Georgetown Medicine Spring/Summer 2018

SPRING/SUMMER 2018

The Healing Arts Physician and musician Dr. Rupa Marya (M’02) blends the worlds of art and medicine

SPRING/SUMMER 2018

THE HEALING ARTS

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Musings on the Art-Medicine Journey

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Crafting Artful Care

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Practicing Medicine, Practicing Art

Neuroscience and the Arts Researchers study perception of beauty, the neurological dominance of music, and the power of creativity.

In Perfect Harmony New Georgetown Arts & Medicine student collective fosters healing.

Children and families discover the art of healing through Tracy’s Kids.

Alumni artists Rupa Marya (M’02), Stephen Madigan (M’80), and Saeed Marefat (M’85) draw inspiration from medicine and the arts.

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Check Up News & Research

Issues in Bioethics On Campus Alumni Connections

Reflections on Medicine Sylvia Morris (M’98), second from right, with Leah Matthews (M’97), Angela Barnes Walker (M’97), Diane Clarke Boykin (M’98) and Jessica Osborn Pennington (M’98)

From the Archives Visit the Booth Family Center for Special Collections at Lauinger Library to page through this Georgetown treasure, a 1568 edition of De humani corporis fabrica. Created by Flemish Renaissance physician and master anatomist Andreas Vesalius (1514-1564), the fabulous Fabrica ushered in a new understanding of the human body and a new age of scientific inquiry.

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A publication for alumni and friends of Georgetown University Medical Center

Paving the Way for Our Daughters Really nice job with this last issue of Georgetown Medicine on women in medicine. The authors did an impressive job highlighting the success stories of female leaders in our field. I found this material both positive and impactful in many ways.

This issue brought home how far we have come but that there is still more work to be done in this regard.

As one whose wife is a pediatrician and who also has two daughters, both of whom have shown an early interest in the field of medicine, I greatly appreciated the work that these innovators are doing and how you positively spotlighted them in your writing.

Editor Jane Varner Malhotra

Contributors Chelsea Burwell (G’16) Kate Colwell Giuliana Cortese (C’13, L’16) Jeff Donahoe Monica Javidnia Patti North Camille Scarborough Leigh Ann Sham Karen Teber Kat Zambon

Design Director Fall/Winter 2017 Georgetown Medicine magazine

Robin Lazarus-Berlin Lazarus Design

University Photographer

Michael Karch, MD (M’95, R’02)

Phil Humnicky

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Executive Vice President for Health Sciences and Executive Dean Edward B. Healton, MD, MPH

Dean for Medical Education

Georgetown, Medicine, and Women on the Rise As a young female physician, I was thrilled to see an entire magazine devoted to the role of women in medicine. My career is just starting but I recognize that it could not have come to be without the strength and support of the women before me.

I remember sitting nervously during my white coat ceremony as they asked physician family members to come to the front of Gaston Hall to place white coats on their children. I thought the most exciting thing that would happen that day was to be welcomed into the medical community. However, as I watched my mother ascend the stairs—one woman among only a handful of female physicians on stage during that ceremony—I found the joy and pride of being welcomed in by my own female pioneer.

Reading through the article on GUSOM’s trailblazing female physicians, I was reminded of my own mother and inspired by the number of women who simply did not accept that being female was somehow a handicap. The other wonderful articles in the magazine demonstrate that the overall question of the acceptability of women in medicine is thankfully long gone and replaced with the question: How high can we push ourselves to rise?

Moving forward, I hope we can maintain the motivation to be strong leaders, advocates, mentors, and friends to the women who follow.

Christina M. Hanna, MD, MPH (F’08, M’14)

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Stephen Ray Mitchell (W’86), MD, MBA

Georgetown Medicine is published by the Georgetown University Office of Advancement Communications. Visit the magazine online at gumc.georgetown.edu/magazine. The magazine welcomes inquiries, opinions, and comments from its readers. Address correspondence to georgetownmedicinemagazine@ georgetown.edu or: Jane Varner Malhotra, Editor Georgetown Medicine Office of Advancement P.O. Box 571253 Washington, DC 20057-1253 For address changes contact alumni records addup@georgetown.edu or 202-687-1994.

For up-to-date information on Georgetown events and alumni news on campus and around the world, visit Georgetown Alumni Online: alumni.georgetown.edu. © 2018 Georgetown University

Cover: Singer-songwriter Dr. Rupa Marya (M’02) blends the beautiful worlds of arts and medicine. © Michelle Magdalena Photography

CH ECK UP

NEWS & RESEARCH

New Information to Combat Fatigue Disorders A recent spinal fluid and brain imaging study may help diagnose chronic fatigue syndrome and Gulf War Illness.

Top: Elijah Hiett / Bottom: Nathan McBride

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Researchers at Georgetown University Medical Center have found distinct molecular signatures in two brain disorders long thought to be psychological in origin—chronic fatigue syndrome (CFS) and Gulf War Illness (GWI). The disorders share commonalities, such as pain, fatigue, cognitive dysfunction, and exhaustion after exercise.

“This news will be well received by patients who are misdiagnosed and instead may be treated for depression or other mental disorders,” says James N. Baraniuk, MD, professor of medicine and senior investigator on this study.

Narayan Shivapurkar, PhD, assistant professor of oncology at the medical school, was also a member of the research team.

The work supports a previous observation by Georgetown investigators that there are two variants of GWI. GWI has developed in more than one-fourth of the 697,000 veterans deployed to the 1990-1991 Persian Gulf War, according to Baraniuk and his colleagues.

CFS affects between 836,000 to 2.5 million Americans, according to a National Academy of Medicine report. The disorder was thought to be psychosomatic until a 2015 review of 9,000 articles, spanning 64 years of research, pointed to unspecified biological causes. No definitive diagnosis or treatment is currently available.

This study focused on spinal fluid of CFS, GWI, and control subjects. Spinal taps before exercise showed miRNA levels were the same in all participants. In contrast, they were significantly different after exercise, with each study group showing distinct patterns of change. For example, CFS subjects who exercised had reduced levels of 12 different mRNAs, compared to those who did not exercise.

The two GWI subtypes showed other differences caused by exercise. One subgroup developed jumps in heart rate of over 30 beats when standing up that lasted for two to three days after exercise.

Imaging showed they had smaller brainstems in regions that control heart rate, and did not activate their brains when doing a cognitive task. In contrast, the other subgroup did not have any heart rate or brainstem changes, but did recruit additional brain regions to complete a memory test. According to Baraniuk, finding two distinct pathophysiological brain patterns in patients reporting GWI “adds another layer of evidence to support neuropathology in the two different manifestations of Gulf War disease.”

The study lays the groundwork to understand each of these disorders in order to diagnose and treat them effectively, says Baraniuk. n

Beyond Geriatrics: Aging Well “As we age, we gain momentum. More experience and greater wisdom push us forward. That experience and insight add energy and possibility, and enable us to contribute to society’s vitality in new ways.”

Pamela Saunders, PhD, associate professor in the departments of neurology and psychiatry at Georgetown University Medical Center and director of the university’s new Master of Science in Aging and Health

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Pass the Veggies

Eating soy foods and cruciferous vegetables may reduce treatment side effects in breast cancer survivors.

Consuming soy foods such as tofu and edamame, and cruciferous vegetables such as cabbages, kale, bok choy, and Brussels sprouts, may be associated with a reduction in common side effects of breast cancer treatment in survivors, say a team of scientists led by Georgetown Lombardi Comprehensive Cancer Center.

In the study, published in Breast Cancer Research and Treatment, higher intakes of cruciferous vegetables and soy were

associated with fewer reports of menopausal symptoms. More soy was also associated with less fatigue. The breast cancer survivors studied included 173 non-Hispanic white and 192 Chinese Americans.

Breast cancer survivors often experience side effects that persist long after completion of the treatment. To prevent breast cancer recurrence, many treatments inhibit the body’s production or use of estrogen, the hormone that can fuel breast cancer growth. Survivors may then experience hot flashes, night sweats,

and vaginal dryness.

The lead author, Sarah Oppeneer Nomura, PhD, of Georgetown Lombardi, says that the study addresses a gap in research on the role of lifestyle factors in relation to treatment side effects. When quality of life is adversely impacted, she notes, it can lead to survivors stopping ongoing treatments, but diet may be a modifiable target to reduce symptoms.

When study participants were evaluated separately by race/ethnicity, associations were significant among white breast cancer survivors; however, while a trend was seen in the benefit for Chinese women, results were not statistically significant.

Chinese women typically report fewer menopausal symptoms, and most already consume more cruciferous vegetables and soy.

Whether the reduction in symptoms accounts for longtime use of these foods needs further investigation, says the study’s senior author, Judy Huei-yu Wang, PhD, of Georgetown Lombardi’s Cancer Prevention and Control Program.

Although cruciferous vegetables and especially soy foods may reduce breast cancer risk, soy food intake during breast cancer treatment remains a controversial topic. Soy foods contain a plant chemical genistein that resembles natural estrogens and activates the estrogen receptor. In laboratory experiments, genistein stimulates the growth of human breast cancer cells. However, studies in breast cancer patients consistently show that soy intake reduces the risk of recurrence. Until more research is conducted, breast cancer patients undergoing treatments should not start taking supplements containing genistein, says Leena Hilakivi-Clarke, co-author of the study and professor of oncology at Georgetown University.

“Women who have eaten soy foods as a part of a healthy diet should continue consuming them to potentially reduce some treatment-related side effects,” she adds. n

After Cancer “People diagnosed with cancer are living much longer now than they did 20 years ago. Advances in specific therapeutic trials and treatments, and surgery discoveries, have led to new opportunities for improving cancer survivorship.”

Kristi Graves, PhD, associate professor of oncology and director of the new Survivorship Research Initiative at Georgetown Lombardi Comprehensive Cancer Center

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Top: Shutterstock / Bottom: Georgetown University

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Beating Ewing Sarcoma— Minus the Side Effects?

Because the disease often affects teens, side effects like infertility from current treatments are hard to bear. New research at Georgetown offers hope for an alternative.

Wikimedia Commons

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Based on a novel approach to drug discovery, researchers at Georgetown Lombardi Comprehensive Cancer Center say an agent approved to treat leukemia might also help young people with a much rarer but aggressive form of cancer, Ewing sarcoma.

The findings, reported in Oncogene, mean that the drug clofarabine soon could be tested in a clinical trial for Ewing sarcoma, a cancer found in bone or soft tissue.

It predominantly affects young people between the ages of 10 and 20, and while survival can be as high as 70 percent, treatment-related side effects can produce second cancers, heart problems, and infertility.

“Our goal is to improve both survival and quality of life for Ewing sarcoma patients, and this drug, when used in combination with other therapies, may do the trick,” says Aykut Üren, MD, associate professor of molecular biology at Georgetown University School of Medicine and a member of Georgetown Lombardi. The research team aims to share knowledge about how to make safer derivatives with fewer side effects, he notes.

They chose a druggable target protein, CD99, which is significantly expressed in

Ewing sarcoma cells. CD99 is a transmembrane protein— one end sticks out on the cancer cell surface and the other end is inside of the cell.

In fact, making an Ewing sarcoma diagnosis depends on both the appearance of the cell under the microscope and the fact that these cells express CD99 protein. Investigators don’t know exactly what CD99 does but earlier research using experimental monoclonal antibodies that bind on to, and inhibit, CD99 stopped tumor growth in laboratory models.

The team took an unconventional approach to searching a National Cancer Institute database of 2,607 compounds to find one that could potentially help Ewing sarcoma patients. They didn’t tailor the search based on finding the right molecule that perfectly fits into a pre-selected groove in the structure of CD99, but looked to see if anything would bind anywhere on the protein.

They then looked at what happened when these molecules stuck together.

They found 150 compounds that could link on to CD99, but only two had a beneficial function. One was clofarabine and the other was another FDA approved drug, cladribine, used to treat hairy

cell leukemia, B-cell chronic lymphocytic leukemia, and multiple sclerosis. Üren says that while both drugs “drastically” inhibited growth of Ewing sarcoma cells in lab and animal studies, clofarabine “decimated” the cancer.

The study also revealed that when the two FDAapproved drugs bind on to CD99, they work both on the outside and inside.

“It is the inside action of the drugs—their ability to alter DNA metabolism— that produces the known toxicity associated with them,” Üren says. “We believe it is sufficient to act only on the outside of the protein to

kill Ewing sarcoma cells.

Therefore, a derivative of clofarabine—just the part that latches onto CD99 without activating it—would likely work very well in the treatment of Ewing sarcoma.”

But he adds that clofarabine in its existing form should, and could, soon be tested as a treatment. Üren adds that the study offers tantalizing clues that inhibiting CD99 may work as treatment for other cancers or for a number of immune disorders that display these proteins. n Georgetown University has an intellectual property interest in the medical technology described in this research.

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When a doctor arrives at the world’s largest refugee site, where does she begin?

“The first thing you do when you get there is make friends. Who is the local imam?

Who is the local midwife? Who are the community health workers? The first day, you want to talk to those people.” —Ranit Mishori (M’02) Last fall, the family medicine doctor, professor, and journalist spent time in Bangladesh at the world’s largest refugee site, working with Physicians for Human Rights to document medical evidence of trauma. Upon her return to campus, Mishori shared insights with Georgetown medical students.

Flu 100 Years Later A century since the 1918 Spanish flu raged through the nation’s capital, Georgetown is hosting a series of interdisciplinary events and lectures to mark the occasion. Supported by the university’s Global Health Initiative, the programs aim to promote greater dialogue regarding pandemic preparedness across the university, the Washington, D.C. community, and beyond.

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Top: Tommy Trenchard/Panos / Bottom: Library of Congress, Prints & Photographs Division

Amid the Chaos

“HIV treatment is not a ‘set it and forget it’ proposition,” says study co-leader Charles Holmes, who photographed this cemetery in Lusaka, Zambia in 2016.

Tracking ‘Silent’ Deaths

Researchers uncover underreporting of HIV mortality rates in Zambia n n

Zambia’s HIV mortality rates for patients in treatment are substantially underreported, according to a new study called Better Information for Health in Zambia.

Researchers arrived at more accurate mortality rates using a novel sampling methodology that may be a model for improved surveillance approaches, and ultimately, more effective HIV treatment strategies.

Official sources report that AIDS-related deaths have fallen by 50 percent since 2005. However, routine monitoring and evaluation fail to systematically capture most deaths, making it challenging to accurately assess the impact of HIV services and to identify where improvement is most needed, the researchers say.

“Deaths often occur outside of the health system

and are therefore ‘silent’ events unknown to those providing or managing care,” says the study’s co-leader, Charles Holmes, MD, MPH. Holmes is faculty codirector of Georgetown University Medical Center’s Center for Global Health and Quality, a visiting associate professor at Georgetown’s School of Medicine, as well as associate professor of international health and medicine at Johns Hopkins University.

The research was conducted in Zambia through partnerships with the Centre for Infectious Disease Research in Zambia, the Zambian Ministry of Health, and with local and global academic centers and researchers.

Researchers looked at a sample of 160,000 patients who had visited governmentoperated HIV treatment sites in four Zambian provinces.

The team also traced the “lost to follow-up” patients, in order to ascertain their status. They used this information to create a corrected regional survival estimate as well as corrected site-specific mortality estimates. The team found underreporting of mortality rates in provincial program data—by as much as three- to nine-fold— among HIV-infected individuals starting antiretroviral therapy (ART). At the clinic site-level, “corrected” mortality rates were found to be up to 23-fold higher among those on ART. Based on the findings, certain prevailing assumptions that underlie HIV programs may need to be re-examined, say the researchers. For example, length of time on therapy alone may not be a reliable marker of stability, a finding that will have implications

for delivery strategies. Additionally, approximately 50 percent of deaths among those newly starting ART occurred shortly after a clinic visit, suggesting greater need for attention to diagnostic services and clinical vigilance for co-existing illnesses.

The authors seek to encourage national- and global-level policy makers to investigate and address the root causes of underestimated and highly variable mortality rates, so they can refocus their quality improvement efforts and strengthen HIV programs.

“We believe our study also highlights the critical need for investments in vital status registries and data systems, to enable better visibility into patient outcomes,” adds Holmes. n

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Resilient Baby Brains

Newborn babies who suffered a stroke regain language function in opposite side of brain. n n

Teenagers and young adults who suffered a stroke in the left side of their brains around the time of birth use the right side of their brains for language in an

exact, mirror opposite region to the left normal language areas, reports a team of researchers from Georgetown University Medical Center.

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LH Perinatal Stroke R

Scans of two controls compared to two who suffered left-hemisphere (LH) perinatal stroke show reorganized language areas.

These findings demonstrate how “plastic” brain function is in infants, says cognitive neuroscientist Elissa L. Newport, PhD, professor of neurology at the School of Medicine, and director of the Center for Brain Plasticity and Recovery at Georgetown University and MedStar National Rehabilitation Network.

This finding makes sense in very young brains, Newport explains. “Imaging shows that children up to about age four can process language in both sides of their brains, and then the functions split up: the left side processes sentences and the right processes emotion in language.”

Newport’s study used imaging to study the brains of 12 individuals, aged 12 to 25, who had a left-brain perinatal stroke, finding that all of them used the right side of their brains for language.

“Their language is good— normal,” she says, as are their basic cognitive functions like

language comprehension and production.

This study was more carefully controlled in terms of the types and areas of injury included than were previous studies, which had reported inconsistent findings about the brain’s ability to relocate language functioning.

“We believe there are very important constraints to where functions can be relocated,” Newport says. “There are very specific regions that take over when part of the brain is injured, depending on the particular function.” Her research suggests that while “these young brains were very plastic and could relocate language to a healthy area, it doesn’t mean that new areas can be located willy-nilly on the right side” she explains.

The research team is also collaborating on studies looking for the molecular basis of plasticity in young brains, as such information might help switch on plasticity in adults who have suffered stroke or brain injury. n

Demolition of the former medical and dental student residence hall is underway to make room for MedStar Georgetown University Hospital’s new 477,000-square-foot medical/surgical pavilion, which will feature 156 private patient rooms, a new emergency department, larger operating rooms, a rooftop helipad with direct access to the emergency room, and three levels of underground parking. Above ground, a pedestrian-friendly green space is planned to enhance connectivity with the university’s main campus. For plan details, visit www.buildingmedicalexcellence.com.

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Top: Elissa Newport

Goodbye, Kober Cogan (1959-2018)

Kidney Cancer Responds to the 1-2 Punch New immunotherapy combination is effective in patients with advanced kidney cancer.

Top: Alamy Stock Photo/Panther Media GmbH

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A new drug combination to fight advanced renal cell carcinoma, the most common form of kidney cancer, generated unprecedented results in an early-phase clinical trial, according to Michael B. Atkins, MD, deputy director, Georgetown Lombardi Comprehensive Cancer Center and principal investigator for the study.

“The combination doubled the efficacy of the drugs when used alone and the treatment was found to be tolerable,” Atkins reported. “Specifically, over 90 percent of patients exhibited tumor shrinkage and the disease was kept under control for a median of over 20 months.”

The study assessed the effect of combining an anti-angiogenesis agent (axitinib) with an immunotherapy agent (pembrolizumab). Axitinib inhibits angiogenesis, the process of blood vessels forming to feed a tumor. It was previously approved by the FDA as a second-line treatment for advanced kidney cancer. The immunotherapy agent, pembrolizumab, blocks a self-defense mechanism used by cancer cells to evade attack and destruction by the body’s immune cells. It is FDA-approved for the treatment of patients with several cancer types but has only had limited study in patients with kidney cancer.

The investigators started their phase I clinical trial of this combination in 2014 and enrolled 52 advanced renal cell carcinoma patients who had not previously been treated for the disease. Seventy-three percent of patients experienced significant tumor shrinkage in response to the combination therapy. By March 2017, 25 patients were still being treated, with 22 receiving the drug combination and 3 receiving pembrolizumab only. Overall survival results are as yet incomplete as 88 percent of the patients were still alive at a minimum 18 months after starting therapy.

Atkins reported that a randomized phase III trial is underway to compare this drug combination to the previous standard-of-care regimen for kidney disease. “This combination could present a major advance in the treatment of his disease,” he notes, “as well as help define effective combinations of similar drugs for other cancers.” n The work was sponsored by Pfizer Inc. in collaboration with Merck (known as MSD outside the U.S. and Canada). Atkins has been a paid consultant to Pfizer and Merck, as well as other pharmaceutical companies, on cancer-related issues including, but not limited to, kidney cancer.

Connecting the Dots: Dyslexia and Math Why are children with dyslexia more likely to also struggle with dyscalculia—the understanding and manipulation of numbers?

Exactly how these disabilities are linked, or even if they are, is the question that Guinevere Eden, D.Phil., is taking on.

In March, Eden, director of the Center for the Study of Learning at Georgetown University Medical Center, will start a four-year study that examines brain function in children with math disability, and compares these children with those who have reading disability, as well as those with math and reading disability combined.

Her team will use brain imaging and behavioral tests, and the groups will be followed after receiving interventions in the form of tutoring.

The $1.7 million grant supporting the research was one of the first awarded under the Research Excellence and Advancement for Dyslexia (READ) Act, signed by President Barack Obama in 2016, and granted to Eden and her colleagues by the National Science Foundation (NSF). READ is designed to help children with dyslexia and improve detection of the condition.

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Arts Musings on the Art-Medicine Journey I happened to be visiting family in Dubai in June 2009 when Michael Jackson died. The news felt surreal. I had grown up with the Jackson Five and Michael as my soundtrack. The magic of the Roller Dome in Indiana transcended land and sea that morning and filled my heart with a soul-ache I struggle to describe.

Our rare but beloved trips to the glitzy Arabian city had always been more about playing Uno with grandparents than exploring beaches or snow skiing in a shopping mall. But that night my husband and I had decided to treat our kids to a special “touristy” Dubai experience. We were going to the massive new water park for “Family Night.”

Do you know about Michael Jackson and Dubai water parks? In his later years, he liked to rent out a whole one to himself, don a burkini, and ride water slides all day. His spirit somehow reverberated in that place. I could feel it when we arrived. All around us, a truly global community—all ages, shapes, sizes, languages, colors, creeds—came together for swimming, sliding, and late-night picnics. And when “Wanna Be Startin’ Somethin” came on over the sound system, a chorus rose up among the people: Mama say mama sah mama coosa. Our energy was shared, and the rhythm rolled over the crowd in a visible wave, taking us and moving us and bringing something to us all together and at once. Something between solace and joy.

A beautiful unity. Humanity.

Did we experience a phenomenon that science can explain? What does it mean when a community of strangers rides a wavelength together? How does a shared perception of beauty connect and uplift us to a place where differences are transcended? And, if we can better understand what happens in our bodies when we experience art, will this help us heal?

In this issue we explore the intersection of medicine and the arts.

Through the healing power of art in pediatric oncology, the flourishing new medical student arts group, and a visit with three School of Medicine artist-doc alumni, Georgetown’s ongoing work in this arena is made visible through action. But our medicine-art journey begins in the mind, and so we open with a peek into the vast research underway across the university on neuroscience and the arts.

Jane Varner Malhotra Editor

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The Brain and the Beholder Neuroscientists and artists team to build a theory of beauty

By Jane Varner Malhotra

“I wanted to understand the brain processes involved not n a winter’s evening, the sky glows pink-orange just in perceiving the world, per se, but also in determining that behind a black lace of bare trees. A hundred miles away, it’s a warm rainy night in a blurry, sparkling city. something is beautiful, or ugly for that matter,” Grzywacz says.

“Separating this perception from the emotion of beauty, from On the other side of the planet, a quiet misty morning unfolds the aesthetic emotion, is the practical neuroscience question. along a river in the countryside. Nature surrounds people and I wanted to uncover and quantify the relevant variables, and becomes a shared common experience of beauty. Not just visual develop a general neuroscientific theory of beauty.” beauty, but sounds too like birdsong, crashing surf, a beating heart, or rustling leaves. Beautiful sights and sounds generate a Crossing the common human response, a art-science divide tangible feeling of awe, bliss, Adding to his team of two peace.

PhD students from the InterThroughout human disciplinary Program in Neuhistory, around the world, Quantifying, classifying, and measuring roscience, the self-described people have sought to the experience of art is part of the hardcore scientist went out on capture what is beautiful a big limb and hired a postand recreate this feeling emerging field of neuroaesthetics. doc with a degree in art and through art. Why? architecture. “Not a scientist.

Enter the scientist.

And that was on purpose,” Norberto Grzywacz (proGrzywacz says, smiling. “As nounced “greevats”), PhD, is we conducted the research, I a professor of neuroscience and physics. After three decades of wanted someone who would actually tell me how the artists work in the field of visual research at MIT and USC, he came think.” He wanted to know the vocabulary of the artist, for to Georgetown in 2015 as dean of the Graduate School of Arts starters, but also gain insight into the process of art making— & Sciences. Alongside his administrative work, he now studies the decisions an artist goes through to create what is typically what happens in the brain when a person thinks something is seen as a very personal work. beautiful.

Getting out of his science comfort zone was not easy, “At the University of Southern California, I was in the Grzywacz admits. “When you get good at something, it is department of biomedical engineering, helping, among other difficult to step out, but it’s the thing you have to do.” Crossing things, to build devices for people who are blind,” he explains. the often wide chasm between science and art offers an out“We investigated how the brain works for daily things—how sider’s perspective back onto one’s area of expertise, from either you see basic motion and shapes, what happens when you don’t side, and that experience inspires new approaches that break see, and what you do experience in that case. Our research ground. involved physiology, psychophysics, and a lot of mathematical Quantifying, classifying, and measuring the experience of art modeling.” is part of an emerging field called neuroaesthetics, typically He began to consider new questions about aesthetic emousing neuroimaging to inform its theories. The idea of the field tions after reading an article by the renowned neuroscientist itself is controversial. To many artists, the very concept of scienV.S. Ramachandran of University of California San Diego. tifically understanding and perhaps replicating art is appalling.

The article raised new questions for Grzywacz, who wondered For many scientists, the idea of attending a conference about art if we could see and measure the experience of beauty. Is there a and beauty elicits chuckles at best. common impetus for it, across humanity? And if this experiBut as more evidence reveals the power of art on the brain, ence of beauty is universal, what might be an evolutionary purpose to creating beauty by making art? If not universal, what studies like Grzywacz’s are gaining the attention of other “hardcore scientists.” makes it different across cultures?

Alessandro Gottardo

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number to the amount of surprise a chord brings to a listener.

His study began with the attempt to quantify the physical And it is very clear: songs that are not at the top of the cart tend properties of a painting that cause a person to like it. “You might walk by a house and look at it, and think it’s not bad. But to use more common chords.”

This element of “harmonic surprise” does not stand alone in then you see a painting of the house, and you say ‘Ahhh.’ It’s the what makes a song popular, he notes. They found patterns in the same house, but there is a difference.” chorus and verse structures of the most appealing songs.

Together with his PhD student Hassan Aleem and his By breaking a song into its two main parts—the chorus, postdoctoral fellow Ivan Correa, Grzywacz employed statistical which repeats itself and quickly becomes familiar to listeners, research to try to understand, and measure, the physical and the verses, which tell the song’s story and therefore have characteristics in famously beautiful portraits composed by changing lyrics—the scientists discovered a surprising pattern. master painters. They began by analyzing the works of art and “Everybody sings the chorus even if they do not remember quantifying their features, and then compared the results with the rest of the song,” Grzywacz explains. “Our analysis showed everyday portraits snapped in spontaneous situations. that harmonic surprise in the verses tended to be higher than “In portraits, the physical characteristics are a little simpler, and easier to analyze,” Grzywacz explains. “As a physicist, I said surprise in the chorus in successful songs.” Listeners enjoy variability, as long as the foundation is stable. we had to quantify things that we can relate to in an objective “The relationship between the harmonies in the music manner.” So his team narrowed further to Renaissance masters and how far they went is and took cues from art histoimportant,” he notes. rians about the properties to Further research is now measure: symmetry, balance, underway to strip away more and complexity. of the variability in the study, In the meantime, music Scientists analyzed 33 years by using computer generated stepped in. of Billboard magazine chart toppers new music based on the probMeasurements that abilistic distribution of harand their written musical scores. struck a chord monies, and asking listeners When PhD candidate Scott what they prefer.

Miles had to change advisors “So in this way it becomes as he neared his final stretch just the melody, no lyrics as a of research, the musician and interdisciplinary neuroscience factor, no famous artist,” says Grzywacz. “This is behavioral student approached Grzywacz about teaming up. Their comneuroscience, because we were testing the theory with real mon interests in statistically analyzing the perception of beauty people. And results have been the same: people prefer songs matched up well, albeit in different but complementary art with the most interesting—the most surprising—chords. In forms. addition, people prefer songs with reduction in surprise from “Scott works on the neuroscience of music, and he wanted to verses to choruses.” study the statistics of music—what is it in a song that makes you Early results reveal clear patterns in music preference that like it,” explains Grzywacz. underscore findings from the previous Billboard chart study.

The music study offered a more straightforward opportunity Using generic music helps control for things like the impact to quantify what appeals to the masses: 33 years of Billboard of advertising on a song’s popularity and narrows the focus so magazine chart toppers, along with their written musical scores. researchers can better understand the innate neural mechanisms This meant they could actually assess some of the physical charthat are universal for humans. acteristics of popular music and correlate them with the songs Cross-cultural pleasure prediction that people chose to buy. Because people tend to buy songs that they enjoy, the scientists used the Billboard ranking as a rough In order to formulate a general neuroscientific theory of beauty, proxy to aesthetic preference. Acknowledging the variables in Grzywacz and his colleagues are looking not only at universal what makes a song popular (like inspiring lyrics, a hip-twisting neural mechanisms, but also at the effects of culture. Aesthetic dreamy vocalist, or good marketing by the recording studio), values appear to differ for people from different places. “For a their research unveiled a clear pattern related to song structure. neuroscientist,” Grzywacz says, “learning is the process through “The chords made an important difference,” says Grzywacz. which differences across cultures emerge. How does the brain “We quantified the distribution of chords, and could thus tell learn aesthetic values?” how probable a certain chord was to appear in any given song.

Multiple fMRI studies have revealed three brain areas that Using a trick from information theory, we were able to give a are specially active in response to beauty. The first is the orbital

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frontal cortex, which has a sensory association role. Next is the anterior insula, bringing motivated behaviors such as hunger or sex drive into the picture. Finally, the basal ganglia plays a crucial part in the appraisal of potential pleasure, implementing the learning of how much reward an action related to an object may produce.

“Like when we see a beautiful apple and we think, ‘eating this apple will be good,’” Grzywacz explains.

The theory that Grzywacz and colleagues are working on proposes that this predicted reward is equivalent to the aesthetic appraisal of an object or a related action.

“Together these brain regions reveal the circuitry that is designed for the evaluation of things, and this same circuitry may be tapped by art,” says Grzywacz. Along with his colleagues, he has begun computer simulations with this theory and has seem some interesting results, “such as the role of culture and individuality,” he notes. “The latter comes about in great measure because of the difference in motivated behaviors in different people.”

Another surprising result was already predicted by Ramachandran in his earlier article, says Grzywacz. “Artists have to exaggerate the beauty of the world, not just copy it, in order to activate the brain pathway to cause pleasure.”

The research continues, and preliminary understandings confirm the statistical importance of balance, symmetry, and complexity in the perception of beauty in visual art. It also became clear that while complexity is necessary, to what degree varies between viewers. The findings are explored in an undergraduate course co-taught by Grzywacz, first offered last summer and again in 2018, on “The Brain and the Experience of Beauty in Art” at Georgetown’s Villa Le Balze in Florence, Italy.

Who can truly quantify that je ne sais quoi—that inexplicable something we experience when a beautiful painted landscape draws us in, or a portrait speaks to us?

Gryzwacz is hopeful that by working together across disciplines, artists and scientists at Georgetown can make it happen.

“The experience of beauty continues to be subjective,” says Grzywacz. “What is beautiful to you and to me may not be similar and that is not going to change. But the way the brain reaches the conclusion of what is beautiful may be amenable to science. We can study it, and learn about it.” n

Want to learn more?

Founded in 1994, Georgetown’s Interdisciplinary Program in Neuroscience includes faculty from 14 departments across the medical center and main campus: www.neuroscience.georgetown.edu.

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The Mind on Music

By Patti North

speak, but are suddenly able to sing the lyrics of a song, perceive nyone who has ever had an “ear worm”—that maddenrhythm, and tap along. “The sensorimotor link between the audiing musical refrain the brain occasionally seizes upon tory and the musical quality in the motor systems is clearly there and won’t let go of—may wonder why we don’t get an —it’s not lost even in people with dementia,” Rauschecker said. equivalent experience with other sensory input. We don’t talk The benefits could also accrue to healthy people. As the popuabout having an “eye worm,” repeatedly visualizing a fragment lation ages, and memory drops off—beginning at about age 60— of an image for hours or even days later. Could it be that music music could help us understand how to better access and read out is hard-wired into our brains in a way that no other sensory the memory chains we already possess and have stored away, by memory can match? strengthening some of the connections or synapses between Researchers at Georgetown are studying how and why music is so neurologically dominant. The answer seems to lie in rhythm nerve cells.

“There are places in the and how the brain processes world where the music doesn’t sequences—and they are conemphasize melody, and the fident that a better underconcept of harmony doesn’t standing of these functions “We want to understand exist at all, but rhythm—the will lead to more effective integration of audition, motor, medical treatment and disease how music resides in the vestibular, and vision—is uniprevention. brain and the body.” versal across cultures,” says Although use of music and Jessica Phillips-Silver, PhD, a use of language are both compostdoctoral fellow in the plex brain activities, scientists Georgetown Laboratory of are nearly certain that music Integrative Neuroscience and Cognition at the School of preceded language in human development.

Medicine who studies rhythm entrainment, or how rhythm “We know from studying humanoid fossils and from comparintegrates body and brain. “We hear the melody, but we feel the ing our brains with those of nonhuman primates that the brain beat.” For example, newborn infants respond demonstrably to structures that allow us to modulate our voices, or sing, are older being rhythmically bounced or patted by their parents. than the brain structures we need to articulate and form vowels Phillips-Silver also points to rhythm outside the realm of and consonants,” says Georgetown auditory neuroscientist Josef what we think of as music. “Comedians and actors strive for good Rauschecker, PhD, DSc, director of the Laboratory for Integratiming,” she notes, “which significantly impacts the quality of the tive Neuroscience and Cognition. performance.”

Music also has direct access to the brain’s limbic system and It’s not surprising then, that our relationship with rhythm is thus to our emotions. This means that music has long had an oboften traced to the beating of our mother’s heart in utero—but servable healing effect on the brain, restoring some of its plasticother animals also experience this without developing music. ity—but the effects could not be well quantified until fairly “We want to understand how music resides in the brain and recently. Brain imaging has moved the study of music from psythe body,” Phillips-Silver says. “When we fully understand that, chology into the realm of neuroscience. “Using functional MRI, we can now see how the brain works in both afflicted and healthy we will get to a new frontier of the effect of music in medicine.

We want to capture a process that is at the core of what it means subjects,” Rauschecker explains. to be human.” n Anticipating growth in the field of restoration of function, Rauschecker hopes to see more young people with music backgrounds drawn to neuroscience. “We need to bring together the Web Extra clinicians, musicians, brain imagers, and neurologists and have them talk to each other and see the patients together. A vision Clinicians and patients are experiencing creative new like this is developing here at Georgetown that we hope to fully applications for music and healing. Read more at animate.” www.gumc.georgetown.edu/magazine.

Stroke victims with aphasia, for example, may not be able to

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Alessandro Gottardo

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THE HEALING ARTS

The Creative Spark

Georgetown researchers study electricity and creativity

By Kate Colwell

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eorgetown psychology researcher and associate professor Adam Green grew up surrounded by a family of writers. He always admired his sister’s talent as a poet, and wanted to emulate her, but could never quite match her imaginative ability. Since childhood, Green has pursued insight into the human brain’s capacity for ingenuity.

So when Green teamed up with cognitive neurologist and neuroscientist Peter Turkeltaub, MD, PhD, of Georgetown University Medical Center, they sought interdisciplinary answers to two questions: what happens in the human brain when a person enters into a creative state, and can electrical stimulation enhance brain function when a person consciously chooses to think more creatively?

“Our work is somewhat relevant to individual differences, like why my sister is more creative than I am,” Green says.

“But more so, we’re asking, how can a person become more creative?”

Turkeltaub, who also directs the aphasia clinic at MedStar National Rehabilitation Network, says he and Green initially met to discuss the overlap in their fields. Turkeltaub focuses on how language is organized and produced by the brain; Green studies how changes in brain function support a state of heightened creative thinking when needed, and whether a person can consciously engage or disengage that heightened creative state.

They decided to collaborate on an extension of Green’s research on word association. His findings, based on a series of functional imaging studies, suggested that increases in activity in the left frontal pole of the brain supported improved creative performance when subjects actively attempted to formulate distant associations between words. The researchers wondered whether transcranial direct current stimulation of the frontal pole, to facilitate neural activity in this brain region, would support creative verbal thinking and reasoning. In other words, could electricity give the brain a creative boost?

To test the hypothesis, Turkeltaub designed safe and controlled levels of local electrical stimulation and compared its effects against a placebo. In order to facilitate activity in the frontal pole, Turkeltaub used anodal transcranial direct current stimulation, a kind of electricity that increases the ability of a population of neurons to fire.

“Creativity is complicated,” Green says. “The target of stimulation in this research is just one aspect of a highly complex system of neural networks. This was a place that we thought we

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could intervene because it was clear that more activity in the frontal pole was associated with better performance.”

Problem-solving and measuring metaphors In search of a quantitative approach to measure creative relational reasoning, the researchers settled on a way to look at “semantic distance” using a quantitative analysis tool called latent semantic analysis. Subjects were assigned two different types of word association tasks, designed by Green to assess the creativity of a person’s relational connections between words, both with and without transcranial direct current stimulation.

In the first task, Green gave a person a noun and asked them to come up with verb to go with it. Then, by comparing their choices with a massive computer database of texts that show how frequently individual noun and verb pairs appear together, Green measured how closely the noun and the verb related.

When subjects came up with more distant word associations that were less frequently used together, those responses scored numerically as more creative.

For the second task, Green created an analogy matrix using sets of words similar to older verbal reasoning questions from the SAT test. The matrix consisted of an array of different analogy pairs, such as “pencil is to eraser as pen is to whiteout” or “man is to boy as dog is to puppy.” Subjects examined the possibilities and selected pairs that made sense.

But many sets of words had less obvious pairings, requiring more abstract creative thinking. For example, some subjects selected the pair “pencil is to eraser as memory is to amnesia.” The more creative analogies a person chose, the higher they scored.

“Analogy is the basic element of metaphor,” Green explains.

“It’s primarily thought of as an important building block for problem solving. Our work is more related to writing a poem than painting a picture.”

The result of the study, published in 2016 in Cerebral Cortex, suggested that creativity may be enhanced, with the meticulous and controlled application of this sophisticated electrical thinking cap. While these findings don’t directly address differences in creativity between people, they show scientific progress in the ability to understand an individual’s personal capacity for creativity.

The study provides new insights into the functions of the frontal lobe, but Turkeltaub is cautious about implied applications.

“I don’t like to tout practical value because I don’t want people hooking themselves up to electrodes,” he says.

Green shares a concern about the proliferation of ineffective and potentially harmful electrical stimulation devices on the market today. “Our work in the lab involves careful computer modeling of tissues in the head,” Green says. “It’s important to understand where the electrical current is going and how it is behaving. DIY devices may be dangerous.”

Alessandro Gottardo

A boost for the brain The two researchers see implications from this study for improving verbal performance in patients recovering from stroke.

Turkeltaub’s work with patients struggling with written and verbal language disorders such as aphasia prompts him to imagine how, down the line, findings could be used to ease patients’ frustrations in communicating.

“I work with people suffering from speech and language problems after an injury,” Turkeltaub says. “They struggle with words and sentences, trying to talk around these obstacles. That task relies on creativity. In my work, I am helping people not to fix their difficulty finding words, but to get around the difficulty better by enhancing their creativity.”

Turkeltaub wishes more people knew about the widespread condition of aphasia.

“It’s a problem that affects two million people in the U.S.,” Turkeltaub says. “Aphasia is terribly devastating. Imagine you are

a parent. You wake up one morning with a stroke, and for the rest of your life you can’t read to your kids; can’t talk to them; you can’t understand them. It’s heartbreaking. We don’t have good treatments for aphasia, and it’s a major area of need.”

For now, clinical applications of Green and Turkeltaub’s research remain moored in their imaginations, but the team has come up with another tack. They hope to study not only the frontal lobe, but also how that region communicates electrical signals to the rest of the brain.

“The way we deliver electrical current is constant, which boosts activity overall,” Turkeltaub details. “It seems that one of ways the brain processes information is not through constant activity but through oscillating waves of activity. Depending on the connections and different frequencies, you can try to match the communication frequencies of the brain to boost it. We think boosting communication between the frontal lobe and the parietal lobe, where information is stored, might be more effective, and may help us understand how the whole brain works together to allow for creativity.”

In the meantime, Green will enjoy his sister’s poetry. n

Want to learn more?

Check out the Society for the Neuroscience of Creativity, co-founded by Green and funded in part by the National Science Foundation: tsfnc.org.

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In Perfect

Harmony Medical student arts collective fosters healing

By Mike Unger

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he laughter started rippling through the ProctorHarvey Amphitheater soon after Nick Stukel (M’18) sang the first verse of his song, “Doctor,” but it really exploded when he reached the chorus.

“I want to be a doctor, if I can make it through this thing,” he belted out in a pitch-perfect voice from behind a piano he was playing. “Will it ever be over? So many highs but so much strain. Got a long list of mnemonics, no more room in my brain.

Time to make some more space baby, and play the game.”

Stukel wrote the tune, set to Taylor Swift’s “Blank Space,” in less than 24 hours, following a particularly stressful few weeks (aren’t they all in medical school?) of interviewing for residencies. Like the other musical numbers, dance exhibitions, poetry and essay readings that highlighted the Arts & Medicine student group’s “What Makes You… More Than Medicine?”

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night of performance, his rendition was exceptional not only in its composition and execution, but also for the sheer and obvious joy it brought the audience and other participants.

The mid-January show was the perfect example of why the dozens of students who take part in one of Arts and Medicine’s many events say the group has changed their medical school experience—and made them better doctors-to-be.

“I find it interesting when people think there’s a dichotomy between art and medicine,” says Christine Papastamelos (M’19), one of the group’s cofounders. “I’ve always found them to be supplemental to one another. I was an art history major in college, and people would be like, ‘That’s weird, you’re doing pre-med.’ But engaging yourself in art is a way to understand other people and to share something about yourself. I think a lot of it is about listening, and human connectedness.”

THE HEALING ARTS

Papastamelos, John Guzzi (M’19), and Dylan Conroy (M’19) started Arts & Medicine in 2015. As an undergraduate at Boston College, Guzzi played in a rock band and was president of a musician collective that performed for kids at a children’s hospital.

“That’s what got me turned onto medicine in the first place,” he says. “I couldn’t imagine not doing that kind of work.”

So when he got to Georgetown, he and his two new friends founded what was originally called Music & Medicine.

Then, as they still do now, they played for children in the pediatric ward of MedStar Georgetown University Hospital.

Equipped with guitars plus tambourines and shakers for the kids to use, a handful of med students performs on weekends for the patients and their families and friends. Their catalogue includes Disney songs like “Let It Go” from the movie Frozen, a Justin Timberlake tune or two, and classics that older people enjoy. For the little ones, “Old MacDonald” and “Wheels on the Bus” are surefire winners.

“If you talk to anyone in the club, playing for the kids is probably our favorite thing we do in med school,” says Conroy, a guitar player (and singer when he “has to be”). “Not only to see the kids light up, but it also takes a little bit of stress away from the families. I can only imagine how terrible it is to have your 2or 3-year-old kid in the hospital.”

Sadly, Claire Hughes knows that reality all too well. Her 12-year-old son Will was diagnosed with brain cancer two years ago. He was in the hospital for more than a week when he had his first surgery in January 2016.

“It was such a nice break for him to be distracted by all these wonderful students who sang,” she says. “He smiled and so did everybody who was with him. You go from crying to smiling—the music just brings you joy and happiness and lifts your spirits. That’s why I fell in love with the program.”

Yet listen to the students who perform

at the hospital describe the experience and it isn’t clear who benefits from the visits the most.

“It helps you look at people as more than just numbers, and it really helps you connect with their stories,” says Marilyn McGowan, co-president of Arts & Medicine. “Looking at medicine just as a science makes you think in a very binary and formulaic way. Having that arts component helps us remember that no two people and no two patients are the same.”

“Difficult classwork is one thing, but what you really lack in med school, especially in the first two years, is face-to-face

“We don’t really understand why creativity is so healing.

But it’s restorative, like sleep, and nobody understands that either.”

interaction with the people you get to serve,” Papastamelos says. “A lot of time being a student can be solitary—you’ve got to learn your information. But when we take a break and go see these kids who are really sick or have just had a major surgery, it’s gratifying to realize that this is the profession you’re growing into.”

Increasingly, medical institutions across the country are offering programs to support arts-based healing, despite a continuing shortage of evidence-based research on the impact of the arts on health care providers and patients.

One reason for the lack of data, says Dr. Caroline Wellbery, Arts & Medicine’s faculty advisor, is because designing studies on the subject is exceedingly difficult.

“It’s not like taking a pill,” she says.

“There are so many things that impact patient care. But I think arts are integral to what humans need. The arts in medi-

cine have multiple purposes, one of which is entertainment and pleasure. But also it’s an avenue toward reflection. Performance makes you think about things a little more deeply. It’s healing for students to be engaged in something like this, where they can turn off part of their brain and just be in the moment. We don’t really understand why creativity is so healing.

But it’s restorative, like sleep, and nobody understands that either.”

On a rainy winter Saturday, a group of six Arts & Medicine musicians made their way to the post-op unit at MedStar Georgetown University Hospital.

Patients were asked if they wanted a visit from the troupe, to which Kelley Williams enthusiastically responded “Yes, please!”

As medical student guitarists and vocalists entered the room, and her face lit up with joy. The musicians squeezed together to make a little more space as they keyboardist rolled his instrument in on a hospital over-bed table. As they began an achingly beautiful rendition of “Wagon Wheel,” the energy transformed the room and those in and around it.

Busy staff walking by the open door couldn’t help but smile, and a patient walking the hall with his two family members slowed to linger and enjoy the melodious voices. A group of recent Nursing & Health Studies graduates gathered outside the room, too, soaking in the sounds and smiling when they learned the musicians were Georgetown med students.

Between songs, the patient shared that she is an elementary orchestra director, and plays the viola and violin. She closed her eyes and took a deep breath. She opened her eyes and looked around slowly at each musician. “What you’re doing is so important,” Williams says softly, shaking her head. “You never know who you touch. You made my day.”

Shortly after its formation, Arts & Medicine broadened its focus from music to include the written and visual arts.

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The School of Medicine and Medical Center community gathered in January for a talent showcase called “What Makes You…More Than Medicine?” inspired by the Jesuit concept of magis (more than).

“I think one reason our club took off so quickly is because there’s just something inherent about art being an avenue to open yourself up to other people,” Papastamelos says. “I think that really draws our class together; they experience that connectedness. It’s really pretty infectious, although infectious is probably a bad word in medical school. Infectious in a good way.”

Today, many poems, essays, photos, short stories, and paintings are featured in Scope, the group’s creative journal. It offers students who are more introverted a forum to share their work and a way to be involved with the organization, without having the knee-knocking experience of standing before an audience to perform.

The second volume, released early in 2018, includes a watercolor of children on a beach (“Summer Days” by Katherine Wickholm (M’19)), a painting of MedDent by Karen Schirm (M’20), and an untitled, abstract oil painting by Cameron Zachary (M’21). There also are plenty of stunning photographs, including a dramatic sunset at Yosemite National Park by William Ferris (M’20).

In the issue, Lauren Klingman (M’19) has a series of pencil sketches entitled “A Physician’s Exam: Inspection,

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Auscultation, and Palpation.” At the event in January, she dealt with personal identity in her reflection, “From Acting to Medicine,” which took the audience through 20 years of her life as an actor.

“It’s hard for me to believe that it’s been almost seven years since I decided to officially call it quits on theater and go into medicine,” she said. “It was the last time I called myself a professional actor or artist. I’m still struggling to redefine myself and questioning if it is alright to feel like an artist. I’m still trying to find a way to blend both.

“It’s a part of my identity that often doesn’t get brought up,” she said after her reading. “You get stuck in this ‘cookie cutter’ role of a medical student. It’s nice to let people know you have another identity.”

Perhaps that’s why Stukel’s song was such a hit. As medical students, most in the audience could relate to the lyrics of “Doctor,” which detail the specific trials and tribulations of each of the four years of medical school. But they also appreciated their classmate’s ability and willingness to perform.

“For a lot of medical students and physicians, some form of involvement in the arts, whether it’s music or writing,

allows for a creative release of a lot of the tension and frustration that builds up through difficult patient situations,” says Stukel, who keeps an 88-key keyboard in his room. “By tapping into that right brain side, the more creative aspect of ourselves, we’re able to be better communicators, maybe notice more subtle things with patients and their demeanors, and relate to them in a little broader way than just the clinical context.”

A native of South Dakota and graduate of Creighton University in Nebraska, he was a member of a Christian rock band named Godstruck that played for audiences of 50 to a few thousand people throughout the Midwest. The reception from some of those crowds might have been louder, but few could possibly have been more enthusiastic than the one at the January event, which gave him a rapturous ovation after the final verse.

“Feels like forever, that med school’s way too hard,” he sang. “And even when it’s over, that I won’t know enough. Got a long list of case studies, they’re driving me insane. Buckle down, let’s do this, get that M-D in my name.” n Giuliana Cortese of GUMC Communications contributed to this story.

Break a Leg Operating theater takes center stage at the university’s annual Heart of the Harvey dramatic arts festival. starred the Wizard of Oz as a cynical attending physician. he concept of a theater-in-the-round isn’t new, but In contrast, a faculty member’s monologue explored the performing short plays, dances, and spoken poetry psychological strain of recurring cardiac episodes. in a medical school’s operating theater seems uniquely “Going through medical school you grow an extraordiGeorgetown. nary amount through situations that push your emotional, The idea was born from a conversation between Bill intellectual, and physical boundaries,” says Jameson Rebeck, a neuroscience professor, and Susan Lynskey, MFA, Holloman (M’17). “The Heart of the Harvey allowed me a performing arts professor, when the W. Proctor Harvey Amphitheatre was renovated. Both agreed the space seemed like the perfect spot for a dramatic event hosted by the School of Medicine and the university’s Center for Social Justice.

“It’s not that surprising,” explains Rebeck, who earned his MFA in playwriting a couple of years ago. “A big part of the medical field is creative problem-solving. You need to ask questions and use your imagination.

That’s what we’re doing at Heart of the Harvey. It’s an unusual space and we work with what we’ve got.”

Now in its third year, the event features artistic endeavors that are in some way related to health and medicine. Beyond that unifying principle, the Heart of the Harvey is very open: participants come from all areas of the university, from the business school to Since 2016, Heart of the Harvey connects the Georgetown community—and art and medicine—through theater. the development office, and include staff members as well as students. to explore issues within medicine that I’ve been thinking Dean Stephen Ray Mitchell loved the idea from the start, about for a while.” especially in light of the fact that the late W. Proctor Harvey This year’s event will focus on “Soul” with more particiwas an avid theatergoer. pants utilizing the nontraditional space. In addition to plays “In the Buddhist tradition, a gentle bow and a ‘Namaste’ that range from love to limbo, the event will feature soul indicate that the light in one’s heart recognizes the light in another,” shares Mitchell. “Over the last two and a half years, music and soul food.

“It’s a pleasure to bring the joys and challenges of this wonderful event unites the light in the heart of the remarkable Proctor Harvey with the light in others from across science to a larger audience, and I’m certain that everyone involved learns more about empathy and humanity,” Rebeck the university community.” says. “But we are also having fun—and that’s just as Last year’s event, with the theme of “heart,” evoked both important.” n laughter and tears. One student play, “Over the Rainbow,”

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Crafting Artful Care Children and families discover the art of healing through Tracy’s Kids

By Chelsea Burwell (G’16)

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he layout of most medical reception areas is relatively similar: chairs, end tables, brochures, magazines, and patients anxiously listening for their names. However, one waiting room at Georgetown Lombardi Comprehensive Cancer Center is facilitating healing for young patients as soon as they walk through the door.

Nested in the pediatric oncology unit of MedStar Georgetown University Hospital, Tracy’s Kids is not just a waiting area—it is a safe and creative artistic space devoted to children and young adults affected by cancer. By way of art therapy, the non-profit organization helps young cancer patients and their families cope with the emotional stress, trauma, and difficulties of the diagnosis and treatment process.

According to the American Cancer Society, each year more than 10,000 children in the United States under the age of 15 are diagnosed with cancer.

Though childhood cancers account for less than one percent of all cancers diagnosed annually, the rates have gradually increased over the last few decades, making cancer the second leading cause of death in children in the U.S. (after accidental injuries). However, thanks to advancements in medicine and therapy, more than 80% of young patients diagnosed with cancer survive for more than five years.

Since its founding, Tracy’s Kids has aided thousands of patients and families during the cancer recovery process at no cost to them.

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Tracy’s Kids has raised more than $5 million to fund the flagship location at Georgetown, along with the six other locations in the Washington, D.C. metro area, Baltimore, San Antonio, and New York.

Difficult beginnings, worthwhile endings The story of how the leaders of Tracy’s Kids crossed paths is just as awe-inspiring as the work that comes out of the program.

“I was diagnosed with cancer as a 10year-old on the day that Martin Luther King Jr. was killed,” reveals Matt Gerson (L’84), president and founder of Tracy’s Kids. Recalling his own experiences as a young cancer patient, Gerson expressed his resolve to improve the patient experience for children and families coping with medical trauma. “Thirty years later, on my 40th birthday, I decided to support something that addressed the psychological side of cancer, because I understood how scared and lonely kids could be,” he explains.

In 1998, following a meeting with cancer research specialists, Gerson was referred to Councill, an art therapist at what was then Georgetown University Hospital. A professional artist, Councill was drawn to art therapy after learning about it from a music therapist. She enrolled in the graduate art therapy program at George Washington University in 1986, merging her love for people and art, and later interned at Georgetown Hospital in the pediatric hematology-

oncology unit with Joe Gootenberg, MD. “Our clinic only operated during the morning, so I was there three mornings a week, and we shared the space with the breast cancer clinic. I would set up the space and clear it by noon so the ladies for the breast clinic could come in,” Councill recounts.

At the end of her internship, Gootenberg sought funding to secure a permanent position for Councill at Georgetown. In the meantime, she worked as an art therapist at other hospitals in the area, but her commitment to the field made a lasting impression on Gootenberg.

“He called me three years later and said, ‘We’re going to write a grant. If you help me write it and it’s accepted, you can have the job.’”

Twenty-seven years after returning to Georgetown, the woman behind the organization’s name continues to practice and teach art therapy, and is a leading national advocate for the practice in pediatric spaces. In what started as a test run during an internship, Tracy’s Kids continues to expand. The philanthropic program now offers art therapy for hundreds of young patients each year in Maryland, Virginia, Texas, and New York, in addition to the District of Columbia.

Councill explains why starting the program at a space like Georgetown was necessary for her work to grow.

“Cura personalis is a big part of why my work here has been so successful.

From the beginning, the hospital was

Tracy Councill (standing) welcomes patients and families to pediatric oncology’s nontraditional waiting room.

open to the idea that we really needed to engage kids on their imagination and development, outside of receiving just the medical treatment,” Councill says.

The evolution of patient experiences and expression Today, researchers notice the benefits of fusing art and medicine as a means of tapping into the patient’s overall health and fostering open lines for communication between patient and physician.

However, avenues for art therapy, as well as the importance of space for treatment of children, are just now breaking through obscurity.

Though much has changed with regard to the technology used for detecting and treating cancer, the psychological

and emotional toll of the disease remains.

Feelings of stress, isolation, and guilt still befall some patients and families after a loved one is diagnosed. Councill, who has studied the psychological effects of cancer diagnoses on children and families, says some believe their diagnosis is a result of previous bad behavior. She recalls a conversation at the art table one day amongst patients and their siblings.

“These two brothers came in and while they were creating, one of the other kids randomly asked, ‘Why do people get cancer?’ And immediately, the brother said, ‘I know why my brother has leukemia. I pushed him off the bunk bed.’ He thought he had given him leukemia, because of the bruise after the

fall, but in reality, that bruise diagnosed him,” she says.

Councill goes on to explain that those who feel this guilt after the diagnosis stifle their wants, needs, and feelings for the sake of the family, and attempt to make themselves smaller. “You can only be but so good,” she says.

Therefore, the art therapy benefits of expression, confidence-building, processing emotions, and understanding one’s health are vital to the patient’s overall well-being, particularly for children.

“My grandson told the nurse technicians, ‘You’ve got to hurry up and take my blood because it’s going to coagulate soon!’” recalls Mary Chapman, who travels from Delaware each month to bring her grandson and his brother to

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Councill shares a laugh with Gerson, whose philanthropy has helped bring art therapy and healing to children and families for 20 years.

Tracy’s Kids. “I had to laugh a little, because he was so serious and sure about his body.”

Kristin Ramsey, fellow art therapist at Tracy’s Kids, explains that the agency with which these patients-turned-artists are equipped ultimately allows them to express themselves in ways that family members, and even doctors, may not have noticed. As kids tackle their inner conflicted voices—or “monsters”— Councill says the artistic process that each patient embarks on allows therapists and physicians to take a peek into their world.

“They are the masters of their own art, so we just let them take the lead. But then, we’ll get a lot of monsters, and when one comes up, we try to figure out what it wants to say or do. It can really be a vehicle for understanding kids’ feelings of anger and bewilderment,” Councill describes.

One of the paramount aspects of the organization is its emphasis on community. From patient-to-patient interactions to making art with family members, Tracy’s Kids promotes a communal atmosphere. The program’s physical spaces are designed to counter the siloed recovery process that many cancer patients endure.

“Everybody is trying to stay in their lane and get through treatment,” Councill says. “However, I have seen that being here gives patients the opportunity

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“On my 40th birthday, I decided to support something that addressed the psychological side of cancer, because I understood how scared and lonely kids could be.”

—Matt Gerson (L’84)

to build community and not be isolated.

Parents can network, and I can connect with these kids and build a relationship with them throughout this process.”

Life-changing and conversation-shifting art Thousands have been changed forever by Councill’s work and the Tracy’s Kids experience. With varied channels of artistic expression available—from painting and drawing to pottery and sculpting—selfdiscovery is working in tandem with treatment.

Many patients have returned to visit Tracy after completing treatment, telling her that they’re now interested in pursuing art or art therapy as a career. Danielle

Eichner, a former patient at Tracy’s Kids, is now the trained art therapist at the organization’s location in Baltimore.

Kalani Looper has been coming to Tracy’s Kids since April 2017 when she was diagnosed with acute myeloblastic leukemia. During her five-month hospital stay, Looper was introduced to Councill and Ramsey. Upon starting art therapy, the 19-year-old District Heights, Maryland native admitted that at first she didn’t realize that her recovery began with writing and talking about her cancer diagnosis—a tough pill to swallow for some patients and families.

“Outside of here, recovery is not an open discussion, because cancer is almost like a curse word you can’t say, or a whistle only we can hear,” Looper explains. “But talking doesn’t have to feel like therapy. Every time I sit down, it’s like this amazing podcast except no one’s recording. You have a chance to talk about any and everything.”

Looper says that while cancer has tested her faith, she hasn’t let it change who she is.

“If people ever want to talk to me about cancer, that’s fine,” Looper says.

“But don’t ever call it mine, because it wasn’t mine to have. I don’t claim it. It was never a death sentence; it was just an interlude.” n Find out more at www.tracyskids.org.

THE HEALING ARTS

Art Inspires in Clinical Settings Curator Personalis

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hile young cancer patients at Tracy’s Kids take part in interactive, tactile art therapy, the soothing chords from Karen Ashbrook’s hammered dulcimer can be heard footsteps away in the Georgetown Lombardi Comprehensive Cancer Center waiting area, creating a calming space for adult patients and caretakers. Ashbrook, a certified music practitioner through the Music for Healing and Transitions Program, is one of more than 15 specialized artists-inresidence in Georgetown Lombardi’s Arts & Humanities Program.

Seeking to foster a holistic and restorative healthcare environment for patients, staff, and visitors, the program facilitates therapy through music, dance, yoga, writing, and visual arts performed by professional artists. Founded in 1998 and funded by Georgetown University Medical Center and MedStar Georgetown University Hospital, the arts program bridges two institutions that many patients never realize are separate—the university and the hospital—in the common pursuit of care.

“Our artists bring energy and hope, and they’re some of the greatest empaths,” says Faculty Director Julia Langley.

Recently appointed to the School of Medicine faculty, Langley is a cancer survivor and art historian, and brings a unique combination of skills to the program’s 20-year work.

The Arts & Humanities Program brings art to the medical setting, and now also helps put medicine in the art setting. The program recently launched a new partnership with the National Gallery of Art, bringing medical students

to the museum to develop visual literacy, communication, and empathy through art study and contemplation.

“Music and the arts have traditionally been a part of healthcare,” Langley notes. “Different cultures have their

Langley unveils new collection of prints in the Lombardi Atrium by renowned color-field artist Sam Gilliam.

standards for healing—from shaman to Navajo healers.

In western culture after the Enlightenment, there was a separation. But Georgetown’s foundation as a faith-based hospital allows us to consider what care for the whole person really looks like.” n

The Artist Among Us

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enerations of Georgetown doctors knew and loved Thomas C. Lee, MD (C’48, R’59) (1927-2015), surgeon, professor, and artist. In addition to the works he shared with family and friends, his art graced the covers of this magazine’s predecessor, Georgetown Medical Bulletin, which he edited for nearly 20 years. Though he worked in a variety of styles, Lee often created portraits to accompany profiles, including this one of Ray Holden (M’28) which can be found today in the department of Obstetrics and Gynecology at MedStar Georgetown University Hospital. Plastic surgeon John Gatti (M’78), who continues to paint in watercolor and oils, was inspired by Lee. “He gave me the courage to do it,” he says.

As his Washington Post obituary noted, “In art circles he was the ‘the surgeon’; in his medical practice he was ‘the artist.’ In his description of himself, they were inseparable.” n

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Practicing Medicine, Practicing Art

By Jeffrey Donahoe

For as long as medicine has been practiced, physicians have turned to the arts for inspiration.

Georgetown Medicine spoke with three alumni who find a new sense of self, improved clinical skills, and the joy of discovery through the art they create.

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THE HEALING ARTS

Border Crossing

Jennifer Hampton

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f anyone was born to embody the worlds of medicine and art, it is Rupa Marya (M’02), an associate professor of internal medicine and hospitalist at UC San Francisco, and composer and lead singer of her global roots band Rupa and the April Fishes.

Marya’s mother comes from a long line of artists and was set to be a concert pianist before her arranged marriage. And the lineage of Marya’s father? “More doctors,” she says.

Marya grew up in the San Francisco area with extended time in France and India. Her parents encouraged her interests in music and theater. But as she reached adulthood, they didn’t understand when she announced that she wanted to pursue music professionally as well as becoming a doctor. (Her two undergraduate degrees from UC San Diego are in theater, and in biochemistry and cell biology.)

“They didn’t see music and medicine as complementary,” Marya says. “But, historically, music has been a healing experience, so being a doctor and an artist makes total sense to me.”

After a post-undergraduate gap year of odd jobs and writing and performing music in San Francisco, she started medical school at Georgetown. Washington gave her opportunities to perform, but when the time came for the medical board exams, “I had to put my guitar under my bed for a while,” she says. The demands on a third- and fourth-year medical education left no room for music.

But Marya knew that, after singing since she was 5, she didn’t want music to become solely an after-hours hobby.

“I was kind of tortured about music and medicine,” she says. “I knew I was both. My friends gave me lots of advice. It was conflicting, of course.”

Marya took a year off between her internship and residency to attend a program on making audio documentaries.

“That experience helped me be a better clinician and diagnostician,” she says.

“It taught me the art of interviewing, to listen, to hear how people talk.”

Returning to UCSF for her residency, she pushed for a longer program that was two months practicing medicine and two months off. This gave her the time to be serious about performing and writing. In 2008, she joined the faculty of UCSF’s

other cultures.

Some of her song ideas draw from her patients. “Medicine is an unusual opportunity to be close to people’s fears, dreams, and hopes,” at a particularly vulnerable moment in their lives, she notes. “It’s impossible not to be affected by that.”

Today, Marya is working on a new album, Growing Upward. The title subtly references the natural elements which

Left: Rupa Marya; Above: Rupa and the April Fishes

division of hospital medicine, negotiating the time commitment she has today— working 60 percent of full time, so that she can continue to write and perform professionally.

She formed Rupa and the April Fishes as a street band in 2006. Like Marya’s life in music and medicine, her compositions and the band’s sound defy traditional boundaries. They mix musical vocabularies, evoking jazz and gypsy music, French chansons, and flavors of Marya’s Punjabi heritage, among other influences. The lyrics’ languages—English, French, Hindi, and Spanish—reflect the band’s respect and appreciation for the world’s rich cultural diversity and encourages audiences to deepen their own understanding of

spark Marya’s activism around the interrelation of the environment and health equity. Her medical research focuses on the health outcomes of racism and law enforcement violence.

Marya says that one of the best kernels of wisdom she received came from infectious disease specialist Harry Hollander, also at UCSF, who counseled her on her unusual career path. “Bind to your fear,” he told her.

“It means, be okay with not knowing,” she says.

“In medicine, there is so much attempt to know. But the mysteries of human life and the body are unknown and unknowable,” she says. “In art, you’re also sitting in the unknown.” n

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THE HEALING ARTS

Stephen Madigan, who has been in a wheelchair most of his life, rehearsed with cast members in Shakespeare’s Richard III at Portland Stage Company in 2015.

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Radiologist Drawn to New Role

Shawn Patrick Ouellette/Portland Press Herald via Getty Images

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his winter, after his long work days end, radiologist Stephen Madigan (M’80) is still reading—carefully, thoughtfully, searching for all that exists beneath the surface of what the eye can see.

Sometimes it’s a late night reading radiology images, but more often Madigan has been poring over a dramatic script, learning lines and inhabiting Robert Louis Stevenson’s iconic characters Dr. Jekyll and Mr. Hyde.

Madigan played both roles in April in a new theatrical production of the novel at Footlights Theatre in Falmouth, Maine, where he lives and has his practice.

Dr. Jekyll and Mr. Hyde is only the second play in which Madigan has performed. The first was in downtown Portland, Maine, in 2015, when he played the title role in Shakespeare’s Richard III at Studio Theater at Portland Stage.

Madigan came to the production with no theatrical background or training— an amateur alongside professionals, a doctor among artists. And playing one of Shakespeare’s most debated and difficult roles, no less.

Madigan says that Richard III director Sally Wood took a huge chance on him.

Before she cast him, Wood talked with Madigan for 90 minutes without hearing him recite a single line. “What struck me first was his passion for the project,” she recalls. “The main thing a good actor needs is enthusiasm for the project and Stephen had that in spades.”

His fellow actors might have been a little nervous when he joined the production, Madigan admits, but he

turned the challenge into an opportunity.

“I explained why I was drawn to the role and that I wanted their input and help.”

Over rehearsals, they grew and learned together.

“I love actors,” Madigan happily says.

“Theater people only care about who you are as a person, what you are working at, what you are doing.”

Dr. Jekyll and Mr. Hyde director Michael Tobin remembered Madigan from the three-week run of Richard III and encouraged him to audition.

Asked if he enjoys acting, Madigan points to the intensity of the craft. “‘Fun’ isn’t a word that I would use for acting.

I’m really into the moments on stage, so I can’t later remember more than little wisps. A friend who saw me as Richard said ‘He’s coming right out of you.’”

Madigan’s two turns as an actor are perhaps even more noteworthy because he has been in a wheelchair since 1975, when an auto accident left him paralyzed from the waist down. Madigan recalls waking up in intensive care the morning after the accident: “They told me straight that I’d be paralyzed.” He spent nearly seven months hospitalized. Family, music, and films got him through it.

Before the accident, he spent a few years floundering as an operating room assistant while trying unsuccessfully to get into medical school. The applications weren’t going anywhere, and neither was he. From his hospital bed, Madigan recommitted to applying to medical schools.

In all aspects his life, Madigan refuses to let his disability get in the way of what he wants to achieve. “I don’t think of

myself as a man in a wheelchair. It’s just the way it is.”

His list of his achievements is long and inspiring. He’s drag raced at one of New England’s most challenging speedways, studied with a horse whisperer, can pilot a training plane using top-gun maneuvers, and has sung in an opera. “I am fascinated by everything,” he says. “There’s so much to learn, so many things to know.”

On ordinary days, Madigan practices radiology from a specially built addition on his home that fully accommodates his wheelchair and the technical demands of digital radiology. While Madigan refuses to see barriers in his life, older buildings present challenges. The newer Footlights Theatre needed only to build a ramp over one step to be wheel chair-accessible for Madigan, vastly less work than was needed in the older theater where Richard III was performed.

In addition to his home radiology suite, Madigan has a hospital-based practice at Down East Community Hospital in Machias, Maine, but admits that the late nights there can make him less inclined to practice his lines once he gets home.

Madigan says that radiology and theater are separate worlds for him, which might make the evenings as an actor easier. “Radiology is demanding but you start and leave,” he says. “The advantage is that I can shift gears at night.”

“I’m fortunate. I’ve had a pretty rich life,” he says. “There are days when it is not easy, but you just push through. You keep going,” he says. “Keep pushing.

Something good will come of it.” n

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Plastic surgeon and artist Saeed Marefat (M’85) at his home studio

THE HEALING ARTS

Acts of Discovery

Lisa Helfert

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he light-red brick, streamlined home of plastic surgeon and artist Saeed Marefat (M’85) sits modestly on a quiet street in upper northwest D.C. But the house is also Marefat’s art studio, and wonders await behind the front door.

Inside, hallways have become galleries.

Windowsills hold original sculptures.

The basement is a large painting studio.

A photo darkroom was once a small bathroom. There is no car in the garage; instead Marefat has turned the space into a sculpture studio. He’s cutting and welding metal, making a large multi-piece installation that will be part of a larger meditation on war and September 11.

Some paintings mix highly detailed realism with fantasy to interpret myths from Marefat’s native Iran. Nearby, he is completing a large canvas, building soft strokes of paint to capture the sorrow of an Afghani family devastated by war. A small sculpture of St. Ignatius waits for a final coat of paint before it can be given as an award from the Georgetown Clinical Society.

Marefat works on his art as much as he can on the weekends and sometimes after a day of work in his Falls Church, Virginia practice. It’s about priorities, he says. “I make time for art, no matter how busy I am. If I am not doing art, I don’t feel good.”

Marefat says that art and medicine are completely interrelated. “I’m a better painter and sculptor because I know more about anatomy. And I can apply techniques from sculpting to surgery,” he says, putting his thumbs and forefingers together to form a view finder. He holds them over a clay sculpture he made of the face of a young woman. “To build up the face, for it to be realistic, you must know the volume of the face, the fat and the muscles, the materials.”

His finger traces the outlines of the

sculpture, then stops. “Art schools are paying less attention to anatomy,” he says with disapproval. “You have to know anatomy, no matter how you present the body.”

Marefat, now a U.S. citizen, grew up in Iran, and came to the U.S. at 18 for undergraduate studies at George Washington University. At GW, he continued his boyhood interests in drawing and painting as well as preparing for a medical career.

Entering medical school, he wanted to become a psychiatrist. But once at Georgetown, he fell in love with the human body. “When we started doing dissection, I knew I wanted to be a surgeon,” he says. “I already liked to draw, and somehow drawing and surgery melded into each other.”

Dr. John Little, a longtime Georgetown faculty member and plastic surgeon, had students sketch from live models to sharpen the eye for detail. “I just ate it up,” Marefat says. He now dedicates time to work with Georgetown students in the anatomy lab.

His current project is large: the metal sculpture of the New York skyline on September 11 and the large painting showing both sides of current strife. Together, they are his War Series. The works are products of his imagination, but also made of research into preliminary sources and materials. Anything can inform his art—whether a photo or a statistic.

Unfinished paintings, vying for attention at the easel, start to give the artist’s perspective. One is a cityscape of chaotic motion, American camouflage, and smoke. The next, a quiet open courtyard of mourners.

He’s not political, he insists. He’s an artist.

“I have a curiosity to discover, to learn,” he says. “That act of discovery is what makes art and science so alike.” n

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Brain Death Symposium Explores Questions for Our Time

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he brain—a magnificent organ that enables human expression— forms the most elaborate electrical network in the human body. At the same time, it is somehow also responsible for the distinctly human trait of morality.

Our brains administer our memories, emotions, and dreams, and enable each infinitesimal physical component of our bodies to function. Even the beautiful photographic renderings of the brain made by neural imaging reveal fascinating insights about a person’s fulfillment of purpose, and the paths forward for novel medical technologies and therapies.

One might compare the brain to the conductor of an orchestra, as renowned medical ethicist Melissa Moschella, PhD did at a recent day-long Georgetown symposium on “Brain Death: New Questions for Philosophy and Theology.”

What happens when a conductor dies?

Moschella argues that the orchestra is no

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longer capable of artistic dynamism, synchronization, or adaptability without the unifying power of the conductor.

The Columbia University professor joined panelists from Georgetown, SUNY Buffalo, St. Louis University, and Duke at the second conference of a fourpart series on “Dying a Christian Death in the 21st Century: Moral Controversies in Case at the End of Life” funded by the McDonald Agape Foundation. The program was led by Georgetown’s end-oflife scholar Daniel Sulmasy, MD, PhD, André Hellegers Professor of Biomedical Ethics at Pellegrino Center for Clinical Bioethics. Medical, theological, and ethical leaders gathered to sift through the philosophical and legal conundrums around brain death in the modern world.

Conference attendees included students, researchers, theologians, physicians, philosophers, and religious leaders. They convened in the historic

Bioethics Library in Healy Hall, surrounded by intricate wood paneling, antique furnishings, elegantly time-worn library stacks, period piece portraits, and stained glass windows—the ideal space to listen, reflect, discern.

Although a brain death definition was established decades ago, today the medical, legal, and ethical consensus around the issue grows increasingly ruffled. The complexity arises in part from the fact that cultural and religious communities have strongly held but differing views on the determination of brain death. To further cloud the issue, today there are medical technologies capable of preserving bodily functions far beyond the length of time possible when the definition of brain death was first legislated in the U.S. in the 1970s. For example, in recent years brain dead women have Above: Rembrandt Peale’s The Court of Death, 1820

Library of Congress

By Kristina Madarang

ISSUES IN BIOETHICS

completed pregnancies and delivered babies. Teenager Jahi McMath, declared brain dead in California, was transported to New Jersey where different laws place her in the category of the living, and where her family has maintained her on a ventilator for several years.

The scholars explored today’s pressing questions around defining and understanding brain death. Can we quantitatively measure brain death? Do some definitions of brain death constitute legal fictions facilitating organ transplantation? Although this practice is no longer done, consider the case of Denise Darvall, the donor for the first heart transplant performed by Dr. Christiaan Barnard in 1967, whose heart was stopped during an operation to facilitate the donation. Is brain death true biological death? Can we realign clinical diagnostic testing with the ontological concept of brain death? Can current medical technology differentiate between neurological activity that constitutes personhood and activity that does not? What are the implications of experimental ideas like transplanting a head?

The Pellegrino Center for Clinical Bioethics at Georgetown University supports engagement with and reflection on the ever-shifting medical ethical issues like this one that transcend age, religion, and socio-economic demography. Although not every question has a clear answer, the Center seeks to foster open academic discourse around evolving medical, ethical issues—part of a definitively Georgetown vision.

Enabling this dialogue is central to the McDonald Agape Foundation’s mission.

“The questions about brain death are questions for our time,” says Peter McDonald, president of the foundation.

“As such, it’s a privilege and a strategic topic for the McDonald Agape Foundation to encourage distinguished scholarship for subsequent medical and global impact.”

The foundation hopes to nurture a promising new definition of brain death

that may address today’s ethical, medical, and philosophical quagmires around the issue.

“Pope Pius XII and Pope John Paul II both have stated that the Catholic Church has no competency in determining death, as that belongs to medicine to determine,” notes McDonald. “Dan Sulmasy’s paper started to pull together a singular, ontological definition of brain death that includes a coherence of philosophy, ethics, and medicine to build the trust of the medical community and the larger society. His proposal includes testing for integration compared to testing for organ function.”

research technologies and innovations, and patient care. In this way, the series provides an integral service to Georgetown and to humankind, supporting the vision of cura personalis.

“Cases of patients persisting on life support after determination of brain death, and objections to the concept on religious or moral grounds, have threatened to undermine what otherwise seemed like a consensus on the idea of brain death,” says Sulmasy. “It’s not clear whether Christians should re-evaluate the concept of brain death in light of these developments. With expertise in philosophy, theology, neuroscience, and

“It’s not clear whether Christians should re-evaluate the concept of brain death in light of these developments. With expertise in philosophy, theology, neuro-science, and clinical bioethics, Georgetown is the ideal place to grapple with these questions.”

— Daniel Sulmasy, MD, PhD

Questions around brain death affect everyone—from families picking up the pieces after a loved one suffers a tragic accident, to those caring for elderly parents during a time with increasing age-related neurodegenerative diseases like dementia and Alzheimer’s. The challenge impacts medical practitioners providing ethical consultations for amilies in difficult end-of-life decisionmaking processes. As technologies continue to advance, future generations of students and faculty in the health care field will continue to grapple with related clinical, ethical issues.

The Brain Death conference presented an exercise in reflection, helping to inform the best direction for new

clinical bioethics, Georgetown is the ideal place to grapple with these questions.” n

Kristina Madarang, MS, is Associate Director of Development at Georgetown University Medical Center, raising philanthropic support for research, education, and patient care in a range of areas, from neurodegenerative disease to clinical bioethics.

She is currently pursuing a veterinary nursing degree and researching wildlife management of captive species at the urban/suburban interface. In her resting state, Madarang is a vocalist and tennis player and instructor. She can be reached at Kristina.Madarang@georgetown.edu.

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ON CA MP US

FACULTY POINT OF VIEW

Picturing the Future

The faces of medicine are getting a makeover

By Caroline Wellbery, MD, PhD, Professor of Family Medicine

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s a newly arrived School of Medicine student, Suliman EL-Amin (M’15) felt “pride, humility, and a hint of anxiety” during the White Coat Ceremony. The moving celebration, which marks the students’ symbolic entry into the medical profession, inspired him to create The Cloaking (2012). The painting tells the story of a sea change in the faces of doctors.

Medical student demographics are shifting. As recently as 2015, white matriculants comprised just half of the student body. In 2017, the American Association of Medical Colleges reported that for the first time, more women than men enrolled in medical school.

But walk the halls of many medical schools and you will see portraits of founders and leaders, scientists and clinicians. What you won’t much see are portraits of women or persons of color.

For many, the old images provoke bemusement and consternation. “As a woman and a person of color, I felt incredibly out of place,” says Hamsini Rao (M’21), reflecting on her first year as a medical student. “None of the people displayed on the walls looked like me.”

Georgetown University School of Medicine is one institution addressing this issue. The Office of Diversity and Inclusion has transformed a main hallway with rotating photographic exhibits celebrating students’ diverse identities. With support from the Georgetown Women In Medicine’s ‘Women on the Walls’ campaign (gwim.georgetown.edu), Rao has joined a student-led initiative to identify female role models for new portraits.

There’s an implicit understanding that this new look in hall decor does more than just mirror a changing demographic.

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Representative portraits invite historically underrepresented students to aspire to visibility and leadership. In this spirit, EL-Amin chose to depict a Black dean and a female physician faculty member of unspecified ethnicity. The Cloaking pays homage in two layers, celebrating both the student’s rite of passage, and the accomplishments of minorities, shown in

of the portrait guard make any difference? A recent commentary in Academic Medicine enjoined its readers to ‘break the silence’ on racism. Silent as portraits are, they speak to us. Though there are no studies (yet) to prove it, the eloquence of so-called ‘walls of diversity’ inspires the challenging, real-life conversations demanded of us.

Suliman EL-Amin (M’15), The Cloaking (2012). “I chose robust colors and confident figures to reflect positivity, strength, and diversity in the medical field. It is my belief that this mirrors the public’s perception of health care providers as the last guardians of human vitality.”

positions of authority. The message is hopeful, and indicative of a future not yet wholly realized.

Racial discrimination remains painfully evident in patient outcomes.

Inferior care, implicit and explicit bias, and societal limitations that contribute to racially skewed morbidity continue to plague our health care system. Enrollment rates of Latino and Black medical students have plateaued. Can a changing

“The act of making room for more images is not an erasure of the individuals that have contributed to the growth of the institution,” notes EL-Amin. “To the contrary, it widens the net, aligning institutional diversity goals with tangible outcomes.”

In the context of a changing student body profile, women, minorities, and their portraits are redefining the face of medicine. n

ON CAMPUS

From Compounds to Clinics, Classrooms to Community

By Monica Javidnia

Dreamstime

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rom an idea scribbled in a lab notebook to a therapy administered in a clinic, the path toward developing a treatment takes years. And more often than not, the process fails.

To address the deficiencies in this approach, the National Center for Advancing Translational Science has funded the Clinical and Translational Science Award (CTSA) consortium, comprised of over 60 major academic medical centers across the country, including Georgetown. Established in 2010, the Georgetown-Howard Universities Center for Clinical and Translational Science, more commonly known as ‘GHUCCTS’ (pronounced to rhyme with “ducks”) encompasses five institutions: Georgetown University, Howard University, MedStar Health Research Institute, Oak Ridge National Laboratory, and the Washington DC Veterans Affairs Medical Center.

“From discovery of a molecule to the eventual testing and use of a drug is a 20-year process on average, even longer,” explains Joseph Verbalis, MD, co-director of GHUCCTS. “And most of the drugs that get into clinical trials actually fail.

A major idea of a CTSA is to develop efficiencies in how we research treatments to make the process quicker, and more successful.”

Drawing from the complementary strengths of each institution, GHUCCTS has proven to be a model for scientific advancement in the areas of research and innovation, community engagement and diversity, and education and training programs. This is an immense undertaking, as GHUCCTS partners span from Tennessee to Maryland and include academic, government, and private institutions.

It comes as no surprise that research

is costly, and no lab is an island.

GHUCCTS co-director Thomas Mellman, MD leads the efforts toward promoting innovative and collaborative work with the Interdisciplinary Collaborative and Investigator-Initiated Pilot Project initiatives. These programs provide competitive funding toward a wide array of research proposals, from developing dengue virus replication inhibitors to assessing telerehab in aphasia, allowing investigators to develop preliminary data for a larger grant.

GHUCCTS’ successes are not limited to those in faculty and fellow support; a large part of the mission includes preparing the next generation of translational scientists. Now in its third year, the Translational Biomedical Science Program (TBS) directed by Kathryn Sandberg, PhD funds and educates a diverse group of pre- and postdoctoral scholars from GHUCCTS institutions.

“Being able to collaborate well with others, especially across different fields, opens up whole new possibilities,” says Mary Katherine Howell, a TBS PhD student in clinical psychology. “And not just in terms of funding and audience for your research. These partnerships exponentially increase the speed at which research benefits the public.”

Ensuring the public benefit is a challenge researchers across the country face, with historical ethics atrocities and research shortcomings leading to a lack of diversity in clinical trials. With the help of the Community Advisory Board, GHUCCTS researchers tackle this by building trust in the communities they hope to serve.

“You can’t necessarily take results from one group and reliably extrapolate them

to another,” states Verbalis. “Our Community Advisory Board advises us not only on specific trials and how we can better engage the community, but also on issues of gaining trust in different populations. Our CTSA has always been at the forefront of including diverse groups in our clinical trial population.”

Many funding and training opportunities are open to GHUCCTS consortium members, including undergraduate and graduate students, medical students, postdoctoral fellows, faculty, and staff.

For more information, contact ghuccts@georgetown.edu. n Monica Javidnia is an amateur homesteader in Upstate New York, and a postdoctoral fellow in regulatory science and experimental therapeutics in the department of pharmacology and physiology at Georgetown University, and at the University of Rochester’s Center for Health and Technology.

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AL UMNI CONNECTIONS

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What’s in my white coat?

Interview by Kate Colwell Charles “Chip” Read (M’85, R’88, W’91) is a pulmonary and critical care physician at MedStar Georgetown University Hospital. He is a professor of medicine and surgery, vice-chair of inpatient services for the Department of Medicine, and director of adult critical care.

1. I sometimes misplace my stethoscope, so I bought a blue one to help me identify it from the usual black ones around.

2. (From his desk) I still have my old Proctor Harvey stethoscope from med school, but the rubber wore out.

One day on the ICU rounds, I was listening to a patient’s breath but the sounds were out of sync with the ventilator.

I realized that the tubing had worn off and I was listening to my own breathing through the earpieces.

3. I keep my old-school caliper for reading EKGs, to measure rates and rhythms. It reminds me of days of yore and still comes in handy.

4. I used index cards when I was at D.C. General to record patients’ names and data before we had EMRs. We didn’t have a good record system, so I would keep my own minirecords in my desk.

5. I have a pen fetish, a black roller-ink Pentel. In the days of written charts, I liked a bold, black ink so that I could page through the record and find my own notes easily. I order them by the gross. When one is found lying around, anyone who knows me also knows it belongs to me.

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6. I like using a planner to keep a record of where I’ll be and important dates. I have kept them since 1985. If I write my memoirs, I can relive a certain day just by paging back through them.

7. If you’re working with radiation like fluoroscopy or X-rays, you carry a radiation badge, so they can monitor your exposure level.

8. I carry my two business cards (MedStar and the university), plus my old one from D.C. General. I have the transplant consortium’s card. I also keep my dentist’s office card, with his office manager’s name on the back. He is a young guy who developed a viral myocarditis and required a heart assist device while awaiting a transplant. It reminds me of how quickly life can turn on a dime. My father passed away back in ’92, and I still have one of his business cards with my brother’s phone number written on it. That card reminds me of my roots. n

CURA Fosters Connections

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fter Match Day and graduation, when new graduates head out to begin their residencies around the country, they often face overwhelming changes on top of busy schedules. That’s where CURA comes in.

The CURA (Connecting and Uniting Residents and Alumni) program was founded in 2005 with the goal of connecting Georgetown medical alumni with each other, wherever they may end up.

Every year, CURA (formerly MATCH) pairs Georgetown medical alumni with recent School of Medicine graduates in their region.

“When you first start your intern year, you can feel disconnected,” says Christina Hanna (F’08, M’14). “It’s helpful to have people remind you of the greater goals in medicine, and the

balance between work and life.”

Hanna was paired with Regina Torsney-Durkin (C’73, M’77) in Philadelphia, and both alumni have found the experience transformative.

“CURA is something we can do to help young alumni,” says TorsneyDurkin. “It’s nice to have somebody who trusts you enough to pick up the phone and ask a question that they wouldn’t ask to somebody at the hospital where they work.”

Torsney-Durkin adds that CURA mentors sometimes host gatherings with other Georgetown medical alumni in their area, including those who have not participated in the program before. “In Philadelphia, these gatherings have created lifelong friendships among alumni who did not previously know each other.”

For new graduates, the program offers the support of the strong Georgetown medical alumni network, the common cura personalis way, and that individual mentorship from someone who understands.

“The CURA program exceeded my expectations,” says Hanna, “and a large part of that is Regina. Not only was she patient with my chaotic residency schedule, but when we did meet for dinner, I was so impressed by this lovely, brilliant, warm-hearted person. She became my listening ear, and also a guiding light.” n

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Reflections on medicine with

Sylvia Morris (M’98), Internist in Atlanta, Georgia I was a second year in medical school, back home in LA for Thanksgiving, when my mother died. I’m an only child, and my Georgetown friends became my family. After the funeral, they picked me up from the airport, made me food, helped me focus.

Internists are the smartest. (All the internists will read that and say, yeah we are.) Internists are the chronic disease people, old school diagnosticians—like Dr. Knowlan or Dr. Mitchell, who can look at a patient and say, Oh your thyroid is probably off. They’re present with the patients, thinking and listening to what they’re saying. The fund of knowledge is broad and the clinical acumen is high. It’s a thinking specialty.

I’m a bit of a talker. I’m better in communicating than that fine motor movement needed in surgery. I’m not huge on procedures. I’d rather come in the room, have a conversation with you, and assess how you are.

I like when patients share their stories. You learn from your patients. When I wasn’t practicing, that’s something I missed.

After practicing for many years, I took a break. Sometimes you need that. You work so long to achieve this, and when it doesn’t meet your expectations, it’s hard.

I worked in health care IT doing sales and informatics. It was good to see medicine from another point of view. I then returned to practice for eight more years, working nights at Emory as a hospitalist.

I left practice again to work in consulting in DC. I learned about the business of medicine— billing, coding, reimbursement. Last year I returned to Atlanta to practice medicine.

It’s a privilege to be a physician, in these intimate interactions with people. It’s remarkable what people tell you. And their resilience. There’s not a day when I don’t laugh with a patient.

I’ve done many other things, but the grass is not greener.

It’s just grass. You have to choose your own happiness and figure out what that looks like.

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I’m board certified in holistic medicine.

That got me thinking about how we impact health, about obesity and plant based diets, and how to have a conversation about exercise when the patient is working two jobs. You meet people where they are.

In today’s millennial culture, we think more about how to have fuller lives. In my mother’s generation you went to school and you got a job. Who cares about being happy? You got a roof over your head! Now we think more about the complete person, the cura personalis. And that’s a good thing.

I like traveling—my Georgetown friends and I do an annual girls trip. And I like shoes. I buy comfortable shoes that are pretty. My girlfriends tease me about my shoe budget, but I wear a size 11. I have to pay full price because the selection is limited!

I was lucky to have mentors who modeled compassion. It’s important to nurture the relationships with our colleagues, get to know each other, and break bread together.

I had a COPD patient on oxygen who continued to smoke, was readmitted multiple times with shortness of breath. It was frustrating for me. But in his care, I missed the mark, by not figuring out how to help him in his suffering. Patients who

are “noncompliant” need our compassion.

At the bedside I try to be present with spirit and mind, and be tech-free. I take pen and paper, sit with my patients and ask, “How are you?” n

Dreamstime / Shutterstock

I’m from Los Angeles, California. Medicine is the only thing I’ve ever wanted to do. My mother was the first nurse in my family. I’m the first doctor.

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MUSIC AS MEDICINE Medical student musicians took white coats off and put guitar straps on for hospital rounds with a twist. Georgetown’s new Arts & Medicine student collective is on a mission to enhance patient care and medical education through the arts and creative programming (www.artsandmedicine.org). Story page 20.