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Nawal Nour, MD, MPH, Reflects on Learning to Embrace Uncertainty and Explore Uncharted Waters

“Just as the river flows forward, you can’t go back,” says Nawal Nour, on living without regrets and accepting the winding journey her career has taken.

Nawal Nour, MD, MPH, sees her life reflected in rivers. Even through unexpected twists and turns, currents perpetually push the water forward. Her career has adopted a similar momentum — pressing ahead, branching out and flowing into new territories with continued purpose.

Nour, chair of the Brigham’s Department of Obstetrics and Gynecology, knows something about rivers.

As a young girl growing up in Sudan, she regularly played along the banks of the Nile River with her three siblings. The southern region of the Nile consists of two branches that meet in Khartoum, the capital of Sudan and Nour’s hometown. And it was in Khartoum where Nour would discover the first branch of her professional interests after reading The Hidden Face of Eve by Nawal El Saadawi, an Egyptian psychiatrist and feminist who wrote about and fiercely challenged the practice of female genital cutting.

“She became one of my role models,” said Nour, who has made it her life’s work to end female genital cutting and to care for women who have experienced it. “I loved her advocacy. I loved that she was outspoken. I loved how she was in the midst of a country where women were not supposed to speak up, and certainly not supposed to speak up about external genitalia — such a taboo subject — and that she had the guts and grit to do so.”

Nour reflected on the immense influence El Saadawi’s 1977 text had on her, among other experiences that shaped her career in women’s health and academic medicine, in the opening of her keynote address, “From the Nile to the Charles River,” during the 2022 Women in Medicine and Science Symposium.

The annual event, now in its 11th year, highlights the achievements of women faculty and trainees at Brigham and Women’s Hospital and Massachusetts General Hospital (MGH). This year, the event was a collaborative effort co-hosted by the Offices for Women’s Careers at the Brigham and MGH.

Throughout her remarks, Nour returned regularly to the metaphor of rivers as she traced the winding path of her career and what she has learned along the way — including the value of taking risks and embracing uncertainty.

“It’s about the journey. Just as the river flows forward, you can’t go back,” she said. “It’s not helpful to be regretful, but it is helpful to learn from your lessons.”

‘So Much More to Learn and Do’

As an undergraduate at Brown University, Nour discovered another passion: public health. She pursued an opportunity to work in a refugee camp, found a mentor in women’s rights, abandoned her pre-med track for a degree in development studies and international relations, and ultimately landed a job with the United Nations’ Division for Women in Development.

While the work was fulfilling, she eventually longed to go back to medicine. She was accepted into Harvard Medical School and made her home near a new river, the Charles.

“Be comfortable with uncertainty. It truly cultivates creativity,” she said. “Some people might say, ‘Oh, gosh, if you’d only stuck with being pre-med, you could have been in med school two years earlier.’ No. Those were really valuable times for me because they made me think, what’s next?”

Like the Nile, Nour said, the two branches in her life would converge in the work she did at the Brigham. In 1999, she founded the African Women’s Health Center, whose mission is to improve the health of refugee and immigrant women who have undergone female genital cutting. It provides access, understanding and community to women who have long-term complications from this tradition and who seek reproductive health care.

That same year, Nour also became the Brigham’s director of Ambulatory Obstetrics and Gynecology, a role she held for nearly two decades until she was named chief diversity and inclusion officer for Faculty, Trainees and Students in 2018.

Nour acknowledged she was initially reluctant to accept the role of chief diversity and inclusion officer, fearing it would take her away from her love of patient care. But she decided to follow her own advice and find an opportunity for growth amid uncharted waters.

“I honestly, transparently and genuinely had a lot to learn. I had spent my world in public health, global health and teaching residents how to do cervical exams, deliver a baby and perform C-sections and hysterectomies,” she said. “Diversity, equity and inclusion were not part of my education. It wasn’t my background, but I learned a lot.”

Her appointment as chair of Obstetrics and Gynecology in October 2020 — becoming the first Black department chair and the first woman to lead OB-GYN at the Brigham — marked another significant change.

“Some rivers have waterfalls. Some are very rapid, slow down in certain areas and then meander. But as you get closer and closer to the bigger body of water, whether it’s the Mediterranean Sea or the Boston Harbor, the water slows down and spreads out,” Nour said. “As our careers progress, our expertise expands. I feel that I’m in that expansive portion of my career, where it can be slower but there’s so much more to learn and do.”

In addition to pursuing passions and taking risks, Nour emphasized the importance for women in medicine and science to remain authentic and curious while forging relationships with mentors, sponsors and peers.

Turning back to the Nile, Nour also said the region holds another lesson — a contemporary one from the nearby Suez Canal. She recalled the 2021 incident involving the large container ship Ever Given, which ground international commerce to a halt when it became stuck in the Egyptian waterway.

After humans failed to extricate ship, nature prevailed. A full moon eventually raised the tides, dislodging Ever Given and enabling it to continue its journey.

“There are times in your career where high winds are going to shift you, and you’re going to get stuck. I’ve had that happen to me so many times, and I felt like I was not moving anywhere. I had to ask, what’s next for me? Is this what I really want to do? What else should I learn?” she said. “Just know for sure that you are going to be unstuck. If you can sit through that uncomfortable situation, know that the moon is going to rise, and the sun will come out again.”

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Diagnosed with Alzheimer’s Disease at 58, Patient and Family Learn to Navigate a New World

“It was very clear something was going on,” says Peg Movelle (right), describing the events that led to her wife, Sue Morong (left), being diagnosed with early-onset Alzheimer’s disease.

After building a long and successful career in finance, Sue Morong never expected that numbers would one day become a source of confusion. But shortly after starting a new job a few years ago, she made a serious error at work.

“Sue dealt with spreadsheets all day, every day. She was a whiz at numbers. All of a sudden, they were almost foreign to her,” recalled Peg Movelle, Morong’s wife of 25 years. “It was very clear something was going on.”

In 2018, at age 58, Morong was diagnosed with early-onset Alzheimer’s disease, a rare form of the disorder affecting people under age 65.

While her episodes at work ultimately became a wakeup call for the Jamaica Plain couple, they later realized it was only one of many worrying signs that Morong’s memory and cognitive skills had begun to deteriorate. Activities requiring coordination and concentration, such as driving and cooking, had become difficult and even dangerous for her.

“You don’t really think of people in their 50s and early 60s as having significant memory issues,” Movelle said. “But there were all of these minor things that added up to major things over time.”

Advancing the Science

After visiting her primary care physician and a general neurologist, Morong was referred to the Brigham’s Seth Gale, MD, a cognitive-behavioral neurologist who specializes in caring for patients with Alzheimer’s and an investigator with the Center for Alzheimer Research and Treatment (CART), which conducts research related to the disease.

Through CART, many clinical trials enroll patients with mild impairment who have underlying Alzheimer’s disease but haven’t yet developed loss of independence in daily functioning abilities.

“Sue is someone with early Alzheimer’s who was quite high-functioning in day-to-day life,” said Gale, co-director of the Brain Health Program in the Division of Cognitive and Behavioral Neurology. “So, I knew she was a good candidate.”

Although there are FDA-approved treatments for Alzheimer’s disease, these only have the potential to lessen some symptoms to a modest degree. No drug has been proven to stop or reverse the disease’s progression, and the newest drug for Alzheimer’s that was approved in the U.S. in 2021 showed mixed results in its effectiveness. Thus, the decision to participate in clinical trials can be a delicate one for many families, adding to the uncertainties and emotional ups and downs that already accompany living with Alzheimer’s.

Even so, the choice to participate in clinical trials was a welcome one for the couple.

“We were thinking not so much that there would be some miraculous breakthrough, but that we might as well give back and help others through research, since there really wasn’t anything else we could do,” Movelle explained.

In addition to providing opportunities for patients and families to participate in cutting-edge trials, the CART team also engages with Alzheimer’s and dementia investigators around the world to share their findings — hoping to one day discover effective therapies for all patients.

“We try to do no harm, but can we actually help? That’s the big question,” Gale said. “The treatment of progressive brain diseases is an enormous, remaining challenge in medicine. There have been hundreds of medications over several decades studied for the treatment of just Alzheimer disease; six of these have been approved in the U.S., five remain on the market, and none of them definitively slow the disease in any way. While knowledge about Alzheimer’s and related dementias has exploded in recent years, there is still so much work to be done.”

Adapting to Change

Morong was eligible to participate in two trials. The first study tested a medication that hoped to disrupt the signaling pathways that cause the development of amyloid plaques — clumps of protein that form in the brain of someone with Alzheimer’s. She felt there was no benefit from the experimental drug.

She later enrolled in another trial of a monoclonal antibody treatment for early Alzheimer’s, but was unable to complete the study when an unrelated medical issue affected her ability to come in regularly for the IV infusions.

Outcomes like these are not uncommon, Gale explained, but he emphasized that they also aren’t the end.

“Patients and families are often told, ‘There’s nothing we can do,’ but that’s not correct,” Gale said. “I tell newly diagnosed patients that, of course, nothing can sugarcoat the news they’re hearing today, but there are positive and effective things that they and we can do, starting today. There is a lot of evidence that brain-healthy behaviors — like exercise, healthy eating and mental stimulation — can change the trajectory of decline to some extent, perhaps especially for individuals like Sue who have the early stages of mild cognitive impairment.”

Movelle has encouraged Morong to pursue these activities and believes they have helped slow her decline. However, as the years have passed, certain parts of everyday life have inevitably changed for them both.

Morong, who had done most of the cooking throughout their time together, has mostly hung up her apron and now leans on her wife as head chef for their household. Although once an avid bookworm who could devour a novel in an afternoon, she has shifted her daily reading to reciting the headlines for Movelle. And instead of driving or giving directions, Morong now relaxes in the passenger seat while her wife drives and Google Maps leads the way.

As a caregiver, Movelle regularly reminds herself to prioritize her own well-being, too, and to take it one day at a time. For those also caring for a loved one with Alzheimer’s, she shared three pieces of advice: “Enjoy the humor in it, allow your tears and cherish every moment.”

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Q&A with Daniel Kuritzkes, MD: What You Need to Know About the Newest COVID-19 Booster and Flu Shots

A new COVID-19 booster shot targeting the highly transmissible omicron strain of COVID-19 is now available for people aged 12 and older, following a recent authorization from the U.S. Food and Drug Administration.

Daniel Kuritzkes, MD, chief of the Division of Infectious Diseases, spoke with Brigham Bulletin to address common questions about the new booster and flu shots.

Let’s start with the basics. What is different about this updated booster?

Daniel Kuritzkes

DK: The new COVID boosters are what we call a bivalent booster. Instead of having just one of the COVID variants represented in the vaccine, it includes two variants. So, in addition to having the original strain — often referred to as the Wuhan strain — the booster also includes the BA.5 subvariant of omicron. That’s important because it’s the strain causing the most infections today.

The concept of having multiple strains, or variants, represented in an individual vaccine is not new. The flu vaccine is a great example of this. For years, we used to get a trivalent, inactivated flu vaccine. Now, it’s standard to use a quadrivalent vaccine, which means there are four different strains of flu represented in the vaccine. Similarly, the polio vaccine had been a trivalent vaccine and is now a multivalent vaccine.

What do we know about how effective this booster is against the newer strains of COVID-19?

DK: We know these vaccines are safe and will generate the desired antibody response, which is what we believe is protective. The bivalent vaccine induces better antibody levels against omicron, including BA.5, than the original vaccines — all of which are based on the ancestral strain, which is quite distantly related to omicron. While we don’t have clinical trials data demonstrating just how effective the vaccine is against preventing infection, that is not unusual. We typically rely on so-called surrogate markers, or laboratory markers, of protection to move forward from one type of vaccine to another. Similarly, the flu vaccine is updated annually, and, clearly, we’re not doing clinical trials every year to demonstrate the efficacy of each season’s flu vaccine.

If you recently had COVID, would you still benefit from a booster? If so, when should you get it?

DK: Yes. We know that people who received the original vaccine series, had COVID and then got a booster had very strong protection. Even though the original vaccine — which remains the vaccine approved for primary vaccination — is not as protective against infection or symptoms of the current strains in circulation, it is still extraordinarily protective against severe disease, hospitalization or potentially dying of COVID.

The hope with the bivalent booster is that we gain a bit of an edge and perhaps return to better prevention of symptomatic infection, although that remains unproven. We’ll know in a few months just how successful it is.

In terms of timing, it’s recommended that people wait to get boosted until about three months after recovering from an episode of COVID, and at least two months since receiving their last booster or completing their primary vaccination series.

Does your booster need to be from the same manufacturer as your original vaccine?

DK: No, it doesn’t matter which one you had originally. You can get boosted with the Moderna or the Pfizer vaccine — which are the only ones authorized as boosters — regardless of which vaccine you had initially. My advice would be to find the place most convenient for you to get boosted and whichever booster they’re offering, that’s the one I would take.

With flu season soon upon us, can you get your flu shot and COVID booster together? Are there any concerns with, or benefits to, getting both at the same time?

DK: There are no concerns, other than potentially having a sore arm from each vaccine. I think it’s probably far more convenient for most people to go once to get both vaccinations.

It’s extraordinarily important for people to get their flu vaccine this season. It’s been a couple of years since we’ve seen much flu activity, but we already have clues from Australia about what to expect this flu season because they’re currently coming out of their winter. Now that very few places require masking or emphasize social distancing, they saw a lot more flu activity this season than in recent years.

It’s expected that we, too, will see a significant flu season here in the Northern hemisphere. And because people haven’t seen flu in a few years, immunity may have waned if they weren’t regularly vaccinated, so it’s important for people to do that this season. If you have symptoms, you should also get tested for both, since you can’t really tell flu apart from COVID based on symptoms alone. And if you do have symptoms of either respiratory illness, stay home until you’re symptom-free, so you don’t spread it to your co-workers, friends and other people in public spaces.

Flu Vaccination Program: 3 Things to Know

All Mass General Brigham workforce members — including faculty, staff, trainees, volunteers, students and contractors — must receive their seasonal flu shot and document it with Occupational Health Services (OHS), unless approved for a medical or religious exemption.

Here are three things to know about this year’s program:

  • The deadline for submission of religious and medical exemption requests is Oct. 7. Flu shots must be received and documented by Nov. 14.
  • If you receive a flu shot from OHS or a Peer-to-Peer vaccinator, no further action is required. If you get a flu shot from another source, you must take additional steps to document it. Learn more.
  • OHS will host flu shot clinics at the Brigham starting Sept. 25. View the complete schedule.
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Driving Change: Car Magnets Prove to Be Simple Solution to Discharge Delays

From left: Surgery interns John Gaspich and Christian Cullen demonstrate a simple system used on Braunwald Tower 15 to indicate a patient is ready for discharge and should call their ride.

When Caprie Bell, MSN, RN, a charge nurse on Braunwald Tower 15, enters a patient room during her morning rounds, she does two things: First, she greets her patient with a warm and friendly smile. Next, she glances at a whiteboard on the wall to see if there’s a small magnet in the upper corner.

That magnet, which depicts either a green or yellow car, is used on the unit to indicate the patient’s readiness for discharge after recovering from surgery. If there’s a green car, that means the team of surgeons and physician assistants (PAs) who rounded earlier that morning determined the patient can be discharged as soon as their ride arrives. If there’s a yellow car magnet on the whiteboard, it means the team believes the patient is almost ready to go home but first needs to meet certain clinical benchmarks.

“When I see the green car on the board, I know that a conversation has taken place,” Bell said. “I can say to the patient, ‘Good morning. It looks like you’re going home today. Have you called your ride?’”

The intentionally low-tech system has bridged a communication gap that existed between clinical teams in Surgical Intermediate Care ― enabling clinically ready patients to avoid unnecessary delays at discharge while improving teamwork across the unit.

The multidisciplinary project began in response to capacity challenges in the flow of patients from the Operating Rooms (ORs) to the Post-Anesthesia Care Unit (PACU) to the surgical floors. An analysis in May 2019 found that 12 percent of surgical patients on Tower 15 were discharged by noon, even though a greater proportion of them were ready to safely discharge by that time.

“We sometimes know at 6 a.m. which patients are ready to go, yet it was taking six to eight hours for them to leave the hospital,” said Jennifer Beatty, MS, PT, PA-C, director of Clinical Operations and Surgical Physician Assistants. “That’s not a positive experience for anyone. It means that staff on the floor are slammed with both discharges and admissions in the afternoon, patients in the PACU are waiting for a bed, and the patients who are going home will be sitting in city traffic when they could have left much earlier. We knew there had to be a better system.”

As it turned out, there was.We pursue excellence logo

Since the car magnets were introduced in conjunction with a daily morning huddle between Beatty and Tower 15 charge nurses and nursing leaders, the percentage of patients on the unit who are discharged in the morning has more than doubled. As of June 2022, 30 percent of surgical patients on Tower 15 are discharged by noon.

“This project has been an amazing collaboration with shared ownership to improve the discharge process for our patients,” said Karen Reilly, DNP, RN, MBA, NEA-BC, associate chief nursing officer for Critical Care, Cardiovascular and Surgical Services. “The 15th floor has been able to develop a process that allows for timely discharge that not only impacts the patient going home but also improves patient throughput within the hospital.”

Malcolm Robinson, MD, vice chair of Clinical Operations in the Department of Surgery, agreed.

“We often focus on the high-tech ― and high-cost ― solutions when there are times that a low-tech, low-cost solution is actually the most effective,” Robinson said. “The car magnet project is an example of this, and the results speak for themselves.”

Resolving the ‘Information Lag’

So, what had been causing the discharge delay? In early 2019, clinical leaders enlisted the help of Process Improvement experts from Analytics, Planning, Strategy and Improvement (APSI) to find out.

After conducting observations on the unit and staff interviews, the Process Improvement team concluded that nurses weren’t receiving a reliable signal that the patient was ready for discharge in the morning.

Due to the unique needs of the OR schedules, surgeons and surgical PAs complete their rounds earlier than many other units ― usually between 6 a.m. and 7 a.m. ― and before their nurse colleagues’ shift change. In addition, like many rounding clinicians, surgeons and PAs typically entered all their orders later in the day.

That misalignment meant nurses often had to navigate conflicting information about a patient’s discharge readiness based on secondhand information from the patient versus what their electronic medical record indicated.

“There was an information lag of three to four hours,” explained Mark Galluzzo, MHA, lead process improvement consultant for APSI. “The rounding clinician knew that patient A had met all clinical milestones and would plan to put in a discharge order, but that information was just in their brain. Then the patient might tell their nurse, ‘The doctor said I’m going home,’ but when the nurse went into Epic, they didn’t see any record of that. Until the unit staff felt confident discharge was going to happen, they weren’t going to start to move on it.”

While the underlying challenges were complex, those involved in the project said it soon became clear that the solution was simple: “All we needed to do was tell each other what was happening,” said Jan McGrath, MHA, BSN, NE-BC, nursing director for Tower 15.

Beatty agreed: “By 7:30 a.m., we know a lot about what our patient movement will be for the day, but we recognized that didn’t play into how we prioritized our activities and communicated with nurses.”

Creating a Culture Shift

The APSI team came together with four PAs and four staff nurses on the unit to brainstorm ideas to bridge the gap. However, conventional approaches, such as adjusting schedules or having clinicians pause between rounds to enter orders, were not conducive to the way each role group worked.

The teams started thinking more creatively and realized they needed a visual cue ― what became the car magnet ― that nurses on the morning shift could trust to indicate discharge readiness. Additionally, rounding clinicians committed to making it a priority to submit any orders for “green car” and “yellow car” patients right after completing rounds. And finally, the teams implemented a multidisciplinary huddle at 8:45 a.m. to ensure everyone had the same information and to address any unresolved issues in real time.

“The car magnets are low-tech, but I think that’s part of the reason why they work. It’s so simple ― you can’t mess it up,” said Joanna Cassidy, MSN, RN, CNL, assistant nurse director on Tower 15, who was part of the initial workgroup. “The daily huddle we have with Jen has also been a huge help because she’s able to answer a lot of our questions and follow up as needed. It has really improved communication across the unit.”

While the project has been a work in progress, its benefits continue to unfold.

“The metrics are impressive, but I think the bigger part of it has been the culture change on the floor,” Beatty said. “The mindset has changed.”

Kendra King, PA-C, a PA in General Surgery, said that using the magnets is now “second nature” for her and her colleagues during morning rounds.

“You know when you’re in the room that you have to move the car,” King said. “It took a lot of training to get that muscle memory down, but it’s truly saved two to four hours every day in eliminating all the back and forth we used to do. In the end, it’s better for everyone.”

For Bell, the car magnets have also improved her workflow as a charge nurse.

“I have a better understanding of those who are ready to go in the morning, and that knowledge trickles down to the rest of the team. For instance, I can inform the nursing assistants sooner that this patient is going to be discharged in the morning, so they know it’s a good time to help the patient gather their belongings or shower so that they’re ready when their ride arrives,” she said. “It’s all about how we can better care for the patients because they’re the No. 1 reason we’re here.”

After the Loss of His Hand, First Patient to Undergo Novel Amputation in Acute Setting Ready to Make Waves Again

Shaun Melendy with his mother, Joyce, during a recent follow-up visit at the Brigham.

When Shaun Melendy, 42, was kayaking down the river behind his West Bridgewater home one winter morning and realized a section of it had frozen over, there was, in his view, an obvious solution to this problem. It did not involve getting out of the water.

Instead, Melendy, a U.S. Coast Guard veteran and diehard outdoorsman, plunged a hunting knife into the ice and used it to pull himself along. As he inched his kayak down the river, he enjoyed the fruits of his labor: a peaceful paddle through a snow-covered forest.

On the surface, the story is a simple anecdote that amuses his loved ones. But it also speaks to something deeper — an adventuresome spirit and relentless optimism in the face of adversity.

Those qualities continue to guide Melendy through what has become the most difficult chapter of his life, which unfolded when he was struck on his motorcycle by a distracted driver who had drifted into oncoming traffic on May 5.

The crash left him with devastating injuries, including the traumatic amputation of his left hand at the scene.

First responders rushed Melendy to the Brigham, where he underwent emergency surgery for severe injuries he sustained throughout the rest of his body. In addition to suffering fractures to his skull, spine, hips, legs, ankles and feet, he needed an 8-inch skin graft to cover a wound on his left leg.

After waking from a medically induced coma, Melendy says one of his first memories was seeing a friendly face at the foot of his bed.

“He had his mask on, but he had a bright smile in his eyes,” Melendy remembered.

It was Matthew Carty, MD, of the Division of Plastic and Reconstructive Surgery, who had stopped by to speak with him about the opportunity to undergo an experimental surgery — part of a clinical trial in collaboration with MIT — that could make it easier for him to use a prosthetic limb. If successful, the procedure would preserve the normal signaling between his brain and muscles, a connection that ordinarily gets severed in an amputation.

“He said, ‘Shaun, I think you’re going to be a good candidate for this surgery. You seem like the type of guy who was active before, and I think I can help you stay active in the future. I don’t think any of the things you’ve done the past are going to end,’” Melendy recalled.

That was all he needed to hear.We pursue excellence logo

“I said, ‘Yes, absolutely,’” Melendy said. “I’m not one to sit still. I love being outdoors. I surf, swim and race kayaks. I cut firewood. I climb trees. I do sprint triathlons. Knowing I do all these things, I thought I would be more upset. But I just knew that I was going to be able to truck forward and figure out what the next step is. I can’t wait to use a prosthetic.”

Another key motivator for him was the ability to help other amputees, particularly fellow veterans, by participating in this clinical trial.

“I want to help people move forward from what they lost,” he said. “Veterans who come home from war should not have prosthetics that don’t work for them.”

‘Mind-Blowing’ Results

That bedside conversation would lead Melendy to become a pioneer — making him the first patient in the world to have lost an upper limb in a traumatic injury and undergo this novel procedure, known as an agonist-antagonist myoneural interface (AMI) amputation.

Traditional amputations, which have seen little innovation since the Civil War, cause amputees to lose the ability to finely control the muscles in their residual limb and, more importantly, the ability to perceive where it is in space without looking at it. This often leads to difficulties when using a prosthesis.

From left: Spine fellow James St. Clair listens as Melendy describes his experiences since his last spinal surgery.

In 2016, a clinical team at the Brigham led by Carty, in collaboration with Hugh Herr, PhD, of the Center for Extreme Bionics in the MIT Media Lab, invented a new method of amputation for lower limbs. It was called the Ewing amputation in honor of its first patient, Jim Ewing. The AMI procedure maintains natural linkages between muscles in an amputated limb, so amputees using a prosthesis feel as if they are controlling a physiological limb.

Importantly, this method can send movement commands from the central nervous system to a robotic prosthesis, so when an amputee intends to flex their ankle, for instance, the robotic limb responds appropriately. It also relays feedback describing movement of the joint back to the central nervous system, allowing an amputee to sense the speed, location and other attributes of the artificial limb.

In 2018, the team adapted the procedure for upper-limb amputations. Since then, four patients at the Brigham had undergone AMI amputations at the arm or wrist, but all were under elective conditions — typically after enduring chronic pain for years due to an old injury. Melendy became the first to have the experimental surgery following a traumatic amputation.

“We’ve always thought these techniques could be applied in the acute setting — something we believe will be especially useful for military personnel with combat injuries,” Carty said. “But in terms of testing that hypothesis, there are clear difficulties: Such events are rare, and obviously we cannot anticipate when the opportunity will arise. Shaun turned out to be a great candidate for surgery and continues to do very well, proving our assumption that upper-extremity AMI amputation can be done safely in the context of acute trauma.”

After receiving a temporary closure at the wound site and recovering from his other surgeries, Melendy prepared to undergo the five-hour AMI procedure.

“The fact that we were working from a traumatic injury made it a little bit harder because we had to use our knowledge of anatomy to reconnect the muscles in the correct manner. You can do that with relative reliability, but it’s much easier when the limb is still in place,” Carty explained. “It made it a little more difficult, but by no means impossible.”

During a post-operative visit six weeks after the surgery, Melendy said it was “mind-blowing” to see even the early results.

“Dr. Carty was checking my residual limb by putting his hands at the end and asked me to move my thumb,” he said. “You could see the muscle constructs moving under the skin, as the surgery was designed to do. Then he asked me to move all my fingers, and all my ‘fingers’ were moving. It’s amazing how those muscles and nerves can still talk to each other.”

Finding Strength

After his discharge from the Brigham, Melendy continued his recovery at Spaulding Rehabilitation Hospital for his other injuries, which amounted to about 20 broken bones and required 10 surgeries over three weeks. Throughout his time at both institutions, Melendy said the care he’s received has been exceptional.

Melendy receives a warm welcome home in July from his beloved dog, Blu, an 8-year-old Cane Corso.

“The coordination between the staff and doctors has been wonderful, and they all made me feel very comfortable,” he said. “They even told me I gave them inspiration. They would tell me, ‘Shaun, I was having a bad day, and since coming in and talking to you makes my day better, I came to see you first.’”

Among those he connected with was Brigham nurse Alex Poliansky, RN, of Braunwald Tower 8.

“He was so optimistic and upbeat. Any other person in his condition probably would have been depressed, but he was not giving up,” Poliansky said. “It was easy to go along with that. We were all hopeful for him.”

Melendy credits his positive outlook to an influential figure in his life: his Grandma Candy.

“My grandmother was paralyzed from polio from the time she was 2 years old until she passed away. She brought me inspiration throughout my whole life,” he said. “So, when I woke up and noticed my hand wasn’t there, I didn’t cry. I wasn’t sad. I just knew I would have her strength behind me to guide me through it.”

The support of his loved ones, including his parents and sister, as well as his local community, has also been incredibly uplifting, he said. And while he has remained relatively stoic throughout his experience, Melendy acknowledged he did have one emotional moment during his recovery: FaceTiming from his hospital bed with his dog, Blu.

“Losing my hand didn’t bother me as much as not being able to spend time with him,” he said. “The first time I FaceTimed with him, I started speaking to him in German, as I had taught him a lot of German commands, and to see him responding when I told him to bark — that made me cry.”

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Q&A with Michael Klompas, MD, MPH: What You Need to Know About Monkeypox

Published: Aug. 16, 2022

On Aug. 4, the Biden administration declared the monkeypox outbreak that started in May 2022 a national emergency. Hospital Epidemiologist Michael Klompas, MD, MPH, recently spoke with Brigham Bulletin about what we’ve learned so far.

More general information about monkeypox is available in this FAQ, compiled by infectious diseases experts across Mass General Brigham.

How significant is this outbreak?

Michael Klompas, MD, MPH

Michael Klompas

MK: We’re now in the midst of the largest outbreak of monkeypox ever. There’s large and growing number of cases both nationally and internationally — over 12,000 U.S. cases and over 30,000 cases worldwide in at least 81 countries. Historically, monkeypox was a disease that was concentrated in Western and Central Africa, but the vast majority of cases we see now are occurring in other parts of the world. The current hotspots are the United States, which has the most cases in the world, and various countries in Europe, particularly Spain, the United Kingdom and France.

This isn’t the first time we’ve seen monkeypox in the U.S. How is this outbreak different from the last one we saw in this country?

MK: In 2003, pet importers brought Gambian pouched rats from Central Africa to a pet distribution warehouse in the Midwest. While there, those rats infected some prairie dogs with monkeypox. Those prairie dogs were then sold as exotic pets to people around the United States and ended up passing on monkeypox to some of their pet owners — classically, through a bite or a scratch, sometimes through close cuddling or cage cleaning. It ended up causing about 70 cases across the country.

What was striking about those cases was that there was no secondary transmission, meaning there was transmission from prairie dog to pet owner, but no transmission on from that human to other people. This mirrors the traditional transmission pattern for monkeypox observed in Africa: The natural reservoir for this virus is rodents, with occasional spillover into human beings through a bite or a scratch, followed by very little onward transmission to other people.

There have been two additional cases in the U.S. since 2003 and before the current outbreak. Both were in travelers from Nigeria and both were diagnosed in 2021: one in Maryland and one in Texas. What is striking about these cases is that these travelers had hundreds of contacts — all the passengers in the airplane, household members, people they interacted with in the medical system — and there were no cases of transmission from those travelers to others. That’s worth keeping in mind because it gives us insight into the very limited risk of monkeypox transmission from casual or passing encounters.

Is monkeypox dangerous?

MK: The good news is that the prognosis is very good. Out of the 30,000-plus cases that have been reported outside of Africa in the current outbreak, there have only been nine deaths reported thus far. I don’t want to minimize those deaths — each one is a tragedy — but from a population-level point of view, the risk is very low.

The hospitalization rate appears to be about 3 percent. Most people who require hospitalization for monkeypox are admitted for pain control or because of bacterial superinfection at the site of the monkeypox lesions. Fortunately, we do have a good treatment — a medication called tecovirimat, also known by the brand name TPOXX. This medication has an interesting history because it was developed as a biodefense strategy against smallpox, which is in the same family as monkeypox. It turns out this treatment is effective against monkeypox as well.

Nonetheless, while the vast majority of people with monkeypox do not get sick enough to require hospitalization, it can still be a very unpleasant experience. Some of the lesions, especially those on the genitalia or rectum, can be very painful, and people can have systemic symptoms that leave them feeling pretty lousy. These can include fever, swollen glands, fatigue, muscle aches, headache and sore throat. These additional symptoms might not all be present, nor all at the same time, and which one appears first varies from person to person.

How is it spread?

MK: Most transmission appears to be through close skin-to-skin contact with infected lesions, such as through rubbing or a scratch. The monkeypox consists of fluid-filled bumps that are packed with virus. They evolve over time and ultimately scab, but throughout their evolution they contain a lot of virus. Direct contact with these lesions is believed to account for most transmissions. Once the virus enters the body of a contact, it can spread to other parts of the body.

Does that mean we should be worried about catching monkeypox by touching surfaces in places like the grocery store, the gym or on public transportation?

MK: The Centers for Disease Control and Prevention (CDC) just published a summary of the first 1,195 cases in the U.S., and there are several insights from this and similar case series from Europe that suggest that, no, the risk of transmission in these kinds of casual contexts is exceedingly low.

First, 99 percent of the people who have been diagnosed with monkeypox are men. To some degree, that might reflect bias in who is getting tested because anyone can get monkeypox, but we’re seeing the same pattern in Europe, which has been dealing with the current monkeypox outbreak for longer than us and where testing has been more broadly available in some jurisdictions. Additionally, the majority of cases have been seen in younger men, and 94 percent of the U.S. cases studied involved men who had sexual or close, intimate contact with another man in the three weeks before their illness began. The other big clue is that half or more of people diagnosed with monkeypox during the current outbreak note that their lesions first appeared on their genitalia or buttocks. Putting those factors together, we can intuit that most transmission is now taking place through sexual or intimate contact.

This fits with the general infectious disease principle that there’s a good correlation between quantity of virus and risk of transmission. We know from studies quantifying the amount of monkeypox virus in different parts of the body that the highest amount of virus is found in skin lesions (more so than in the throat, blood, urine, feces, etc.). Patients with monkeypox can shed virus into the environment, but typically the amount is small — below the level required to be able to infect cells. The rare exception to this is surfaces with heavy exposure to skin lesions, such as patients’ linens.

Finally, public health authorities do think that respiratory transmission is also possible but rare. Monkeypox spreads through the air much less efficiently than SARS-CoV-2. In fact, the CDC estimates that respiratory transmission requires more than three hours of sustained, close contact for transmission to occur.

What this all says to me is that your risk of getting monkeypox from a passing encounter or by touching a random surface in a store or restaurant is close to nothing. If this were a highly contagious disease that you could get by, say, sitting on a bus, going to a restaurant or shopping in a supermarket, we would expect to see many, many more cases in women and children. That said, if you live with someone who has known monkeypox, where there is more opportunity for close contact and for sustained and repeated virus shedding on high-touch surfaces, you should be cautious about washing your hands, cleaning surfaces, avoiding close contact and not sharing food, utensils, bed linens or towels. You should also wear a mask and try to optimize ventilation in shared spaces.

Are there unique risks for health care workers?

MK: Historically, there was only one documented case of a health care worker infected by a patient outside of Africa. It was in someone who changed the linens on a hospital bed occupied by someone with monkeypox. The speculation is that in the course of shaking out the bed linens, some of the virus got into the air and they inhaled it, leading to an infection.

During the current outbreak, two additional health care worker infections have been reported: one due to a needlestick injury and one in whom the mechanism of infection is still being investigated. Relative to the number of patient infections thus far and the number of providers they’ve interacted with, the number of health care worker infections thus far is extremely small.

Given the mechanisms of transmission of monkeypox, MGB is following CDC guidance and recommending that health care workers wear gloves, gown, N95 respirator and eye protection whenever they manage a patient with possible or confirmed monkeypox.

Mental Health Bill to Improve Treatment Access for Health Care Professionals with SUD

On Aug. 10, Governor Baker signed a bill into law that implements measures to address the mental health crisis in Massachusetts. Leaders at Mass General Brigham (MGB) and other organizations played a key role in championing one of these measures: to expand access to treatment for health professionals with substance use disorders (SUD).

“It is deeply important that we remove the stigma surrounding SUD and work together to foster a supportive environment where nurses and other health care professionals can recover and safely work in their practice settings,” said Maddy Pearson, DNP, RN, NEA-BC, senior vice president of Patient Care Services and chief nursing officer at the Brigham. “Removing barriers to treatment for health care professionals is vital to their ability to seek support and ultimately deliver safe care to patients, which is our top priority.”

Pearson, who co-chairs the MGB Chief Nursing Officer Council, was among leaders of the system’s advocacy for this legislation in partnership with the Massachusetts Nurses Association, the Massachusetts Health and Hospital Association and the Organization of Nurse Leaders.

In addition to Pearson, MGB leaders involved included Chris Philbin and Kevin Sanginario of the Office of Government Affairs; Bernard Jones, vice president of Value-Based Care, Public Policy and Administrative Operations at the Brigham; Vanessa Gilbreth of the Office of General Counsel; and Regina Hagono, of Analytics, Planning, Strategy and Improvement at the Brigham.

“This was a collaborative effort among internal and external stakeholders, and we’re thankful to everyone involved for their efforts to secure the passage of this important bill that supports health care professionals,” said Philbin, vice president of Government Affairs.

Currently, nurses with suspected SUD are referred to the Substance Abuse Rehabilitation Program (SARP) through the Board of Registration in Nursing. The program has been underutilized, with 0.01 percent of the state’s nurses in enrolling in fiscal year 2018.

“The stringent eligibility criteria prevent nurses with a mental health history from applying, and wait times for the program are long,” said Pearson. “Additionally, if a nurse has a relapse, he or she must wait at least a year to request monitored re-entry into practice. We know relapse is a normal part of the recovery process, and it should be treated with the same understanding given to those who have relapses in treatment for other chronic illnesses.”

With the bill’s passage, the Department of Public Health (DPH) will establish a new, voluntary program for all licensed health care professionals who seek support for their mental health or substance use.  An advisory committee of external stakeholders will assist DPH in the development and implementation of the program with the goal of creating a best-in-class experience for participants.

“Our goals were to revamp the state’s program for nursing and to ensure that other health care professionals would also receive improved access to care and treatment,” said Gilbreth, senior legal counsel. “It’s critical that all health care professionals have the resources to receive care, recover and successfully return to their work.”

In addition to nursing, the bill also pertains to pharmacy, dentistry, nursing home administrators, physician assistants, perfusionists, genetic counselors, respiratory therapists, community health workers, naturopathy and emergency medical services. Physicians receive support through the Physician Health Services Program in Massachusetts.

“Other states have non-punitive programs that support nurses and health care professionals and provide the treatment they need to successfully return to practice,” said Pearson. “Massachusetts is renowned for the world-class health care we offer to patients and loved ones. We need to make sure we are also caring for our health care professionals and treating them with the same compassion they show each one of us when we find ourselves in their care.”

Jones noted the dedication of the individuals and organizations leading this effort.

“The passage of the bill is the culmination of nearly four years of work for those involved and is a perfect example of the important role our institutions can play in developing and, in this case, improving public policy,” he said. “This effort has included extensive research, the development of a white paper, and testimony at a public hearing, all to ensure that we have provided information and education around this issue in support of improved access to treatment and ultimately to change how the system works.”

Meet the 2022 Class of Deland Fellows

From left: Deland Fellows Judah Soray and Jenny (Torres) Azzam

Each summer, the Brigham welcomes a new class of Deland Fellows in Health Care and Society. This one-year administrative experience prepares early-career professionals to lead health care institutions. Each fellow works closely with a member of the senior leadership team who serves as their mentor.

Jenny (Torres) Azzam, MBA

Hometown: Fontana, California

Executive mentor: Christina A. Lundquist, Senior Vice President of Clinical Services, Real Estate and Facility Operations

Previous roles: Clinical Operations Manager at Intelli-Heart Services and, most recently, Performance Excellence Administrative Intern at UCLA Health

What drew you to Brigham? I was initially drawn in by Brigham’s mission and vision of maintaining and restoring health and am particularly intrigued by our value proposition focused on scalable innovation. Brigham and Women’s Hospital is home to some of the most groundbreaking innovations, and as health care continues to evolve, I aim to be part of an institution with an embedded “change culture.” It is clear that the Brigham and Mass General Brigham continuously strive toward advancement for the well-being of our staff and patients as a system. Thus, the Deland Fellowship was the best opportunity to learn from all the brilliant leaders seeking change to build a healthier world.

What projects are you looking forward to working in during your fellowship? Improving access for patients is a driver for me. I am excited to get involved in performance improvement, operations and strategy work, allowing our patients to obtain timely, efficient and high-quality care while also focusing on improving their experience.

Fun fact about you: I am one of those strange individuals who enjoys running ultramarathons for fun!

Judah Soray, MHA, BPharm, CSSGB

Hometown: I’m originally from Trinidad and Tobago but have lived in Orlando, Florida, and Bristol, England, before moving to Boston for the fellowship.

Executive mentor: Sunny Eappen, MD, MBA, Chief Medical Officer and Senior Vice President of Medical Affairs

Previous role: I’m a trained pharmacist and worked in the retail setting before pursuing graduate school. Most recently, I interned at the Cleveland Clinic in International Operations.

What drew you to the Brigham? Health care is rapidly evolving, and there are many uncertainties about the future. I feel that the academic health care setting is most agile. With such a rich history of pioneering health care, the Brigham is ready to adapt and cater to future needs. Having met with the outstanding leadership team through the application process, I knew I wanted to join the Brigham and support its many dedicated, highly competent and skilled teams. Additionally, the opportunity to collaborate with senior leadership across the entire organization and tackle projects that fit both the organization’s mission and my goals were highly motivating.

What types of projects are you looking forward to working on during your fellowship? The collaborations currently underway across Mass General Brigham appeal to me, so I’m very much looking forward to working on areas that can expand access to more integrated care. My skillset plays well into the international services space, and I hope to help expand those efforts of providing care to patients most in need, both within New England and worldwide. I also hope to join our Patient Experience team in striving to improve the care continuum for every single patient, from admission to discharge and beyond. Another aspect of the Brigham I’m very interested in is our approach to climate and sustainability initiatives— mitigating health care’s impact on our environment, reducing our carbon footprint and helping shape a more environmentally conscious health care industry.

Fun fact about you: I hold nationality in three different countries: Trinidad and Tobago, the United Kingdom and the United States​

To learn more about the Deland Fellowship, visit brighamandwomens.org or attend an upcoming information session on Aug. 15, noon–1 p.m., or Sept. 12, 2–3 p.m.

In Memoriam: Martin C. Mihm Jr., MD, Department of Dermatology

Brigham and Women’s Hospital mourns the loss of Martin C. Mihm Jr., MD, a physician, researcher and educator in the Department of Dermatology whose groundbreaking discoveries have saved lives and whose lifelong commitment to mentorship influenced generations of clinicians in the fields of dermatology, dermatopathology and pathology. He died on July 19, 2022 of a sudden illness at age 88.

An international expert on malignant melanoma, Dr. Mihm helped shape the way skin cancers are identified and diagnosed, and his discoveries and insights influenced the way these tumors are ultimately treated. Notably, he established the importance of tumor-infiltrating lymphocytes — a type of cell that can recognize and destroy cancer cells — in contributing to the prognosis of patients with primary and metastatic melanoma. He also collaborated with the late melanoma expert Wallace Clark, MD, to create the current clinical categories for melanoma: superficial spreading, nodular, acral lentiginous and lentigo maligna.

“This is a man who has saved countless lives, and I am forever grateful for the degree to which he has enhanced my own life as a mentor and friend,” said Dermatology research colleague Tobias Schatton, PharmD, PhD, who recently partnered with Dr. Mihm on a melanoma study. “Martin set the prime example of how to live with integrity and purpose.”

In addition to his tremendous contributions to science and medicine, Dr. Mihm had an equally profound impact on others with his joyful spirit.

“Beyond his credentials, accomplishments, publications and degrees, Marty was a warm, funny, kind and generous man,” said Thomas Kupper, MD, chair of Dermatology. “His enthusiasm was palpable and infectious. He could make a microscope slide image come alive with subtle insights that, once pointed out, were obvious. He was also considerate, taking time to know the names of all the residents and students in the program and to learn about people around him. He truly was one of a kind — the sort of character who comes along rarely, like a comet leaving light and brilliance in his wake.”

Colleague and friend Jennifer Lin, MD, director of the Melanoma Risk and Prevention Clinic, reflected that Dr. Mihm was always ready to share his experiences and words of encouragement with those around him.

“He had a kind word for everybody,” Lin said. “His enthusiasm and positivity were contagious — and made coming to work so wonderful.”

Dr. Mihm’s passions for life and medicine often intertwined. Lin recalled that Dr. Mihm and Dr. Clark named the “superficial spreading” category of melanoma after sharing the morphological pattern of this lesion with students from the Boston’s Museum of Fine Arts and learning of a painting with similar morphology.

“That he could share his gifts and brilliance with us was a truly wonderful experience, and we are all better for it,” said Kupper.

Dr. Mihm was dedicated to promoting education and mentorship throughout his career. Beginning in 1974, he served as chief of the Massachusetts General Hospital Dermatopathology Unit, where he founded one of the first five dermatopathology training programs in the United States. In 1993, he joined the faculty of Albany Medical Center to establish a new dermatology and dermatopathology training program there.

“Through his mentorship and training for generations of residents, fellows and faculty, Martin’s impact will continue to grow exponentially,” Schatton said.

Beginning in 2010, Dr. Mihm served as director of the Melanoma Program in Dermatology and the Dana-Farber Brigham Cancer Center. He was also the founding director of the Mihm Consultative Service in Dermatopathology.

Over the course of his career, Dr. Mihm’s commitment to patient care inspired his work to make health care, particularly cancer treatment and prevention, more widely accessible. He was a co-founder of the Rare Tumor Institute of the World Health Organization in Milan, Italy, before acting as its external coordinator for five years, and he also helped establish clinics in Albania, India, Italy, Russia and Vietnam. Most recently, he served as co-director of the European Organisation for Research and Treatment of Cancer’s Melanoma Pathology Program.

Adriano Piris, MD, co-director of the Mihm Cutaneous Pathology Consultative Service, met Dr. Mihm after coming to Massachusetts General Hospital for his first dermatopathology rotation. Dr. Mihm soon became an important force in his life, as an inspiring mentor and a dear friend. Piris was honored to eventually work with Dr. Mihm as co-director of the Consultative Service.

“Words cannot express the meaningful impact Dr. Mihm had on my career. Over the years, he became a close friend and a family member. He embodied the concept of true mentorship and friendship for life,” Piris said.

Colleagues and friends noted that Dr. Mihm always remained committed to helping others and acting as a positive influence in people’s lives.

“Up until the final days of his life, he was committed to helping others through his unparalleled kindness, knowledge and compassion,” Schatton said. “Martin’s warmth to everyone around him, without exception, made him a very rare individual, and his absence will be felt by many.”

Dr. Mihm is survived by his cousins, godchildren and loving friends.

A Recipe for Healing: After Cooking Injury, Burn Patient Finds Support, Empowerment in Brigham Care Team

Laurie Mott with her husband, Ron, prior to her injury.

Laurie Mott was preparing a big family dinner one day in April when she experienced a terrifying emergency. “I had the table set and everything ready,” she recalled. “I reached over the boiling potatoes to grab the onion powder for the gravy, and that’s when my shirt caught fire.”

Despite the shocking turn of events, Mott — who was one of the first women to volunteer as a Boston firefighter and is also married to a retired firefighter — acted on instinct as she extinguished the flames and called 9-1-1. She was transported to the Brigham’s Burn Center, where she remained for 16 days to recover from the injuries she sustained.

During her time at the Brigham, Mott was eager to understand her condition. She asked her care providers to explain the possible treatments for the burns that extended over her upper body and learned from the nurses on her team how to dress and clean her burns, working hard to participate in her treatment plan.

“She was so sweet and very interested in learning about her condition and her own role in her healing,” said Mary O’Neill, RN, one of the members of Mott’s care team.

We care. Period. logo

Providers informed Mott that a skin graft operation could significantly reduce her chance of infection, decrease her recovery time and improve her overall health care outcomes.

At first, Mott had reservations about the surgery. Not only did she hope to return home as soon as possible, but due to burns under her arms, the operation, which would involve a transplant of healthy skin from other areas of her body to the skin affected by burns, would require one of her arms to remain extended for five days following the operation. Mott worried about discomfort and limitation to her mobility.

Anupama Mehta, MD, medical director of the Burn Center and Mott’s physician, listened, explained all treatment options and then encouraged and empowered Mott to pursue what she felt was the right treatment for her. “Understanding a patient’s lifestyle and where they’re coming from is important when creating individualized, relevant treatment plans,” Mehta said.

Delivering Patient-Centered Care

Being considered an essential member of her own care team made Mott feel more comfortable with the idea of undergoing surgery, she explained. She felt particularly comforted by O’Neill, who supported Mott as she adjusted to caring for her burns and helped answer her questions. When she first saw her burns and worried about what her treatment plan might be, Mott recalls tears coming to her eyes, but she felt reassured by O’Neill, who said, “This is your body. You’re involved in taking care of it.”

After discussing all options with her care team, conducting her own research on the operation and witnessing the collaboration and mutual respect among the members of the Burn Center, Mott elected for the skin graft.

She recalled feeling reassured by the high regard that care providers showed to one another at the Brigham. “Everyone respected each other and played such a wonderful role in my experience,” Mott said. “After I decided to proceed with the procedure, I felt relieved because I was sure it was the right thing to do,” she said.

In thinking back on her time at the Brigham, Mott fondly remembers the kindness her providers showed her. Lauren Pozerski, RN, would bring Mott cups of tea from the nurses’ station after noticing her love for the beverage. When her hands were bandaged, the patient care associates helped her eat. “The little things really made a difference,” said Mott. “They treated me so well. I can’t say enough about them.” Mott was moved to write letters to her physicians and nurses before leaving the hospital, thanking them for their care.

This summer, Mott celebrated her 70th birthday at home, surrounded by her family. While Mott faces obstacles as she continues to recover, she is glad to be home with the support of her loved ones. For now, she is enjoying her husband’s cooking — and looks forward to preparing and sharing a meal with her children when she’s ready to return to the kitchen.

Higgins Named Inaugural Incumbent of Nabel Family Professorship

“No doubt, Dr. Higgins will make a far-reaching impact and nurture the Brigham’s strengths into the future,” says former Brigham President Betsy Nabel (right) of her successor, Robert S.D. Higgins (left), who was honored at a July 25 event.

On July 25, more than 100 guests gathered to celebrate The Elizabeth G. and Gary J. Nabel Family Professorship in Surgery at Harvard Medical School (HMS) and its inaugural incumbent, Brigham President Robert S.D. Higgins, MD, MSHA.

This endowed professorship, which is the highest honor HMS can bestow on a faculty member at one of the school’s affiliated institutions, will stand in perpetuity and be held by the president of Brigham and Women’s Hospital. The professorship is named for former Brigham President Betsy Nabel, MD, and her husband, Gary Nabel, MD, PhD, who made a $1 million gift to support its creation and were joined in their generosity by several Brigham Board of Trustees members.

Higgins — who was lauded for his exemplary leadership, pioneering contributions to surgery and research, and tremendous dedication to mentorship and service — described the appointment as “the honor of a lifetime.”

“It’s a privilege to build and expand on the great work of my predecessor, Dr. Betsy Nabel, whose leadership elevated the Brigham to new heights as a premier academic medical center during her impressive tenure,” Higgins said. “Betsy left an indelible mark on the Brigham, and as the steward of this generous gift, I hope to ensure these resources advance our clinical and research enterprise.”

Nabel said she looks forward to seeing Higgins lead the Brigham into its next great chapter.

“By creating this professorship honoring the Brigham president in perpetuity, it’s our collective hope the institution continues to grow better every day,” she said. “No doubt, Dr. Higgins will make a far-reaching impact and nurture the Brigham’s strengths into the future.”

Attendees of the July 25 celebration included hospital leaders, invited speakers, and the Nabel and Higgins families and loved ones. Throughout the evening, guests were treated to warm remarks and stories that highlighted Higgins and the Nabels as leaders, innovators and mentors — and also showcased the collective strength of the Brigham community.

HMS Dean George Q. Daley, MD, PhD, kicked off the celebration, which included remarks by Board of Trustees Chair John Fish, who presented Higgins with a proclamation celebrating and recognizing Higgins’ many achievements.

In addition to the evening’s three guests of honor, other speakers included Gerard M. Doherty, MD, chair of the Brigham’s Department of Surgery and surgeon-in-chief, and Jeffrey Leiden, MD, PhD, executive chairman of Vertex Pharmaceuticals and an alumnus of the Brigham’s residency and fellowship training programs. Daley also read heartfelt remarks from TIMI Study Group Chairman Eugene Braunwald, MD, in his absence, and Brigham primary care physician Thomas H. Lee Jr. MD, and William A. Baumgartner, MD, one of Higgins’ mentors, shared words of praise and congratulations.

Reflecting on his first several months as president, Higgins said the inspiring and welcoming community he found here has exceeded his expectations in every way.

“Throughout my career, I’ve always known the Brigham to be a special place — a place of innovation and inquiry, compassion and caring, and academic rigor and unparalleled mentorship,” Higgins said. “Now that I’ve had the opportunity to experience this community firsthand, I am impressed by the talent, ingenuity, dedication and expertise that exist throughout every corner.”

New Mobile Communication Tool Makes It Easy, Efficient for Care Teams to Stay Connected

From left: Unit coordinators Allison Mulhern and Dhanani Gurung with Anne Bane during the Voalte implementation in the Connors Center for Women and Newborns in 2021

When Barbara Lakatos, DNP, PMHCNS-BC, APRN, and Christine Murphy, PMHCNS-BC, CARN-AP, are providing psychiatric nursing consultations on inpatient units, they often need to page a staff member and wait for a return call before they can move to their next patient on another unit.

We pursue excellence logoThat’s no longer the case, thanks to the rollout of Voalte, a communication tool that enables HIPAA-compliant texting and voice calls among staff. Launched previously in limited areas of the hospital, Voalte was recently implemented throughout inpatient areas and roles to connect staff in a unified directory. The implementation was made possible thanks to funding from the Caregivers Fund, which provides critical resources to support Brigham employees’ well-being and address emerging needs.

“Voalte has improved our ability to communicate with team members as we move between units,” said Lakatos, who serves as program director of the Psychiatric Nursing Resource Service with Murphy. “We can call, text and page from the app, which streamlines communication and decreases redundancy.”

Christine Wang, MD, a resident in the Department of Medicine, also noted the increased efficiency and positive impact on patient care.

“It’s so easy to check in and close the loop with nurses and other providers on the clinical team, and it decreases any waiting time because Voalte is at our fingertips,” she said. “It also improves quality of care for patients because we’re able to work through issues together as a team in real time.”

A Convenient Way to Connect

Speech language pathologist Stacey McCauley says Voalte has made daily communication more convenient for staff.

Following the most recent rollouts of Voalte in July, 3,800 staff are now experiencing the benefits of the mobile technology.

After signing into Voalte, staff can look up patient names, medical record numbers and bed/room numbers. Staff can see the care team members for each patient, initiate a call or text and confirm when the recipient has received and read a message. Voalte also indicates if a care team member is offline.

Additionally, the app includes quick references — such as paging, drug administration guidelines and Ellucid policy links — to facilitate workflow.

As of July 22, staff have sent an average of 10,077 texts and placed approximately 580 calls per day with Voalte, with about 860 active users per day.

“It’s very convenient to be able to send a message via Voalte without having to log into a computer,” said Stacey McCauley, MS CCC-SLP, speech language pathologist in Rehabilitation Services.

The Speech Language Pathology team began using Voalte earlier this spring and created a daily group message to stay in touch about new consults and other timely information. “We’ve been looking forward to more staff joining so we can easily communicate with other members of the interdisciplinary team,” McCauley said.

“The conversations are happening in real time,” says nurse Jessica Ruxton.

Staff in Pharmacy Services had a similar experience.

“Voalte has been particularly well-received by pharmacists, as it has allowed for easier and more efficient communication with other members of the health care team, as well as with colleagues within the Pharmacy,” said Jeremy Degrado, PharmD, BCCCP, BCPS, clinical pharmacy manager.

Maddy Pearson, DNP, RN, NEA-BC, senior vice president of Patient Care Services and chief nursing officer, noted Voalte’s positive impact on the ways staff communicate and collaborate. “Our goal was to improve the experience of staff and providers and streamline the way we communicate with colleagues and across different teams,” she said. “It’s wonderful to hear from our teams that they are already noticing a difference in workflow. We’re also grateful for constructive feedback that will help us refine our processes as we move forward.”

Recent Rollouts

Over the past two weeks, the implementation team launched the tool in numerous inpatient units and departments in two large waves.

Jessica Ruxton, BSN, RN, and Rachel Colby, BSN, RN, shared that the rollout on Shapiro 9/10 went smoothly and that they are already experiencing the benefits of Voalte.

“The feedback has been nothing but positive,” says nurse Rachel Colby.

“Voalte allows for closed-loop communication with the whole multidisciplinary team,” said Ruxton. “The conversations are happening in real time, allowing non-urgent concerns to be addressed sooner with prompt response time, putting our patients’ minds at ease.”

Colby agreed. “Voalte is fabulous,” she said. “So far, the feedback has been nothing but positive. Everyone is loving the easy use and quick way of communication.”

During the July implementation, staff received support from the Voalte team, Nursing Informatics, nursing leadership and a group of “go-live” volunteers.

“The rollouts have gone very well, thanks to everyone’s efforts,” said Anne Bane, MSN, RN, director of Nursing Informatics and Medication Safety. “We heard overwhelmingly positive feedback from staff.”

Bane and Jenni Theriault, director of Strategic Initiatives for Brigham Digital, co-led the implementation in collaboration with Mallika Mendu, MD, MBA, associate chief medical officer, Charles Morris, MD, MPH, deputy chief medical officer and vice president of Medical Affairs, Mike Clyne, manager of mobile technology for BH Digital, and Catherine Schroeder, deputy chief information officer.

“I want to thank Anne, Cath, Jenni, Chuck, Mike and Mallika for leading this effort, as well as all staff for embracing the technology and sharing their feedback to help us continually improve,” said Adam Landman, MD, chief information officer and senior vice president of Digital for Mass General Brigham. “For a project this size, the rollout has gone very smoothly, and we’re excited to already be hearing from staff about how it is benefiting their workflow, improving communication and, ultimately, enhancing the delivery of care.”

Building on Success in the Connors Center

From left: Labor and Delivery nurses Catrina Pitts and Chanel Daly try out Voalte during the CWN rollout last year.

Some areas previously implemented Voalte, including the Neonatal Intensive Care Unit about five years ago and mother and baby units throughout the Mary Horrigan Connors Center for Women and Newborns (CWN) last fall.

Renee Zaya, BSN, RN, said that the tool has made an immense difference in the day-to-day experience of nurses. “Voalte has been one of the biggest positive changes for communication on postpartum units in years,” she said.

Previously, with the paging system, nurses would spend a lot of time waiting for return calls from physicians and other staff not based on the postpartum units. “It’s almost like texting from your phone,” Zaya said. “These messages can save so much time in your day as a nurse that you can be spending with your patients instead of waiting at the phone for a call back.”

For example, when a patient is experiencing increased pain and requires a new medication order, nurses can message the physician, communicate back and forth, have the orders placed during the process and receive pharmacy approval quickly — all via Voalte.

“In the old system, we would have to page the doctor, wait for the call back, let the doctor know what we need and then wait for the orders,” said Zaya. “The result with Voalte is that the patient receives the medication more quickly, which is the most important thing — providing safe, quality patient care.”

For more information on Voalte, visit this page.

Patient Achieves Life-Changing Weight Loss with Support from Brigham Care Team

Kris Gagnon, pictured over the years with New Kids On The Block (NKOTB) singer Donnie Wahlberg, chronicles her 300-pound weight loss over 2015, 2017, 2019 and 2022. Gagnon is a huge fan of NKOTB.

After years of living with obesity and feeling uncomfortable in her own skin, Kris Gagnon visited the Brigham’s Center for Weight Management and Wellness in 2016 to learn more about her options. She was screened by the center’s surgeons, psychologist and dietitians, who agreed that bariatric surgery could help improve her health over the long term.

Six months later, Gagnon underwent the surgery and lost more than 300 pounds over the next six years.

“I’ve lost more weight than most people weigh themselves,” Gagnon said. “I’m living my best life because the Brigham gave me a second chance.”

The skills and resources Gagnon received at the Center for Weight Management and Wellness provided the support she needed for her successful weight-loss journey.

By focusing on the physical, mental and emotional aspects tied to successful weight loss, the Center for Weight Management and Wellness takes a comprehensive approach to weight management. Unlike many institutions, the Brigham has a three-pronged program — combining bariatric surgery, endoscopic bariatric approaches and obesity medicine — with each component led by world-class experts.

We care. Period. logo“The center is the reason for my success,” Gagnon said. “No hospital compares to the care we get here. These doctors truly have a dedication and passion for helping patients live healthy lives. This is one of the few programs that follows us for life, and I can access them and their resources for as long as I want. I see my surgeon twice a year, a psychologist anytime I need to and a dietitian every week.”

Endoscopic dietitian Catherine Page, MEd, RD, CDE, recalled how committed Gagnon was to making lasting changes to meet her weight-loss goals.

“Kris is probably one of the most motivated and driven patients I’ve ever worked with,” Page said. “I was always incredibly impressed with how dedicated she is to her health. Anytime I gave her a suggestion, or when we came up with an idea together, she would take it and run with it.”

Dietitians help patients stay on track before surgery and after their recovery. Page explained their team’s dietitians typically first meet with patients monthly for the six months before their surgery, helping them establish healthy habits and a different approach to food, as well as an understanding of meal planning, balanced meals and food shopping. They continue to meet with patients in the immediate post-operative period and over the long term to establish a sustainable plan for maintaining their progress.

Bariatric surgery aids in weight loss in more ways than one. “Because of the changes to the stomach, bariatric surgery not only makes the stomach smaller, but also affects the hormones that control satiety — your sense of fullness and hunger — and how we process and digest food,” added Page.

“Bariatric surgery is also one of the top treatments for cardiac and orthopaedic issues,” added Scott Shikora, MD, FACS, director of the Center for Weight Management and Wellness. “It can put diabetes or high blood pressure in remission or get rid of them altogether. These are very low-risk procedures with the lowest complication rates of all abdominal surgeries. The benefits of the operation dramatically outweigh the risks.”

Since her surgery, Gagnon appreciates the benefits on a daily basis. “Standing in the elevator used to make me winded,” she said. “Now, I walk up five flights of stairs instead of using the elevator.”

Determination and Dedication

In addition to having a supportive care team, Gagnon has shown what one can accomplish with determination. “Once you’re declared a candidate for bariatric surgery, you have to prove you will change your lifestyle for six months before surgery,” Gagnon explained. “You have to change your life and relationship with food. It’s challenging, but you can do it.”

After Gagnon suffered a serious hemorrhagic stroke in 2011, she gained 300 pounds rapidly. “Rapid weight gain is common after serious illnesses or accidents,” explained Page. “A lot of it has to do with stress on the body, which can cause a lot of inflammation and lead to weight gain. In Kris’ case, she also wasn’t able to exercise to the manner she was before she had the stroke. On top of that, she had dietary changes because the stroke created some chewing and swallowing issues that had to be addressed. Certain medications that decrease infection risk can also cause weight gain, as well.”

Gagnon’s first bariatric surgery was a laparoscopic sleeve gastrectomy, which was later converted to a gastric bypass to help alleviate her chronic case of gastritis and acid reflux, the latter of which she still manages. “It was not an easy road for her, but she fought and accomplished what I would have never predicted,” said Shikora. “Despite her challenges, she would always come into the clinic smiling and happy. She’s a real fighter.”

Gagnon hopes her success inspires others who are interested in bariatric surgery. “If I can do it, anyone can. You will have hard days, but every struggle will be worth it,” she said. “It’s the most rewarding thing you will ever do for yourself.”

Nurse-Doctor Co-Teaching Program Seeks to Dismantle Hierarchies and Promote Unique Expertise of Multidisciplinary Teams

From left: Bill Martin-Doyle and Holli Murray co-teach a session on alcohol withdrawal in 2019.

As she began her residency at the Brigham, Marina Zambrotta, MD, MEd, often thought of the advice her mother, a nurse, had given Zambrotta while she was in medical school: Listen to the nurses.

She carried those words with her daily — and nightly, as it turned out.

“I remember being on nights in the ICU as an intern at the Brigham and learning just as much, if not more, from my ICU nurse colleagues as I did from my attendings, fellows and co-residents,” said Zambrotta, now an internist with the Indian Health Service in Shiprock, N.M., and an affiliate physician for the Brigham.

So, when Zambrotta was awarded a medical education fellowship in her second year of residency and tasked with conceptualizing and designing a new medical education program, she didn’t have to think twice about her proposal: Invite nurses to share their expertise with residents in a more structured way.

That kernel of an idea turned into the Nurse-Doctor Co-Teaching Program, which pairs staff nurses with attending physicians to co-lead educational sessions on various clinical topics for residents and other interested staff. First launched as a pilot in the General Medicine Service (GMS) in 2019, the program has since expanded to Medical Oncology and the Emergency Department.

“There’s a historic hierarchy in medicine, and it’s something doctors get exposed to starting in medical school. We need to prioritize breaking down that hierarchy by listening to all of the valuable experience and knowledge that nurses have to share,” Zambrotta said. “It’s really important to emphasize this as early as possible in medical training so that interns who are told and expected to listen to their attendings also listen to and equally value nurses’ input.”

Marly Diallo, BSN, RN, a staff nurse in GMS on Braunwald Tower 14CD who has co-taught several sessions, said participating in the program provided an opportunity to expand her own skills while also strengthening interdisciplinary relationships on the unit.

“I enjoy teaching, and it’s something I do almost every day precepting new nurses, so I thought this was a good opportunity to do more of that and improve the way that we communicate as doctors and nurses,” she said. “As we get new interns and residents throughout the year, that mutual respect is something we always want to reinforce so that we continue to have a culture where we approach each other in the same way.”

Hospitalist Bill Martin-Doyle, MD, who co-teaches sessions on caring for patients exhibiting symptoms of alcohol withdrawal, agreed that the program has been a shining example of enhanced multidisciplinary collaboration.

“It was immediately apparent to me, right from the start, what a great idea this was and the kind of thing that makes you think, how come this hasn’t been happening the whole time?” he said. “There are so many clinical topics where we might have different viewpoints and understandings of the nitty-gritty details, and it’s been fantastic to get everybody in the same room and speaking the same language.” 

In the process of preparing for and conducting the sessions with her physician co-instructors, Diallo said she felt it was an informative experience for both clinicians — and one that can ultimately enhance care in the long run. For instance, in co-teaching a session on arterial blood gas tests, Diallo said she received a greater understanding about the thought process behind a physician ordering the test and interpreting the results.

“For me, it wasn’t just about teaching residents. It’s a learning opportunity for all of us. Let’s say I’m back on the unit and another nurse or nursing student has a question about arterial blood gases, I feel like I can provide a more informed answer,” Diallo said. “It always comes back to the patients, too. The more I know, the better I can communicate with my patients about their care.”

‘We Insisted on Equality’

While the content of the sessions is rigorously evidence-based, the program seeks to cultivate a relaxed atmosphere and create a fun learning environment that bucks convention, explained Helen Shields, MD, a faculty member of the Division of Medical Communications and the Division of Gastroenterology, Hepatology and Endoscopy, as well as the program’s course director.

In place of dry PowerPoint presentations, attendees participate in interactive activities, including Family Feud-style competitions to test their knowledge and contests to redesign catheters. The sessions are also intentionally kept brief — 30 minutes, as opposed to the typical hour-plus format of an academic lecture — to keep everyone engaged.

Marly Diallo (upper right) and David Rubins (upper left) co-teach a virtual session on arterial blood gases in 2020.

But behind the breezy exterior is a serious commitment to achieving the program’s original vision of presenting nurses’ and physicians’ unique viewpoints, Shields said.  

“The big value was showing the equality of the knowledge and skillsets, but we had to tease out what were the expert areas of the nurse versus the doctor, then unify them and link them — not just the nurse lectures here and the doctor lectures here. They go back and forth in a complementary manner,” she said. “We insisted on equality from the get-go, and the nurse’s name always comes first in the list of presenters as a sign of that respect.”

Madelyn Pearson, DNP, RN, NEA-BC, senior vice president of Patient Care Services, chief nursing officer and the Beth V. Martignetti Distinguished Chair in Nursing, said this kind of interdisciplinary exchange is invaluable to all members of a care team. 

“Nurse-doctor co-teaching teams are one important way we can bring disciplines together, learn from one another’s perspectives and ultimately enhance the care we deliver,” Pearson said. “This kind of collaboration is more important than ever, given the intense challenges that we continue to face in health care.”

Holli Murray, MSN, RN, PCCN, a staff nurse on 14CD who co-taught the session on alcohol withdrawal with Martin-Doyle, said the program has helped improve collegiality between the two disciplines. While physicians and nurses may work on the same unit, differing shifts and rotations can mean that they don’t have much time to get to know one another. Coming together for these sessions provides an important opportunity to mingle in a more casual setting, Murray said.

“Anytime I can, I try to interact more with the doctors to build those relationships so that later I’m more comfortable speaking up about something,” she said. “I also don’t necessarily feel like I’m instructing the doctors, but I think it’s helpful for them to understand that, as a nurse, I might have different concerns around the patient’s safety and comfort.”

For Zambrotta, it has been exceptionally rewarding to see her original vision come to life. In addition to its expansion to units beyond GMS, the program has also been spun off into a Harvard Medical School course, “Nurse-Doctor Co-Teaching,” to train future medical educators in developing nurse-doctor co-teaching programs. (The next course will be held virtually on Sept. 23.) Zambrotta also hopes to expand the Brigham program to include additional allied health professionals as co-instructors.

“What I was hoping with the initial pilot study on GMS was that interns and residents would feel more comfortable seeking out knowledge and teaching from the nurses on the floor and, vice versa, that the nurses would feel comfortable going up to the interns and saying, ‘Hey, I have a question about this order,’” she said. “Rather than coming from a place of ‘one more page I have to respond to,’ it opens up a more friendly line of communication.”

Brigham Honored by U.S. News as One of Nation’s Best Hospitals, OB-GYN Ranks 1st in the Nation

Once again, Brigham and Women’s Hospital has been recognized as a top hospital in the 2022 U.S. News & World Report’s annual ranking of the best U.S. hospitals. The Brigham was ranked 14th by the publication, while its Obstetrics & Gynecology specialty was named the best in the country — a noteworthy affirmation at a time when access to reproductive health services is being challenged across the U.S. In all, four specialties earned a spot in the top 10 and three specialties made the top five.

The Brigham was also ranked in 12 of the 13 specialties it is eligible to be ranked in, out of a total of 15 specialties rated by U.S. News. In addition to the top ranking for OB-GYN, the Dana-Farber Brigham Cancer Center ranked fourth in cancer, Rheumatology was fifth and Cardiology & Heart Surgery was 10th. Additionally, the Brigham earned the publication’s highest distinction in 18 of the 20 most serious and complicated medical conditions and procedures.

“These rankings are a reflection of the tremendous talent here at the Brigham, as well as our employees’ incredible commitment to our patients and their families,” said Robert S.D. Higgins, MD, MSHA, president of the Brigham and executive vice president at Mass General Brigham. “Through innovative research, comprehensive care and collaboration across our many specialties and disciplines, these rankings are a testament of our dedication to our mission and commitment to provide compassionate and high-quality health care for every patient.”

Nawal Nour, MD, MPH, chair of the Department of Obstetrics and Gynecology, said it was an honor for the department to receive such a prestigious recognition.

“There is a deep commitment and long legacy of support for women’s health care at the Brigham, and we are thrilled to be recognized as the top OB-GYN specialty in the country,” Nour said. “Our specialty is dedicated to ensuring high-quality, comprehensive and equitable patient-focused care to all of our patients, while recognizing each of their individual, and often very personal, needs.”

The annual ratings were developed to help consumers determine which hospitals provide the best care for challenging or complicated health conditions and for common elective procedures. They are based on a point system derived from a comprehensive nationwide evaluation of nearly 5,000 medical centers in 15 adult specialties and 20 procedures and conditions.

Several other Mass General Brigham hospitals were also honored by U.S. News & World Report. Massachusetts General Hospital once again earned a spot on the Honor Roll among the top hospitals in the country. Three Mass General Brigham specialty hospitals — McLean Hospital, Spaulding Rehabilitation, and Mass Eye and Ear — were recognized for national excellence. McLean Hospital was ranked No. 1 in the nation in psychiatry. Spaulding Rehabilitation is No. 1 in rehabilitation in New England and ranked No. 3 in rehabilitation in the nation. Mass Eye and Ear is No. 1 for otolaryngology (ear, nose, and throat care) and ophthalmology in New England and ranked No. 4 for both otolaryngology and ophthalmology in the nation.

Additional details about the U.S. News & World Report ranking system can be found here. The complete listing of America’s Best Hospitals can be found here.

By the Numbers: Rankings by Specialty

*Brigham is not eligible to be ranked in Ophthalmology or Rehabilitation. Mass Eye and Ear, which is tied to MGH for Honor Roll Purposes, ranked No. 4 for Ophthalmology. Spaulding, which is tied to MGH for Honor Roll purposes, ranked No. 3 for Rehabilitation.

** 2021 ranking is based on Gynecology only. 2022 includes both Obstetrics and Gynecology.

In Memoriam: Robert Osteen, MD, Division of Surgical Oncology

Brigham and Women’s Hospital mourns the loss of Robert Osteen, MD, a cancer surgeon and educator whose contributions to the field of surgical oncology influenced generations of surgeons. He died July 14 from complications following a recent injury. He was 81.

With a remarkable tenure spanning almost 50 years at the Brigham, Dr. Osteen established himself as a leading expert in surgery for tumors of the pancreas, liver, stomach, esophagus, colon, breast and other organs. Throughout his career, he served as an influential and beloved surgeon, teacher and mentor. Gifted with a sharp mind, colleagues frequently consulted Dr. Osteen for clinical guidance. Although he retired from clinical practice in 2006, he remained engaged in the instruction and mentorship of students and trainees.

“Bob Osteen had a huge presence at the Brigham and beyond,” shared David Brooks, MD, former director of Minimally Invasive Surgery and program director of the Advanced Minimally Invasive Fellowship. “Despite having long since stopped operating, he was at our Wednesday morning Morbidity and Mortality conference nearly every week, adding sage advice, challenging the residents and staff and generally providing wonderful gravitas to the meetings. His surgical wisdom was always valued. He will be greatly missed by all who knew him.”

Gerard M. Doherty, MD, surgeon-in-chief and Crowley Family Distinguished Chair of Surgery, reflected on the countless lives that Dr. Osteen touched over the course of his illustrious career.

“Few of us can hope to have the impact on those around us — co-workers, trainees, patients and others — that Dr. Robert Osteen had,” Doherty said.

Colleagues remembered Dr. Osteen not only as a great surgeon but also a great teacher — one who inspired others both personally and professionally with his guidance and wisdom. In recognition of his lasting influence on surgical education, the Department of Surgery established a Junior Faculty Fellowship Award in his honor in 2006.

“Dr. Osteen was one of our most respected and active teachers,” added Doherty. “After retiring from clinical practice a decade and a half ago, he patiently devoted himself to the work of teaching Harvard Medical students how to think through challenges in clinical surgery. Dr. Osteen brought his wry smile and gentle guidance to hundreds of students, always grounding them in basic principles and allowing them to work their way through the analyses. At his core, he cared about people and their lives — patients, students, trainees and colleagues — and he made us all better by his friendship and his mentorship.”

Monica Bertagnolli, MD, chief of the Division of Surgical Oncology, remembered Dr. Osteen as a generous mentor, teacher and friend.

“Bob Osteen was an extraordinary role model in every way,” Bertagnolli said. “He had a deep knowledge of the science of oncology. In the operating room, his command of technique was such that no motion was ever wasted. As a junior faculty member, I remember visiting him almost weekly carrying a pile of X-ray films, and he would patiently coach me through the management of my more challenging patients. Every one of his trainees hoped to achieve his level of excellence as a surgeon. It is devastating to hear of his passing. I am so very fortunate to count myself among his many trainees and colleagues.”

Brigham colleague Atul Gawande, MD, MPH, who trained under Dr. Osteen during his residency and is currently serving with the Biden-Harris administration to lead global health at United States Agency for International Development, reflected on the many ways Dr. Osteen touched his own life and career over several decades.

“Losing Bob Osteen is a devastating blow,” Gawande said. “Across almost three decades, I saw him in many roles — as the residency program director who welcomed my internship class, as a teacher in the OR and countless Friday pizza conferences, then as a wise colleague and reliable friend. He was the soul of Brigham surgery for an entire generation of trainees and faculty. He came to occupy a place inside each of us, shaping our ideas about what it means to be a master surgeon, a master teacher and, if you got to know him, a joyful human being.” Gawande also described his time with Dr. Osteen in this 2011 New Yorker article.

Dr. Osteen led a full life that extended far beyond the Brigham’s doors. “He knew how to live well — his keen wit, enthusiasm for life and joy in family and friends were readily apparent,” Bertagnolli remarked.

“He never forgot what is vital and special about the role surgeons have in people’s lives — nor how to leave room for a full and enthusiastic life beyond the hospital,” added Gawande.

In addition to his work with the Brigham, Dr. Osteen published a collection of poems, Zero to Five Knots and a Book (2021), and a history book, Festina Lente: Charting the Mediterranean 1814–1824 (2016). An avid reader, Dr. Osteen researched a range of topics from surgery in the World War II to King Philip’s War. He was also a devoted sailor, navigator and collector of antique maps.

“Outside the hospital, he was charm itself,” Brooks reflected. “A raconteur, singer, actor, poet, historian, sailor of considerable renown — he was a renaissance man who embodied so many things we all admire and aspire to be.”

Dr. Osteen is survived by his wife of 58 years, Carolyn McCue Osteen; two daughters, Carolyn (Morey) Osteen Ward and Sarah Lloyd Osteen; and four grandchildren.

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In Memoriam: Sunni Reis, BSN, RN, Emergency Department

Brigham and Women’s Hospital mourns the loss of Sunni Reis, BSN, RN, a nurse in the Emergency Department (ED), who passed away June 7. She was 37.

Ms. Reis joined the ED team in 2019, working mostly on nights. She is remembered by her colleagues for her kindness and dedication to her patients.

Jenna Collentro, BSN, RN, who served as Ms. Reis’ preceptor, spoke of her ability to remain calm during challenging situations.

“Sunni was a gift to this department, and I knew when I met her that she would do incredible work at the Brigham,” Collentro said. “She caught on fast, always kept her cool, provided excellent care and connected with people.”

Collentro described Ms. Reis as “bright, intellectually and spiritually — a real empath,” adding that “her energy was contagious, her laugh infectious and her light always visible.”

Jeanine Coggswell, BSN, RN, an experienced nurse, recalled the support that Ms. Reis provided to her when she transferred to the ED. “I was feeling overwhelmed and doubted my ability to be successful,” Coggswell said.

But when she began working alongside Ms. Reis, something shifted for Coggswell. “Sunni’s genuine character, her infectious smile, her unpretentious no-nonsense attitude, her humor, her commitment to her patients, her overwhelming pride and fierce love for her children created an energy about her that somehow put me at ease and fueled my flickering confidence,” Coggswell said. “For the first time, I started to actually feel like I was going to be OK and successful in the ED.”

Other colleagues described similar experiences in working with Ms. Reis. “Sunni became one of my first and closest friends when I started in the ED in 2020,” said Stephanie Santos, BSN, RN. “We realized that we lived a few minutes from each other, started carpooling together and quickly connected on a level that made us feel as if we knew each other for a lifetime. We wouldn’t have a second of silence during our hour or more drive to and from work, talking about anything and everything under the sun.”

Santos shared that she counted on Ms. Reis for advice, both inside and outside of work. “She always made the time to ask how you’re doing and did so in a genuine and caring way,” Santos said.

Ms. Reis was a devoted mother to her son and daughter, speaking of them often and with great pride. “She loved her babies and was so proud of her son and devoted to her sweetheart, ‘mini me,’ beautiful daughter,” said Collentro.

Santos agreed. “I often told Sunni that she was a ‘super mom’ after her numerous displays of dedication and love for them,” she said. “She will be sorely missed, and her smile and laugh will always remain with us.”

Ms. Reis earned her bachelor’s in nursing from Bristol Community College in 2010 and worked in emergency departments at several other hospitals before joining the Brigham ED.

Ms. Reis is survived by her son, Sonny D. Pierre; her daughter, Evvie B. Best; her father, Paul J. Reis; her mother, Staci A. Andrews; her stepmother, Jamie B. Brunache; her brothers and sisters, Brianna C. Fernandes, Raynna M. Rezendes, Julian P. Reis, Talia M. Reis and Jhaden P. Reis; her grandmother, Patricia J. Silveira; and many aunts, uncles, nephews, nieces, cousins and friends.

In Memoriam: Donald Jocelyn, Central Transport and Equipment Services

Brigham and Women’s Hospital mourns the loss of Donald Jocelyn, an equipment transporter in Central Transport and Equipment Services, who died of a sudden illness on July 1. He was 60.

A member of the Brigham community for approximately 20 years, Mr. Jocelyn was responsible for maintaining the supply of wheelchairs available in the hospital’s three main lobbies and for discharges on CWN 9 and 10.

Colleagues remembered Mr. Jocelyn for his steadfast commitment to ensuring patients always had access to the equipment they needed to safely and comfortably navigate the hospital.

“Donald was a fixture here at BWH, and although not everyone knew his name, they knew he was the man ‘behind the wheelchairs.’ You often saw him on the Pike pushing about five wheelchairs at once and knew he was on a mission to get them to where they were needed,” said Claire Zaya, nursing director for Postpartum and the OB Float Pool. “I would jokingly tell people that if they saw him on the Pike with wheelchairs to make sure they let him pass, since he was probably on his way to CWN and we needed them for discharge.”

Natasha Jimenez, a patient escort in Central Transport Services, said Mr. Jocelyn took great pride in his work and approached it with a strong sense of purpose.

“He was such a happy person and felt good knowing he was making a difference,” she said. “When a transporter couldn’t find a certain type of wheelchair, all I had to do was call Donald. He was one of a kind and will be truly missed.”

Germaine Dorfeuille, a Central Transport supervisor and longtime friend and colleague of Mr. Jocelyn, remembered the joy he brought to so many people.

“Donald was always making everybody laugh. If you knew Donald, you were never sad,” she said. “He loved the Brigham and being around people here. He used to say he didn’t need a vacation because he liked to come to his job.”

When his help was needed, Mr. Jocelyn was an unstoppable force, colleagues said.

“He was a ball of caffeine. He had a tremendous work ethic,” said Erlande Jean-Louis, senior manager of Central Equipment Services. “You could not miss him — he’d have four wheelchairs lined up in front of him on his way to replenish the lobbies. He was not a tall person, but his energy made him seem bigger than he was.”

Staff on CWN 9 and 10 were grateful to have such an enthusiastic and dedicated colleague supporting them, Zaya added.

“CWN has special discharge carts and they always seem hard to find, especially on the days we have a lot of discharges. Donald was always so responsive with locating them and getting them up to the units,” Zaya said. “Staff knew the days he was not here because we would not have as many available. Donald always had a smile on his face and was humble with accepting our appreciation. His presence will be missed.”

Although his main duties involved equipment, Mr. Jocelyn occasionally assisted with patient transports as needed. In those moments, his characteristic kindness and charm provided comfort to whoever was in his care, Jean-Louis added.

“He treated patients as if they were his own family members,” she said. “He cared. He didn’t forget he worked at a hospital and carried a sense of urgency for what he did.”

Mr. Jocelyn is survived by his niece, Tatiana Roc, and many friends and loved ones.

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After 113 Days of Hospitalization, Young Patient Grateful for Lifesaving Gift of Lung Transplant

Kristen (Rousseau) Larochelle hits the ski slopes in her home state of Maine, a favorite hobby she can enjoy again after a lung transplant cured her of cystic fibrosis.

This past winter, Kristen (Rousseau) Larochelle felt the cold air tingle in her lungs as she inhaled deeply on a ski mountain in Maine for the first time in eight years. It felt good.

From birth, Larochelle had lived with cystic fibrosis, a genetic disorder that causes a person’s airways and lungs to become clogged with thick, sticky mucus. This constant buildup makes it difficult to breathe, and the gluey mucus easily traps bacteria, often resulting in regular lung infections. These complications can be life-threatening.

While some people with cystic fibrosis experience milder symptoms, Larochelle developed a severe form of the disease, including a complication that frequently caused her to cough up large amounts of blood.

By the time she reached her mid-20s, her health began to deteriorate. Although once a CrossFit enthusiast, she soon found herself requiring the use of supplemental oxygen for basic activities like grocery shopping. Cold air made it harder to breathe, which also meant giving up her beloved hobby of skiing. Even talking for an extended amount of time would leave her winded. She became reluctant to travel by plane, fearing she might die if her lungs started bleeding uncontrollably mid-flight.

“I was stuck at home pretty much all the time,” Larochelle recalled. “A lot of people I met didn’t even know what I like to do because they knew me as the person who likes to read books and all these things that involve just sitting there, and that’s not really me at all.”

That all changed for Larochelle in late 2018 when a dramatic series of events led to her hospitalization at the Brigham, where she received advanced care in the Thoracic Intensive Care Unit (ICU) to help manage her worsening symptoms until a set of donor lungs became available for transplant.

A Bridge to Transplant

Although Larochelle had been active on the national transplant waiting list since March 2018, it wasn’t until one morning that October that it became clear how urgently she would need a double lung transplant.

Larochelle enjoys a day at the beach with one of her dogs, Khloe.

“I woke up to my lungs bleeding. Within minutes, my bedroom looked like a murder scene,” she remembered.

She called 9-1-1 and was rushed to her local hospital in Maine. There, she learned that cystic fibrosis had severely damaged her lungs — to the point that there were now abnormal and dangerous connections between the blood vessels and airways. Recognizing that she required more advanced care, Larochelle’s providers arranged an ICU-to-ICU transfer to the Brigham.

Shortly after her arrival, Larochelle was placed on a ventilator through a tracheostomy. During one especially intense bleeding episode, her breathing tube became clogged with life-threatening blood clots.

Her body needed oxygen-rich blood. She would benefit from ECMO, a machine used to oxygenate the blood when a patient’s lungs are too sick to perform that function themselves. But there was a serious complicating factor: ECMO can’t be used when there is active bleeding in the lungs. That’s because a large dose of a blood thinner, heparin, is necessary when a patient is connected to an ECMO machine. Heparin increases the risk of bleeding.

After weighing the potential risks and benefits, her care team determined it was Larochelle’s only chance of survival. After injecting her with heparin, they successfully started ECMO, which Larochelle remained on for more than 40 days.

“What was special about Kristen’s case was she was one of the early examples of us using ECMO as a tool to bridge patients to transplant,” said Anthony Coppolino, MD, director of Ex Vivo Lung Perfusion in the Division of Thoracic Surgery. “She was basically on the highest-risk side of transplant that you could really consider.”

‘A Fighting Spirit’

In addition to the physical toll her illness took on her body, being in the hospital for so long became emotionally draining, too, Larochelle said. Most of all, she missed her beloved dogs. To lift her spirits, members of her care team decorated her room with photos of her dogs. One nurse gave her a stuffed animal that resembled one of her pups.

“I would take him for walks around the floor. We’d put him on my walker and say, ‘Let’s take Austin for a walk,’” Larochelle remembered.We care. Period. logo

During that harrowing time, the warmth and compassion of her Brigham care team made all the difference.

“They became like family,” Larochelle said. “There were so many of them, each so special.”

Taylor Risotti, BSN, RN, one of her Thoracic ICU nurses, said Larochelle’s strength of will at 28 years old was humbling to witness.

“Seeing someone my age go through that — I look up to her,” Risotti said. “She was such a trooper. She did anything and everything to stay strong and get to the point of transplant.”

Finally, in November, Coppolino entered her hospital room with the news that there was a donor. While Larochelle and her family had been anxious to hear those words for more than a month, she also knew the weight they carried.

“It was what I’d been waiting for, but I just kept thinking someone lost their family member,” Larochelle said.

As she was being wheeled to the Operating Room, Larochelle said she was comforted by familiar faces from her Brigham team, including anesthesiologist Alissa Sodickson, MD, who did a FaceTime call with Larochelle from home right she before went under anesthesia.

From her initial admission to her local hospital in Maine, her transport to the Brigham and eventually her transfer to Spaulding Rehabilitation Hospital, Larochelle was hospitalized for a total of 113 days.

In January 2019, after a challenging recovery, Larochelle was finally able to go home. A year later, she sent a letter to her donor’s family to thank them for their lifesaving gift. They now talk regularly, and Larochelle visits when she can.

“They’re my heroes,” she said. “They made sure their son’s wishes were honored to donate life.”

Three years out, Kristen is back to skiing, traveling and walking her dogs — living the life she loves and not taking any moment for granted.

“Kristen had a fighting spirit from the moment I met her,” Coppolino said. “To see her persevere through that difficult course and to have the opportunity to help her get there is very gratifying. It makes what we do worth it.”

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Brigham Care Team Creates Special Moment for Bridesmaid Undergoing Cancer Treatment

Caitie Donohue was able to virtually attend her best friend’s wedding in style with help from her Brigham care team.

On Nov. 7, 2021, Caitie Donohue watched her best friend, Ashley, walk down the aisle, recite her vows and marry the love of her life. Dressed in a light pink bridesmaid gown with a view from the front row, Donohue watched every part of the wedding — from the ceremony to the couple’s first dance — via video on an iPad.

That’s because Donohue participated from a hospital bed at the Brigham, where she was receiving treatment due to complications from her acute myeloid leukemia (AML). Donohue had been suffering from this cancer of the blood and bone marrow since January 2021.

When it became clear Donohue wouldn’t be able to attend Ashley’s wedding in person, her friends and family sprang into action. They transformed her hospital room into a wedding-ready space and helped Donohue dress up for the day. Brigham staff worked closely with Donohue to make sure she could participate — monitoring her health, managing the foot traffic in and out of her room and making sure she didn’t get too overwhelmed.

Prior to her death in June, Donohue expressed her gratitude for the members of her care team who helped make this special moment possible, including one of her nurses on Braunwald Tower 6, Meghan White, MSN, BSN.

“She’s the most amazing nurse, one of the best that I’ve had, and I’ve had a lot of nurses,” Donohue said. “She coordinated everything that day, making sure all my medications lined up so that it wouldn’t interrupt the ceremony. She had signs made for my door to make sure no one came in and interrupted. She just went above and beyond to make sure that I had the best experience that I could have had.”

White, a nurse at the Brigham for 19 years, said she was honored to help lift her young patient’s spirits.

“Caitie kept telling me how much she wanted to be there,” White said. “I said, ‘I’ll make sure no one disrupts you. If anyone tries to come into that room, they’ll have to go through me.’”

From Medical Scribe to Physician Assistant: Brigham PA Reflects on Her Journey to Patient Care

Hannah Prange (right) says she was thrilled to work alongside her longtime mentor, Donna Collins (left), during her first shift as a physician assistant at the Urgent Care Center in Foxborough, where Prange began her Brigham career as a medical scribe four years ago.

When Hannah Prange, MS, PA-C, was 2 years old, she carried a toy stethoscope and wore scrubs four sizes too big.

“I was one of those people who always knew what they wanted to do,” Prange said. As a child, one of her biggest role models was Heidi Handman, DO, her mother’s best friend and a neonatologist who, known to Prange as “Dr. Heidi,” inspired her to dream of pursuing a career in the medical field.

Those dreams would eventually lead her to the Brigham, where, after a chance encounter, she seized an opportunity to learn and grow with the support of colleagues and mentors.

Four years after she joined Brigham and Women’s Urgent Care Center in Foxborough as a medical scribe helping providers document information during patient visits, Prange recently began caring for her own patients as a physician assistant (PA) — in the very same clinic.

“There were times before and during PA school that were challenging for me, but I look back on my experiences, and I was really motivated and determined. Now I’m here full circle, and I feel like I have my dream job,” she said. “My colleagues really helped me get there.”

After graduating from PA school in 2019, Prange returned to the Brigham the following year as a PA in the Emergency Department (ED). As she gained experience, she expanded her rotation to other sites. Today, Prange works as a PA in both the Brigham and BWFH EDs, as well as the Foxborough Urgent Care Center where she started her career.

Prange’s colleagues said it has been inspiring to witness her professional growth over the years.

“There is nothing more rewarding than watching our employees grow and supporting them as they strive for the goals they have set for themselves,” said Julia Raymond, regional director of Ambulatory Operations, who previously served as Prange’s supervisor in her prior roles. “Hannah worked so hard to gain the right experience, learn from our providers and establish mentors who would help her along the way.”

Making Connections

As Prange became more focused on a health care career while she attended college, it was after graduation that she discovered her desire to become a PA. She met practicing PAs and was impressed by the care they provided and their ability to explore various fields of medicine. She also shadowed PAs at Dana-Farber Cancer Institute, and she later felt the personal significance of the care that a PA provided her mother following her cancer diagnosis.

Around that time, she happened to meet a Brigham doctor at the Patriot Place’s Dunkin’ Donuts. Prange gathered the courage to introduce herself and ask about medical scribe positions, and the doctor suggested she look at job openings at the Foxborough Urgent Care Center. A few months after becoming a scribe there, she sought more direct experience in patient care as a medical assistant, and her colleagues helped her train for the role.

According to Prange, the community she discovered at the Brigham inspired her to return as a PA.

“Working in health care can be difficult, but my co-workers and colleagues — the people — were supportive of my career path and have been a big part of why I’m happy at the Brigham,” she said.

Prange faced setbacks as she prepared for PA school, including rejection letters during her first round of applications, but she remained resolved. When she ultimately graduated from PA school, Prange was overjoyed at the accomplishment, though also nervous.

Donna Collins, PA-C, assistant medical director of the Foxborough Urgent Care Center, who mentored Prange through the process, says she never doubted that Prange would succeed.

“It has been a pleasure watching Hannah start as a young, eager scribe and then get hands-on experience as a medical assistant,” Collins said. “She is a quick study and hardworking.”

When Prange began her first shift as a PA at Foxborough Urgent Care, she was relieved to see a familiar face: Collins was working alongside her. “The fact that I still work with Donna is so special,” she reflected.

Moments like that helped her gain confidence and feel bolstered by a sense of community.

“Truly, I could not have done it without the other PAs who were training me,” Prange said.

Beginning Work as a PA

Between the lingering pandemic and continued high demand for health care services across the region, Prange acknowledged it has been a challenging time to begin her PA career. Yet, it has also been a learning opportunity and a humbling privilege to help so many patients, she added.

“My job is the most challenging thing in my life, but I love that challenge because I feel like every day I’m learning,” she said. “Even though some days are really hard, you go to work to save lives.”

Looking ahead, Prange hopes to continue expanding her skill set as a PA and to possibly explore other medical specialties — including obstetrics and gynecology, as she has long been interested in that field and recalls her passion for medicine started with Dr. Heidi.

“I’ve always just wanted to help people, and I’ve finally found my calling,” Prange said.

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Student Success Jobs Program Celebrates the Class of 2022

Claire-Cecile Pierre (center) delivers an uplifting keynote address to SSJP’s graduating seniors and other attendees of the program’s virtual graduation ceremony on June 15.

For as long as he can remember, Devin O’Loughlin has been intrigued by his grandmother’s stories about nursing during World War II and the polio epidemic. Now, he looks forward to following in her footsteps as he graduates from Boston Latin Academy and prepares to enter nursing school — a milestone made possible in part by his participation in the Brigham’s Student Success Jobs Program (SSJP).

SSJP matches high school students, primarily from underserved Boston neighborhoods, with year-round paid internships in over 60 departments across the Brigham.

O’Loughlin, one of 26 seniors graduating from the program this year, was awarded a scholarship to study nursing at Wagner College. His experience working alongside and learning from Brigham nurses in the Department of Obstetrics and Gynecology inspired him to pursue his own career in the field.

From left: Robert Higgins celebrates with Devin O’Loughlin at an event for SSJP graduates on June 27.

“Nurses are always in touch with their patients, and they’re caring,” O’Loughlin said. “That’s the kind of medical professional I want to be.”

O’Loughlin described OB-GYN as a welcoming place, one where he felt respected as a team member and empowered to grow.

“Everyone knew me, and I knew everyone,” he said. “The work environment just felt really healthy.”

Supporting Students

SSJP students are paired with supervisors who serve as mentors, and the program further supports students by providing access to academic resources, including tutoring and college scholarships, as well as wellness services, such as mental health support.

By creating job opportunities for students from underserved backgrounds, SSJP seeks to foster and support a diverse workforce in health care. In 2021, 89 percent of SSJP students identified as people of color, 85 percent of SSJP students attended an economically disadvantaged high school, and 74 percent of SSJP students identified as women.

“The program represents a long-term investment in improving patient care, as well as advancing the economic mobility of neighborhoods, families and communities,” said Pamela Audeh, program director of Youth Development and Economic Advancement in the Brigham’s Center for Community Health and Health Equity, which oversees SSJP.

“I had access to resources I didn’t think I would ever have,” said Frenkli Mitrushi, a graduating SSJP senior who interned with the Department of Pathology.

To celebrate students’ achievements, the program hosted a virtual graduation ceremony for seniors on June 15, featuring speeches from student leaders, such as Mitrushi, who, along with O’Loughlin, is a member of the SSJP Student Council. During the ceremony, graduates were reminded that support from their SSJP and BWH communities will continue beyond high school. Through the SSJP, students will have continued access to offer scholarships, internships, academic and mental health resources and support for entering the workforce and obtaining advanced degrees.

Mitrushi joined SSJP as a high school sophomore passionate about the sciences. In addition to the hands-on experience his internship has provided, he has enjoyed the opportunity to interact with SSJP peers and his Pathology colleagues, whether in an informal chat in the Garden Cafe or while learning more technical skills in the lab. His experience at the Brigham has inspired him to pursue the pre-med track at University of Massachusetts Boston, where he plans to study biology, with a goal of addressing health inequities.

Mitrushi’s interest in health care began when he and his family immigrated to the United States from Albania. He realized that despite the vast medical resources in the United States, health care remained inaccessible to many people, particularly in low-income communities. As a leader of the student council, he has facilitated many discussions on health equity, and he plans to be a leader in addressing health inequity throughout his future career.

From left: Robert Higgins congratulates Frenkli Mitrushi.

“I joined the student council to see if leadership was for me, and what I found was that it is,” he said.

‘Crucial Contributions’

The COVID-19 pandemic directly affected SSJP students, their families and their communities in many ways. Even while navigating their own personal challenges and traumas, many students felt inspired to contribute to the Brigham’s pandemic response and chose to work extra hours at testing sites, vaccine clinics and food-distribution sites — often aiding their own communities in the fight against COVID-19.

For Mitrushi and O’Loughlin, the pandemic brought the significance of patient care and equity into sharp focus. Mitrushi helped to facilitate student discussions on equity and the disproportionate effects of the pandemic on Black and brown communities in the United States. When internships returned after a hiatus in 2020, O’Loughlin supported the OB-GYN department, and Mitrushi assisted Pathology as the pandemic continued.

“I really took pride in my work,” Mitrushi said.

All SSJP students make crucial contributions to the hospital. “It’s really amazing to see. Our students are vital members of the Brigham community,” said Audeh.

For Mitrushi and O’Laughlin, what makes the program unique is its support for students and its community of peers.

“It’s great for making friends as well as networking, and it has so many opportunities for truly impacting your life,” said Mitrushi.

Brigham B.A.A. 10K Teams Make Triumphant Return to Course

Heal Ukraine was one of 50 teams of Brigham staff members, patients, and supporters who participated in the B.A.A. 10K to raise funds for Brigham and Women’s Hospital.

More than 6,100 runners made a long-awaited return to the streets of Boston on Sunday, June 26, for the annual Boston Athletic Association (B.A.A.) 10K, presented by Brigham and Women’s Hospital, the race’s exclusive fundraising partner.

Runners braved hot, humid conditions to compete in the eagerly anticipated race, which marked its return from a three-year hiatus due to the pandemic. The event kicked off with a performance of the national anthem by Charlene C. Hollins, MSN, APRN, FNP-C, a nurse practitioner for Mass General Brigham Urgent Care and former nurse in the Brigham’s Emergency Department, and concluded with post-race stretching led by Brigham physical therapist Karen Lovely, PT, DPT, OCS.

This year, the Brigham welcomed 444 runners and 50 teams — including 266 Brigham employees — who participated either in person or virtually. Together they raised over $200,000 to fuel work at the Brigham that holds special meaning for them, and each had their own story of what brought them over the finish line.

Brigham neurologists Robert Mallery, MD, and Sashank Prasad, MD, co-captains of the newly formed Brainiacs team, ran to raise funds for the Ann Romney Center for Neurologic Diseases. They were inspired to support the work of their colleagues, who are researching treatments for Alzheimer’s, Parkinson’s and other serious neurologic diseases.

“We are excited to have a diverse team of physicians, nurses and trainees, and have been awed by the generosity of those who have made donations on our behalf,” Mallery said.

Charlene Hollins sings the national anthem at the B.A.A. 10K. Check out more race photos here.

“Most of all, we are inspired by our patients and honored to participate in this event for them,” Prasad added.

The ongoing crisis in Ukraine inspired members of the Center for Surgery and Public Health (CSPH) to form the Heal Ukraine team. The team’s goal of supporting cancer and trauma care in Ukraine reflects the mission of the center, which, more broadly, seeks to advance the science of surgery through research that informs policy and program development for safe, high-quality and equitable, patient-centered care in the U.S. and around the world. Among the ways CSPH is supporting Ukraine is by offering consultations to the country’s physicians during this time.

Team co-captains Amanda Reich, PhD, MPH, and Robert Riviello, MD, MPH, participated in past races with colleagues, and both have a longtime love of running.

“Fundraising with the Brigham through the B.A.A. 10K offers the opportunity to combine our personal and professional interests,” Reich said.

“This year, we raised money to support work focused on translating physician- and patient-education resources into Ukrainian and facilitating peer-to-peer consultations for physicians in Ukraine, led by our colleague Dr. Nelya Melnitchouk,” Riviello added. “We were excited to run, work and fundraise together with our friends from CSPH on these shared goals.”

Interested in starting a team, joining an existing one or getting more involved in next year’s race? Sign up for email reminders here.

Brigham OB-GYNs Reflect on What Dobbs v. Jackson Means for the Future of Abortion Care and Women’s Health

On Friday, June 24, 2022, the U.S. Supreme Court delivered a decision in Dobbs v. Jackson that overturned decades of federally protected abortion rights made possible by the court’s landmark 1973 Roe v. Wade ruling. As a result of this decision, federal protection of abortion rights is effectively eliminated. This ruling leaves it to the states to decide whether abortion should be permitted, and to what extent.

In Massachusetts, state law secures a patient’s right to an abortion for any reason through 24 weeks of pregnancy. The Supreme Court’s decision does not alter this protection in Massachusetts, nor the Brigham’s longstanding commitment to providing high-quality care to pregnant patients, which dates to 1832 with the opening of the Boston Lying-In Hospital.

One of the nation’s first maternity hospitals designed to care for women unable to afford in-home medical care, the Boston Lying-In Hospital merged with the Free Hospital for Women in 1966, forming the Boston Hospital for Women. In 1980, the Boston Hospital for Women, the Peter Bent Brigham Hospital and the Robert Breck Brigham Hospital merged to become Brigham and Women’s Hospital.

In response to this historic change in women’s health, Brigham Bulletin spoke with four Brigham OB-GYNs and abortion care experts about the various outcomes they foresee as a result of the Supreme Court’s decision.

Nawal Nour, MD, MPH
Chair, Department of Obstetrics and Gynecology

What’s your reaction to this ruling?

“I am deeply disappointed in the Supreme Court’s decision in Dobbs v. Jackson that has now eliminated federally protected abortion rights; however, I am not surprised. We’ve seen state legislatures propose over 500 laws in 2022 alone that would restrict abortion access. Those of us in the Obstetrics-Gynecology community have been bracing for this day ever since oral arguments were heard in December 2021, and now it has arrived.

This decision goes against reproductive justice, one of the basic principles that leads equitable gynecologic and obstetric care, and it also goes against our mission here at Brigham and Women’s Hospital, which is to maintain and restore health through leadership in compassionate care, scientific discovery and education. There is nothing compassionate about denying a pregnant person’s fundamental right to bodily autonomy, which includes choosing to have an abortion.

While we are fortunate that our Massachusetts Legislature passed the ROE Act, which explicitly makes abortion rights a state law and expands those rights to people ages 16 and 17, there are at least 20 states where abortion will be severely restricted if not outright banned because of the Supreme Court’s decision. No one should have to leave their home state in order to access care, and this decision will place an increased burden on people of color, LGBTQIA and low-income persons.”

Deborah Bartz, MD, MPH
Director of Education, the Mary Horrigan Connors Center in Women’s Health and Gender Biology

Associate Director, Family Planning

As a medical educator in abortion care, how do you expect this decision will shape the training landscape for the next generation of providers, both here at the Brigham and beyond?

“As a medical student, I chose to specialize in OB-GYN very deliberately so I could provide abortion care to patients who needed those services.  When I was a student in the 1990s, the average age of abortion providers was in the mid-60s; most U.S. abortion doctors at that time had lived and worked in the pre-Roe era, and they saw the morbid realities of unsafe, illegal, desperate abortion. My desire to pick up the torch and contribute to training the next generation of abortion providers was actualized with the help of the Ryan Residency Training Program in Family Planning and the Fellowship in Complex Family Planning. Situated in nearly 100 academic medical centers throughout the country, these two training programs have trained thousands of OB-GYN residents and fellows over the last three decades — stabilizing the abortion workforce and providing greater geographical reach for patients.

In Massachusetts, we are fortunate to have abortion protections, and abortion services will remain available in our state. We have created robust curricula that has improved abortion understanding and sympathy among all medical students, not just those going into OB-GYN. Residents are trained in and support both first- and second-trimester abortion care. Moreover, our student, resident and fellow training programs will continue to provide education in full-scope abortion care. In addition to serving Massachusetts residents, we anticipate that some patients will travel to BWH from abortion-hostile states, which may increase our clinical volume and capacity for training.

However, many academic hospitals are facing a different, harsh reality.  Of the 286 accredited OB-GYN residencies, a 2022 study found that 44.8 percent are located in states that are certain or likely to ban abortions without the federal protection of Roe. Abortion training is a required component of OB-GYN residency training for accreditation, and thus students, residents and fellows will have to follow the same migration patterns of patients and seek out-of-state training opportunities. This will be costly and burdensome. This may also be completely unfeasible as abortion services in the remaining 24 abortion-providing states become profoundly overburdened and may not have the bandwidth to train additional residents and fellows. Thus, I fear that we will return to the situation of the 1970s, ’80s, and ’90s, with a small number of trained providers shouldering the provision of safe abortion care for generations to come.”

Amaka Onwuzurike, MD, MPH
Medical Director, Ambulatory Gynecology Clinic

What consequences can we expect this ruling to have on other aspects of women’s health care in states where abortions become severely restricted or wholly unavailable?

“Severely restricted access to abortion care is likely to contribute to an increase in maternal mortality in the United States through an increase in unsafe abortion and continuation of unwanted pregnancies, particularly in populations already at highest risk of experiencing severe maternal morbidity and mortality in the U.S. Approximately 5 percent to 15 percent of maternal deaths worldwide are due to unsafe abortion. While in recent years this has not been a leading cause of maternal death in the U.S, it might begin to rise as it has in countries where abortion is illegal.

The alternative of continuing a pregnancy is not without potentially serious risks. We know that the U.S., unfortunately, has the highest maternal mortality ratio as compared to other high-income countries. We also know there are significant inequities in maternal death in the U.S. because of racism, geography and many other factors. For example, Black and Indigenous women and women residing in rural communities are much more likely to die during pregnancy, childbirth or the postpartum period. These are the same communities that are likely to be disproportionately affected by restrictive abortion laws. In addition to the potential physical harms of continuing an unwanted pregnancy, so too are there mental and emotional harms, and an impact on the social and economic well-being of the pregnant person and their family for years to come.

Restrictive abortion laws are also likely to go hand in hand with other laws that restrict access to critical components of sexual and reproductive health care, creating an environment in this country that is dismissive of, or even hostile toward, the health care needs of women and pregnant people. Closures of clinics that provide abortion services will simultaneously reduce these communities’ access to other sexual and reproductive health services previously provided (e.g., contraception care, sexually transmitted illness testing and treatment, etc.). In this way, severely restricting abortion access may also indirectly contribute to maternal mortality by creating a culture and environment that further de-centers and diminishes the needs of women and pregnant people.”

Alisa B. Goldberg, MD, MPH
Director, Division of Family Planning and Complex Family Planning Fellowship

How will the reversal of Roe v. Wade become a health equity issue?

“Abortion is already a health equity issue, but the reversal of Roe v. Wade will dramatically exacerbate existing inequities. Black, Indigenous and people of color (BIPOC) as well as poor and low-income individuals have higher rates of unintended pregnancy than their white and wealthier counterparts and are similarly overrepresented among people seeking abortion.

Abortion is an exceedingly safe procedure and carries a lower risk of death than dental procedures and colonoscopies. However, we know from the era in the U.S. before Roe and from countries where abortion is illegal that the criminalization of abortion makes it less safe. In settings where abortion is illegal or highly restricted and inaccessible, people seeking abortion who have money and resources will travel to obtain a safe, legal abortion. Those who are without resources and unable to travel — disproportionately BIPOC, low-income and young — will be forced to either self-source an abortion or carry their pregnancies to term. Some people self-sourcing an abortion will be able to obtain a safe but illegal abortion with pills, while others will try less-safe or less-effective methods.

Research shows that those forced to carry undesired pregnancies to term are at least 14 times more likely to die due to childbirth complications than had they received early abortion care. A 2021 study found that if all abortions in the United States were to stop, 21 percent more people would die from pregnancy complications, and 33 percent more non-Hispanic Black people would die.

Beyond exacerbating the existing inequities in maternal morbidity and mortality, the reversal of Roe and inability to access abortion will also worsen socioeconomic inequities and other social determinants of health. One large study that followed more than 1,000 women for five years after being denied an abortion found that those denied were more likely to fall below the federal poverty level, struggle to make ends meet and be evicted from their home.

Women’s health and lives will be universally harmed by the reversal of Roe, and a disproportionate share of the harm will be shouldered by those who are already marginalized.”

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‘It Was Like He Was Your Dad’: Family Expresses Gratitude for Father’s Lifesaving, Compassionate Care

From left: Nurse Sarah Veader embraces Shannon Wilding during an emotional reunion with the team who cared for Wilding’s father, John Bosse (center), while he was hospitalized for COVID-19. Members of the family, including Bosse’s wife, Nancy (second from right), and son, Brad (far right), returned to express their gratitude for the outstanding care he received.

In celebration of Father’s Day, Brigham Bulletin is highlighting the touching story of a Brigham care team that rallied to support a Maine father and grandfather, along with his family, while saving his life from severe complications of COVID-19.

Are they brushing his teeth? Even though she had a hundred other things to worry about while her father was hospitalized for COVID-19 at the Brigham last fall, Shannon Wilding couldn’t get the question out of her mind.

Compared to everything else that her father, John Bosse, 65, had endured since getting sick, Wilding knew that her dad’s teeth were probably the least of his care team’s worries.

Shortly after his COVID-19 diagnosis last September, Bosse’s health sharply declined. His wife of 45 years, Nancy, brought him to the emergency room three times at two different hospitals near their home in Lewiston, Maine, when breathing became especially difficult for him. While receiving monoclonal antibody treatment during one visit at a local hospital, Bosse’s blood oxygen levels plummeted. He was admitted to the intensive care unit (ICU).

Bosse was sedated and intubated, and his health continued to deteriorate. His care team in Maine gently suggested the family prepare for the worst and say their goodbyes.

We care. Period. logo

As doctors investigated transferring him to another medical center with greater resources, a family friend urged them to advocate for a hospital in Boston where more advanced care was available. Three days after his ICU admission, Bosse was transported by a Life Flight air ambulance to the Brigham, where he remained intubated under sedation for another 20 days in October and November.

During that time, Bosse’s family visited frequently and stayed in regular contact with his ICU care team on Braunwald Tower 8 — checking in daily, sometimes multiple times a day, to see how he was doing. Wilding, her brother, Brad, and their mother were anxious to learn the latest updates to his condition. How were his blood gases today? When might he be extubated?

But even with so many big concerns, Wilding found that the question about whether someone was brushing her dad’s teeth gnawed at her mind. In the end, it wasn’t only about preserving his dental hygiene — but also his dignity as a person, not just as a patient.

She spoke with one of his nurses, Sarah Veader, BSN, RN. Yes, of course they were brushing his teeth, Veader assured her.

“Dad was still intubated, with so many tubes coming out of his mouth. With no hesitation, Sarah brushed his teeth with confidence and ease,” Wilding remembered. “Rarely, I’m at a loss for words, but I was speechless. At that point, I had only known Sarah for a very short time, but in that moment I knew Dad was in the very best hands.”

Wilding held back tears as she reflected on that memory when she, her father and their family recently returned to the Brigham to thank members of their Tower 8 care team for their lifesaving care and outstanding compassion.

“Everything you guys did — it was like he was your dad, and that was overwhelming,” Wilding told staff during the emotional reunion in the Bretholtz Center for Patients and Families. “You treated us like he was your family.”

Bosse, his loved ones and several representatives from his Tower 8 care team celebrate his recovery.

Bosse was eventually discharged to an inpatient rehabilitation facility in Maine before returning home a few days before Christmas. Although he remembers almost nothing from his time in the hospital, Bosse said he and his family will never forget the extraordinary difference the Brigham made in their lives.

“It was not just the care I received. It was also the way the staff treated my family. They tear up every time they talk about it,” Bosse said. “I know there was a large team, and my family spoke highly about them all. They made this tough time more tolerable for them.”

‘You Do Make a Difference’

The severity of his illness was never lost on Bosse and his family.

“Whenever he sees the news about people in our own town who passed away, he says, ‘That could have been me,’” his wife said.

Bosse reveals a T-shirt his family made for him with the phrase “This Pep Beat COVID.” Pep is short for pépère, a French-Canadian term for grandfather that became Bosse’s nickname years ago. During his illness, “Pep Strong” became his family and community’s rallying cry.

Following his discharge from the Brigham, Bosse embarked on three weeks of inpatient physical, occupational and speech therapy at New England Rehabilitation Hospital in Portland to rebuild his strength. He transitioned to outpatient therapy, and earlier this year was walking with the help of leg braces, a walker or cane.

When he returned to the Brigham in April with his family to thank staff, he walked into the 75 Francis St. entrance with the help of just ankle and foot orthotics. Bosse shared with staff that he’s already back to doing what he loves, including golfing. In August, he plans to participate in a local 10K with his 10-year-old grandson, Conor. By September, he hopes to be back on ice skates to rejoin his hockey league.

“This is such a gift,” said Diane Tsitos, MSN, RN, nursing director for Tower 8, upon hearing all the progress Bosse has made since his discharge. “It really warms our hearts. This is why we do what we do.”

During their visit, the family showed their appreciation by distributing treats to staff and small cards with “The Starfish Story,” a parable about a man who picks up starfish stranded on the beach and returns them to the ocean — a tale to illustrate the influence one person can have on another.

“I am so grateful,” Bosse told the Tower 8 staff gathered in the Bretholtz Center. “Don’t give up on what you do. You do make a difference. It certainly has in our lives. We’re never going to forget.”

Attending intensivist Sarah Rae Easter, MD, emphasized the important role families play in caring for patients and thanked Bosse’s loved ones for their support as well.

“We know him as a patient. We know his labs. We know the physiology. We know the medicine. But that doesn’t mean that we know him,” Easter said. “You know him as a person. You know his passions, his quirks, his pet peeves and his values.  We can’t make decisions about him as a patient without your insights about him as a person. While you were so grateful to us, it was your advocacy for his care that got us to his outcome.”

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