to the emergency plan for BMC was the safe and timely transfer of patients out of the affected units to area hospitals, including the Brigham, for care. At the end of Quality Rounds, the Brigham was presented with an award from BMC in recognition of the assistance staff provided during the flood incident. 

Karen Fiumara, PharmD, BCPS, executive director of Patient Safety at Brigham Health, said the Brigham teams that responded to this challenging situation were “nothing short of remarkable.” 

“While continuing to safely care for their existing patients, they welcomed this group of BMC patients and their loved ones to the Brigham with open arms and provided them with exceptional care,” Fiumara said. “This was one of those amazing stories that makes you proud to be part of the Brigham community.” 

Katherine Gregory, PhD, RN, associate chief nursing officer for the Mary Horrigan Connors Center for Women and Newborns, echoed Fiumara’s thoughts.

“The Brigham comes together in a crisis like no other, and we care—not only about our patients but also those across the city and region,” she said. “It was our privilege to care for the women and newborns who were affected by the BMC flood last year, and we stand ready to serve if called upon by our obstetric and newborn colleagues again in the future.”

Like a Dream: Brigham Completes Mattress Conversion Project

Members of the mattress conversion project’s “Dream Team”

Members of the mattress conversion project’s “Dream Team”

Over the course of a week in December, the Brigham replaced nearly 800 mattresses in patient care areas throughout the hospital. The logistically complex project was completed not only with minimal disruption to patient care, but also two and a half days ahead of schedule, thanks to the dedication of a multidisciplinary team representing many departments, including clinical and non-clinical staff.

Prior to distributing the mattresses throughout the Brigham, a large team, including the hospital’s pressure injury taskforce, assembled to research and trial different mattresses over the summer. The six-month-long project culminated with the deployment of the mattresses in December.

In addition to enhancing patient satisfaction and comfort, the mattresses, manufactured by Sizewise, will be an important factor in achieving the Brigham’s goal of reducing hospital-acquired pressure injuries, also known as bed sores, which can occur in patients who lie in bed or sit in chairs for long periods without moving.

The mattress conversion team, now known as the “Dream Team,” visited patient floors and swapped out the prior mattresses with the new product—all while working efficiently to minimize disruption for patients and their families. The team comprised approximately 75 people from more than a dozen departments. Sizewise was also a collaborator and recycled the prior mattresses at the end of the week.

Deploying nearly 800 mattresses in busy patient care areas can seem like a daunting task, but the team came together to make it happen—all while ensuring that safety of the patients and staff remained a top priority. Throughout the deployment period, the Brigham’s Patient Safety and Risk management team tracked the safety of patients and staff who were involved in the project and reported there were no safety events noted.

Witnessing the Dream Team complete the conversion earlier than expected was a very proud moment for Kerrie-Ann Jack of Biomedical Engineering, who helped oversee the project.

“It was absolutely phenomenal to see how well everyone worked together to make this happen,” Jack said. “On day one of the mattress rollout, I remember seeing the team come together and hearing someone say, ‘Let’s make this happen.’ And that’s exactly what we did.”

The Brigham ordered 855 mattresses from Sizewise in total. The 64 new mattresses that weren’t part of the conversion will be stored and remain available as spares.

In an email to Dream Team members, Sunny Eappen, MD, MBA, chief medical officer; Maddy Pearson, DNP, RN, NEA-BC, chief nursing officer and senior vice president of Patient Care Services; and Julia Sinclair, MBA, senior vice president of Inpatient and Clinical Services, expressed their deepest gratitude to the staff for their accomplishment.

They wrote: “Thank you, from the bottoms of our hearts, for your outstanding contributions to this project and helping us deliver the highest-quality care and an exceptional experience to the patients and families we serve.”

Patient Receives Life-Changing, and Lifesaving, Heart Procedure

From left: Daniel and Martina Haaser

From left: Daniel and Martina Haaser

The day after undergoing a minimally invasive procedure to repair his heart, Daniel Haaser, 53, sat in his bed in the Shapiro Cardiovascular Center and wept tears of joy. After nearly four months of suffering and uncertainty, he finally felt like himself again.

“I had been at a point where I couldn’t even remember how my life was before,” Haaser said. “When I came out of surgery, there was no need for oxygen. I could walk. I could do things. I was completely and totally overwhelmed by this wonderful turn of events.”

That was a radical change from the weeks leading up to his procedure at the Brigham on Dec. 17 to correct a leaky mitral valve. This life-threatening condition affects a flap controlling blood flow from one chamber of the heart to another. When the mitral valve does not close properly, blood leaks backward through the circulation, driving up pressure in the lungs and potentially contributing to shortness of breath with activity.

While most patients with a mitral valve leak have it repaired through open-heart surgery, Haaser would require a different approach—one that hinged on the collaborative, multidisciplinary expertise of his Brigham care team. That’s because Haaser’s condition was discovered just a few weeks after he had undergone open-heart surgery at another hospital to address multiple severe blockages in his heart.

“From the end of November until the day of my procedure at the Brigham, I was just trying to survive,” recalled Haaser, a software engineer and a volunteer emergency medical technician. “I tried to get out of the house every day, but I ran out of breath so quickly. I could not work or even participate in a meeting. I would lose my stamina and focus. In 10 minutes, I was completely done.”

Otherwise healthy and active, Haaser wasn’t especially concerned when he first experienced chest pain while he and his wife, Martina, were visiting her family in upstate New York over Labor Day weekend. But when the pain persisted and worsened, the Connecticut couple went to the nearest emergency department. There, doctors told Haaser he needed coronary bypass surgery. A litany of complications followed the operation, resulting in a 45-day stay in the intensive care unit that included two weeks in a medically induced coma.

Once home, Haaser thought he was on the path to recovery, but soon his health sharply declined. That was when his cardiologist in Connecticut diagnosed the mitral valve leakage and referred Haaser to the Brigham for a MitraClip procedure, a minimally invasive treatment option for patients who are not candidates for open-heart surgery.

During the procedure, a multidisciplinary team—including interventional cardiologists and cardiac surgeons, anesthesiologists and nurses—works together to insert a catheter through an incision in the patient’s leg and guide it through the vein to the heart. The MitraClip is then positioned at the site of the leak. The team closes the clip’s arms to cinch the two valve flaps together, like a clothespin, explained Pinak Shah, MD, director of the Brigham’s Cardiac Catheterization Laboratory.

To improve Haaser’s health before the procedure, Shah enlisted the help of his colleagues in the Division of Cardiovascular Medicine’s Cardiomyopathy and Heart Failure Program. For days prior to the procedure, Haaser’s care team worked to treat his heart failure medically and prepare him for the MitraClip—ultimately draining 10 liters of excess fluid from his body.

“This is a great example of the collaborative care we that we provide to patients at the Brigham. The excellent outcome here is the composite result of the work done by the entire heart team,” said Akshay Desai, MD, medical director of the Cardiomyopathy and Heart Failure Program. “Having a team of physicians, nurses and cardiac subspecialists working together to attend to all relevant aspects of the patient’s care is the key to the success of these complex structural heart interventions.”

Discharged on Dec. 21—just in time to be home for the holidays—Haaser said he was deeply grateful for the compassionate, lifesaving care he received at the Brigham.

“I couldn’t be happier at this point,” he said. “I consider myself a Brigham and Women’s success story.”

The Power of Hand Hygiene

La’Lena Etheart BSN, RN, PCCN and staff

From left: Nina Jordan, La’Lena Etheart, Michelle Lafferty and Reba Dookie

I recently went back to school for my master’s degree in Nursing Administration. I had to design a brochure as part of an assignment, and I decided to make a brochure about hand hygiene and preventing the spread of infection. I thought of the idea to have real nursing staff in my visuals, and my amazing coworkers on Shapiro 9/10 were more than willing to help! This picture is the cover photo of my brochure, which was titled “The Power Is in YOUR Hands!”

La’Lena Etheart BSN, RN, PCCN
Nurse in Charge, Shapiro Cardiovascular Center 9/10

A Shared Commitment to Improving Diabetes Care

Hudson and colleages

From left: Lauren Godsoe, Margo Hudson and Maricruz Merino

I have been going annually to New Mexico with the Outreach Program with Indian Health Service since 2009, and each year gets better. I have primarily been involved with the diabetes program at Gallup Indian Medical Center in Gallup, N.M.

A former Brigham internal medicine resident, Maricruz Merino, MD, is now their chief of Medicine, and we have been working together closely over the years developing inpatient and outpatient glucose-management protocols. We are both close friends as well as colleagues, and we have shared the joys of the birth of children and grandchildren with each other in addition to seeing the growth of the diabetes program.

This past March, I had the pleasure of traveling with Brigham Health nurse practitioner Laura Godsoe, NP, for a week of lecturing and consulting on patients. I am so proud of the work we have done and thankful to Outreach Program for continuing to support this opportunity.

Margo Hudson, MD
Division of Endocrinology, Diabetes and Hypertension

Rekindling a Special Bond with a Former Brigham Nurse

By far, my shining moment this year was the day I reconnected with my primary nurse, Vivian Kelley, RN, after 39 years! Vivian helped save my life back in 1979, when I came to the Peter Bent Brigham Hospital for a bone marrow transplant. I had aplastic anemia (a rare and life-threatening blood disease) and spent two and a half months in an isolation room. Vivian was there at every turn—when I got my chemo and during the hundreds of hours that followed as I waited for my new immune system to mature. The photo in which I’m wearing a mask marks the day I went home. The other picture was taken when we reconnected this summer in Boston. Vivian moved to the West Coast a year after my transplant and continued practicing nursing until she retired. I credit Vivian’s intelligence, nursing skills and her calm, positive attitude for getting me through a terrifying time in my life. I’m so grateful we found each other again.

Jessica Keener
Associate Director, Proposal Management, Development Office

Thankful for Our Friends in Shiprock

Carlson with Shiprock members

Alissa Umana (far left), Sally Carlson (second from left), Loren Day Lewis (second from right) and Kyle Dale Walters (far right)

In November, I had the privilege of traveling with three of my team members to the Northern New Mexico Navajo Medical Center in Shiprock, N.M., as part of the Brigham and Women’s Outreach Program with Indian Health Service. This is the second year that we have been able to travel with the Outreach Program to provide training in customer service and communications for clinical and administrative staff throughout the hospital. It is an incredibly rewarding experience to deliver our training to such an eager and enthusiastic audience—and to know that, in some small way, we are helping them improve the quality of care delivered to the Navajo population on the reservation.

This year, our trip happened to coincide with Native American Heritage Month, and as part of the celebration, Navajo dancers of all ages performed for staff and patients. Wearing intricately detailed costumes and accompanied by traditional music, the dancers offered moving performances of ceremonial dances to a crowd gathered in the hospital atrium. After the performance, we had the honor of being photographed with one of the dancers, who is also a supervisor at the hospital. It is a wonderful memento from the trip and a reminder of our friends in Shiprock.

Sally Carlson
Senior Manager, Training and Communications, BHIS

Schwartz Rounds: Caring, Celebrating and Grieving as a Team

From left: Panelists Kevin Farley, Monique Cerundolo, Mariya Kalashnikova, Beth Flanzbaum and Neldine Alexandre

From left: Panelists Kevin Farley, Monique Cerundolo, Mariya Kalashnikova, Beth Flanzbaum and Neldine Alexandre

Details have been altered in this story to protect patient privacy.

Kevin Farley, RRT, never imagined the first patient he’d care for on his initial day at the Brigham as a respiratory therapist would turn out to be someone who shaped his career.

“Claudia made me a better therapist,” Farley said. “She was the very first patient I had; she was the first patient I charted on. Her room was the first patient room I walked into. I had a lot to learn when it came to Claudia. Everything I do here goes back to her.”

During the Dec. 15 Schwartz Rounds, “When the Team Becomes Family: Caring, Celebrating and Grieving Together,” a panel of five Brigham staff members—representing just a few of the dozens of people on Claudia’s care team—discussed their experiences caring for Claudia and, ultimately, what it was like to lose her. The monthly Schwartz Rounds series is a multidisciplinary forum focused on optimizing compassionate care by exploring the human dimensions of health care.

Born with an incurable lung condition, Claudia left her native country and came to the U.S. in search of a second chance at life. As her health declined, doctors back home told her they couldn’t offer the advanced care she needed and advised that she travel to the States for treatment.

In addition to causing breathing problems, Claudia’s condition triggered other severe health issues. She passed away last year at the Brigham due to complications related to her lung condition.

Claudia had lived in the U.S. for more than a year and frequently came to the Brigham for care. Subsequently, she grew very close to the multidisciplinary experts who worked tirelessly to save her life. It was during this time that her team formed a tight bond with each other, too, as they navigated their patient’s challenging case. Together, they said, they felt like a family as they cared for Claudia, celebrated her life and grieved her loss.

Described as a kind soul whose smile could light up a room, Claudia was a patient the panelists said they’ll never forget. They reflected on the personal and professional struggles they grappled with when caring for her, as well as the emotional toll it took on them all as Claudia’s health failed to improve.

“Nothing helped her. We exhausted all of our resources,” Farley said. “I could only hold her hand and say, ‘I am here with you.’”

Forging Bonds

In the face of these challenges, providers looked for opportunities to lift Claudia’s spirits. One time, they hosted a small celebration for her following a procedure. On another occasion, panelist Neldine Alexandre, BSN, RN, of Thoracic Surgery, painted Claudia’s nails for her. They said these gestures might have been small, but they were significant to Claudia and to each of them.

The panelists spoke about the profound grief each of them experienced last summer when Claudia had died. Her death came as a shock because Claudia had been out of the hospital for some time before her health rapidly declined.

Monique Cerundolo, MA, BCC, of Spiritual Care Services, remembered the day she learned what happened. She was alerted that a family had requested a viewing of their deceased loved one. Not knowing the name of the patient, Cerundolo prepared to assist the family—a process she’s often involved in when patients pass away. When she received the paperwork and saw Claudia’s name listed, Cerundolo was stunned.

“I was heartbroken,” she said. “I had two minutes to gather myself together before I met the family. I had lost someone who was very important to me.”

Mariya Kalashnikova, MD, a fourth-year resident in the Harvard Brigham and Women’s Hospital/Boston Children’s Hospital Combined Internal Medicine-Pediatrics Residency Training Program, was Claudia’s primary care physician. She said losing Claudia was especially difficult because she was the first outpatient of hers who passed away. Kalashnikova reflected on how upsetting it was to hear about Claudia’s passing and the importance of being able to talk with her peers who had also been grieving.

“When I’ve lost patients in residency, they’ve all been inpatients and I had warning. I could be with them and their families,” Kalashnikova said. “It was hard not being able to be there for Claudia during her final moments.”

Healing Together

After grieving individually, the care team banded together again following Claudia’s death to begin the healing process. They comforted each other, wrote poetry and organized a remembrance gathering.

“It’s never easy to lose a patient,” said Alexandre. “But as long as we talk about her and learn from her case, Claudia will always be in our memories in a very special way.”

The panelists encouraged their peers to take the time to process their grief after a patient passes away and set aside even just a few moments to speak with a colleague about how they’re feeling.

“For the rest of my life, with every patient I treat, I will see a piece of Claudia in each of them,” Farley said. “She taught me so much about being a respiratory therapist. I am so glad that Claudia came in to my life—it’s just unfortunate the way that it ended.”

At the end of the discussion, Martha Jurchak, PhD, RN, director of the Ethics Services and coordinator of Schwartz Rounds, commended panelists for their candid reflections.

“It requires a certain kind of bravery to talk about events like this and to acknowledge the grief you experienced,” Jurchak said. “You have shown that we become better providers by sharing our loss and grief so that we can take care of the next patient we encounter. I want to thank you all for being brave in this way.”

Schwartz Rounds are held the second Tuesday of each month, noon–1 p.m., in the Anesthesia Conference Room.

The Heart of the Matter: Brigham Team Delivers Precious Outcome

Jasmine Taylor with her son, Jaydan

When doctors told Jasmine Taylor, 30, five years ago that pregnancy would be a life-threatening condition due to her poor health, including a complex heart defect she’s had since birth, it didn’t come as a surprise to her. It was something Taylor had heard from her care providers since adolescence. Still, as she and her husband, Damon, dreamed of starting a family, that didn’t make the news any less heart-wrenching.

Today, however, her heart overflows with love. Seemingly against all odds—and thanks to the support of Taylor’s passionate and collaborative multidisciplinary care team at the Brigham and Boston Children’s Hospital (BCH)—the Stoughton couple welcomed their son, Jaydan, to the world in July.

“When I heard him cry for the first time in the delivery room, I thought, ‘I want to protect and love him forever,’” Taylor said.

Getting to that point was a long and difficult road, one that Taylor said she doesn’t take for granted. She was born with a severe form of tetralogy of Fallot, a cardiovascular disorder that restricts the passage of blood to the lungs. By the time she was a teenager, Taylor had undergone three open-heart surgeries—the first one performed when she was just eight months old.

Upon reaching her 20s, her health continued to decline. She became overweight, diabetic and struggled with high cholesterol. On top of that, she wasn’t keeping up with the long list of medications she had been prescribed to treat these issues; at 23, she had a stroke. The frightening event was a wakeup call, Taylor said.

She began taking her medications dutifully. She adopted a healthier diet and intensive exercise regimen, leading her to drop 100 pounds in one year and safely come off most of her medications. Taylor said she did it all with one aspiration in mind: getting healthy enough to become a mother.

“There was a chance—a hope—that I could become a parent, so I was very determined to make it happen,” Taylor said.

‘We’re Going to Do This’

Even with the dramatic improvements to her health, Taylor’s weak heart would make pregnancy challenging. Among the many changes women undergo while pregnant is a significant increase in blood volume—sometimes almost doubling to nourish a fetus—which puts more stress on the heart to pump blood through the body.

“I told Jasmine, ‘It’s going to be hard work,’” recalled obstetrician Katherine Economy, MD, co-director of the Brigham’s Pregnancy and Cardiovascular Disease Program. “She just looked and me and said confidently, ‘None of this is a problem for me. My goal is to have a baby,’ and I said, ‘That is my goal now for you, too. We’re going to do this.’”

Economy is just one member of the large interdisciplinary care team that worked together over the past two years to achieve a safe pregnancy and childbirth for Taylor and baby Jaydan. But just as important as the advanced, comprehensive care they delivered was Taylor’s fierce commitment to staying healthy and starting a family, her providers emphasized.

“It takes more than a village of expert care, compulsiveness, outreach, detail, innovation, coordination and attention to quality outcomes at every step,” said cardiologist Michael Landzberg, MD, senior staff member, founder and immediate-past director of the Boston Adult Congenital Heart and Pulmonary (BACH) Program, a joint effort of the Brigham and BCH that cares for adults born with heart conditions. “That said, without identifying and utilizing her unique strengths, Jasmine could never have accomplished what she has near-miraculously done. She remains a hero to each and every one of us.”

Close Collaboration

After facing fertility challenges unrelated to her heart condition, Taylor was referred to the Brigham’s Center for Infertility and Reproductive Surgery, where she underwent two rounds of in-vitro fertilization (IVF) at the center’s Weymouth clinic. Even at this stage, her complex health needs influenced how her fertility care was planned, said reproductive endocrinologist Janis Fox, MD.

“There were definitely unique considerations in performing IVF on someone with her history,” Fox said. “I very much wanted to avoid rare but known complications such as ovarian hyperstimulation, and I absolutely wanted to avoid a multiple pregnancy, as we all felt that would be an unnecessary challenge for her heart.”

Throughout her pregnancy, Taylor’s providers were in near-constant communication and, via the Pregnancy and Cardiovascular Disease Program, met monthly to discuss her progress and anticipate possible complications. The team also involves experts from other disciplines—including anesthesiology, cardiac surgery, neonatology and nursing—to ensure they are fully prepared, said cardiologist Anne Marie Valente, MD, co-director of the program.

“We coordinated and developed a written care plan so that at any point, no matter who was on call, each of us would know exactly the potentials and treatment plan,” Valente said.

As a patient, Taylor said her providers’ extraordinary commitment, support and compassion have been remarkable: “These are priceless people in my life. They are like my extended family.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

In Remembering Leonard Nimoy, Lung Center Highlights COPD Awareness

Julie Nimoy with her father, Leonard Nimoy

From left: Julie Nimoy with her father, Leonard Nimoy

When actor, director and artist Leonard Nimoy was diagnosed with chronic obstructive pulmonary disease (COPD) in 2013, the beloved Star Trek icon dedicated his time to raising awareness about this devastating, progressive lung disease until it took his life two years later. Through a documentary directed and produced by his daughter, Julie, and son-in-law, David Knight, Nimoy’s mission continues to live long and prosper.

In honor of COPD Awareness Month in November, the Brigham Health Lung Center partnered with Julie and David to screen the 2017 film, Remembering Leonard Nimoy: His Life, Legacy and Battle with COPD, on Nov. 29. The screening, held at the Joseph B. Martin Conference Center at Harvard Medical School, was followed by a panel discussion and question-and-answer session with Brigham clinical and research experts specializing in pulmonary care and thoracic surgery.

Ranking as the fourth-leading cause of death in the U.S., COPD is a family of chronic lung diseases that permanently damage the airways and, over time, make it increasingly difficult to breathe. In patients for whom the disease is in the most advanced stages, everyday activities like walking across a room can become extremely taxing. COPD is most commonly caused by smoking but also appears in nonsmokers, suggesting environmental and genetic links.

While preventable and treatable, especially in the earlier stages, there is no cure for COPD.

The Need for Early Detection

Told through interviews with Nimoy and his family members, the hour-long documentary features stories from the actor’s childhood in Boston, early career in Hollywood and breakout role as Spock in Star Trek. It also provides a candid look at his experiences living with COPD, his passionate support for smoking cessation and the toll the disease took on his family.

One poignant message the film underscored was that COPD is believed to take root at a young age, but patients often mistake its early signs—when treatment would be most effective—as the normal effects of aging or an inconvenient consequence of smoking. The takeaway resonated with Brigham experts who participated in the panel discussion.

“This is a disease that is difficult to diagnose early, and yet it’s medically important to do so,” said Bruce Levy, MD, chief of the Division of Pulmonary and Critical Care Medicine and co-director of The Lung Center. “It destroys the lung tissue, so the more that occurs as time goes on, the less responsive it is to medical therapies.”

Speakers highlighted the Brigham’s innovative research in the field and the comprehensive, multidisciplinary services offered through The Lung Center for patients with COPD—including medical therapies, such as pulmonary rehabilitation, and procedural interventions, such as lung transplant.

Internationally renowned COPD expert Bartolome Celli, MD, a physician-investigator in Pulmonary and Critical Care Medicine, said it is imperative that COPD screening become part of routine preventive care. The test for it, known as spirometry, should be as common as mammograms and colonoscopies to maximize the likelihood of early detection and long-term survival, he noted.

“It is our duty to go out and preach that this disease is treatable and preventable,” Celli said.

‘This Is Always New’

Nimoy’s granddaughter, Morgan Pearson, who attended the event, recalled how eye-opening it was to see her grandfather’s rapid decline between his diagnosis and his death at age 83.

“Even to those of us who knew him very intimately, he was larger than life and didn’t seem destructible,” she said. “I can’t say that, as a family, we were really prepared for that.”

Hilary Goldberg, MD, clinical director of Pulmonary and Critical Care Medicine, said the film reinforced the powerful role empathy plays in caring for COPD patients and their families.

“Initiating something like oxygen therapy or new medication seems fairly routine to us, but it is very, very life-altering to patients,” Goldberg said.

“The film really highlighted that it’s important to remember that this is always new to each patient that you see.”

Among the other Brigham panelists who participated in the discussion were Raphael Bueno, MD, chief of the Division of Thoracic Surgery and co-director of The Lung Center; Dawn DeMeo, MD, MPH, a physician in Pulmonary and Critical Care Medicine and a senior respiratory genetics researcher in the Channing Division of Network Medicine; Craig Hersh, MD, a physician-investigator in the Channing Division; and Scott Swanson, MD, director of Minimally Invasive Thoracic Surgery at the Brigham and associate chief of Surgery at Dana-Farber/Brigham and Women’s Cancer Center. Filmmaker Ron Frank also offered remarks.

Learn more about the documentary at rememberingleonardfilm.com.

From Falls to Fires, Staff Partner to Simulate Home-Hospital Scenarios

Nahall Rad (left) and Anish Mehta (right) simulate caring for a patient, played by Herrick “Cricket” Fisher, who has fallen in her kitchen.

Nahall Rad (left) and Anish Mehta (right) simulate caring for a patient, played by Herrick “Cricket” Fisher (center), who has fallen in her kitchen.

While home-based hospital care yields considerable benefits for patients, it also poses unique challenges for care teams as they monitor and treat patients outside the controlled environment of a hospital.

Members of the Brigham’s Home Hospital team recently collaborated with experts at the Neil and Elise Wallace STRATUS Center for Medical Simulation to transform the center’s space in Neville House to mimic a home setting. They practiced responding to events the clinical team might encounter in a patient’s house or apartment—running the gamut from emergency to end-of-life scenarios.

The Home Hospital program provides hospital-level care to select acutely ill adults in the comfort of their home. Eligible patients, who must live within five miles of the Brigham’s main campus or BWFH, are enrolled via the Emergency Department upon seeking care for issues such as infections and exacerbations of heart failure, asthma and chronic obstructive pulmonary disease. If inpatient care is needed, the Home Hospital team will discuss the opportunity with the patient to receive care at home instead of through a conventional hospital admission.

The recent exercise with the Home Hospital team was a first for the simulation experts at STRATUS, who usually set up their facilities to look like traditional hospital settings, such as an operating room or patient room. For this training, STRATUS staff created a mock foyer, kitchen, bedroom and living room.

Seeing the Team Come Together

During the exercise, the nine-person Home Hospital clinical team went through six scenarios, including caring for a patient who has fallen in his or her kitchen; what to do when a dementia patient has forgotten to turn off the toaster, leading to a small fire; and speaking with a cancer patient about end-of-life and goals of care. With assistance from STRATUS, they acted out each scenario and reviewed the appropriate protocols and procedures for handling each situation.

“Our team was phenomenal,” said David Levine, MD, MPH, MA, a physician and researcher in the Division of General Internal Medicine and Primary Care who oversees the Home Hospital program. “To see our clinical team come together to enhance their home-hospital skills and learn from each other was beautiful. I am very proud of our team and look forward to organizing more simulated training experiences with STRATUS in the future.”

Home Hospital nurse Nahall Rad, BSN, RN, said taking part in these types of simulations is critical because it prepares the team for the challenges of delivering care outside the hospital.

“The dynamic nature of patient care in the field requires you to be as best prepared as possible for managing unforeseen and emergency scenarios,” Rad said. “The training we received at STRATUS was crucial in allowing our clinicians to be exposed to these types of experiences in a controlled environment to receive feedback on what was done well and what could have been done better. This allows us to have the highest level of patient care and improves our patients’ outcomes that much more.”

Also participating in the training was Gregory Goodman, MD, a Home Hospital attending physician. He appreciated the opportunity to work through the different cases with the team and learn about ways to improve patient care in the home setting.

“This was a powerful opportunity to work with our Home Hospital colleagues to improve our approach to care in a real-life way,” Goodman said. “It was great to see our team work together to collaborate to deliver exceptional and innovative care.”

Preparation Is Key

Planning and organizing such a course takes a lot of preparation behind the scenes—one year to be exact, Levine said. From writing the curriculum to ordering the furniture and equipment for the simulation, both teams wanted to ensure the course was as authentic as possible.

Michael Sampson, CHSOS, senior medical simulation specialist at STRATUS, enjoyed working with Levine and the entire Home Hospital team to create the course and operate the computerized simulation manikins during the training. He said seeing their passion for continued learning was inspiring.

“It is truly a team effort to put on simulation programs at STRATUS,” Sampson said. “It requires extensive planning and dedication from our staff and faculty members.”

Jamie Robertson, PhD, director of Education at STRATUS, also worked closely with the team to create the curriculum for the course. She said it was an exciting opportunity to think creatively about how to simulate the most realistic experience possible for Home Hospital providers.

Charles Pozner, MD, executive director of the STRATUS Center, said the course is another example of how STRATUS continues to contribute to the transformation of care delivered by Brigham Health providers. “This unique interprofessional program not only enables the Home Hospital staff to stay current with procedural care, but it also provides an excellent opportunity to strengthen the team-based care that is crucial in making this program such an overwhelming success,” Pozner said. “STRATUS takes pride in ‘pushing the envelope’ in health care education and research.”

B-PREP Program Aims to Stop Breast Cancer in Its Tracks

Bprep

From left: Mil Pierce reviews information about a clinical trial with Shivam Dua at the Comprehensive Breast Health Center.

As far as she can tell, Mil Pierce, 55, of Belmont has done everything right in terms of leading a healthy lifestyle. She never smoked. She goes to the gym twice a week and walks her dog nearly every day. She doesn’t drink alcohol in excess. And she’s eliminated red meat from her diet.

Pierce has made these choices with the knowledge that she has a strong family history of breast cancer. The disease has affected her mother, maternal grandmother and a maternal great aunt, among many other relatives.

Yet after Pierce underwent genetic testing to see if she had an inherited mutation in the BRCA1 or BRCA2 genes – an alteration that greatly increases a woman’s risk of breast cancer – the lab results showed she didn’t have the harmful mutation.

That’s why Pierce was stunned to learn two years ago, following a biopsy, that there were precancerous cells in her breast tissue. If left untreated, the abnormal cells could develop into breast cancer.

“When I got that diagnosis, it hit me like a brick. I thought, wow, there’s something else going on,” she said. “Genetically speaking, there’s no explanation for it.”

Today, Pierce is hopeful not only for her own continued health but also that of her two teenage daughters, thanks to the care, resources and guidance she’s receiving through the Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) Program at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC).

Launched about two years ago and led by Tari King, MD, chief of Breast Surgery at DF/BWCC, the B-PREP Program develops a comprehensive, customized risk profile for every patient and a personalized plan aimed at reducing the likelihood of developing breast cancer. Upon entering the program, patients complete a survey that asks not only about their medical history but also a wide range of lifestyle factors that experts believe can contribute to breast cancer risk, including diet, physical activity, sleep, weight changes, whether they work a night shift and more.

“Assessing individual risk for breast cancer is complicated,” King said. “Breast cancer is not just one disease; it is a family of diseases, and the risk factors that can lead to the development of different types of breast cancer also vary.”

King emphasized that the program is open to all patients, including – and perhaps especially – those who don’t know their breast cancer risk.

“Many women think that if breast cancer is not in their family that they don’t have to worry about it, and that is not true. In fact, most women who come in with their first diagnosis of breast cancer don’t have a family history,” King said. “Our doors are open to anyone who wants to learn about their risk.”

Novel Trials

Another big misconception the B-PREP Program is working to dispel is that people at increased risk are at the mercy of their biology, King said. Based on what B-PREP’s multidisciplinary team learns from an assessment, each patient receives personalized recommendations and is connected to relevant resources, such as a referral to the Brigham’s Program for Weight Management or information about clinical trials currently enrolling patients.

One such novel trial is looking at how exercise affects breast cancer risk in women who have dense breast tissue and do not currently engage in regular exercise. Led by Jennifer Ligibel, MD, a medical oncologist specializing in breast cancer at DF/BWCC, the study pairs participants with a personal trainer for 12 weeks. Researchers will collect a breast tissue sample from participants before and after they complete the exercise program.

“We know that women who exercise more have a lower risk of developing breast cancer, but we don’t know why. We also know that denser breast tissue – that is, tissue containing more glandular elements to it and less fatty tissue – is linked to a higher risk, and, again, we don’t know why,” Ligibel said. “In a previous study we conducted looking at women who already had breast cancer, we saw that exercise actually changed the immune system within the cancer. Now, we’re looking at whether those same types of changes from exercise can be seen before a tumor has even emerged.”

Pierce learned about her eligibility for the study from her B-PREP providers and became one of the first patients to enroll. She appreciates how comprehensive the B-PREP Program is, including the opportunities to participate in clinical trials that explore wellness-based approaches to prevention.

“This breast density and exercise study was music to my ears,” she said. “I’m really excited about being on the cutting edge of research, especially since there’s a mystery here.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
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Extending Access to Psychiatric Care for Pregnant, Postpartum Patients

While pregnancy, childbirth and motherhood are joyful times for many women, for others these experiences can be emotionally challenging, isolating or even traumatic. An estimated one in seven women experiences depression during pregnancy or in the first year after giving birth – making depression during this time nearly twice as common as gestational diabetes. 

But unless a mother or mother-to-be already has an established relationship with a behavioral health provider, she faces multiple barriers in terms of accessing specialized care to prevent, identify and manage mental health and substance use concerns.

“Psychiatrists who are trained in and comfortable with treating pregnant and postpartum patients are an extremely limited resource. There are simply not enough,” said Leena Mittal, MD, director of the Division of Women’s Mental Health in the Department of Psychiatry. “Meanwhile, in low-resource areas like Central and Western Massachusetts, the wait time to see any psychiatrist – let alone a perinatal psychiatrist – could be three or four months. In Southeastern Mass., it could take more than six months.”

That usually leaves primary care providers and obstetricians on the front line, but they don’t typically receive the specialized training necessary to feel confident treating these patients either, Mittal said. 

Helping to bridge that gap is the Massachusetts Children Psychiatry Access Program (MCPAP) for Moms, which provides free, real-time perinatal psychiatric consultations and referrals for obstetric, pediatric, primary care and psychiatric providers across Massachusetts. The Brigham serves as the Boston hub for the program, which is based out of the University of Massachusetts Medical School in Worcester. 

Supporting Patients and Providers

From fluctuating hormones to sleep deprivation to a traumatic childbirth, there are a number of circumstances that can make pregnancy and motherhood a difficult time for patients. 

Leena Mittal

Launched four years ago, MCPAP for Moms maintains a consultation, resource and referral phone line that providers can call to receive guidance on diagnosing, treating and prescribing medications for pregnant and postpartum women with mental health or substance use concerns. For complex cases, perinatal psychiatrists in the program conduct in-person consults with patients. The service can also help frontline providers identify other relevant community resources or help facilitate referrals to group and individual therapy or other services.

For example, if an obstetrician suspects that a patient who’s come in for a prenatal care visit is showing signs of depression, the provider could call MCPAP for Moms and ask for input on a possible diagnosis and treatment plan, explained Mittal, one of two Brigham psychiatrists who provide consults through the program.

“There’s this misconception that pregnancy is a time when women are always ‘glowing’ and happy, but it can be a complicated time,” said Mittal, who also serves as associate medical director of MCPAP for Moms. “In addition, women – and sometimes their providers – assume they have to stop all medications, including antidepressants, during pregnancy. But that’s not the case. We give providers evidence-based guidelines, and they can ask questions as needed.”

Nicole Smith, MD, MPH, of the Department of Obstetrics and Gynecology, has used MCPAP for Moms’ services in her practice and recommended it to colleagues as a novel, vital resource for providers. 

“A lot of programs tend to focus on trying to increase the number of and access to therapists and psychiatrists, which is wonderful and very necessary, but that may not meet our patients’ needs,” said Smith, an unpaid obstetric consultant for the program. “Patients can receive great, timely care from their primary care doctor or obstetrician, who may just need confirmation that a treatment is appropriate or a best practice.” 

MCPAP for Moms supplements the Brigham’s robust in-house psychiatric resources, she added. For example, the program makes it easy to help patients who live outside Boston find support services closer to home. “Many patients don’t want to drive to the city with a newborn, and that can be an obstacle to accessing treatment,” she said.

Looking ahead, MCPAP for Moms is expanding its services to support providers caring for perinatal patients with substance use disorders, an effort that will be based out of the Brigham and led by Mittal. 

“Massachusetts is the first state in the country with a program like MCPAP for Moms, and getting to be part of something so innovative has been very exciting,” she said. “We’re moving the needle in the way that perinatal mental health is treated, and I’m thrilled to be part of that.” 

Learn more at mcpapformoms.org or contact MCPAP for Moms at 855-MOM-MCPAP (855-666-6272). Providers interested in training opportunities around perinatal mental health and substance use are also encouraged to contact the program.

Brigham Health’s Strategy in Action: Timely Access
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Lung Center Celebrates Clinic Opening

Staff from the Brigham’s Lung Center gathered for a celebratory breakfast on Oct. 29 before welcoming the first patients in their new clinic space on the Pike. The eight exam rooms and additional flex space enables the Lung Center’s three major disciplines – Pulmonary and Critical Care Medicine, Thoracic Surgery and Thoracic Oncology – to provide comprehensive, interdisciplinary care for patients in a single location. The clinic is located between the 15 Francis St. and 45 Francis St. entrances.

Brigham Health Opens New Facility in Westwood

Staff celebrate the opening of Brigham and Women’s Health Care Center, Westwood.

A new Brigham Health multispecialty, outpatient clinic in Westwood opened Oct. 1. Brigham and Women’s Health Care Center, Westwood, which encompasses two floors and 30,000 square feet, will provide local patients with access to high-quality care in a convenient community setting.

Located in the University Station development, the facility offers primary care service from BWH physicians, including access to X-rays, ultrasounds, mammography and lab services. In addition, Brigham Health providers offer many specialty services, including Cardiology, Dermatology, Endocrinology, Neurology, Obstetrics and Gynecology, and Orthopaedics.

“We are thrilled to bring the Brigham’s exceptional care to the town of Westwood and the surrounding communities,” said Cindy Peterson, MBA, vice president of Regional Ambulatory Operations and Business Development. “Patients can receive the right care at the right time, with the benefit and convenience of it all being under one roof.”

To schedule an appointment, call 1-877-WEST128 (1-877-937-8128). For more information, visit brighamandwomens.org/westwood.

‘You Give Me Hope’: Volunteer Program Pairs Ostomy Patients with Peers

Joseph Currier receives a visit from Linda Martin while recovering from surgery on Tower 15.

Nearly 30 years have passed since Linda Martin, 72, underwent surgery at the Brigham for a partial bladder removal and urostomy, a procedure that creates an opening in the belly through which urine can exit the body. Performed to bypass a diseased or damaged urinary tract, a urostomy siphons urine to a pouch on the body that patients need to regularly empty and change.

Martin, who had both procedures to treat bladder cancer, knew the urostomy would offer her the best chance at continued health. Still, as she prepared for discharge from the hospital, she worried about how her life would change. Like many patients with an ostomy – a category of procedures that also includes ileostomies and colostomies, which involve the intestinal tract – Martin would have the pouch for the rest of her life.

“No matter how excited I was to go home, see my son and husband and sit on my porch, I was afraid. I wondered, can I really take care of this at home?” she recalled. “The nurses were so helpful and encouraging in terms of my medical needs and progress, but at that point I would have loved to meet someone with an ostomy. I had so many questions, even simple ones like, ‘What kind of bathing suit can I wear?’”

Martin quickly learned she had nothing to fear, finding that her life and career would remain just as active and fulfilling as they were prior to the procedure. Inspired to help patients facing the same anxieties she once did, five years ago Martin connected with Wound and Ostomy Care nurses Diane Bryant, MSN, RN, CWOCN, and Mary Willis, MSN, RN, CWOCN. They worked together to establish the Brigham’s Ostomy Peer Visitor Program to support patients with new ostomies transitioning from hospital to home.

Central to the program are volunteers with ostomies who visit patients in their hospital rooms. Initially launched as a three-month pilot with Martin as the sole volunteer visitor, the program has since expanded to five volunteers who represent a diversity of age, gender, personal background and ostomy type.

Volunteers come to the Brigham on Mondays, Tuesdays and Fridays to speak with interested patients on Tower 8, 12 and 15 and CWN 8; they also speak with patients by phone during off-hours. Bryant and Willis work closely with volunteers to provide training and education, introduce them to care teams and collaborate with nurses on the units to identify interested patients.

“We’re a team – the nurses, physicians, social workers and volunteers. We all work together to ensure the patient has the best experience,” Bryant said.

Empathy and Compassion

Patients fearful about being in public or feeling normal again benefit greatly from hearing volunteers share their personal stories, explained Bryant and Willis.

“Ostomies can be life-changing experiences for patients, and we were concerned about quality of life for our patients,” Bryant said. “As nurses, we can provide that physical and emotional care, but often in the back of the patient’s mind is the thought, ‘Well, you don’t have one of these. How can you know what I’m feeling?’ This program supplements the care we provide by connecting patients with someone who can answer questions they may not feel comfortable asking a nurse.”

Willis noted that because having an ostomy often causes considerable anxiety around body image, it is especially meaningful for patients to hear volunteers talk about their experiences with an ostomy while enjoying some of life’s biggest milestones, such as marriage or the birth of a child, and finding accommodations for more routine activities like exercise and travel.

While speaking with volunteers can reduce patients’ anxiety, simply seeing them is equally powerful, Bryant and Willis added.

“When a volunteer goes into the patient’s room, you can see the patients giving them a once-over and looking for the outline of a pouch under their clothes,” Willis said. “It’s really helpful for them to see they’re dressed like everybody else, and you cannot tell there’s a pouch, even under fitted clothing.”

Martin said she feels honored to help others by sharing her story and being a compassionate listener.

“I’m comfortable with having an ostomy now, but I haven’t forgotten what it was first like,” she said. “Patients hold my hand and say, ‘You give me hope.’ I’m grateful to help their heart feel a little lighter.”

AERD Center Aims to Clear the Air on an Underdiagnosed Disease

From left: Alice Maxfield speaks with David Doyle during a recent follow-up appointment.

For David Doyle, 54, taking in the flavors and aromas of food is more than his passion – as co-owner of several restaurants in Jamaica Plain, it’s also his livelihood. So when what seemed like unusually intense seasonal allergies caused his senses of smell and taste to diminish three years ago, Doyle grew concerned.

First experiencing severe nasal and chest congestion, he tried several over-the-counter allergy medications. Nothing worked – in fact, his symptoms worsened. Within a few months, Doyle not only felt miserable physically, but he was also devastated to find he could no longer smell or taste anything.

“I didn’t really want to eat because there was no joy in it,” Doyle said. “On a professional level, it was also really hard to work with these great chefs who would ask, ‘David, can you taste this?’ and all I could comment on was the texture.”

Hoping his symptoms would eventually subside, he continued taking allergy medications and pain relievers, even though their effects were minimal. It wasn’t until after suffering a frightening medical event that Doyle would learn the very medications he was taking to feel better were actually making him sick.

Doyle was on vacation with his family in Spain when he realized something was gravely wrong with his health. Suffering from a bad headache and congestion, he took some ibuprofen, a treatment he had used before without incident. This time, however, he began experiencing serious respiratory distress within a few hours and was rushed to a local hospital.

“My lungs were filled with fluid. I felt like I was suffocating,” Doyle said. “I had no idea what had prompted that reaction, but I was starting to suspect something had changed inside me.”

After returning home, he was referred by his primary care provider to Tanya Laidlaw, MD, director of Translational Research in Allergy in the Division of Rheumatology, Immunology and Allergy, who diagnosed him with aspirin-exacerbated respiratory disease (AERD). Triggered by a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, AERD is a chronic condition that includes severe asthma and recurrent, fast-growing nasal polyps.

Also known as Samter’s Triad, the disease often strikes otherwise healthy adults and progresses rapidly. Its cause is unknown, and effective treatments are elusive.

“This is a disease that is really not well-known and is underdiagnosed,” said Laidlaw, who also serves as director of the Brigham’s AERD Center. “It requires a multidisciplinary approach, particularly between ear, nose and throat surgeons and allergists – specialists who don’t ordinarily talk to each other about patients with these symptoms. Without that communication, an ENT surgeon is unlikely to ask about an aspirin allergy, and an allergist doesn’t typically look for nasal polyps.”

Founded five years ago, the Brigham’s AERD Center brings together allergists, ENT surgeons and researchers to explore new treatments and improve the lives of patients with AERD. The center’s clinicians diagnose and treat hundreds of patients per year, and its investigators manage an international research registry of more than 1,000 people with AERD. Combined with its robust clinical trials program, these efforts make the Brigham’s AERD Center the largest clinical and research center for the disease worldwide.

“We have an incredibly collaborative relationship between bench scientists and those of us who see this disease in patients,” Laidlaw said. “We are all in constant communication. Every patient with an aspirin allergy seen by an ENT surgeon is likely referred to us. That proves education can solve the diagnosis gap. However, there is still an enormous need for broader awareness and research funding.”

Tasting Success

Upon returning home and beginning treatment at the Brigham, Doyle enrolled in a clinical trial at the AERD Center to initiate high-dose aspirin treatment, which involves administering increasing doses of aspirin to patients and closely monitoring them for the next several hours.

After starting this daily therapy and seeing only marginal improvement, Doyle underwent two surgeries to remove nasal polyps under the care of Alice Maxfield, MD, an ENT surgeon in the Department of Otolaryngology. A third procedure adjusted the blood flow in his nose to reduce inflammation. Within days of the last surgery, Doyle said he felt dramatically better.

Today, Doyle estimates he’s recovered about 90 percent of his senses of taste and smell, and his respiratory symptoms are largely under control. Although it was a long road, Doyle said he is deeply grateful for the expert, compassionate care he has received at the Brigham.

“I feel like my experience mirrors many others with AERD. It’s really frightening to develop symptoms that don’t make sense to you, so it was a huge relief just to know what was happening,” he said. “My hope is more clinical trials will shed light on not only the causes of this disease but also treatments for it.”

Shortly after recovering from his final surgery, Doyle and his family returned to Europe to vacation in Italy. It was on this trip that he realized his senses started to return. The first food he remembers tasting? Truffles.

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

State-of-the-Art 7T MRI Available for Clinical Use

The 7 Tesla MRI is lowered by crane into the Hale Building of Transformative Medicine in this 2017 photo.

A 7 Tesla (7T) magnetic resonance imaging (MRI) scanner, added to the Brigham’s suite of imaging technologies last year, received federal and state approvals for clinical use and become available for patient care as of Sept. 10. Availability of this new technology provides clinicians and patients with an advanced diagnostic imaging tool that is more than double the strength of a conventional high-field scanner.

Part of a new generation of ultra-high field instruments, the 7T MRI at BWH is the second in the country to be approved for clinical use and can now be fully integrated into the MRI program at the Brigham, focusing on world-class research and advanced patient care.

Weighing almost 25 tons, the 7T was lowered by crane into the Hale Building for Transformative Medicine (BTM) when it arrived at BWH in May 2017. The system’s superior field strength and advanced electronics provide a stronger signal used to generate higher-resolution images that offer advanced clinical insights into neurologic diseases, including multiple sclerosis and epilepsy, and musculoskeletal conditions that involve the cartilage, muscle and fascia of the knee joint. Initially used for research, the 7T has allowed BWH researchers to identify lesions in 38 percent of epilepsy patients that were not readily discernible on high-quality 3 Tesla MRI scans.

“Clinicians who see patients with neurological conditions for the brain – such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, brain tumors, epilepsy, cerebrovascular diseases and traumatic brain injury – will be able to capture details about these diseases and address clinical questions that current, lower-field magnets have not fully answered,” said Srinivasan Mukundan Jr., PhD, MD, medical director of Magnetic Resonance Imaging in the Department of Radiology.

Added James D. Kang, MD, chair of the Department of Orthopaedic Surgery: “The 7T will allow orthopaedic surgeons to get a noninvasive, detailed picture of various structures within the knee that are often the source of pain and disability.”

Patients of the main campus ambulatory neuroscience and musculoskeletal clinics will be referred by their physicians for a scan using the 7T when it is clear that the advanced images will provide a clinically meaningful benefit. The amount that patients and their insurers are billed for diagnostic MRI examinations is the same regardless of the field strength of the MRI instrument.

“Our clinical deployment of the new 7T MRI scanner will be a resource for clinicians and researchers across our system, and we look forward to collaborations with our colleagues at Massachusetts General Hospital,” said Giles Boland, MD, chair of Radiology. “Technical expertise developed over the past decade by MGH researchers working with the first 7T MRI system located at their Charlestown Naval Yard facility will help facilitate clinical translation at BWH. Likewise, clinical advances made at the Brigham will inform research efforts.”

‘An Amazing Gift’: Patient Receives Rare, Lifesaving Heart-Lung Transplant

Camille Frede (right), pictured with her mother, Nancy, is the first BWH patient to undergo a heart-lung transplant in more than 20 years.

When Camille Frede, 28, saw Antonio Coppolino III, MD, MSc, then a fellow in the Division of Thoracic Surgery, enter her patient room at the Shapiro Cardiovascular Center earlier this year, her heart skipped a beat as she recalled their last conversation several weeks prior.

“The next time I see you will be when we get ‘the call,’” Coppolino, now an associate surgeon in the division, had told Frede and her family at the time. “The call” would be the care team’s notification that a matched donor heart and lungs were available for transplantation. Frede received her transplant in March following two months of hospitalization at the Brigham. The 10-hour surgery was completed by a multidisciplinary team comprising nearly 60 staff members. 

The rare, complex surgery – which requires the donor heart and lungs to be transplanted simultaneously – was the first performed at the Brigham in more than two decades. 

For Frede, the transplant cured pulmonary hypertension, a life-threatening condition she had lived with since age 4. It causes high blood pressure in the arteries of the lungs and severe breathing problems. The condition worsens over time, progressively restricting the flow of oxygenated blood and potentially leading to heart failure. After trying numerous therapies over the years, Frede and her family grew worried as her health continued to decline.

“We would go on family bike rides, and I would be blue,” Frede said. “We were always waiting for another tragedy to happen.”

In February, she began receiving inpatient care at BWH. Within a month, she was treated with high-flow oxygen and extracorporeal membrane oxygenation (ECMO), a machine that pumps blood and oxygen for a patient when their own heart and lungs can no longer do so adequately. The therapy sustained Frede while she waited for suitable donor organs to become available. 

Patients whose pulmonary hypertension worsens to the point of requiring organ transplant normally undergo a lung transplant only, explained Hari Mallidi, MD, FRCSC, section chief of Transplant and Advanced Lung Diseases in the Division of Thoracic Surgery. 

But Frede also was born with an atrial septal defect, often referred to as “a hole in the heart,” which drove the need for both a donor heart and lungs, Mallidi said. 

“Even though her heart function was OK, we couldn’t technically make all the connections in the right places without changing everything,” he said. 

‘A Whole New Chapter’

Now six months post-transplant, Frede says every day she feels stronger and that a world of possibilities has opened up. She is hiking, biking, doing yoga and, for the first time in her life, running. 

“Every time I’m doing one of those things, I pray and think of my donor and their family. Without them, none of this would have been possible,” Frede said. “It’s been an amazing gift.” 

Aaron Waxman, MD, PhD, director of the Brigham’s Pulmonary Vascular Disease Program, who has treated Frede for the past 10 years, is thrilled to see her progress. 

“It’s a whole new chapter of her life,” Waxman said. “My expectation is she’s going to have a completely new, healthy life.”

Frede, who recently obtained her bachelor’s in nursing, is now evaluating advanced training programs to fulfill her dream of becoming a nurse practitioner to help others – a goal inspired by her mother, Nancy, who is also a nurse. In addition, Frede hopes to dedicate her time to raising awareness about pulmonary hypertension and the importance of organ donation.

While the past year was challenging for Frede and her family, they said the remarkable, compassionate care they received at BWH helped them weather the stress and uncertainty. In ways big and small, their Brigham care team lifted their spirits and provided a supportive environment for healing. 

Throughout her life, including during her hospitalization, Frede sought to remain as active as possible. While she was on ECMO, care team members helped her obtain a stationary bike for her hospital room and played YouTube videos of scenic routes while she pedaled. In the months following discharge, Frede completed several bike rides around New England with Waxman and her exercise physiologist, Julie Tracy, of the Division of Pulmonary and Critical Care Medicine. 

Nancy recalled the moment she and several Shapiro nurses shed tears of joy as they watched Frede listen to her own heartbeat with a stethoscope for the first time post-transplant. She said the experience marked the first of many wonderful moments to come.

Brigham Health’s Strategy in Action: Advanced, Expert Care
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NICU Milk Analyzer Study Aims to Personalize Pre-Term Infant Nutrition

From left: Mandy Brown Belfort and Valencia Koomson, with baby Justin

During a prenatal visit for their second child, Valencia and Jude Koomson were surprised to learn Valencia had pre-eclampsia, a form of high blood pressure that can occur during pregnancy. The diagnosis, just 28 weeks into her pregnancy, led to immediate hospitalization and, within days, the premature birth of their son.

That was the best option for the health of both Valencia and baby Justin, born 12 weeks before his due date and weighing just over 3 pounds. He would require intensive support to continue to grow and develop in the Brigham’s Neonatal Intensive Care Unit (NICU).

With breathing assistance for Justin’s developing lungs and a feeding tube to deliver human breast milk to his belly, he grew and thrived. He soon graduated from the Intensive Support area to the Growth and Development area, no longer needing oxygen support and becoming strong enough to feed on his own.

One novel technology available to him was a breast milk analyzer, a device that assesses nutritional composition of human breast milk. Justin was among the first babies enrolled in a new study at BWH to examine whether knowing the exact nutrition in individual feedings of human milk, and adding the right nutrients (also known as fortification), could aid the smallest babies.

“We know that more optimal nutrition is a predictor of better growth and neurodevelopment,” said Mandy Brown Belfort, MD, MPH, of the Department of Pediatric Newborn Medicine.

Special Nutritional Needs

Human breast milk is uniquely equipped to meet nutritional needs of full-term infants. But pre-term babies – especially those born before 35 to 36 weeks’ gestation – generally require that a fortifier containing calories, protein, calcium and micronutrients such as zinc and Vitamin A be added to a breast milk diet. This aims to replicate the nutrition the baby would receive from the mother’s placenta if still in the womb.

Typically, a premature infant’s growth is followed carefully, but the fortifier is only adjusted if the baby’s weight gain slows over several days. Belfort and her team are using the milk analyzer to avoid this lag, with the goal of delivering accurate, customized fortification with each feeding.

The milk analyzer was initially developed and used in the dairy industry. Recently adapted for human breast milk, it is approved for use in Europe and Canada. In the United States, it is currently available only for research purposes. BWH is one of a few NICUs engaged in that research.

Prior research by Belfort and others has shown surprising variations in the nutritional composition of a mother’s milk throughout a given day. Nutritional makeup also varies from one mother to the next, and it is not necessarily related to the mother’s diet. It’s also known that nutritional quality can degrade as expressed milk is handled and stored.

In Belfort’s current study, each feeding of milk is sampled and analyzed using the countertop device that sits in the NICU’s milk storage room. A tiny syringe, containing less than a teaspoon of milk, is inserted into the analyzer. A readout shows within seconds the milk’s nutritional elements. The results determine how much fortifier should be added on top of the standard fortifier to ensure that nutrient targets are met.

Study results won’t be known immediately as to whether this nutritional fine-tuning will improve growth and development in pre-term babies. The first patients began in the study in spring 2018. Belfort’s team is continuing to offer NICU families the opportunity to volunteer.

Valencia, a scientist herself, was glad to know that she was giving her baby every opportunity to grow, while contributing to newborn science.

“We are thrilled and blessed that he could participate to customize his feedings to his specific nutritional needs,” Valencia said. “Particularly for NICU mothers, there is so much anxiety and uncertainty about what your baby needs. It’s a great comfort to know he’s being fed well here. A baby needs to eat to grow.”

She also expressed her gratitude for the high-quality, compassionate care that she and her family received.

“All the people here are so consistently amazing,” Valencia said. “I want to say a big thank you to the staff at Brigham and Women’s Hospital and the NICU. At all levels of staff, there are such wonderful, caring and loving people here.”

Brigham Health’s Strategy in Action: Discovery and Innovation
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BWH Receives First NICU Installed MRI System in the U.S.

Work crews lower the NICU’s MRI into the Connors Center.

Arriving by crane through a roof hatch in the Mary Horrigan Connors Center for Women and Newborns on Sept. 8, a new MRI system specifically designed for safe imaging of newborns will provide high-quality scans directly in the Brigham’s Neonatal Intensive Care Unit (NICU). The system, approved by the U.S. Food and Drug Administration last year, is the first NICU-dedicated MRI in the country.

“The installation of the state-of-the-art, neonatal MRI system will greatly enhance the research capabilities of BWH and elevate and expand neurocritical care for our littlest patients,” said Terrie Inder, MBCHB, chair of the Department of Pediatric Newborn Medicine. “Locating this technology within the NICU will reduce time and patient risk associated with transporting newborns to a traditional MRI and allow MRI access from the first hours of life through the challenging, sometimes life-threatening, time within the NICU.”

Babies undergoing scans will be in a temperature-controlled, self-contained incubator bed that minimizes the patient’s movement while allowing for better control of the environment and continuous monitoring of vital signs. Information gained from the MRI can inform a care team and family as to whether brain injury has occurred and, in the future, guide which treatments may assist in preventing disability.

The self-shielded, permanently magnetic system has been specifically designed for the NICU, an area that would be typically size- and risk-prohibitive for an MRI. The system is also quieter than traditional whole-body scanners to ensure the safety and comfort of infants undergoing scans.

Manufactured by Aspect Imaging, the system, known as EMBRACE, initially will be used for research purposes.

“This new MRI system, designed with a single use – scanning of the newborn – will enhance the care we provide for our NICU patients. This empowering technology will complement our existing fleet of MRI scanners and improve efficiency by offering imaging to our tiniest patients within the controlled confines of the NICU,” said Srinivasan Mukundan Jr., PhD, MD, medical director of Magnetic Resonance Imaging in the Department of Radiology.

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

‘This Is What We Do’: Teamwork Shines amid Baby Boom

A few of the many BWHers who helped care for multiple complex patients during an unusually busy shift, from left: David Beadles, Andrea Oulton, Mandy Belfort, Nichole Young and Tammy Hyre

In her 22 years as a Brigham NICU nurse, Debby Schlehuber, RN, has seen her share of busy shifts. But few compare to the night she and her colleagues recently experienced when they helped deliver and care for extremely premature twins and triplets – in addition to arranging emergency transfers for two other patients – all in the span of just three hours overnight.

Despite the challenges of managing so many complex cases in rapid succession, BWHers involved said the remarkable outcome is all thanks to a large multidisciplinary team from the NICU and Labor & Delivery whose expert care, collaboration and communication ensured everything fell into place.

Staff across the Mary Horrigan Connors Center for Women and Newborns (CWN) said they were grateful to be part of such a collaborative interprofessional team, which included administrative staff, anesthesiologists, Environmental Services staff, midwives, nurses, physicians, respiratory therapists, trainees, unit coordinators and many more. In addition to staff from the overnight and day shifts, the team was supported by several BWHers who offered to assist before or after their shift.

“After that night, I was never prouder to be a Brigham nurse. Everybody came together, and we all knew we needed to work as a team,” said Schlehuber, who was the NICU nurse-in-charge that evening. “I didn’t for one second think, ‘How are we going to do this?’ We always find a way – because it’s all about our patients.”

Nichole Young, BSN, RNC-OB, the Labor & Delivery nurse-in-charge that night, added that while she too had never experienced such an exceptionally busy shift in her 15-plus years as a Brigham nurse, she was not surprised by the professionalism, dedication and skill demonstrated by all.

Like her colleague, Young emphasized that the extraordinary teamwork across many disciplines was pivotal to their success.

“It was a picture-perfect example of what we do when we’re at our best,” Young said. “It made me feel really proud and honored to work among such amazing colleagues.”

Mandy Brown Belfort, MD, MPH, of the Department of Pediatric Newborn Medicine and the attending neonatologist that night, remembered getting the call from Labor & Delivery that triplets were on the way moments after getting the critically ill newborn twins settled in the NICU.

“The whole team kicked into action,” Brown Belfort said. “Nobody got flustered. We are a very team-oriented specialty – this is what we do.”

Keith Hirst, MS, RRT-ACCS, RRT-NPS, AE-C, neonatal respiratory manager, agreed that the series of events highlighted remarkable collaboration among multiple disciplines, noting he was especially proud of the contributions made by respiratory therapists.

“It was an incredible night, and each of the respiratory therapists helped make it success,” Hirst said. “It was a team effort to make it as successful and as smooth as possible while continuing to deliver outstanding patient care.”

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‘Frailty Pathway’ Leads to Safer, Standardized Geriatric Trauma Care

From left: Ann Cook, a patient on the frailty pathway, speaks with Lynne O’Mara on Tower 8B.

Older patients face a unique set of health challenges – including chronic fatigue, low muscle mass, cognitive impairment, bone fractures and reduced mobility – that can raise their risk of illness or injury during hospitalization.

Launched in 2016, the BWH Frailty Identification and Care Pathway is a multidisciplinary program addressing these challenges by providing clinicians with standardized guidelines for identifying and accommodating frailty – a complex, often age-related syndrome characterized by physical decline and increased vulnerability to stressors.

“Frailty and cognitive impairment are often key contributing factors in falls and accidents that lead to fractures and other injuries among older patients presenting in our Emergency Department,” said Zara Cooper, MD, MSc, FACS, of the Division of Trauma, Burn and Surgical Critical Care. “We believe that focusing on these underlying conditions is essential to optimizing the care and outcomes of these patients.”

Physician assistant Lynne O’Mara, PA-C, of the Department of Surgery, was one of many BWHers who played a key role in implementing the pathway in the Emergency Department (ED) and the Surgical, Burn and Trauma Intermediate Care Unit on Tower 8ABCD. Part of a multidisciplinary team that sought to identify and remove barriers to care for older patients, O’Mara worked closely with Cooper and Samir Tulebaev, MD, of the Division of Aging and Center for Older Adult Health, to create order sets for the pathway.

The Frail Scale

At the heart of the initiative is an assessment tool known as the “frail scale,” which is used to screen for frailty in patients over the age of 65 when they arrive at the ED. In the frail scale, “frail” also functions as an acronym, with each letter representing the constellation of symptoms and conditions that may indicate frailty. Patients are considered frail if they meet three or more of these criteria:

  • Fatigue (“Are you fatigued?”)
  • Resistance (“Can you climb one flight of stairs?”)
  • Ambulation (“Can you walk one block?”)
  • Illnesses (“Do you have more than five illnesses?”)
  • Loss of weight (“Is your weight loss greater than five percent?”)

It’s important to recognize these risk factors early because frail patients are more likely to experience negative health outcomes, including increased rates of morbidity, obesity and trauma, O’Mara explained.

In addition to the normal effects of aging, a patient’s circumstances at home may contribute to or worsen their frailty, O’Mara said. For example, a patient might have poor muscle mass because they’re not eating, and they might not be eating because they’re on a fixed income and don’t have the financial means to purchase food. While such challenges are not unique to frail patients, understanding this context is key to helping these patients recover smoothly, avoid injury, discharge safely and reduce readmissions, O’Mara said.

During hospitalization, frail patients are also at greater risk of experiencing delirium, an acute state of confusion that is separate from dementia. Patients who experience delirium may try to pull out their IV lines or attempt to get out of bed when they cannot safely do so, leading to a secondary injury, O’Mara said.

The frailty pathway includes standardized ways to prevent, assess for and treat delirium. Since implementing these measures, the rate of delirium has decreased by a remarkable 50 percent among patients over 65 on Tower 8ABCD. The mortality rate for the same population has dropped by 30 percent, and complications have decreased by 47 percent.

“Our main goals when we first started the pathway were to prevent delirium and preserve function for these patients, which we have since been able to achieve,” O’Mara said.

Standardizing Care

Once a patient is screened and meets the criteria for frailty in the ED, providers enter a set of admission orders to standardize the care for each patient on the pathway. Within 72 hours, the patient receives a comprehensive geriatric assessment, which includes an evaluation of medical conditions, cognition, function, nutrition, emotional status and risk for delirium, with a geriatrician, and a nutritional assessment with a nutrition consultant. This information is detailed in the patient’s electronic medical record to ensure a safe transition of care.

On Tower 8ABCD, care teams work closely with patients on the pathway to ensure they eat, get out of bed, have bowel movements and perform other self-care tasks on a routine basis.
O’Mara said collaborating with her colleagues to develop and implement the pathway – and ultimately achieve better outcomes for patients and their families – has been extraordinarily fulfilling.

“I really enjoy the personal interaction with the patients,” she said. “I like having that one-on-one time to talk with them on the floor, meet their families, discuss their diagnoses and create a personal care plan. You really become part of the patient’s family for a couple of days.”

Reiterating the importance of the frailty pathway’s multidisciplinary model, O’Mara has engaged both staff and trainees in the program. To date, she has trained 70 residents on the pathway, and she continues to offer ongoing training for new residents and providers.

“The pathway has brought the entire trauma floor together and has gotten me really excited about geriatrics,” O’Mara said.

Brigham Health’s Strategy in Action: Highest-Quality, Safe Care
Learn more about our strategic priorities at BWHPikeNotes.org.

Patient Runs from Brockton to BWH to Commemorate Lifesaving Surgery

Patient Runs from Brockton

Brian and Laura Clay are interviewed by the media after Brian’s 18.5-mile run.

Brian Clay is no stranger to lacing up his running shoes.

What made his June 14 run unique, however, was that it marked the anniversary of a lifesaving open heart surgery he underwent at the Brigham last year.

“I always knew I wanted to start running again – it was never a question,” said Clay, who had been diagnosed with acute aortic dissection, a serious condition where the inner layer of the large blood vessel branching off the heart (the aorta) tears.

Initially believing his symptoms of chest discomfort and blurry vision could be caused by a panic attack, the New Bedford resident went to Good Samaritan Medical Center’s emergency department in Brockton at his family’s urging. His diagnosis, which is most common in men in their 60s and 70s, came as a shock to the 42-year-old long-distance runner.

Within minutes of his diagnosis, Clay was on a MedFlight helicopter to BWH.

“Aortic dissection is a pathology where minutes count,” explained Steve Singh, MD, of the Division of Cardiac Surgery, who was part of the multidisciplinary team that performed Clay’s procedure. “The expeditious work of several teams made all the difference.”

The surgery was a success, and Clay was eager to get back on the road.

With his doctors’ support, he began a cardiac rehabilitation outpatient program closer to home. Each week, Clay began to walk on the treadmill and use the elliptical, slowly increasing his heart rate, as his care team monitored his vital signs. He remembers the first day he could run at all – a 12-minute-mile pace for five minutes on the treadmill. Once he passed that milestone, he began thinking big.

“I had this plan in my head for a while that I would commemorate the one-year anniversary of my surgery,” Clay said. “Since the date fell on a Thursday and it’s tough to find a marathon on that day of the week, I decided to do something on my own.”

His motivation paid off. After months of running with a heartrate monitor at the gym, completing the New Bedford Half Marathon with his wife, Laura, Clay set out to run the 18.5-mile MedFlight route from Good Sam to the Brigham with his sister and close friend keeping pace.

And when the trio rounded the corner onto Francis Street, Clay was overwhelmed by what he saw.

“My wife, three children and extended family and two of my doctors were there, along with a crowd of reporters from every local TV station,” Clay said, adding that the day couldn’t have been possible without the help of BWH’s Development, Media Relations and Facilities teams. “This experience was way more than anything I could have ever imagined.”

Clay also used his training period to raise $9,000 for Wings for Falmouth Families, a volunteer-based charity that provides financial support to families experiencing medical crises. In the future, Clay plans to raise money for BWH in honor of his care team.

“For him to return to his passion of running and raise money for other patients was tremendous to see,” Singh said. “It’s rewarding to participate in a program so committed to restoring healthy lives to patients like Mr. Clay.”

Brigham Surgeons Arrange Skydiving Experience for Patient

Skydiving Experience for Patient

From top: Michael Elliott of All Veteran Group skydives in tandem with Matthew Pierce at Fort Bragg. Photo courtesy of All Veteran Group.

When Matthew Pierce learned he had an aggressive form of cancer at age 19, he was crushed knowing that the diagnosis meant his lifelong dream of pursuing a career with the U.S. Marine Corps was over. A patient at BWH, he shared this with members of his care team, who became inspired to help Pierce heal in more ways than one.

On June 6, the now 22-year-old had his wish come true for a day by skydiving in tandem with the All Veteran Group, which consists of active and retired members of the U.S. Army’s Parachute Team, also known as the Golden Knights, based at Fort Bragg in North Carolina. Giving new meaning to the phrase “going the extra mile,” neurosurgeon Ian Dunn, MD, of the Department of Neurosurgery, joined Pierce and Pierce’s girlfriend, Emily Johnston, on the parachute jump out of an airplane at 15,000 feet. Another member of Pierce’s care team, Edward J. (E.J.) Caterson, MD, PhD, of the Division of Plastic Surgery, who helped organize the jump, was also there to cheer for them on the ground.

Dunn, who had never gone skydiving prior to this, said participating in the parachute jump with one of his patients was unforgettable and meant a lot to him personally and as a care provider.

“As surgeons, we want to restore patients’ lives and see them thrive post-surgery,” Dunn said. “It has been phenomenal getting to know Matt. He’s a very special young man, and I am honored that I could be there with him for this once-in-a-lifetime experience.”

Several years ago, Caterson contacted the Golden Knights and arranged a jump with them and one of the Brigham’s face transplant patients. To this day, Caterson remembers the awe-inspiring experience and said he felt privileged to help facilitate it for another patient.

Ian Dunn

Ian Dunn suits up for skydiving. Photo courtesy of All Veteran Group.

“Matt is an incredible human being who hasn’t let his obstacles define him,” Caterson said. “Instead, he has overcome adversity in his life with such grace. It was our pleasure to find a way to honor Matt for his bravery and courage. At the Brigham, many of us are quite fortunate to play roles in many multidisciplinary teams of diverse expertise – all working together for the betterment of our patients.”

In 2015, Pierce was diagnosed with Ewing’s sarcoma, a rare form of cancer affecting mostly children and teenagers that forms in the bones or in the tissue around bones. It is often treated with a combination of chemotherapy, radiation and surgery. Pierce’s grapefruit-sized tumor was situated at the base of his skull, a location Caterson noted is extremely rare, and needed to be removed.

Pierce was cared for by a multidisciplinary team at the Brigham and Dana-Farber Cancer Institute. He underwent 14 rounds of chemotherapy, 28 radiation treatments and surgery in 2016 to remove part of his skull and reconstruct the area where the tumor was growing. The 10-hour surgery involved three surgical disciplines working together: Neurosurgery, Plastic Surgery and Surgical Oncology.

Pierce has been in remission for almost two years. He’s currently a student at Norwich University in Vermont and hopes to one day become a federal law enforcement officer. Pierce thanked his care team at the Brigham – including Dunn, Caterson and Chandrajit Raut, MD, MSc, of the Division of Surgical Oncology – for believing in him and giving him a second chance at life.

“Without them, I would not be here today,” Pierce said.

Raut said he is moved by Pierce’s resilience: “Seeing Matt move forward with his life and live his dream motivates us as health care providers to do what we do each day.”

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