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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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Expanded Awards Program Supports 5 Physicians and Researchers

Galen Henderson and Tina Gelsomino (first and second from left) and Robert Higgins (far right) celebrate with awardees (center, from left) Gezzer Ortega, Shaina A. Lipa, L. Nicolas Gonzalez Castro and Ayobami Akenroye. Not pictured: Ivy Franco

Five rising stars in academic medicine and research were recently named the winners of the 2022 Minority Faculty Career Development Awards (MFCDAs), which seek to support and retain underrepresented in medicine (UIM) trainees and junior faculty at the Brigham.

This year marks the program’s largest-ever number of awardees — a milestone made possible through the support of the Office of the President.

“It is not enough to simply say that we are committed to advancing diversity, equity and inclusion. We must take action to demonstrate that commitment, especially when it comes to creating a culture and environment where the next generation of UIM physicians and scientists can thrive,” said Robert S.D. Higgins, MD, MHSA, president of the Brigham and executive vice president at Mass General Brigham. “It’s our honor to support these emerging leaders in science and medicine through this year’s expansion of our Minority Faculty Career Development Awards program.”

This year’s winners are Ayobami Akenroye, MBChB, MPH, of the Division of Allergy andStronger Together Brigham Values Logo Clinical Immunology; Idalid (Ivy) Franco, MD, MPH, of the Department of Radiation Oncology; L. Nicolas Gonzalez Castro, MD, PhD, of the Brigham’s Department of Neurology and the Center for Neuro-oncology at Dana-Farber Brigham Cancer

Center; Shaina A. Lipa, MD, MPH, of the Department of Orthopaedic Surgery; and Gezzer Ortega, MD, MPH, of the Center for Surgery and Public Health in the Department of Surgery.

Established in 1996 thanks to the efforts of Marshall Wolf, MD, Howard Hiatt, MD, and Robert Handin, MD, the MFCDA program was created to increase the representation of UIM physicians and scientists in fellowship programs and faculty positions at the Brigham. It provides $100,000 awards to recipients over five years — with a quarter of the funds reserved for clinical/research-related and career development purposes — and is administered by the Brigham’s Center for Diversity and Inclusion.

According to the American Association of Medical Colleges, “underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” At Brigham, those identities include African American/Black, Alaskan/Hawaiian Native, Hispanic/Latinx and Native American.

“On behalf of the Center for Diversity and Inclusion, we are thrilled to offer five Minority Faculty Career Development Awards to these outstanding faculty members,” said Galen Henderson, MD, chief diversity and inclusion officer for Faculty, Trainees and Students. “This type of award is crucial for faculty early in their careers so they can dedicate time to the advancement of scientific research, clinical care and their own professional development. These awardees are the future leaders of our organization and in academic medicine.”

Learn more about this year’s winners and what the award means to them:

Ayobami Akenroye, MBChB, MPH
Division of Allergy and Clinical Immunology

“My long-term goal is to be an outstanding physician-scientist, conducting translational epidemiologic research in the area of heterogeneity of treatment effect of monoclonal antibodies in the treatment of asthma. Ultimately, I want to improve the care of everyone with asthma — regardless of age, gender, body mass index, or race or ethnicity. I intend to use the period of this award to develop preliminary data, which will inform my first and potentially subsequent R01 applications. My prior training, additional training during the period of this award and excellent mentorship will position me to be one of the rising leaders in my chosen area of research.”

 

Idalid (Ivy) Franco, MD, MPH
Department of Radiation Oncology

“Through the support of the MFCDA, I will be able to effectively acquire the tools needed to address cancer health disparities, focusing on efforts in health equity, access and inclusion — leading to improved workforce diversity and patient outcomes within Radiation Oncology. I aspire to have my work improve patient outcomes for our most vulnerable communities and inspire younger generations to continue to apply a health equity lens to their work.”

 

 

Nicolas Gonzalez Castro, MD, PhD
Department of Neurology, Brigham and Women’s Hospital
Center for Neuro-oncology, Dana-Farber Brigham Cancer Center

“The support of the MFCDA will help advance my current research in glioblastoma genomics and epigenomics, increasing our biological understanding of this aggressive and invariably fatal brain tumor and uncovering new therapeutic targets. Support at this stage of my career will also help me generate preliminary data to apply for additional funding mechanisms as I continue developing as a physician-scientist in neuro-oncology.”

 

Shaina A. Lipa, MD, MPH
Department of Orthopaedic Surgery

“My main goal over these early years is to build my clinical practice in order to deliver quality and equitable spine care to my patients, which is and has always been my primary motivator. One of the byproducts of this goal is that this will allow me to become a respected faculty member of the spine surgery community and greater orthopaedic community at large. Secondly, this will inform my research, which is focused on the delivery and quality of orthopaedic care in the ever-changing climate of health policy. Receiving the MFCDA would provide the financial support to pursue coursework to gain new skills in the area of quality and safety, which is an area of interest for me, given its relation to primary goal of delivering quality and equitable care to patients.”

Gezzer Ortega, MD, MPH
Center for Surgery and Public Health, Department of Surgery
Patient Reported Outcomes, Value & Experience (PROVE) Center

“The MFCDA will accelerate my overall career goal of becoming an independently funded physician-scientist focused on identifying and addressing inequities in surgical care. I have been highly productive in the early stages of my career, but there are critical knowledge and skills gaps that this MFCDA will resolve so that I can become a nationally regarded expert in improving outcomes for surgical patients with limited English proficiency and advancing language-concordant care.”

DE&I Town Hall Highlights Projects Addressing Racial Disparities in Patient Care

Quoc-Dien Trinh explains how the Prostate Cancer Outreach Clinic has adopted a proactive approach to ensure Black men have equitable access to prostate cancer care.

Asking difficult questions, facing hard truths and challenging long-held norms — while at times uncomfortable, these actions are essential to addressing health equity and eliminating racism in health care settings, noted presenters at the Brigham’s Diversity, Equity and Inclusion (DE&I) Town Hall on May 26.

One important conduit for this work is the systemwide United Against Racism (UAR) initiative, explained Brigham President Robert S.D. Higgins, MD, MHSA, during his opening remarks for the event. Composed of three focus areas — health equity, community health and workforce equity — UAR seeks to identify and eliminate racist barriers, systems and actions inside and outside of Mass General Brigham.

Additionally, the Brigham recently established a new multidisciplinary team, the Communication Resource Committee, to advise the Office of the President and Office of Strategic Communication on responding to external events, including those involving issues of racial justice and health equity.

“To really move the needle in dismantling racist systems, we need to address these issues on a number of fronts,” Higgins said. “Real change also requires that we engage the highest levels of our organization while also supporting local efforts and projects.”

A Catalyst for Change in Prostate Cancer Care

The DE&I Town Hall spotlighted two projects at the Brigham — both supported with UAR grants — that are working to address health inequities and structural racism in clinical settings.

Quoc-Dien Trinh, MD, FACS, of the Division of Urological Surgery, discussed the Mass General Brigham Prostate Cancer Outreach Clinic (PCOC), a joint program between the Brigham and Massachusetts General Hospital (MGH) that seeks to make high-quality, affordable prostate cancer care accessible to more men of color.

The clinic, which Trinh co-founded with MGH colleague Adam Feldman, MD, MPH, was created to address the disproportionate burden of prostate cancer among Black men, who are 22 percent less likely to receive treatment for the disease compared to white men.

“Even in Massachusetts, despite the access to insurance, there’s a disparity in access to care,” said Trinh, who also serves as director of Ambulatory Clinical Operations for Urological Surgery, co-director of the Prostate Cancer Program for Dana-Farber Brigham Cancer Center and a core faculty member of the Center for Surgery and Public Health.

In designing the program, Trinh and Feldman met with Black men across Massachusetts to better understand the current barriers to care. Inconvenient services, high costs and mistrust of large health care systems ranked high among the reasons the men interviewed said they avoided care at academic medical centers like the Brigham and MGH.

Rather than relying on a conventional approach of waiting for patients to seek care, PCOC was founded on the principle that providers must be more proactive with outreach and education to connect patients with the care they need, Trinh explained.

Stronger Together Brigham Values LogoA community health worker helps patients navigate appointments, a collaboration with the Department of Quality and Safety proactively identifies at-risk patients who lack referrals, and partnerships with third-party organizations are helping to build trust with local communities.

“The vision is to use PCOC as a catalyst to bring our communities compassionate prostate cancer care,” Trinh said.

Identifying ‘Blind Spots’ in Behavioral Health

Meanwhile, a UAR grant-funded multidisciplinary training program developed in collaboration with faculty from the Brigham, Brigham and Women’s Faulkner Hospital (BWFH) and MGH Emergency Departments (EDs) is addressing how to reduce racial bias and provide trauma-informed care when managing agitated patients.

Dana Im, MD, MPP, MPhil, director of Quality and Safety and director of Behavioral Health for Brigham Emergency Medicine, explained that the project was inspired by a study led by Emergency Medicine resident Jossie Carreras Tartak, MD, MBA, and senior author Wendy Macias Konstantopoulos, MD, MPH, MBA, vice chair for Diversity, Health Equity and Inclusion for MGH Emergency Medicine, in close collaboration with Tom Sequist, MD, MPH, Mass General Brigham chief medical officer, and his team. The multi-institutional research team looked at the use of restraints for patients under an involuntary hold during an emergency psychiatric evaluation. After examining data from 11 EDs across Mass General Brigham, they found that Black and Hispanic patients experienced higher rates of physical restraint in the ED.

Following that 2021 publication, the Brigham’s ED team launched its Emergency Medicine Antiracism and Trauma-informed (ART) Interdisciplinary De-escalation Training Program, which approximately 120 ED staff — including physicians, nurses, support staff, security officers and psychiatrists — have completed to date.

“We felt that, in order to address the disparities in the ED that were highlighted in the study, we couldn’t just present the numbers to our staff and ask them to provide unbiased care,” Im said. “We really had to equip and empower them to provide equitable care.”

Initially launched as a pilot to reduce racial bias during de-escalation, the program, led by Emergency Medicine fellow Farah Dadabhoy, MD, has been expanded to include trauma-informed and antiracism principles. It will be used to train all ED staff at Brigham and BWFH. A similar training program has been implemented in MGH ED as part of the UAR collaboration.

An important component of the training is standardizing the way agitation is assessed and addressed, Im explained. When designing the program, Im and her colleagues learned from their interviews with ED staff that while one clinician might perceive a patient as violent and in need of restraint, another clinician might see the same patient as upset.

In addition to developing a consistent description of agitation, the team developed a team-based algorithmic approach to deescalating ED patients in an agitated state to ensure equitable care.

“We tell our trainees to think of a patient who comes to mind when EMS calls and says there’s a 55-year-old intoxicated male picked up at Forest Hills station. Then juxtapose that image with the patient you picture when EMS calls in with two intoxicated males picked up at a Boston College party,” Im said. “This exercise gives us space, time and opportunity to think through our blind spots and how bias really seeps into our clinical care.”

Taking a Trauma-Informed Lens

Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN, co-chair of the Mass General Brigham Trauma-Informed Initiative, explained how understanding the trauma a patient has experienced, including individual and systemic racism, can influence the way they experience health care settings.

“Trauma is intersectional — individual, interpersonal, collective and structural. It’s an event, series of events or set of circumstances that’s experienced by an individual as either physically or emotionally harmful, and the key to it is that it has long-lasting effects,” said Lewis-O’Connor, who also serves as founder and director of the C.A.R.E. (Caring Approach to Resiliency & Empowerment) Clinic.

Trauma-informed care (TIC) is a set of principles that providers can incorporate into their practice to improve the quality of care by building trust, create safe spaces and empowering patients and staff, while also strengthening peer support and interdisciplinary collaboration.

“In fact, TIC does not require you to do more work; rather, it suggests a way to reframe how we work,” Lewis-O’Connor said. “It’s a strength-based framework. It’s about not asking ‘What’s wrong?’ but rather ‘What’s happened?’ and ‘How has that impacted you?’”

View a recording of the event.

Emergency Department Expansion Goes Live with Completion of Construction Phase

Among the many additions to the expanded and renovated ED are two state-of-the-art trauma rooms that make up the Ron M. Walls, MD, Trauma Suite, which is pictured above and was named in recognition of a generous gift from Jane C. and Brian L. Crowley.

After seven years of planning, approvals and a building process that included continued construction during a worldwide pandemic, the Brigham’s Emergency Department (ED) expansion project celebrated the end of its final phase of construction this month.

In addition to doubling the ED’s total square footage and creating another 30 beds, the expanded space boasts a new trauma suite, a dedicated area for behavioral health patients and additional emergency imaging capabilities.

“We’re excited to formally open our new Emergency Department, which will allow us to continue to support our patients who need emergency medical care,” said Robert S.D. Higgins, MD, MSHA, president of the Brigham and executive vice president at Mass General Brigham. “This new, state-of-the-art space is part of our ongoing commitment to meet the needs of our community and improve our patients’ experience.”

The expansion will improve efficiency for ED staff, support a reduction in wait times and provide a more comfortable, healing environment for patients and families, explained Michael J. VanRooyen, MD, MPH, chair of the Brigham’s Department of Emergency Medicine and enterprise chief of Emergency Services at Mass General Brigham.

“We focused on designing a space to both provide the best health care experience possible to our patients and to support our staff,” VanRooyen said. “It’s not just about creating more space but also prioritizing the workflow and the patient journey to make sure we’re leading the way and being an example for other emergency departments in the future.”We pursue excellence logo

The COVID-19 pandemic disrupted numerous facets of hospital operations throughout the year, and the ED was no exception. However, through the work of hospital and ED leadership, Brigham Infection Control experts, construction teams and local regulatory agencies, the construction project continued through this difficult stretch of time.

“We maintained the highest safety standards despite the unique challenges posed by the COVID-19 pandemic,” said Sonal V. Gandhi, vice president of Real Estate, Planning and Construction. “It is a testament to the innovative and dedicated team of professionals who work tirelessly to meet the critical need for increased capacity while providing the best health care experience for our patients, families, surrounding community and staff.”

The three-phase construction project broke ground in 2019 and has resulted in a 26,000-square-foot expansion of the ED’s footprint. The renovation included the creation of an additional 32 exam rooms, an increase from 49 to 81 beds, two state-of-the-art trauma rooms, two advanced X-ray rooms, an additional CT scanner and a second ultrasound room.

The project also included a new entrance, security and check-in desk, waiting room, care initiation and triage rooms, as well as an eight-bed behavioral health observation unit. Care initiation and triage rooms make it possible to quickly advance patient care during longer wait times and for low-acuity patients who can be seen and discharged by medical staff without waiting longer for care elsewhere in the department. A specialized oncology unit catering to the unique needs of patients with cancer emergencies will open at a later date.

These resources could not become available at a more important time, as emergency departments across the city, including the Brigham’s, continue to face high censuses and inpatient boarding challenges, said Christopher Baugh, MD, MBA, vice chair of Clinical Affairs for Emergency Medicine.

“Through this expansion, our team looks forward to better serving patients and families,” Baugh said. “This expansion is also an important part of our mission to ensure that we are supporting our surrounding community — especially as it pertains to serving those patients for whom it could be lifechanging or lifesaving to have access to the highly complex and specialized care that we provide here at the Brigham.”

Specialized Care for Behavioral Health Patients

The behavioral health observation unit has been environmentally tailored to suit the needs of this patient population by providing safe and private space, with softer lighting and reduced noise.

“Improving patient privacy and making sure we provide our behavioral health population with the most respectful space, tailored to their needs, was a top priority for the ED’s nurses, who have been involved in every aspect of the new space,” said Janet Gorman, MM, BSN, RN, associate chief nursing officer of the ED.

“We really wanted to create a space that was internal to the ED but separate from all the other activity so that we can provide dedicated care to our behavioral health patients,” says Dana Im (picture in foreground) about the ED’s new behavioral health unit.

Equipped with its own nursing station, medication room and a dedicated team of providers, the unit was designed to ensure behavioral health patients receive personalized care, explained Dana Im, MD, MPP, MPhil, director of Quality and Safety and director of Behavioral Health for Emergency Medicine.

Patients in the unit also receive a “comfort menu,” which invites them to access a variety of items and services to support a comfortable stay — including earplugs, books and magazines, crossword puzzles, snacks, personal hygiene items and sleep aids. The handout also provides relaxation tips, such as breathing exercises, as well as information about safety and privacy guidelines. Patients are also given an opportunity to contribute to their care plan by sharing their preferred calming strategies and which conditions trigger emotional discomfort.

“Our old ED environment was not conducive to behavioral health care, and we also felt our staff was being pulled in so many directions. It’s really hard to care for an escalating patient while EMS stretchers are passing by every five minutes and trauma teams are activated right next door,” Im said. “We really wanted to create a space that was internal to the ED but separate from all the other activity so that we can provide dedicated care to our behavioral health patients.”

One notable aspect of the Brigham’s behavioral health unit is it is staffed by a multidisciplinary team of ED clinicians, who work closely with social workers, psychiatrists and, most recently, a psychiatric occupational therapist, Im explained. The multidisciplinary team focuses on acute stabilization, treatment and reassessment of both medical and psychiatric illnesses.

Additionally, in anticipation of the unit’s opening, Im and her colleagues implemented interdisciplinary rounds in the ED for behavioral health patients. Rounding in the traditional sense is uncommon in EDs, but the team recognized a need to bring together clinical and nonclinical staff to optimize care for this patient population.

“It’s really a great opportunity for us to come together as a team for patients. Centralizing the care in the new unit will now make it even easier for us to do so,” Im said. “We see a lot of medically complex psychiatric patients, and we’re now uniquely equipped to provide a higher quality of care to our behavioral health patients.”
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ED Renames Pods to Honor Boston Marathon Route

Included in the project is a new naming convention for the six areas (pods) that make up the ED. Those pods are now named after the Boston streets that are connected to the final stretch of the Boston Marathon: Arlington, Berkeley, Clarendon, Dartmouth, Exeter and Fairfield.

The naming convention pays homage to the victims of the 2013 Boston Marathon bombing and honors the caregivers, including those in the Brigham’s ED, who played a critical role in responding to the tragic event and caring for the wounded.

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‘More Important Than Ever’: Women’s Health Must Continue Pushing Boundaries, Brigham Experts Say

Featured speakers from the 2022 Women’s Health Luncheon included (from left) Annie Lamont, Hadine Joffe, Robert Higgins and Anita Hill. Not pictured: Bruce Levy

In 2007, a small group of women’s health researchers gathered around a conference room at the Brigham to share insights about their latest discoveries and, distressingly, the tremendous gaps remaining in science’s understanding of how a person’s sex influences disease.

That once-intimate gathering has since grown into a dynamic annual fundraising event supporting and showcasing the groundbreaking work of the Mary Horrigan Connors Center for Women’s Health and Gender Biology before an audience of hundreds of philanthropists, business leaders and women’s health advocates.

This year’s event, held May 6 at the Omni Boston Hotel at the Seaport, marked not only its 15th anniversary but also the luncheon’s first in-person format since 2019. Aptly themed “Finding Our Voice,” the luncheon also coincided with a time when women’s health, specifically reproductive health, is the subject of contentious national debate.

“It is clear that our mission to protect and advance the health and lives of women is more important than ever,” said Hadine Joffe, MD, MSc, executive director of the Connors Center.

Brigham President Robert S.D. Higgins, MD, MSHA, underscored the institution’s unwavering commitment to supporting and advancing all facets of women’s health.

“At the Brigham, we continue to uphold our longstanding mission to provide safe, accessible and high-quality care to all patients who seek it. We deliver care with compassion and without judgment,” said Higgins, who also serves as executive vice president at Mass General Brigham. “We remain patient-centered and focused on achieving the best outcomes. Our commitment to providing high-quality care is importantly inclusive of all women — particularly those from historically disadvantaged backgrounds.”

Uncovering Gaps, Asking Questions

More broadly, speakers noted, women’s health research has made significant strides in recent years — but also still has a long way to go. Throughout that time, the Connors Center has been at the forefront of advocating for meaningful change in the field, Joffe said.

“Fifteen years ago, scientists doing preclinical research were not required to consider sex when they studied animals, tissues or cells. What this means is that research at its most fundamental level and its starting point did not account for the most basic biological differences that exist between females and males,” she explained. “This left us without a clear understanding of how sex influences health and disease, but it left us with medications, medical treatments and guidelines that were not calibrated for women’s specific biology or life experience.”

Several years ago, Connors Center scientists were among those who testified before Congress about this gap. That advocacy contributed to the National Institutes of Health’s 2016 policy requiring scientists to include females and sex-specific information in data they report out, Joffe said.

One compelling and timely example of the need to better understand how sex influences disease can be seen in the condition that has come to be known as “long COVID,” or post-acute sequelae of COVID-19, in which a person who has recovered from the initial COVID-19 infection continues to experience lingering symptoms like fatigue, muscle pain, migraines and cognitive struggles.

Scientists are learning that women are three times more likely to experience long COVID than men, yet the reason for that disparity remains unclear, said Bruce Levy, MD, chief of the Division of Pulmonary and Critical Care Medicine and one of the luncheon’s three featured speakers.

Levy noted that Brigham clinicians and researchers are leading the way nationally in efforts to deliver personalized care to long COVID patients through the COVID Recovery Center and better understand the condition through the Greater Boston COVID Recovery Cohort.

“There are still many long COVID patients we don’t have answers for,” Levy said. “More research is desperately needed, but there are many patients with long COVID who benefit from the care provided at specialized centers like ours.”

The event also featured remarks from Anita Hill, JD, university professor of Social Policy, Law and Women’s, Gender and Sexuality Studies at Brandeis University, and Annie Lamont, first lady of Connecticut and co-founder and managing partner of Oak HC/FT, a venture capitalist firm whose focus includes health care startups.

Reflecting on what it takes to transform women’s health and address inequities, Hill emphasized that research and advocacy must go hand in hand.

“I know we can be, already are and will continue to be the catalyst for the solutions that we are waiting for,” she said. “Find your voice, use it and make change happen.”

The luncheon raised more than $700,000 to fund women’s health research — $150,000 of which was pledged during the event to fund new IGNITE Awards, which provide direct support to Connors Center scientists who are conducting groundbreaking research in women’s health.

After Others Deemed Her Case Inoperable, Brigham Neurosurgery Team Cures a Mom’s Rare, Deadly Brain Disorder

“They are the most important thing in my life,” Nicole Haight (second from right) says about her four children.

In celebration of Mother’s Day, Brigham Bulletin is highlighting how one mother’s unwavering devotion to her family set her on an extraordinary path to healing with the support of her Brigham care team.

The pulsing sound in Nicole Haight’s ears just kept getting louder. Whoosh. Whoosh. Whoosh. It was disorienting as she worked as a building painter, trying to maintain her balance on lifts and ladders. At home, the pulsing was eventually so loud that it nearly drowned out the sound of her youngest son’s cries.

Then came the crippling migraines. Haight, 29, had never experienced anything like them in her life. She saw a doctor near her home in Stockton, Ill. They thought it was a severe ear infection. It turned out to be something much worse.

After undergoing an MRI last June, Haight learned she had an arteriovenous malformation (AVM) in her brain. It’s a condition that causes capillaries — tiny blood vessels that connect veins and arteries — in the brain to form incorrectly.

Haight at work prior to her diagnosis

“One of the best descriptions somebody gave me was that it’s like a bunch of Christmas lights tangled up,” Haight said.

In a healthy person, brain capillaries are like speed bumps on a busy road, preventing blood from flowing too quickly across these connections. In someone with an AVM, blood rushes from the artery into the vein — the source of that loud pulsing sound Haight was experiencing — and causes the vein to blow up like a balloon. At any time, the pressure buildup can cause the vein to burst without warning. If that happens, there is a 20 percent chance of death. Among those who survive, the risk of permanent injury to the brain is greater than 40 percent.

AVMs are rare, affecting one in 100,000 people, and congenital, meaning they are present from birth. They are the leading cause of hemorrhagic stroke in young people.

Haight, a single mother of four, says she wrestled with what this diagnosis meant for her and her family.

“I was so scared,” she said. “I even started a notebook and wrote notes to all my kids, just in case I wasn’t here.”

Determined to Find a Solution

Shortly after her diagnosis, Haight drove two and a half hours for consult with a neurosurgeon in Wisconsin. They told her that her AVM was inoperable and offered to treat it with radiation therapy — an approach that would offer a low likelihood of success and take six years to complete, a period during which her AVM could rupture at any time.

So, she saw another neurosurgeon. And another. And another. In all, she met with seven surgeons across the Midwest. They each told her the same thing: Surgery was just too risky due to the size and location of the AVM, which was in the area of her brain that controls speech. One hospital in Chicago agreed to perform an embolization, a treatment that stops blood flow in a targeted area. The procedure was unable to completely resolve her condition.

An image of Haight’s AVM, captured on a diagnostic angiogram, shows an artery going directly to a vein without intervening capillary.

It started to feel like her life was being taken over by researching doctors, scheduling appointments and traveling across states for consults — all while managing her worsening symptoms. But Haight says none of that compared to the heartbreak she experienced as she watched her children process what was happening.

“It was hard on my kids because I don’t think they fully understood why I was always so sick. That was the worst part,” she said. “My dad had passed a few years prior, and they asked if I was going to end up with their grandpa.”

Haight was determined not to let that happen — and thanks to a chance encounter, she became connected with the Brigham Neurosurgery team who refused to give up on her, too.

Defusing a ‘Ticking Time Bomb’

While at a house-painting job outside Chicago last year, Haight, her mother and her uncle — who all work together as part of a family business — got to chatting with their client and learned that his son was a Neurosurgery resident at the Brigham. After they shared her story, he offered to make an introduction.

That was how Haight met Nirav Patel, MD, director of the Brigham’s AVM Program and a global expert in treating complex AVMs. They scheduled a virtual visit, and Patel reviewed the scans from Haight’s latest MRIs.

Removing an AVM is a painstakingly slow, careful process. The entire surgery is performed under a microscope as Patel and his multidisciplinary team work to untangle and remove the malformed blood vessels, millimeter by millimeter — a process that takes up to 12 hours.

“We often see patients with high-grade AVMs who have been bounced around and told it is a ticking time bomb — that nothing can be done. But that isn’t always true. If we catch it and surgically remove it, it’s gone forever,” Patel explained. “For so much in neurosurgery, we don’t get a cure, no matter how good of a job we do. But this is one of those diseases where, with a great team and a lot of effort, we can cure these patients for life.”

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Among hospitals in Boston, the Brigham stands out for performing the highest volume of AVM removals and taking on the most complex cases, Patel said. Over the course of his career, he has completed more than 100 of these surgeries and is passionate about ensuring patients worldwide have access to this lifesaving procedure.

For Patel, there was no question in his mind that he and his team could help Haight.

That was all Haight needed to hear. This February, she and her mother got into their pickup truck and made the 16-hour drive to Boston. She couldn’t fly, as the cabin pressure in a plane might have caused her AVM to rupture.

But before they could see Patel in his clinic, Haight was struck with severe migraines and went to the Brigham’s Emergency Department. Her care team there paged Patel, who met with Haight and her mother. The team prepped her for surgery.

“‘I’m glad you’re here. We’re going to take care of you,’” Patel remembered telling them.

‘I Feel So Free’

After half a day in surgery, Haight was placed in a medically induced coma for seven days to help her body rest and heal. When she woke up, she only remembered one fact about her life: her four children.

“I’m grateful for every little thing,” Haight says of life after her surgery.

“They are the most important thing in my life,” Haight said.

While it took some time to recover her speech and other fine-motor skills, Haight said all the symptoms of her AVM had vanished. Within a few days, she was eager to return home to her family and received the go-ahead from her care team to rejoin her mother in their pickup truck and head back home. Today, almost fully recovered, Haight is back at work and enjoying every moment with her loved ones. Her AVM is gone — permanently.

“I feel so free now,” she said. “I’m grateful for every little thing.”

Among the recipients of her gratitude are her Brigham care team, she added.

“I’ve never met staff who are so caring,” she said. “Dr. Patel is so different from any other doctor I’ve met. He smiles whenever he sees me. He genuinely cares. At one point, he said to me, ‘I will treat you as a whole person. I know you’re a mother. I know you have kids.’ I felt like to all the other doctors, I was just a case.”

Patel said he was not surprised to see Haight recover so quickly.

“She’s an unstoppable force,” he said. “Mothers always bounce back the best because they have that motivation. They are willing to do whatever it takes to be there for their kids.”

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When Cancer Threatened to Take a Patient’s Eye, a Brigham Care Team Saved It — and Him

Left photo: Ira Santos, shortly after his surgery in April 2020; Right photo: Santos, now fully healed and in remission, enjoys a moment recently with his husband, Barry Macero.

When Ira Santos started to find it difficult to breathe through his nose, he assumed allergies were to blame. But when his symptoms worsened and his face became swollen and painful, he knew something else was wrong.

Even so, nothing prepared Santos and his husband, Barry Macero, for the shocking revelation they received after Santos underwent a CT scan: It was cancer.

They learned Santos had developed squamous cell carcinoma — an aggressive form of skin cancer — in an uncommon location, including his sinuses, palate and the bottom of his eye socket. After consulting with a surgeon near their home in Peabody, Santos and Macero received another bombshell.

“They immediately told him he needed surgery, and they were going to remove his eye,” Macero recalled. “When we asked about alternative therapies and chemotherapy, they said it wouldn’t work.”

The prospect of losing an eye would be difficult for almost anyone to accept. But as a hairdresser, it would have been especially devastating for Santos, who relies so heavily on his vision to do his job well.

“I said to Ira, ‘How are you going to cut hair with one eye?’” Macero said. We pursue excellence logo

They sought a second opinion at Dana-Farber Brigham Cancer Center. That decision saved Santos’ life — and his eye.

“We called and got an appointment right away, and when we came in, we were assigned a team of doctors,” Macero said. “The first thing they said was, ‘Before we do surgery, let’s see if we can reduce the size of the tumor with chemotherapy.’”

Several rounds of chemotherapy were somewhat effective in reducing the tumor size, but ultimately not enough to avoid surgery. However, the care team’s willingness to try a less-invasive treatment strategy — and their understanding of how important it was to preserve Santos’ eye, if possible — made the couple feel like they were in the best hands, they said.

“I can’t tell you how wonderful they were,” Macero said. “They made us feel included in all the decisions.”

‘It Was a Miracle’

Eleni Rettig, MD, of the Division of Otolaryngology-Head and Neck Surgery, who led the team that performed Santos’ surgery two years ago, said a multidisciplinary, patient- and family-centered approach is essential to achieving the best outcome for patients like Santos.

To develop a treatment plan for Santos, Rettig worked closely with colleagues Glenn Hanna, MD, of Medical Oncology, and Danielle Margalit, MD, of Radiation Oncology.

“Head and neck cancer in general is not very common, and because the treatment can have such an impact on your function, it’s ideal to be treated in a high-volume center that has experience with these tumors and the reconstruction,” Rettig said. “We treat patients as a team. We’re able to see them together in our clinic, which is unique and provides patients some comfort in knowing we collaborate so closely.”

In Santos’ case, because imaging showed the tumor had invaded the bottom of his eye socket, the team was uncertain whether the cancer had spread to the area directly around his eye, Rettig explained. They wouldn’t know for sure until he was in the Operating Room (OR) and Rettig had an opportunity to take a tissue sample from his periorbita — a fibrous capsule surrounding the eyeball — to see if cancer cells were present.

In addition, the surgery itself would be challenging, Rettig said. After removing the tumor, Rettig would need to reconstruct his cheekbone and eye socket using segments of bone from Santos’ leg, as well as skin from his leg to recreate his palate. The team used computer modeling in advance of the surgery to plan the reconstruction. Once in the OR, they transferred the bone and tissue and, finally, sewed the blood vessels together under a microscope.

“It’s one of the most complex surgeries we do,” Rettig said.

When a Pathology team reported back that the periorbita was cancer-free, Rettig said she breathed a sigh of relief. There was no need to remove Santos’ eye. After more than 12 hours in the OR, she called Macero to share the good news.

“She said, ‘I saved his eye and got 100 percent of the cancer,’” Macero remembered. “I started crying. I said, ‘Oh, my God. Thank you so much.’ It was a miracle that she saved his eye.”

Santos’ surgery took place in April 2020, just as the pandemic prompted the Brigham to implement restrictions on visitors. Despite all the uncertainty of that time, Santos and Macero said that staff who cared for him postoperatively made them feel cared for and connected to his loved ones.

“Ira used to rave about the nurses when he was there,” Macero said. “They encouraged him to call me as much as he wanted.”

After being discharged home, Santos underwent six weeks of radiation therapy with more chemotherapy to ensure all the cancer was eliminated. Today, Santos maintains a clean bill of health, and says he feels great and that his eyesight is just as good as it was before surgery.

“The recovery was very nice,” Santos said. “The doctor said that maybe I could go back to work in 10 months or one year, and I got back in three months.”

Macero said they are both incredibly grateful for the care they received.

“I can’t tell you how thankful I am for Dana-Farber and Brigham and Women’s,” Macero said. “They are amazing.”

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Hospital Leaders Highlight Successes, Challenges at State of the Brigham Forum

From left: Claire-Cecile Pierre, Sunil Eappen and Allison Moriarty listen as Robert Higgins delivers his opening remarks during State of the Brigham.

In his first five months leading the hospital, Brigham President Robert S.D. Higgins, MD, MSHA, has found one thing abundantly clear: Even in the face of so many challenges, members of the Brigham community demonstrate a level of dedication and compassion that is unmatched, Higgins told staff during his opening remarks at the first State of the Brigham forum on April 14.

Speaking to a live audience in Bornstein Amphitheater and viewers watching the webcast virtually, Higgins acknowledged the past year has been physically, mentally and emotionally taxing. From the ongoing pandemic to capacity issues affecting hospitals nationwide earlier this year, the hardships that health care workers have faced often felt relentless, he remarked.

Even so, Brigham staff have remained unwavering in their support of patients, families and each other, Higgins said.

“I’m proud to say we’ve seen the Brigham community remain rooted in our commitment to high-quality patient care and driven by our mission,” he said.

To illustrate this, Higgins highlighted several examples of how staff bring the Brigham’s values to life. Among these was the recent launch of a groundbreaking clinical trial to test nasal vaccines for Alzheimer’s disease. Reflecting how the Brigham creates breakthroughs, the trial will study how well the vaccine prevents the onset of Alzheimer’s in younger, high-risk patients as well as if it halts the progression of symptoms in patients with active forms of the disease.

“This trial represents the culmination of nearly 20 years of research at the Brigham led by Dr. Howard Weiner,” Higgins said. “For two decades, his team has accumulated preclinical evidence supporting the potential of this nasal vaccine for Alzheimer’s — an amazing testament to the value of investing in this type of research.”

Higgins also underscored the importance of continuing to collaborate across Mass General Brigham and fulfill the promise of truly integrated system of patient care.

Additionally, he cautioned that there are still headwinds on the horizon, particularly as the financial impact of the pandemic continues to reverberate.

“As we have in the past several years, we have to see that our expenses are controlled as we consider how to balance our current budget,” Higgins said. “I’m proud to say that, like everything else, the Brigham will lead the way. As my mom said, pressure makes diamonds, and we want to continue to be the jewel in the crown of the American health care system.”

Additional Updates

The State of the Brigham also featured updates from other hospital leaders about priority areas, including research, quality and safety, and community outreach.

Allison Moriarty, MPH, senior vice president of Research Planning & Operations and Innovation, highlighted the many ways the Brigham research community is pursuing scientific breakthroughs and translating lab discoveries into clinical innovations. Among these are efforts around cell and gene therapy. In alignment with research colleagues across the system, Brigham researchers are expanding their studies of these cutting-edge therapies from cancer to other disease areas.

“All of us have been touched by human diseases and conditions,” Moriarty said. “You can be assured that whatever is ailing you or others across the country, we have somebody who’s working on it.”

Sunil Eappen, MD, MBA, senior vice president of Medical Affairs and chief medical officer, reviewed the results of the Brigham’s recent Joint Commission reaccreditation survey — describing the experience as “the most positive I’ve ever seen” because staff and surveyors genuinely sought to learn from one another, he explained.

Eappen noted that the survey resulted in 58 findings, many of which relate to issues that all staff can, and should, remain vigilant and proactive about addressing.

“If you’re a clinician, don’t use abbreviations. If you see oxygen tanks that are sitting without a container, do something about it — tell somebody. If you see ceiling tiles that are damaged, call to have them repaired,” Eappen said. “These are things that we expect someone else to take care of, but it’s really our responsibility to do that together. And this is not something you should be doing just in the last week before The Joint Commission comes. We should be doing this all year long.”

Another important area surveyors review is an organization’s safety culture, and reporting safety concerns is a vital part of that, said Eappen. He urged staff to report systems, processes and behaviors that could, or do, compromise care quality and safety.

“We want you to feel confident about reporting because we are working to move towards being a high-reliability organization,” he said. “The goal is to get to a point where we are incredibly proactive in thinking about ‘this could be a risk’ and fixing it, so we never have that safety event occur. This is the way the nuclear power and aviation industries work.”

Claire-Cecile Pierre, MD, associate chief medical officer and vice president of Community Health, provided an update on the Brigham’s latest community health needs assessment, a process the hospital is required to complete every three years.

Pierre explained that during the last assessment in 2019, several Boston-area hospitals recognized the opportunity to coordinate in a way that better served local communities and collaborated in conducting surveys, analyzing data and deciding how to allocate resources. The Brigham will build on the success of this strategy for 2022 by continuing to collaborate with other city hospitals and colleagues across Mass General Brigham, she added.

Lastly, the forum provided an opportunity for staff to ask questions, leading to discussions around issues such as staffing, compensation and diversity and inclusion.

Guiding Lights in Dark Hours: Community Partnership Supports Survivors of Violence

From left: Cheryl Lang, Alexandra Chéry Dorrelus, Lawrence Stevenson, Rahsaan Peters and RonAsia Rouse demonstrate the use of a sand therapy toolkit, which the Louis D. Brown Peace Institute uses as part of its Peace Play in Urban Settings program. Funds raised by the Brigham and other hospitals for this year’s Mother’s Day Walk for Peace will support the distribution of these toolkits to community members.

While patients have their most acute care needs met in the hospital, long-term healing often happens closer to home — underscoring the importance of partnerships with community-based organizations. One example of this is the partnership between the Louis D. Brown Peace Institute (LDBPI) and the Brigham’s Violence Intervention and Prevention Programs, whose staff collaboratively deliver compassionate, comprehensive care to patients and families admitted to the Brigham after experiencing community violence.

“In one’s darkest moments — in the midst of the pain of loss and trauma — light often comes from those who rally around us,” said Claire-Cecile Pierre, MD, associate chief medical officer and vice president of Community Health at the Brigham. “It is when partnerships transform into a community of support that we — the Brigham, LDBPI and others — can together provide critical guidance through the complex aftermath of community violence. We are incredibly fortunate to have LDBPI’s leadership and partnership in this work.”

In collaboration with the multidisciplinary teams who care for survivors of violence, Brigham staff in the hospital’s Center for Community Health and Health Equity work with patients and their loved ones through the center’s Violence Recovery Program (VRP) and the Jamaica Plain Neighborhood Trauma Team (JPNTT) to begin the process of physical, emotional and spiritual healing in the aftermath of violence.

Aiming to assist with long-term recovery and prevent readmission, VRP and JPNTT advocates Dana Jackson, Rahsaan Peters, Sade Smith and Lily Stern support patients through crisis intervention and trauma response; communication with family and connection to resources; safety planning and after-care plans; advocacy within the legal, employment and education system; and warm referrals to organizations such as LDBPI.

Determined to honor and carry on their son’s legacy, Joseph and Clementina Chéry established LDBPI in 1994 after their 15-year-old son, Louis, was killed in a crossfire shootout in Dorchester on his way to a Teens Against Gang Violence meeting. Leaving the hospital with no resources or roadmap, his parents sought to transform support for survivors of homicide victims in Boston.We care. Period. logo

“People need to know what comes next,” said Alexandra Chéry Dorrelus, LDBPI’s co-executive director and Louis’ sister. “They need to have somebody guiding them all the way through, and they need to know that something happened that was totally outside of their control and that the control is in their hands now moving forward — and that there is a path forward.”

Building Trust

LDBPI worked with the City of Boston to develop best practices for supporting those who have lost a loved one to homicide. In addition to implementing this model locally with partners such as the Brigham, LDBPI staff have trained other community organizations across the country on these practices.

Within 24 to 72 hours after a family experiences homicide, VRP introduces the family to LDBPI staff and support starts immediately. From helping families bury their loved one and ensuring they know essential, acute information such as their detective, police liaison and court advocate, to engaging them in various longer-term supports, LDBPI guides families with care, expertise, respect and transparency.

Critical to their work is building trust, explained Lawrence Stevenson, LDBPI’s survivor support coordinator.

“A family’s ability to trust is broken at the same time they are being asked to trust all these systems, so we have to go above and beyond to develop that trust, keep our commitments and be transparent,” Stevenson said. “Knowing that this is because families have been victimized and have such a loss of control, it’s important that we’re always putting the control back in our family’s hands. In this field, we have adopted this idea of making sure we’re trauma-informed — and that’s important — but you also have to be survivor-centered as well.”

‘A Guardian Angel’

Describing LDBPI as “a guardian angel,” Rahsaan Peters, the Brigham’s VRP coordinator, works closely with the organization to support patients and its work.

“They’re No. 1 when it comes to homicide support,” said Peters, explaining it is critical to “support LDBPI, whether that’s following its lead, bringing a referral, volunteering there or whatever it may be to make sure I show support to them and to the family.”

Similarly, LDBPI staff emphasized the value of their partnership with VRP and the Brigham.

“We are absolutely shifting culture together,” Chéry Dorrelus said. “Rahsaan has been a part of our providers network from the very beginning and is one of the few people who can walk around and tell the full history of homicide response in Boston.”

VRP’s partnership with LDBPI has extended beyond supporting patients and has benefitted the larger Brigham community as well. For example, by connecting Brigham’s Stepping Strong Injury Prevention Program with LDBPI, Peters helped facilitate a recent “Lunch and Learn” event, where Brigham staff heard from LDBPI and other local leaders about their work and ways in which the hospital can support those who have experienced community violence.

LDBPI’s advocacy at the state level has also resulted more equitable victims’ compensation and the establishment of a Survivors of Homicide Victims Awareness Month, observed Nov. 20–Dec. 20, in Massachusetts.

“After the Lunch and Learn, multiple Brigham employees expressed how much they learned and valued the event,” said Molly Jarman, PhD, MPH, program director of the Stepping Strong Injury Prevention Program. “The Lunch and Learn has served as a jumping-off point for further collaboration with LDBPI, including supporting the Mother’s Day Walk for Peace and Homicide Awareness Month. We look forward to continuing to build on this work.”

VRP, JPNTT, Stepping Strong and LDBPI see this type of education, advocacy work and collaboration as key to bringing more people into the conversation to achieve long-term change.

“The Mother’s Day Walk for Peace is a fantastic way for the Brigham community to support the Louis D. Brown Peace Institute and visibly affirm our commitment to community safety,” said Bernard Jones, EdM, vice president of Value-Based Care, Public Policy and Administrative Operations at the Brigham. “All of us hope for a day when violence prevention and response is no longer necessary. Until that day comes, though, our patients and our neighbors need these important partnerships.”

To join the Brigham’s Mother’s Day Walk for Peace Team, click here.

Boston Marathon 2022 — Choosing Hope

From left: Emilie Schlitt; Paul Kent (center) with Audrey Epstein Reny and Steve Reny; and Vanessa Welten

In celebration of the 126th Boston Marathon, Brigham Bulletin is highlighting the stories of three members of the Brigham’s Stepping Strong Marathon Team. Comprising 138 runners, the Stepping Strong team will follow the historic Boston Marathon route on April 18 — all in support of The Gillian Reny Stepping Strong Center for Trauma Innovation at the Brigham.

About Stepping Strong

Established in the aftermath of the Boston Marathon bombings, The Gillian Reny Stepping Strong Center for Trauma Innovation has evolved from one family’s bold response to a personal tragedy to a thriving, multi-institutional, multidisciplinary hub tackling the continuum of trauma care — from prevention to treatment to rehabilitation. Its mission is to catalyze multidisciplinary collaborations that inspire groundbreaking innovation, effective prevention and compassionate intervention to transform care for civilians and military heroes who endure traumatic injuries and events.

You can advance this critical work by supporting the Stepping Strong Marathon Team. Click here to meet members of the team or make a gift.

Emilie Schlitt, BSN, RN, PCCN, CWOCN

It was a spring day in 2013 when Brigham nurse Emilie Schlitt, BSN, RN, PCCN, CWOCN, wheeled her patient, Gillian Reny, then 18 years old, out of the 45 Francis St. entrance. It was Reny’s first time outside since she had been rushed to the Brigham after suffering devastating injuries in the Boston Marathon bombings.

Sunshine warmed their faces, and Reny relaxed into a smile.

“I couldn’t think of a better team to run for or support,” says Schlitt.

Schlitt still gets choked up thinking about that moment, even after all these years.

“I remember that day like it was yesterday. Just to see that smile on her face was everything. It makes your day as a nurse,” said Schlitt, who was among the team that cared for Reny and other marathon bombing survivors on the Plastic Surgery Stepdown Unit in 2013. “She hadn’t been outside since the bombing, and that was her biggest challenge for the day at that point. Seeing her smile was amazing. It was almost like being a parent — you’re so proud.”

That strength and resilience continue to inspire Schlitt, who will run this year’s Boston Marathon to support trauma survivors like Reny on behalf of the Stepping Strong Marathon Team.

“A lot of what I teach my patients is what the Stepping Strong Center also values: getting patients back to doing what they love,” said Schlitt, who is now a Wound and Ostomy nurse. “Stepping Strong and the Renys have turned something so tragic into something positive, and it’s been incredible to see Gillian flourish into the lovely young woman she is today after going through everything she did. I couldn’t think of a better team to run for or support.”

Although Schlitt is a longtime runner, this will be her first marathon. Even after a few setbacks in her training, she says her momentum and motivation grow stronger each day.

“Marathon training is not easy, but when I think of what Gillian and so many of my patients have gone through, it helps push you through everything,” she said. “Gillian woke up every single day, ready to conquer a new day and a new challenge. There is no reason that I cannot get one foot in front of the other and continue training, no matter what.”

It’s a dedication she also brings to her nursing practice.

“When you are with a patient, they are the only one in that moment,” Schlitt said. “You take a deep breath, push aside whatever else is going on and ensure your patient feels like they are the only person you are caring for that entire day.”

Paul “PK” Kent

Paul Kent, 58, had both of his legs amputated below the knee, but don’t ever tell him he’s suffered limb loss. Quite the contrary, he insists. Becoming a bilateral Ewing amputee gave him everything — most importantly, his life.

Kent stands on a surfboard with his new prosthetics for the first time at York Beach in Maine.

Kent, who goes by PK, developed a genetic peripheral neuropathy in his 30s that, by his late 40s, led to near-constant wounds on his feet. Although he felt no pain, the condition led to life-threatening infections that required frequent hospitalization.

Once an endurance athlete and avid swimmer, Kent found himself struggling to do basic tasks. His health concerns became so grave that the single father of two stopped planning family vacations, unable to even think a few months ahead.

“Every day, I lived with a fear of death because a wound could turn into sepsis. The day of my surgery, Dec. 1, 2020, my life changed for the better — immediately,” Kent said. “I probably wouldn’t be alive today without the Ewing amputation.”

In 2016, a clinical team led by the Brigham’s Matthew J. Carty, MD, a surgeon in the Division of Plastic and Reconstructive Surgery and director of Strategy and Innovation at the Stepping Strong Center, in collaboration with Hugh Herr, PhD, of the Center for Extreme Bionics in the MIT Media Lab, invented a new type of lower-limb amputation procedure, known as the Ewing amputation.

Named after the experimental procedure’s first patient, Jim Ewing, the Ewing amputation preserves normal signaling between the muscles and the brain. Compared to a standard amputation, the Ewing procedure maintains natural linkages between muscles in an amputated leg, so amputees feel as if they are controlling their physiological limb, even though it’s been replaced by a prosthesis.

Once he healed from surgery, Kent was eager to put his new prosthetic limbs to good use.

“When I stood up on a surfboard for the first time this past summer, it told me there are no limits on what I can do,” he said.

Next on his list: running the Boston Marathon, which he will do this year for the first time as a member of both the Brigham’s Stepping Strong team and Spaulding Rehabilitation Hospital’s Race for Rehab team.

The Stepping Strong Center’s bold vision for trauma innovation makes it a powerful incubator for ideas that can transform the lives of amputees, Kent said. In particular, he is impressed with the center’s support of early-career investigators and novel projects that may not necessarily garner traditional research funding.

“I like what’s going on at Stepping Strong and the progressiveness of the program,” Kent said. “It incentivizes out-of-the box thinking.”

Kent is also on his own mission to improve the lives of fellow members of the disabled community, having recently launched (dis)ABLED Life Alliance, a public benefit corporation whose first initiative is focused on increasing access to prosthetic devices.

Although he knows the marathon is an ambitious challenge, Kent says nothing can stop his momentum.

“I’ve been held back for so long,” he said. “As Dr. Chris Carter over at Spaulding said to me, ‘Your victory is showing up at the starting line.’”

Vanessa Welten, MD, MPH

From left: Vanessa Welten is joined by her father, Harry, during a road race; Harry Welten achieves his career best at the 1994 Boston Marathon; a young Harry Welten with baby Vanessa.

Vanessa Welten, MD, MPH, was navigating the usual stressors and challenges of her first year of surgical residency in February 2019 when tragedy struck: Her father, Hendrikus “Harry” Welten, was killed when he was struck by a vehicle while out on a run after work near their family’s home in Ottawa, Canada.

Welten felt like her world came crumbling down.

“It was devastating,” she said. “I needed to find a way to channel my grief.”

Her path to recovery started with taking up the sport her father loved: running. An elite marathoner, Harry Welten had been competing in marathons since his late 20s. On April 18, 1994, he achieved his personal career record of 2 hours, 21 minutes and 45 seconds in the Boston Marathon, finishing as the first Canadian and 52nd overall.

Exactly 28 years later, Welten will follow in his footsteps — literally — and honor his memory by running this year’s Boston Marathon with the Stepping Strong team.

“I learned about Stepping Strong through my work experience, and their mission really resonated with me — the idea of turning tragedy into hope,” said Welten, now a fourth-year resident in General Surgery at the Brigham. “I decided I’m going to do this for my dad, for me and for this bigger cause.”

Training for the race has helped Welten process some of her grief. While running, she listens to music that reminds her of her father: Bruce Springsteen, The Who and Bryan Adams.

“I feel closer to him, but it’s a mix of emotions,” she said.

While Harry Welten had plenty of his own boast-worthy accomplishments, his greatest pride and joy — and what he bragged about the most — were his daughters.

“He would tell everyone every single detail of our lives, regardless of whether they wanted to hear about it. He was so proud of us,” Welten said. “But our accomplishments are in large part a reflection of what he did for us. He wanted us to excel and pushed us because he saw our potential. He encouraged and supported us, and never put a limit on anything we wanted to accomplish. He was our family’s cheerleader and the type of person who made you feel like you mattered.”

Her own family’s experiences have also underscored why a patient- and family-centered approach is essential to surgery.

“I wasn’t the trauma victim, but I very much feel tied to the trauma that happened to my dad,” she said. “When I see patients who have experienced devastating trauma or injuries, I’m also always trying to clue in on those support people in their lives who might be struggling. Taking care of a patient is so much more than taking care of the ailments that you see. It’s a much bigger picture and requires a much bigger team, and that goes back to Stepping Strong. They emphasize a holistic approach to healing because they consider all the different ways trauma can impact someone.”

‘Side by Side Since the Womb’: Brigham Twins, a Physician and a Surgeon, Find Inspiration in Family

From left: Fraternal twins Rosh and Roshan Sethi trained at the Brigham together and continue to practice here today.

In celebration of National Siblings Day on April 10, Brigham Bulletin is highlighting an unlikely pair: twin brothers Rosh Sethi, MD, MPH, of the Division of OtolaryngologyHead and Neck Surgery, and Roshan Sethi, MD, of the Department of Radiation Oncology.

When patients entered the primary care clinic of Asha Sethi, MD, in Calgary, Alberta, they could expect two precocious and enthusiastic individuals to assist them at the front desk: her 10-year-old twin boys, Rosh and Roshan, who often shared a single chair as they checked in patients and retrieved their paper charts.

Quite literally underfoot in their mother’s clinic as children, the Sethi twins say this early exposure to patient care put them on the path — nearly the same one, in fact — to their own medical careers. Both trained at the Brigham and continue to practice here today.

“We just lived in that clinic. We had our entire childhood there,” recalled Roshan, who splits his time between caring for cancer patients as a radiation oncologist and writing and directing film and TV in Hollywood.

“Being of service was something we were taught from a very young age, mainly by our mother,” he added. “Medicine can be a noble, selfless profession, and that was very much the way our mom did it. She would arrive early and stay late. She took care of thousands of patients in the northeast of Calgary, which was an area heavily populated by immigrants where primary care options were limited.”

With encouragement from their mother, the brothers began volunteering as young teens at Tom Baker Cancer Centre, serving high tea to patients. The experience further inspired them, as both gravitated toward areas of medicine involving cancer in their adulthood.

Rosh, a surgeon specializing in complex head and neck tumors and microvascular reconstruction, also studies innovations in treating such cancers as a researcher with the Center for Surgery and Public Health. His areas of focus include oncologic care health outcomes and cost-reduction measures for patients undergoing treatment for head and neck cancer.

“We had an early exposure to medicine, but for some reason I was hooked on surgery at a very young age,” Rosh said. “I would read Grey’s Anatomy at the school library, and later I would watch YouTube videos of surgeries. I loved anatomy and that focus on patient care.”

“I think it comes down to our parents, especially our mom, who always felt strongly that we should be together,” says Rosh Sethi.

Rosh and Roshan, who are fraternal twins, went on to attend Yale University together as undergraduates, lived together as roommates and enrolled in most of the same classes. They both attended Harvard Medical School as well before embarking on residency together at the Brigham. And when it came time to decide where to continue their careers, the Sethi brothers say there was no question about where they wanted to be.

“We always felt a natural inclination toward the Brigham because of the people we worked with and the environment here,” Roshan said.

And while so much of their lives have overlapped, the brothers are the first to acknowledge the differences in — or rather, complementary nature of — their personalities. They are each other’s biggest fan.

It was no surprise to his brother that Rosh — patient, precise and a gifted visual artist — went into surgery. Meanwhile, Roshan is the more animated, free-thinking twin, with a creative mind, photographic memory and talent for storytelling that has allowed him to flourish in two careers, his brother said.

Even for twins, who are often close-knit by nature, the pair share an exceptionally tight bond.

“I think it comes down to our parents, especially our mom, who always felt strongly that we should be together,” Rosh said. “She wanted us to stay together, learn from each other and remember that we’re always the best of friends.”

“We’ve been side by side since the womb,” Roshan added. “Family is really important in Indian culture, and there’s an expectation of staying close. Although that filtered down to us in the way that we were raised, I also just feel like it was meant to be.”

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Brigham OT Offers Neuro Patients Advanced Care Closer to Home

Occupational therapist Nicole Mannion, MA, OTR/L, recently joined a multidisciplinary team in Foxborough to provide outpatient neurological rehabilitation for patients. 

Making a pot of coffee, getting dressed, changing a baby’s diaper — these are everyday tasks that many people don’t give a second thought. But seemingly ordinary activities can quickly become difficult and demoralizing for patients with a neurological condition that impairs their fine motor skills, such as Parkinson’s disease, or those who are recovering from a stroke or brain injury.

Helping these patients regain function and independence is occupational therapist Nicole Mannion, MA, OTR/L, whose newly established role is bringing more complex, specialized care to the Greater Boston area.

Part of a multidisciplinary team delivering outpatient neurological rehabilitation in Foxborough, Mannion said patients with neurological conditions often have multiple concerns that become closely intertwined with their rehabilitation work.

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“It’s atypical that you’re only treating motor issues from a stroke,” she explained. “As you start to care for a patient, you realize they have problems with their vision, executive functioning or ability to problem-solve, or they may have post-stroke depression. Then you add challenges with transportation and navigating the health care system, which can be especially difficult for someone with a cognitive impairment. Those are some of the things that make treatment more complex.”

Part of Rehabilitation Services, the Brigham’s Occupational Therapy team consists of 15 inpatient occupational therapists (OTs) and eight outpatient OTs who support clinics at the main campus, 850 Boylston St. and Foxborough. Mannion is the first and only neuro-focused outpatient OT.

Helping patients find alternative ways to comfortably perform everyday activities and tasks, OTs assist patients in adapting to challenges with their movement and coordination due to an illness, injury or disability. For the patient population Mannion cares for, this can include helping someone recovering from a stroke to use the bathroom by themselves. Recently, she cared for a young mother who was struggling to change her baby’s diaper after a brain injury caused uncontrollable movements in her hands.

A large part of her job is helping patients feel comfortable discussing their goals and limitations, Mannion explained.

“You get down to talking about things that are very personal, and that can sometimes be hard for patients,” she said. “In addition to building rapport with patients, I try to validate their experiences. These patients are living with major issues, and well-meaning family members often say things like, ‘You’re going to be fine,’ but sometimes that’s not what people need to hear. They want validation that this is extremely hard and life-changing.”

Celebrating the progress that her patients make is the best part of her day, Mannion said.

“When they say, ‘Oh, my gosh! I can do this now,’ it’s a really good feeling,” she said. “Being part of these bigger, life-changing events has always been of interest to me. I feel better when I can do things to help.”

Multidisciplinary Care in a Community Setting

In addition to Mannion, the specialized Neuro Rehab team at the Brigham and Women’s/Mass General Health Care Center in Foxborough includes physical therapists (PTs) and speech language pathologist. Adding an OT to the team has enhanced the quality of care across the spectrum of rehabilitation services, explained Beth Regan, MS, CCC-SLP, the team’s senior speech language pathologist.

“We tend to share patients within our caseloads and frequently engage in discussion about goals we are working on, as well as the patient’s strengths and areas for improvement,” Regan said. “This can really be helpful in treatment planning, especially with more challenging neurological diagnoses.”

Mannion noted that making this kind of specialized OT care available in an outpatient, community-based setting is not only about convenience. For patients with neurological conditions, it can make a difference in whether they access care at all.

“For patients who live outside of the city, it’s easier to get here. While that’s important for everyone, it’s especially important for these patients because they often rely on someone else for transportation,” she explained. “And because this site has a comprehensive program, patients can come here and see Speech Therapy, PT and me all in the same place. It makes the care so much more fluid, and for neurologic issues it’s pretty rare to find a clinic that has all three specialties.”

Nancy Kelly, MS, OTR/L, clinical supervisor of Occupational Therapy, described Mannion as “the perfect person to lead the way” in elevating care, especially where the need is so great.

“Expanding our outpatient expertise to include intervention for people who have neurological conditions has been a long-term goal of mine,” Kelly said. “Nicole brings excellence and enthusiasm to her role, and her patients receive outstanding care.”

Occupational Therapy Month is held every April to honor occupational therapists’ substantial role in improving patients’ health and quality of life. In celebration of Brigham OTs, Brigham Bulletin is highlighting one of the many exceptional OTs who play a critical role in our delivery of high-quality, patient-centered care.

Match Day 2022: Family Histories Inspire Future Physicians Matched at the Brigham

Yasmin Kamal (left photo, pictured with her brother, Nabi Akram) and Sam Doernberg (right photo) are among the 75 aspiring physicians who learned of their acceptance the Brigham’s Internal Medicine Residency Program on Match Day.

Growing up, Yasmin Kamal, PhD, and her sisters received a chilling message: Educating girls is dangerous.

Want proof? Just look at Aunt Bibi, they were told by relatives from their small village in rural Pakistan. Aunt Bibi was the only girl in the family who had been allowed to attain a middle school education — and she was the only one who behaved erratically, sometimes with hostility. From the family’s perspective, the link was undeniable.

“They always said Bibi went insane,” recalled Kamal, who learned years later that her grand aunt had been married off at a young age, thrust into city life without any support, suffered a traumatic miscarriage and then experienced the onset of what was likely untreated schizophrenia.

Despite the convictions many in the family held, Kamal’s father, a taxi driver in Washington, D.C., continued to value his children’s education, even in the face of financial barriers during the 2008 recession, in the hope that it would give them a better life — something not afforded to Bibi.

“As I grew older, I learned more about Bibi’s life, what happened to her and the stigma of women getting educated. That stigma percolated a lot in my life because I was the most bookish kid of my six siblings. My family was always worried that if I read too much that I would ‘go insane’ like Bibi did,” said Kamal, who, driven by scientific curiosity and a will to help others, devoted herself to challenging and defying those expectations.

Kamal celebrates her Brigham match during a Match Day ceremony at Dartmouth.

Now, she stands on the cusp of graduating from the Geisel School of Medicine at Dartmouth, and will embark on a career in medicine when she begins her residency training at the Brigham this summer.

“I was so surprised, shocked, grateful and thankful to God it worked out the way it did. The Brigham was my first choice. It’s the perfect place for me to grow and learn as a physician, scientist and person,” said Kamal, who was one of 75 medical students to learn of their acceptance into the Brigham’s Internal Medicine Residency Program on March 18.

Across all Brigham residency programs participating in Match Day — when thousands of medical school students across the country discover where they will continue their medical training — 231 aspiring physicians matched at the hospital this year.

“Match Day was a resounding success with these talented, diverse and altruistic physicians choosing to continue the next stage of their training at the Brigham,” said Joel T. Katz, MD, director of Internal Medicine Residency Program. “They are also a particularly resilient group, having completed much of their medical school training under the strains of the COVID pandemic and helping fight it on many fronts — making contributions to direct patient care of vulnerable populations, innovative educational models, clinical trials and basic science.”

A Motivating Force

For Kamal, the moment of opening the envelope to reveal her match felt like the culmination of so many threads in her life. In addition to her aunt’s story, Kamal witnessed how inadequate access to health care caused other medical conditions in her family to go undiagnosed, sometimes with devastating consequences. She was also inspired by one of her sisters, who has Down’s syndrome and whose experiences ignited in Kamal a desire to understand the links between genetics, disease and disability.

While attending a science and technology high school, she obtained a summer internship at the National Institutes of Health, where she had an opportunity to work alongside physicians and researchers helping patients identify rare, undiagnosed diseases.

“Seeing the impact those physicians made on patients and families really hit close to home for me because it showed that when you’re caring for a patient, you’re taking care of their family at the same time — and the care you give them makes a huge difference,” said Kamal, who aspires to become a physician-scientist specializing in gastrointestinal diseases. “It’s going to be a lot of responsibility, so I’m hoping I can meet the moment.”

Family history also inspired fellow newly matched intern Sam Doernberg, who will graduate from Harvard Medical School this spring and is currently on a rotation in the Brigham’s Emergency Department.

Sam Doernberg celebrates Match Day with his parents at HMS.

In the early 1940s, at age 17, Doernberg’s grandfather sought medical care after seeing blood in his urine. Doctors suspected it was caused by a large kidney stone and advised that he have it surgically removed. During the operation, the surgeon realized that the cause was renal tuberculosis, a version of tuberculosis that spreads to the kidney. In his efforts to remove the kidney, however, the surgeon injured the bladder and ureter. Rather than disclose the error, the surgeon attempted to cover up the mistake.

Those injuries led to multiple complications and infections that left Doernberg’s grandfather chronically ill and bedridden for several years.

It wasn’t until he was examined by another physician that Doernberg’s grandfather learned about the medical error, as well as an opportunity to remedy some of the harm that had been done to him. His grandfather was eventually enrolled in one of the world’s first clinical trials for the antibiotic streptomycin, which ultimately saved his life.

“My grandfather didn’t hold the error against doctors after that. He felt he had been wronged, but he believed there were also good doctors out there trying to do what was best for people,” Doernberg said. “In hearing how physicians both hurt and healed him, I saw that medicine was a career that carried a great deal of responsibility for people’s lives — but it also really meant something to patients when you got it right.”

That nuanced perspective left a lasting impression.

“Having this medical error in my family is what spurred me to become interested in medical ethics,” said Doernberg, who teaches and conducts research in bioethics. “Some people might avoid medicine after that, and there are people who understandably have deep mistrust of physicians because of the ways that medical institutions have experimented on them or wronged them based on their race, status or class. I felt motivated to try to prevent these errors from happening in the future.”

Now, as he readies to take the next steps in his medical career, Doernberg said there is no place he’d rather be than the Brigham’s residency program.

“It’s a collection of incredibly kind, smart people who want to be the best clinicians they can be, improve medicine for everybody and do so in a residency cohort that is supportive, fun, kind to each other, thoughtful about medical education and places a real emphasis on two things: the wellness of residents and a focus on having a career that allows you to do clinical medicine plus something else in health care,” he said. “When I opened the match letter, I was elated — and I’ve been on cloud nine ever since.”

Brigham Alums Continue Legacy of Excellence in Biden Administration

Alumni of the Brigham’s residency programs have gone on to make a profound difference in the field of medicine and beyond. Among them, several former Brigham residents have been honored with appointments in President Joe Biden’s administration.

The latest addition is former medicine resident Shereef Elnahal, MD, MBA, now president and CEO of University Hospital in Newark, N.J., who was nominated by the President to be under secretary for health at the U.S. Veterans Health Administration on March 10.

Biden nominees and appointees with Brigham ties include:

  • Shereef Elnahal, MD, MBA
    Under Secretary for Health, U.S. Veterans Health Administration (nominated)
    Brigham medicine intern, 2012–2013
  • Atul Gawande, MD, MPH
    Assistant Administrator for Global Health, U.S. Agency for International Development
    Brigham surgery resident, 1995–2003
  • Dora Hughes, MD, MPH
    Chief Medical Officer, CMS Innovation Center at the Centers for Medicare and Medicaid Services
    Brigham medicine resident, 1996–1999
  • Peter Marks, MD, PhD
    Director, Center for Biologics Evaluation and Research at the Food and Drug Administration
    Brigham medicine resident, 1991–1993, Hematology/Oncology Fellow, 1993–1996
  • Vivek Murthy, MD, MBA
    19th and 21st U.S. Surgeon General
    Brigham medicine resident, 2003–2006
  • Marcella Nunez-Smith, MD, MHS
    Chair, U.S. COVID-19 Health Equity Task Force
    Brigham medicine resident, 2001–2004

When Two Become Three: Anesthesiology Couple Celebrates Growing Brigham Family

Ryan and Ann Elise Louër with their daughter, Annie

After Ryan Louër, MD, an Anesthesiology resident, and Ann Elise Louër, PA-C, a physician assistant in the Chronic and Cancer Pain Management inpatient service, received such a warm welcome upon joining the Brigham family about three years ago, they knew there was only one place they wanted to be when it came time for the couple to grow their own family.

That all culminated with the recent birth of their daughter, Annie, at the Brigham in late December.

“We wouldn’t have chosen anywhere else to have her,” Ann Elise said.

The first-time parents say they are enjoying every moment with their baby girl, who, now at 12 weeks, is charming them with gummy smiles and adorable cooing.

“I’ve always wanted to be a mom,” Ann Elise said. “I just love being able to show her new things. Not that she will remember, but when we had the blizzard recently, I got to be like, ‘This is snow.’ Those moments are really special. You realize the little things in life are beautiful, and showing them to a new life is really fun.”

“I just love being able to show her new things,” Ann Elise Louër says.

Ryan agreed, saying that even amid the sleepless nights and seemingly endless diaper changes, there is so much joy in everyday activities, such as giving his daughter a bath.

“It’s the little moments,” he said. “Everything that seems routine is all very new, so it’s a lot of fun to navigate that.”

Ryan — whose clinical interests include pediatric anesthesia, critical care and palliative care — also noted that his early experiences as a parent have given him a fresh perspective when caring for patients and their families.

“I have a new light on how I speak with families. By seeing what life is like through the eyes of a tired parent, I can iterate what’s most important and better understand what they might be worried about.” As they traded their scrubs and employee ID badges for a hospital gown and visitor pass, the Louërs said their family’s experience as patients at the Brigham was exceptional. In addition, the support they received from colleagues in the Department of Anesthesiology, Perioperative and Pain Medicine since Annie’s birth has been deeply touching, both said.

“I talked to my supervising physician the other day, and he emphasized that family comes first. I don’t think a lot of work cultures are like that, so that’s been really nice,” Ann Elise said.

Ryan, who recently returned to work from paternity leave, said his colleagues have been similarly supportive of his transition to becoming a working parent, offering to swap on-call shifts if needed.

“The people I work with would give you the shirt off their back,” he said. “They’re great, great people. We’re very lucky.”

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Brigham Trainee Reflects on Humanitarian Response at Poland-Ukraine Border

“Restoring health care that’s been interrupted is going to be one of the biggest tasks going forward,” says Global Emergency Medicine fellow Morgan Broccoli, MD, MPH, who shared the above photo from her recent travels to Poland, where she aided the humanitarian response for refugees fleeing Ukraine.

When emergency physician and Global Emergency Medicine fellow Morgan Broccoli, MD, MPH, landed in Poland earlier this month as part of a team assisting with the humanitarian response in Ukraine, she quickly saw how difficult it would be for responders to help those who needed it most.

“By far, the biggest challenges are safety and access. Those two things go hand in hand,” Broccoli said. “It’s very different than a natural disaster. With an earthquake, sometimes you get worried about aftershocks, but generally you can get into the place where people are the most injured and the need is greatest. But in an active conflict — in a war — it’s not safe to go to the spots where people have the most need. We’ve seen verified attacks on health care personnel and hospitals getting bombed.”

Broccoli, who returned to the U.S. this week, traveled to Poland with Team Rubicon, an international nonprofit that deploys military veterans and first responders to provide immediate relief in areas affected by natural disasters and humanitarian crises.

Working in collaboration with colleagues from the Polish Red Cross, the Polish government, the United Nations, the World Health Organization and other global responders, Broccoli and her team were tasked with evaluating medical needs both at the border and in Ukraine, with the goal of developing a coordinated crisis response.

“We got there pretty soon after the start of the war, and we were trying to figure out where the needs were prior to sending a full team of medical providers,” said Broccoli, who has previously deployed to Haiti with Team Rubicon.

Brigham colleague and emergency physician Erica Nelson, MD, MPhil, MS, who serves as deputy medical director of Team Rubicon, arrived in Ukraine this week to continue that work and assist as needed with the emergency medical response.

Unsurprisingly, Broccoli noted, the greatest need for acute medical aid is in areas of active conflict — primarily eastern Ukraine and, more recently, in the capital, Kyiv, where bombing has intensified in recent days. Yet those conditions are precisely what makes it so difficult, and dangerous, to deliver help.

“People are trapped and unable to get food or water, but it’s not safe to go there, so we decided to set up operations in Lviv, a city in western Ukraine, which has been a stopover point for internally displaced persons,” she said.

At the border with Poland, where an estimated 1.8 million Ukrainian refugees have come through since Russia launched its invasion on Feb. 20, Broccoli said the needs are different. People with chronic conditions, such as diabetes and high blood pressure, fled their homes without their medication — leaving the Polish government and aid organizations challenged with figuring out how to identify and support this vulnerable population.

Restoring health care that’s been interrupted is going to be one of the biggest tasks going forward,” she said. “A lot of organizations are trying to figure that out and assess the burden. For instance, how many diabetics can we expect and how much insulin are we going to need? I don’t know that anyone has the answer to that right now.”

Reflecting on her experience at the border, Broccoli said she witnessed moments of humanity and heartbreak.

“I worry about the Ukrainian people. I wish that we were able to better help people in the cities that are under attack,” she said. “I think the most meaningful part of my time was seeing how welcoming and supportive the Polish people were. It’s challenging to have so many refugees pour into a country, and more are coming each day. But every person in Poland welcomed the refugees with open arms.”

Although this was her first time responding to a warzone, Broccoli said her training as an emergency physician — at the Brigham and beyond — prepared her for such an uncertain setting.

“I think that’s why a lot of emergency physicians are drawn to disaster and humanitarian response — we feel comfortable with the unknown,” she said. “Prior to coming to Brigham, I did not have much training or background in humanitarian response. The Brigham’s Global Emergency Medicine division and Harvard Humanitarian Institute are both leaders in these areas, so I have been able to learn about everything that goes into responding to a crisis of this size from leaders in the field.”

Pillars of Excellence Awards Honor ‘Bright Stars’ of the Brigham Community

Nearly 30 teams were honored during the virtual celebration for this year’s Pillars of Excellence Awards.

Throughout the pandemic, it hasn’t been unusual for Brigham staff to take on additional responsibilities when resources were stretched thin. But even by those standards, colleagues of Rebecca Brooke, MHA, operations manager for Primary Care, say her seemingly superhuman ability to support anyone, anywhere and at any time is nothing short of remarkable.

“Rebecca does more for us than any one person ever could,” wrote one of 10 colleagues to nominate Brooke for a Pillars of Excellence Award, which recognizes individuals and teams for their outstanding contributions to Mass General Brigham’s mission. “She is the pillar who keeps us all going. She cares for patients, providers and staff. She is the backbone of Primary Care Central. Without her, we would be lost.”

Another nominator recalled the day that Brooke, who served in two interim roles last year in addition to her regular duties, helped check in patients at the front desk of the Fish Center for Women’s Health so practice assistants could go to lunch.

“I could not help thinking how lucky we are to have a regional administrative leader such as Becca. Her steady leadership is truly transformational,” the nominator wrote. “She energizes our team to perform beyond expectations in creating a culture of ownership in reaching our region’s vision.”

Brooke was among those honored during the 26th annual Pillars of Excellence Awards virtual ceremony on March 11. This year, awards were presented to 77 individuals and 29 teams throughout the Brigham, Brigham and Women’s Physicians Organization and Dana-Farber Brigham Cancer Center.

“The Pillars of Excellence Awards ceremony is a special event because it highlights and recognizes the work of the talented and committed individuals and teams who make the Brigham one of the best places to work and receive care,” said Robert S.D. Higgins, MD, MSHA, president of Brigham and Women’s Hospital and executive vice president at Mass General Brigham. “What is even more impressive is that this year’s honorees — like so many in our Brigham community — have managed to be bright stars amid another extremely challenging year, as we all continue to face this global pandemic and extremely high demand from our patients.”

Also honored this year was Eric Lindquist, HVAC supervisor for Engineering, who played a key role in creating additional capacity to care for COVID-19 patients by establishing more negative-pressure rooms. And when a car fire broke out in the Hale parking garage in 2021, Lindquist aided the response by using his expertise of HVAC systems to help filter smoke out of the garage.

Robert Higgins congratulates honorees during the virtual celebration.

“Eric has been our go-to for anything HVAC-related,” his nominator wrote.

Marie Innocent Norbrun, a patient care associate in the Neuroscience Intermediate Care Unit on Braunwald Tower 10, was recognized by her colleagues as an “unsung hero” on the unit due to her unwavering dedication and compassion.

“When Marie is in a room working with a patient, her focus and undivided attention is on them,” her nominator wrote. “Marie practices authentic presence and equanimity, providing patients with the calming presence they need while in the hospital. I can tell when Marie has left a room because the patient is clean, comfortable and relaxed. Marie sets the bar high for the standard of patient care.”

In their nomination for Radiation Oncology nurse Pete Meagher, RN, OCN, colleagues noted his calming presence when caring for adult and pediatric patients.

“This is important to Pete, as he understands the tremendous stress that the family is experiencing and wants to ensure that the trust in the medical team is provided,” they wrote. “The children look forward to coming to see him, play a game and have treatment. His ability to adjust to the developmental stages of each age group is unflappable.”

Among the team honorees this year were members of the Brookside Community Health Worker COVID-19 Vaccine Outreach Team, who fanned out into the local community to speak with residents about vaccination and bring resources to underserved areas.

“The team went door to door in the heat of summer to local businesses and restaurants in Egleston Square and Dorchester with flyers and started open conversations with community members about the COVID vaccine,” their nominator wrote. “Our team showed them where and how to get it, explained the facts about the vaccine, dispelled myths, answered questions and addressed fears. Meeting people where they are at, in their native language, was really helpful in building trust. They also gave a presentation about facts and myths of the COVID vaccine to an adult education organization for a largely Spanish-speaking immigrant population. This team is responsible for many of our patients and community members getting vaccinated.”

The Health Promotion Center Food Justice Team at Southern Jamaica Plain Health Center was honored for championing health equity and combatting structural racism in Boston — before and during the pandemic. The team partners with local organizations to support hundreds of families each week with healthy food options.

“The team has found every way possible to get people food by staying late, driving food to people’s homes and mailing gift cards when necessary,” their nominator wrote. “The Food Justice team knows this work is not charity or accommodation. It is about collaboration — the recognition that our community members are not here to be fixed. It is the systems that are doing them harm. With that approach, they have changed the way a food distribution system looks and feels at the health center, even during the hardest of times.”

View a recording of the Pillars of Excellence Awards virtual celebration.

Celebrating International Women’s Day: Q&A with Jocelyn Kelly, PhD

Jocelyn Kelly, PhD, is a research scientist in the Brigham’s Department of Emergency Medicine and director of the Harvard Humanitarian Initiative’s Gender, Rights and Resilience program, where she conducts qualitative and quantitative research to understand and prevent gender-based violence, especially in the context of complex crises.

In celebration of International Women’s Day, Brigham Bulletin spoke with Kelly about her research and how she and her colleagues are working to improve the lives of women in vulnerable communities worldwide.

Why is it so important to address gender, peace and security in fragile states, especially for women?

JK: The pressing issues of our time — addressing climate change, ensuring effective pandemic control measures, creating just and equitable societies — all of these goals are intrinsically linked to women’s rights. Advancing women’s rights helps us understand, anticipate, de-escalate and recover from conflict. Research has shown that the security of women and the security of nations are closely linked. For instance, women’s security is a better indicator of state stability than the level of democracy or per capita GDP. Conversely, violence and inequality undermine the very sources of resilience we need to effectively respond to the threat of conflict, climate change and pandemics.

International Women’s Day marks a call to action for accelerating women’s equality. How does the work you do help in reaching this goal?

JK: My research spans three areas: understanding the links between gender, climate change and conservation; improving equity in the humanitarian system; and addressing root causes of violence. More and more, we are understanding that global issues are deeply interconnected. In my work, I use evidence to reveal previously hidden dynamics and surface these interlinkages. For instance, I authored a paper on the links between fragile states, gender-based violence and the COVID pandemic for the United States Institute of Peace. Another part of my work explores how conflict casts a long “shadow” on societies, creating hidden dynamics that disadvantage women. Years after formal peace is declared, women continue to experience extremely high levels of violence after conflict, both in their homes and communities. Research can help us reveal both barriers and opportunities. It is important to highlight the dynamics — positive and negative — between these large global questions so we can more effectively address them.

What led you to work in humanitarian response? 

JK: One of my first jobs in disaster response was working in Hurricane Katrina. I was in New Orleans while search and rescue efforts were still underway. During that time, I was struck by the fact that the same disaster, illness or threat can affect people in totally different ways, depending on their vulnerabilities and opportunities. As disaster responders, we didn’t always understand those nuances at the time and didn’t consult with people in the community to help us do better.

I wanted to contribute to evidence-based practice in humanitarian response. Currently, my work uses both qualitative and quantitative research to ensure that the experiences, expertise and needs of people affected by disaster inform our responses. They are the experts in their own experiences, and the more we listen and learn, the better we will be at disaster response and prevention.

Is there a woman who inspired you to join this field or mentored you along the way?

JK: This is a tough question because I have so many amazing colleagues! I do want to give special thanks to my colleague, Annie Mwange. She is a women’s rights activist in eastern Democratic Republic of the Congo (DRC). Annie created a grassroots organization in her community for women and children affected by the decades-long conflict in the region. Using her own money, courage and perseverance, she built a non-governmental organization with other women to fight for access lifesaving services for the most vulnerable. Since then, her organization has grown leaps and bounds, and Annie is the head of a national women’s association in DRC. We were just launching a project together when the COVID pandemic hit. Our project used teaching images created by a Congolese artist (a woman!) to conduct evidence-based training on human rights law, occupational safety and climate change. Instead of giving up on this effort during the pandemic, we pivoted to also include information about the pandemic and public health measures to control its spread. We just finished the project and saw remarkable impact in the participating communities — everything from improving pay for women to more women taking leadership roles in their communities.

When efforts to advance women’s rights seem stalled, or seem to be moving too slowly, it’s important to remember that there are millions of women like Annie fighting every day for gender equality and human rights.

Louis Named Chair of Pathology

David Louis, MD, assumed the role of chair of the Department of Pathology at Brigham and Women’s Hospital on March 1.

In addition to serving as chair of the department at the Brigham, Louis will assume the role of chief of Enterprise Pathology at Mass General Brigham, overseeing the new Mass General Brigham Enterprise Laboratory Service (MGBELS). He will also continue in his role as chief at Mass General Hospital (MGH).

In his new role, Louis will work alongside clinical and administrative leadership across Mass General Brigham to coordinate and integrate pathology practice and clinical laboratory services.  

“David is a generous and committed leader that has dedicated his career to advancing and modernizing the pathology field. Under his leadership, we will improve our patients’ experiences by ensuring the highest quality interpretation of laboratory results; standardizing reporting and establishing a seamless connection to the electronic medical record and an enriched Patient Gateway experience; and facilitating the interchangeability of results across all our sites that deliver care,” wrote Brigham President and Mass General Brigham Executive Vice President Robert Higgins, MD, MSHA, and Brigham and Women’s Physicians Organization (BWPO) President Giles Boland, MD, in a message to all staff announcing the appointment. 

As a physician and researcher, Louis is a renowned leader in neuropathology and molecular diagnostic pathology. He earned his medical degree from Stony Brook University and, after training in internal medicine at Albany Medical Center, completed his residency, pathology fellowship and post-doctoral training at MGH.  

As the current pathologist-in-chief at MGH, he is a pioneer in the field of computational pathology and led the department to become a national leader in molecular diagnostics and pathology informatics. Louis is the Benjamin Castleman Professor of Pathology at Harvard Medical School and his research, which focuses on applying molecular diagnostics to brain tumor classification, contributed to a worldwide adoption of molecular testing and management for patients with gliomas. Through this work, he’s spearheaded multiple international efforts to modernize and standardize brain tumor classification, including those of the World Health Organization for the past 15 years. 

I am excited to chair this storied department of Pathology, building on its remarkable strengths to carry it to the next phase in its history, now as part of an entire pathology and laboratory medicine enterprise that will surely be the very best in the country,” said Louis, reflecting on his new role. 

Louis succeeds Jon Aster, MD, PhD, who served as interim chair of the Department of Pathology over the past year, providing critical leadership and support during this transitional time. Aster has been appointed deputy chair at Brigham and Women’s Hospital, and A. John Iafrate, MD, PhD, has been appointed to the role at Massachusetts General Hospital.  

“Dr. Louis is uniquely well-suited to lead the integration of pathology operations across Mass General Brigham, having worked collaboratively with pathology leadership at the Brigham and Mass General Brigham community hospitals for many years,” said Aster. 

Together, the expertise and passion of Louis, Aster and Iafrate will help support, guide and advance the MGBELS as they work toward becoming the most effective and innovative clinical laboratory system in the country. 

Shoutout to Security: Recognizing a Frontline Team’s Efforts to Protect the Brigham Community

Over the past few years, numerous departments across the Brigham have stepped up to continuously meet arising challenges in our community, and the Police, Security and Commuter Services department has been no exception.

The pandemic has created additional security needs throughout the hospital and despite this, the team has worked tirelessly to address every emerging challenge. Recently, the Police, Security and Commuter Services played a critical role in the Brigham’s response to coinciding events: protests of the COVID-19 vaccine requirement for solid organ transplant patients, and the presence of a neo-Nazi group that targeted researchers leading work to ensure every patient receives equitable care.

Word of this complex situation quickly spread throughout the Boston area and beyond. As a result, departments across the hospital received threatening phone and electronic messages from the public. While there were no credible threats to the safety and security of the organization, the team added seven posts to their standard staffing areas, screened all hospital entrances, identified the most vulnerable areas and then placed extra patrols in those spots to enhance protection.

“We worked with the Emergency Preparedness and Patient Quality and Safety teams to evaluate any risks,” said Kevin Slattery, director of Policy, Security and Commuter Services. “The teams audited every call made to the hospital and shared their findings with Security.”

Soon after the first protest occurred, the team learned that a second, larger protest was planned for the following week.

In addition to ramping up security measures, informing the Brigham community of what was happening and mitigating the spread of false information became one of the team’s top priorities. They worked with the Office of Strategic Communication to ensure the workforce received accurate, real-time information regarding all current events.

“We also rounded so we could speak directly with employees about their concerns and staff our patrols accordingly,” said Slattery.

Additionally, the team collaborated with Human Resources and the Employee Assistance Program to make sure employees had all of the resources they needed. Beyond that, they offered additional services to staff who are concerned about their safety.

“We provide safety planning, so if an employee feels threatened or unsafe, they can sit down with our community service officers and design personalized safety plans,” noted Slattery.

Increasing security initiatives across the hospital was not an easy feat, and it required staff to work overtime, often planning into the night and picking up extra shifts.

“I’m proud that our officers, supervisors and lieutenants worked around the clock to protect our community,” stated Slattery. “Many of them came in on their own time to ensure the hospital was safe.”

While playing a critical role in the Brigham’s crisis response efforts, the Police, Security and Commuter Services team did not act alone. Their colleagues at Mass General Brigham supported them in emergency preparedness planning. Together, the teams went through various exercises to proactively troubleshoot potential problems, and generated response plans for all stakeholders.

“The Mass General Brigham Security Council provided crucial support throughout this process,” said Slattery. “They have a Special Response Team and that extra help was invaluable.”

In reflecting on the past few weeks’ events, Slattery recognizes that team efforts go a long way in times of crisis.

“Moving forward, no incident will be completely the same. But this experience has shown us that we can all count on each other,” said Slattery. “Our team is honored to support the Brigham and the great care our staff provides every day.”

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In Memoriam: Paul Farmer, MD, PhD, Pioneering Global Health Physician

All are welcome to share condolences and memories of Dr. Farmer in the comments section below the story.

Click here to view the full gallery dedicated to Paul Farmer, MD, PhD

Brigham and Women’s Hospital mourns the loss of Paul Farmer, MD, PhD, chief of the Division of Global Health Equity, and a pioneer in the field of global health. A world-renowned global health physician and advocate, infectious disease specialist, medical anthropologist, humanitarian and mentor, Dr. Farmer was a champion of improving health care and preventing and treating diseases in under-resourced countries and communities. He died unexpectedly on Feb. 21 at the age of 62.

“Paul was a true giant among us, establishing the field of global health equity. He tirelessly worked his entire career to effect change for better health for all members of society,” shared Department of Medicine Chair Joseph Loscalzo, MD, PhD. “His work benefited in unmeasurable but extraordinary ways the lives of many individuals throughout the world previously without access to modern healthcare. His impact on social justice in global health will be long-lasting as his many trainees continue his extraordinary work internationally.”

Dr. Farmer was co-founder and chief strategist of Partners In Health (PIH) and the Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine at Harvard Medical School. He served as the United Nations Special Adviser to the Secretary-General on Community-based Medicine and Lessons from Haiti.

Born in North Adams, Massachusetts, Dr. Farmer was raised in Florida with his parents and five siblings. He received his bachelor’s degree from Duke University and his MD and PhD from Harvard University.

In 1983, Dr. Farmer traveled to Haiti as an undergraduate volunteer. That’s where Nadia Raymond, PhD(c), MSN/MHA, RN, nursing director of Southern Jamaica Plain Health Center, first met “Polo,” as she called him. Dr. Farmer lived with her family in Haiti at the time. Raymond recalled watching as he “quickly found his true passion in serving others.”

In Haiti, Dr. Farmer served for 10 years as medical director of L’Hôpital Bon Sauveur Cange, a non-profit hospital that provides treatment for people who have little to no resources, including health insurance. In 1987, Dr. Farmer co-founded PIH, which began in Haiti’s rural Central Plateau and now serves millions of patients in need across 12 countries. The organization, in Dr. Farmer’s words, aims to do three things: “directly serve those shut out of modern medicine, train others to do so, and generate new knowledge about how to do it better.”

Dr. Farmer came to the Brigham as an internal medicine resident in 1991.

“From the day I met him, we could all tell that Paul was sui generis—a one-of-a-kind man who, through his wisdom, vision, kindness and courage, had a singularly profound influence on his students, colleagues, patients and the field of global health equity,” said Joel Thorp Katz, MD, director of the Internal Medicine Residency Program, vice chair for education, Marshall A. Wolf Distinguished Chair in Medical Education. “He set and lived up to exceptionally high standards even during exhausting periods of training, in dire work circumstances and beyond, with boundless energy and a reassuring smile at the ready.”

Katz recalled Dr. Farmer’s dedication to his patients and colleagues. “Paul’s genuine curiosity made me—and everyone else, especially his patients—feel special, heard and attended to,” Katz said. “He had an encyclopedic memory for details of people’s lives regardless of their role, circumstances or station in life, and he would turn over every proverbial rock to ensure that his patients and colleagues received the absolute best care and sincerest attention and support possible. While heartbroken, I am so grateful for the lessons he taught me about being a doctor and friend.”

After his residency, Dr. Farmer completed a fellowship in the Combined Longwood Infectious Disease Program in 1996 and later became chief of the Division of Global Health Equity in 2009. He helped found the country’s first residency in medicine and global health equity at the Brigham, enabling the next generations of physicians to train in the clinical, social and administrative factors that affect health care in poor settings

Under his leadership, PIH has delivered care to people in underprivileged countries all over the world, responded to the devastating earthquake in Haiti in 2010 and built hospitals in countries including Haiti and Sierra Leone.

“I had the privilege to be in Rwanda with him about a week ago, and it was so great to see him doing the things he loved: teaching medical students on the wards and caring for patients,” said Joe Rhatigan, MD, associate chief of the Division of Global Health Equity. “Words are inadequate to describe this loss.”

Upon the announcement of Dr. Farmer’s death, social media was flooded with tributes from those he cared for, taught, worked alongside and inspired.

“We were all so fortunate to have had Paul in our lives, although far too short,” wrote Regan Marsh, MD, MPH, attending physician in the Department of Emergency Medicine. “He inspired so many with his vision for a more just and equitable world for all.”

“Paul was our compass, on a dual mission to promote health and equity,” shared Rebecca Weintraub, MD, associate physician in the Division of Global Health Equity. “Paul created proximity to listen and heal. I miss his warmth and friendship. May we all do justice to his memory.”

Authoring more than 200 scientific papers and multiple books, Dr. Farmer wrote extensively about health, human rights and the consequences of social inequality. He received numerous honors throughout his career, including the Bronislaw Malinowski Award, the Margaret Mead Award from the American Anthropological Association, the Outstanding International Physician (Nathan Davis) Award from the American Medical Association, a John D. and Catherine T. MacArthur Foundation Fellowship, and, with his PIH colleagues, the Hilton Humanitarian Prize. Dr. Farmer was also a member of the American Academy of Arts and Sciences and the Institute of Medicine of the National Academy of Sciences, from which he was the recipient of the 2018 Public Welfare Medal.

In addition to his tremendous accomplishments, he is remembered for his optimism, warmth, sense of humor, authenticity and tenacity.

“Despite incredible odds against the poor and periods of challenge as the world caught up with his vision, Paul did not tolerate pessimism. He had a gift to see the good in everyone and the possibilities for societal responses to seemingly intractable dilemmas, such as multidrug-resistant tuberculosis devastating resource-poor communities,” said Katz.

Raymond added, “Polo remained authentic and remembered everyone’s name; his patients adored him. Polo’s legacy lives on in all of us; it is carried forth every time we declare that health is a human right.”

Dr. Farmer is survived by his wife, Didi Bertrand Farmer, and their three children, Sebastian, Elizabeth and Catherine.

Information about a Brigham memorial service is forthcoming.

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In Memoriam: William R. Welch

All are welcome to share condolences and memories of Dr. Welch in the comments section below the story.

The Brigham community mourns the loss of William R. Welch, MD, a surgical pathologist in the Department of Pathology, who died on Feb. 15. He was 79-years-old.

A member of the Brigham community for 42 years, Dr. Welch served as a staff surgical pathologist, practicing gynecologic and genitourinary Pathology. He was also a consultant staff pathologist at the Dana-Farber Cancer Institute and an associate professor of Pathology at Harvard Medical School.

“Bill was known around the world for his expertise in pathology,” said Fred Bieber, PhD, of the Department of Pathology. “He had an attention to detail for even the smallest lesions that could impact patient care and a large following of pathologists outside of the hospital who would regularly send him their cases.”

Ever passionate about pathology, Dr. Welch was an outstanding physician, scientist and mentor to many. Known for his patience as an educator and commitment to setting a high professional standard, he worked with a multitude of pathology residents and left an ongoing legacy.

“Bill was a trusted and skilled teacher, often letting medical students listen to his own abnormal lungs to teach respiratory physiology. He was also a consummate jokester and an incredible role model to everyone at the Brigham. He was humble, sincere, generous and caring,” said Joel Katz, MD, director of the Internal Medicine Residency Program and a physician in the Department of Medicine. Katz also cared for Dr. Welch throughout his illness.

While a dedicated leader, Dr. Welch is remembered by his colleagues for reasons far beyond his work ethic. Close friends recall his humor, his passion for operating his ham radio and his ability to connect with people across the globe.

“He had a tremendous sense of humor; he was always full of jokes,” said Bieber. “If you wanted a joke, you’d go to Bill. You’d be sitting with him at the microscope, and he’d get a phone call. It’d be someone calling from Australia or San Diego telling him a joke.”

Dr. Welch’s impact spread far and wide. He was a close friend to many and he consistently went out of his way to help anyone that needed it.

“Bill was timeless. He was older than many of us by a few decades and yet could be a colleague and a friend. He expected excellence in your work, but then on the side he treated everyone the same,” explained Michelle Hirsch, MD, PhD, associate pathologist in the Department of Pathology. “There was not a person who came through the Pathology Department that was not impacted by Bill. Everybody walked away saying, ‘It was great to work with Bill Welch.’”

Across the Department of Pathology, Dr. Welch is widely remembered for his positivity and unwavering curiosity. Colleagues recall that he even approached his own illness with intellectual interest, optimism and good spirits. Bill had a unique ability to engage with everyone in the medical community.

“I referred to Bill as the ‘Mayor of the Brigham’ because he characteristically struck up hallway conversations with staff of every stripe and flavor, going out of his way to assist patients in need along the way,” said Katz.

Dr. Welch also brought great pride to his work, often inviting family and friends to his lab to explain the complex medical problems he was aiming to solve. While those close to him admit they understood little of what he explained, they’ll never forget the passion Dr. Welch brought to his work.

“Bill was a dear friend to so many of our staff, including me, and his antics and genuine kindness will be missed,” said Katz

Exceeding his attention to his work was that to his wife, Laurel Welch, RN, a nurse he met at the Brigham in 1984. They married in 1995 and maintained a loving relationship.

Dr. Welch is survived by his wife, Laurel Welch; his stepdaughter, Jennifer F. Tanis; his brothers, Lieutenant Colonel (LTC), Ret. Frederick R. Welch and Kevin L. Welch, MD; and his sister Valerie M. Welch, JD, as well as many extended family members, friends and loved ones.

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In Memoriam: Ramesh Radhakrishna

All are welcome to share condolences and memories of Mr. Radhakrishna in the comments section below the story.

The Brigham community mourns the loss of Ramesh Radhakrishna, a Medical Laboratory Scientist in the Clinical Chemistry Laboratory, who died on Feb. 7. He was 67-years-old.

A member of the Brigham community for 21 years, Mr. Radhakrishna was known for his dedication, attention to detail and compassion for others. As a crucial member of the Brigham’s Clinical Chemistry Laboratory, Mr. Radhakrishna brought his utmost commitment to his work and the patients he served. He was always dedicated to producing accurate results, and truly cared about every step of every lab test he ran.

Mr. Radhakrishna’s colleagues recall the pride he brought to his work, and his focus on generating results that enhanced patient care. Many recall him saying, “There is a patient at the end of this tube!”

Over the course of 21 years, Mr. Radhakrishna established himself as a reliable and dedicated asset to the Lab. He always took care to carefully calibrate laboratory equipment and meticulously report the results. When the lab got busy, Mr. Radhakrishna never complained about extra work, and instead reached out to colleagues, always asking how he could help.

Mr. Radhakrishna always provided his utmost support to his colleagues. If someone needed help with an issue on an instrument, he would take over the troubleshooting rather than expressing frustration. He would work at it until he was able to fix it himself, or he would call someone else who could. As a result, he developed excellent working relationships with service technicians as well.

Notably, Mr. Radhakrishna’s compassion translated well beyond his lab skills. He deeply cared for the wellbeing of his colleagues and was known as the one who said, “Good morning,” to everyone he passed. His greetings were always sincere and when he asked, “How are you today?” he genuinely wanted to know how you were doing and always took time to listen to your response.

Outside of work, Mr. Radhakrishna was a dedicated family man, who was incredibly proud of his son. He loved the sport of Cricket, and once dreamed of becoming a professional Cricket player.

“Mr. Radhakrishna was one of the hardest working and most compassionate technologists to come through the Lab at the Brigham,” said Gail Kinchla, technical director of the Clinical Chemistry Laboratory. “His dedication, loyalty to his profession, unwavering work ethic and contagious, cheerful spirit will be greatly missed.”

Mr. Radhakrishna is survived by his wife, Radha Radhakrishna, an accounting manager at Mass General Brigham, his son, as well as many extended family members, friends and loved ones.

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Five Things to Know About The Joint Commission Accreditation Survey

Surveyors from The Joint Commission (TJC) are expected to visit the Brigham unannounced to conduct BWH’s triennial, hospital-wide accreditation survey any day now. Our goal during the five-day visit is to demonstrate the unwavering commitment we have to our staff, patients and their families, our dedication to upholding the highest standards of quality and safety and our work to ensure that our practices are consistent with the 2022 National Patient Safety Goals.

During the visit, a team of surveyors, made up of physicians, nurses, hospital administrators, a hospital safety engineer and other health care professionals, will be escorted by Brigham staff and visit nearly all parts of the Brigham, including inpatient units, select ambulatory care practices and distributed campus locations.

The Joint Commission uses a patient tracer methodology to follow a patient’s care at the Brigham and to observe how we provide care to our patients. Here are five things that every employee should know about their pending visit:

  1. All staff should be prepared to interact with surveyors and answer their questions. Staff should remain positive, welcoming and professional when surveyors visit an area and be prepared to discuss both direct or indirect roles in supporting safe patient care and in quality assurance and performance improvement in the department. Please consult your supervisor or manager if you do not know the answer to a surveyor’s question.
  2. Always wear your hospital ID badge properly, either pinned or clipped to an outer garment, picture side out, right side up, above the waist on the front side of the body. For additional details, please visit PikeNotes.
  3. Understand your role in emergency preparedness and responding to any type of emergency.
  4. Ensure that there is no clutter in hallways, elevator lobbies, connecting corridors and storage rooms, and that any food and drink is in an appropriate location. Please make sure that access to emergency equipment (such as fire doors, fire pull stations, fire extinguishers, medical gas shut offs, sprinklers and eye wash stations) is never blocked.
  5. For patient interactions that involve treatments or procedures, administration of a medication or blood, collecting a specimen or transferring or transporting, remember to always identify using two patient identifiers: name and date of birth or name and medical record number. See more information in the Patient Identification Policy. Remember to always practice hand hygiene before and after every patient interaction.

For many months now, staff from Clinical Compliance, as well as several other teams, have worked to lay the foundation for a successful survey. It is critical that staff continue to do their part to prepare as well because we all play a role in keeping patients safe. For additional details about how we are continually prepare to be ready for every patient, please visit the Continual Readiness page on PikeNotes.

V-Day Event Addresses Intimate Partner Violence in the LGBTQ+ Community

Twenty-six percent of gay men and 54 percent of transgender individuals will experience domestic partner violence at some point in their lifetimes. While healthcare professionals have strategies to identify victims of violence in the medical setting, violence impacting minority populations often goes unnoticed. This may be due to existing stigmas suggesting that intimate partner violence (IPV) predominately impacts women, making it more difficult for male-identifying and non-binary individuals to ask for help.

V-Day is a globally-organized response against violence towards all women. Each year on V-Day, events take place worldwide to raise awareness about marginalized communities experiencing IPV. This year, the Brigham Medicine Grand Rounds examined IPV experienced by people of all gender identities and sexual orientations. Survivors and advocates were invited to share their stories and discuss how healthcare professionals can better identify and care for victims of IPV in medical settings.

Christopher AhnAllen, PhD, the director of the Gender Diversity Clinic in the Department of Psychiatry, shared that providers must be attentive to increased rates of violence in LGBTQ+ communities to proactively identify those experiencing IPV in a clinic or hospital.

Trever Boylston, Racial Equity Action Committee chair of Fenway Health, founder of the Grafton MA LGBTQ+ community organization and a transgender man, shared his experiences to educate medical providers on how to better protect and advocate for LGBTQ+ patients impacted by IPV.

Spreading Awareness Across the Care Team

Boylston grew up in Salem, MA with his grandparents. As a child, he didn’t always have the language or resources to talk about his sexual orientation and gender identity. Before his transition, he was the victim of an emotionally and physically abusive relationship. His trauma and early struggles with his gender identity made him vulnerable and took a toll on his self-esteem.

“What I was trying to do was find a community that fit, to find a home and something outside that would make me feel whole inside,” explained Boylston.

After transitioning, Boylston shared that health care professionals didn’t always take his experiences with IPV seriously. These challenges motivated him to advocate for other LGBTQ+ survivors of IPV. Boylston now works with various community organizations, helping individuals effectively tell their personal stories to create positive change.

At this event, he addressed Brigham medical providers on how to advocate for individuals who’ve experienced IPV.

“It starts with building trusting relationships with your patients,” said Boylston. “They need to feel comfortable enough around you to disclose abuse.”

Providers often ask patients about their relationships and their experiences with intimate partner violence. Boylston, however, emphasizes that it’s not only what they say, but how they say it.

“It’s important that providers have the right vocabulary when working with LGBTQ+ patients. If we come in, and we don’t hear providers using correct pronouns or language, we’re probably not going to come back for follow-up care,” said Boylston. “Language is critical to creating a safe environment.”

Finally, this work can’t happen in isolation.

We must support continuous efforts to spread knowledge and resources regarding IPV in the medical community and ensure that these efforts are collaborative across medical disciplines. This includes hospital administrative staff.

“It starts with the first time the patient walks into the office—at the reception desk, with the nurses and medical assistants. So many patients will spend more time in a clinic’s waiting room than they will speaking with their physician,” said Boylston. “The entire care team must have that level of sensitivity and awareness.”