Sept. 5, 2014
MEDICAL UNIVERSITY of SOUTH CAROLINA
Vol. 33, No. 3
Neuroanatomy of suicide lessens stigma
By Dawn Brazell Public Relations
E
ven before the news of Robin Williams’ death, Mark George, M.D., knew his grand rounds talk would be on the neuroanatomy of suicide. “Today is a teachable moment hopefully about suicide,” said George, to a packed auditorium Aug. 14 at MUSC
where health professionals gathered to learn about how brain disorders may predispose patients to suicide. First, he shared the statistics about its prevalence and impact. It’s the No. 2 killer of 18–to–24 year olds. “Other than cars, this is what kills kids this age. It’s tragic when that happens because they have untapped potential in their lives.”
A veteran kills him or herself every hour, 24/7. “So during my lecture there’s some poor veteran in the States who will decide life is not worth living and act on it.” More soldiers involved in the Iraq and Afghanistan conflicts killed themselves than were killed by the enemy. “If the enemy came up with a new weapon, we’d spend billions trying to figure out how to
combat it. We don’t think about suicide as being a new weapon used in war, but we should and we should devote billions to coming up with ways to prevent it and stop it when it becomes a crisis.” It is estimated that on average the United States loses as many as 400 physicians to suicide each year (the
See Suicide on page 7
When comedy becomes no laughing matter By Dawn Brazell Public Relations
A
n expectant stillness settles on a standing–room– only crowd at Theatre 99. A. Lee Lewis, M.D., stands jabbing his finger into thin air, trying to play “Born in the USA” on an imaginary jukebox that’s broken. Fellow actor Greg Tavares, the theatre’s co–founder, watches him, and then breaks out in song that soon unravels because he doesn’t know the words. The crowd laughs at the improv moment being created by the duo in their ensemble act called “Moral Fixation.” Lewis, who has traveled the nation performing improv, has been acting with the group for 14 years. One of the lessons he’s learned from doing improv is to forget about trying to make people laugh. “It’s
See Comedy on page 6
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MUHA Town Hall Town Hall meeting series kicks off Sept. 22.
photo by Dawn Brazell, Public Relations
Actor and MUSC psychiatrist Dr. A. Lee Lewis (center) performs improv at Theatre 99 with Greg Tavares, the theatre’s co-founder.
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Lifetime Achievement
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Employee of the Month
Campus VP honored with state’s highest award.
5
Meet Grace
10
Employee Wellness
READ THE CATALYST ONLINE - http://www.musc.edu/catalyst
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Employees of the Month Award Gopi Omraju Facilities “Gopi Omraju started in his position as Facility Manager responsible for Ashley River Tower, CMH and McClennan Banks, and maintenance services in the Psychiatric Hospital on July 15, 2012. Since his arrival he has actively sought out ways to improve efficiency and cut costs. Rising electrical costs have been an area of interest based on previous work experiences. Recognizing that for most businesses, lighting accounts for 30 to 60 percent of annual electric costs he identified the lighting in the ART parking area under the building as an area for potential substantial cost savings. While this area is controlled by Parking Management, the lighting costs are included in the ART electrical costs. He researched the SCE&G Energy Wise for Business rebate program and initiated contact with SCE&G, assessed the numbers and types of fixtures in the garage, calculated the paybacks related to different options, coordinated with Parking Management who embraced the project, and was able to utilize his own staff for installation of high efficiency
Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425. 843-792-4107 Fax: 843-792-6723 Editor: Cindy Abole catalyst@musc.edu Catalyst staff: Mikie Hayes, hayesmi@musc.edu
lighting in the ART parking garage rather than having to contract out the work. As a result of Gopi’s effort, SCE&G presented MUHA a rebate check in the amount of $25,375 in April. In addition to this rebate check, the electricity savings are estimated to be $200,000 over the next 10 years. Gopi has made an effort to make others in the department aware of the Energy Wise for Business program opportunities by having SCE&G come and make a presentation to maintenance and construction staff to familiarize them with the different types of eligible projects, including retrofitting existing equipment with more energy efficient technologies, installing high efficiency equipment during new construction or major renovations, and purchasing new equipment or replacing equipment when it reaches the end of its useful life. He’s currently exploring additional lighting projects that could result in additional rebates estimated to be around $20-30,000 with cost savings for years to come. He’s also working with project managers for reducing upfront lighting related construction costs on the ART Pharmacy and ART 7 renovations.” Nominated by David Dement
Physician of the Month
Murray Passo, M.D. Pediatrics — Rheumatology “Dr. Passo always goes above and beyond for his patients. He is very conscientious The Catalyst is published once a week. Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: sales@moultrienews.com.
and takes time to conduct thorough clinic visits and listens to families’ concerns instead of rushing through the appointment. He naturally takes a familycentered approach to care and actively engages families in decisions involving their children’s treatment. He truly cares about the well-being of his patients. Recently, he sought out an expert to see a patient who had a complicated diagnosis. While that may seem
commonplace, Dr. Passo was given the wrong name for the doctor and then given what it may sound like as the description for the doctor’s name. Once he found the right doctor, Dr. Passo composed a 20+ page historical summary for the consultation. Dr. Passo is one of the most intelligent people I have ever met, and he regularly and eagerly shares this knowledge with students, residents, fellows, and other healthcare professionals. He encourages the professional growth of all members of our healthcare team. He also works to improve our clinic process and care outcomes. Dr. Passo exemplifies everything that a physician at MUSC should strive to be. Nominated by Catherine Mims
Medical ICU nurse presented DAISY award
August’s DAISY (disease attacking the immune system) award winner is Jessica Pritchett, R.N., who is a critical care nurse in the medical intensive care unit in the University hospital. Pritchett was nominated by Leanna Loud. Loud wrote: “On this Pritchett exceptionally busy night, we found our floor short-staffed, and getting multiple admissions. We received an admission from St. Francis Hospital, who was sicker than was reported, requiring a higher level of care than we were able to give. I
called the ICU charge nurse Jessica Pritchett, who quickly agreed to assess the patient. Upon assessment, she immediately realized the patient was going to need more intensive care than a floor nurse could provide and there were no ICU beds available. Jessica stayed at the bedside to care for the patient. She called the doctor, placed the patient on a monitor, drew labs, gave medications, started fluids and an insulin drip, reported critical labs, and charted on the patient. She did all this while explaining to the patient’s granddaughter, who is a phlebotomist at a local hospital, what was happening and what to expect. And, she did so in a manner that made the patient’s family comfortable during a time when even though we were short on staffing, we were able to provide extraordinary care.”
What do you remember about Hurricane Hugo? Recognizing the 25th Anniversary The Catalyst’s special section “Remembering Hurricane Hugo” Friday, Sept. 19 issue On Sept. 21, 1988, one of the most destructive storms hit the Lowcountry area. During that time, many MUSC faculty and staff led heroic actions and activities to protect the lives of MUSC patients and property. If you’ve got a memory, personal account of the storm or want to share a photo, tell us. Email Catalyst@ musc.edu or go to Suggest a Story at http://academicdepartments.musc.edu/ catalyst. Deadline for submissions is Sept. 12. Contact Cindy Abole, editor at Catalyst@musc.edu or call 792-4107
The CaTalysT, Sept. 5, 2014 3
Building hope: Children’s Hospital leader tackles cancer By lauren sausser of The Post and Courier In front of a packed room inside the MUSC's Hollings Cancer Center last summer, John Sanders said he expected that lung cancer would kill him. "Unless something else kills me, this will. It's Stage 4," he said during a recent interview. "It's not something that can be eradicated. It's in both lungs. It's in one node. It's something that I'll have to deal with the rest of my life." It's a sobering message from a 54– year–old man who has never smoked. Sanders, the administrator of the MUSC Children's Hospital, was diagnosed with the disease in 2007. Statistics show only 15 percent of patients with Stage 4 lung cancer live five years beyond their diagnosis. "I'm working on seven. I'm part of five percent, so I'll take that," he said. "What Hollings has been able to do for me, not only am I still alive, but I'm living and having a good time." That includes covering hundreds of miles every month on his bike and embarking on the biggest challenge of his career: building a new $350 million women's and children's hospital on the peninsula by 2019. Sanders recently spent time with The Post and Courier to discuss the project, his health and his career path. The following interview has been edited for length. Q: What brought you to MUSC? A: I kind of combined a hobby with what I enjoyed and went to school up in Rochester, N.Y. —RIT (Rochester Institute of Technology) — for biomedical communications medical photography. After I finished my program, I had a lot of contacts here at MUSC. My dad graduated from here. His father graduated from here. His greatgrandfather graduated from here. We had always vacationed in Charleston, so it was kind of a second home. It worked out that I was able to get a job in the photography department here.
I took pictures of anything from surgical procedures, I did rape cases, child abuse, you name it, to public relations–type work. I worked in photography for about five years. In that time, I realized that I wanted to do some more, and I did have exposure to the administration. I went back and got my master's degree here in health services administration. Q: What do you enjoy in your spare time? A: I enjoy riding a bike and doing things with my family. After I was diagnosed and had surgery, I couldn't run anymore and so I tried riding a bike and started doing it a little bit more and now it's kind of an addiction. My wife would probably tell you I ride a little too much. Q: How did your doctor discover the lung cancer? A: I found out by accident. About eight years ago, the Joint Commission was here doing a survey and I was following around one of the surveyors. We went through the heart and vascular area in Children's (Hospital) and Bill Springs was talking to him about a test we were doing called a calcium score, which is a CT scan that shows plaque and stuff in the heart. I was thinking, "Wow. I need to do that because I have heart disease in my family." I kind of forgot about it and a year later I thought, "Well I ought to go do it." I got a pediatric cardiologist to write me a prescription — I still have it on my bulletin board — to go get one done. I went down to see (the doctor) that afternoon. He showed me the scan, he was going through it. I saw him hesitate. He said, "Your heart looks really good. You don't have any problems." He said, "Did you have pneumonia in the past couple weeks?" No. Within two hours, I was talking to a pulmonologist, then the next week, I had a bronchoscopy done, then I had a biopsy in my lung and in about two
photo by Grace Beahm, Post and Courier
Children’s Hospital administrator John Sanders is planning the largest capital project in the hospital’s history, a $350 million women’s and children’s pavillion, all the while fighting lung cancer that was diagnosed in 2007. weeks, I had two lobes taken out on the right side. No symptoms; I had a little bit of a cough, but nothing anyone would notice. Maybe when I think back I had some night sweats. Then I went through a pretty rough course of chemotherapy. About a year later, I got scanned and it was back in both lungs. That's what kind of weird about mine, which is a good thing, it's slow growing. I have multiple spots on both sides, but the therapies I've gotten have kept them either stable, or when they start growing, I start therapy again and they zap certain areas with radiation. I've been able to be pretty productive. Q: You've essentially worked nonstop since your diagnosis? A: For the last three years, not many people would know when I had treatment. I won't lie. You feel pretty bad for a week even for some of the therapies that weren't even that hard. It makes you feel pretty miserable, but to me, it was kind of a challenge not to let it bug me. In fact, in the last chemotherapy I would do, usually I'd just go from here and walk over to Hollings and I'd come back to work. When I'd get home, I'd go ride. To me, that was almost funny that I was able to do that and get the ride down. It didn't feel very good, but I wasn't
going to let it get the better of me. Q: Discuss the new hospital project. A: There aren't many of us in administration that can say we built a hospital. It's really exciting. Q: Why does Charleston need this new building if the existing Children's Hospital was only built in 1987? A: It was built in a good way at that time, but the care of children has changed so much over the years. In the ICUs, we have open bays, so there's no privacy for the families. Our volume has gone up. We've started moving into this building (the main hospital). To provide the kind of care that we know that we can, we need to have a bigger facility. If you go in our rooms now, if the parent spends the night — and we encourage them to be there — you pull the bed out, you can't open the door to the bathroom. We have kids that go through some of our oncology programs who are here up to 100 days. You can imagine how much stuff you accumulate. It just becomes a horror story. Q: What do you enjoy most about your job? A: My team in Children's (Hospital) is amazing. The physicians here are
See Challenge on page 10
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MUSC Medical Center Communications Corner Town Hall Meeting Series
The MUSC Medical Center Town Halls will kick off Monday, Sept. 22. Town Hall meetings are an important part of the medical center’s efforts to make sure that employees are well informed and involved. The meetings are not only an opportunity to hear directly from senior leaders but also to ask questions and share ideas. The schedule below reflects dates, times and locations for the general sessions to be led by Dr. Pat Cawley, Medical Center chief executive officer, and Matt Wain, Medical Center
chief operations officer. Service line and department specific meetings will be added to this schedule and led by their respective service line administrator. You can access the town hall schedule by visiting the medical center intranet or the MUSC Excellence website. Questions and comments can be directed to Ashley Bode at 792–0820 or bode@musc.edu.
Town Hall Schedule Date
Day
Time
Location
Presenter
September 22
Monday
11:00 a.m.
ART Auditorium
Dr. Pat Cawley
September 22
Monday
4:00 p.m.
Storm Eye Auditorium
Matt Wain
September 23
Tuesday
7:45 a.m.
ART Auditorium
Matt Wain
September 23
Tuesday
12:00 p.m.
Webinar
Matt Wain
September 23
Tuesday
7:45 p.m.
ART Auditorium
Matt Wain
September 24
Wednesday
4:00 p.m.
ART Auditorium
Matt Wain
September 24
Wednesday
8:00 p.m.
Webinar
Dr. Pat Cawley
September 25
Thursday
7:45 a.m.
Storm Eye Auditorium
Dr. Pat Cawley
September 25
Thursday
7:45 p.m.
2 West Amphitheater
Dr. Pat Cawley
September 26
Friday
11:00 a.m.
2 West Amphitheater
Dr. Pat Cawley
September 26
Friday
3:30 p.m.
ART Auditorium
Dr. Pat Cawley
September 27
Saturday
3:30 p.m.
ART Auditorium
Dr. Pat Cawley
September 28
Sunday
7:45 a.m.
2 West Amphitheater
Dr. Pat Cawley
September 28
Sunday
3:00 p.m.
Webinar
Matt Wain
September 29
Monday
7:45 a.m.
2 West Amphitheater
Dr. Pat Cawley
September 29
Monday
3:30 p.m.
ART Auditorium
Matt Wain
September 30
Tuesday
7:45 a.m.
ART Auditorium
Matt Wain
September 30
Tuesday
2:00 p.m.
2 West Amphitheater
Dr. Pat Cawley
September 30
Tuesday
8:00 p.m.
Webinar
Dr. Pat Cawley
October 1
Wednesday
11:00 a.m.
2 West Amphitheater
Dr. Pat Cawley
October 1
Wednesday
3:30 p.m.
Webinar
Matt Wain
October 1
Wednesday
7:45 p.m.
ART Auditorium
Matt Wain
October 2
Thursday
7:45 a.m.
2 West Amphitheater
Dr. Pat Cawley
October 2
Thursday
1:00 p.m.
ART Auditorium
Matt Wain
October 2
Thursday
7:45 p.m.
2 West Amphitheater
Matt Wain
October 3
Friday
12 p.m.
Webinar
Matt Wain
October 3
Friday
4:00 p.m.
ART Auditorium
Dr. Pat Cawley
October 4
Saturday
7:45 a.m.
2 West Amphitheater
Matt Wain
October 5
Sunday
7:45 a.m.
Drug Discovery Auditorium
Dr. Pat Cawley
October 5
Sunday
3:00 p.m.
Webinar
Matt Wain
Your Attendance Required! Town Hall participation is now expected of all MUHA employees.
The CaTalysT, Sept. 5, 2014 5
MEET GRACE
Grace Badgett Department MUSC Summerville Dermatology How you are changing what’s possible at MUSC By always putting our patients ďŹ rst How long at MUSC 15 years Family and pets Son, Jeremy; daughter, Missy; and cat, Punky Girl What is your idea of a dream job Retirement and taking care of my grand babies Most embarrassing moment I was performing a solo in high school and halfway through the song I forgot the words and had to make them up on my own. Favorite place in the world The mountains How would you spend $1 million Take care of my kids, retire, give to the Wounded Warriors Project, and travel Words of advice Take care of each other
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ComeDy
Continued from Page One
about investing in the scene and letting ‘funny’ happen naturally. That is what Robin Williams was so good at. It’s one reason news of his death has been so difficult for people to comprehend.” A former fulltime actor who opted to go to medical school, Lewis said he loves keeping acting as part of his life. One reason is that it’s a tight, caring community. “You make a friend in the theater, you make a friend for life.” This may seem like an oxymoron, given the news of Williams’ death, but it’s really not, said Lewis, who also holds the title of assistant professor in the Department of Psychiatry and Behavioral Sciences at MUSC. Often famous, creative people suffer from such issues as depression or bipolar disorder or substance abuse and these can predispose them to suicidal impulses despite a strong social network and great career success. There have been studies linking creativity and mental illness, such as the one by Arnold Ludwig (1995) that found many highly creative people have suffered from major depression. Depression in the Lewis general population runs eight to 20 percent in any given time, Lewis said. Ludwig’s study found the lifetime rate of depression was 77 percent for poets, followed by 59 percent for fiction writers, 50 percent for artists, and 46 percent for composers. Another common issue that can affect creative types is substance abuse. Sixty percent of actors meet criteria to have an alcohol use disorder, he said. “When alcohol is part of their pathology as well, it’s even more likely that depression creeps in with consistent use.” Certain mental illnesses can predispose certain people to depression and suicidal impulses. Writers have a higher rate of suicide than the general population and also a higher rate of bipolar disorder. It explains why some writers had periods of high output during their manic stages and then periods of depression when they hit their lows and are more susceptible to criticism and vulnerable to depression, he said. With more evidence showing how much of a biological basis there is to mental disorders, more people are realizing that it’s not just a state of mind. “Here at MUSC, we’re lucky to be spearheading research looking at how physical and biological stimuli to certain areas of the brain can have a dramatic and almost immediate effect in treating disorders, just like radiation can shrink a tumor in cancer over time,” he said, referring to such treatments as transcranial magnetic stimulation, electroconvulsive therapy and deep brain stimulation. Creativity runs through the prefrontal cortex, the
What Can You Do to help?
Read tips on suicide prevention on MUSC’s News Center. Dr. Lewis shares his tips at www. www.musc.edu/pr/newscenter/2014/improv. html. Read tips from Dr. Mark George at www. musc.edu/pr/newscenter/2014/suicide.html amygdala and the limbic system. “Depression also runs through the limbic system and the amygdala — that’s the emotional areas of the brain. It’s where our emotions are attached to our memories. So it’s easy to see how creative people who are very good at evoking emotion, evoking memory in their work are also prone to having their emotions go a little haywire because they are tapping into that on such an intense basis to do the work they are so good at.” Creative types also can face external, circumstantial challenges. Performers may have five shows in a row, where they are awash in positive feedback and then go through a dry spell. Creative jobs also can come and go and the people who do them are subject to rejection. “Whether you get work or not is not just about your talent, which is important, but it’s based on luck and timing too. Also the ultimate decision about whether you work or how good you are is based on what other people think about you. That’s not really the case in a lot of work places where you are judged by your productivity or your bottom line.” In music, theater, writing and poetry, and other such creative pursuits, people often are judged by whether others find them to be good or not. Those interactions increase stress and can lead to a more depressed worldview if people are saying negative things. This is not to say creativity is a gateway to mental illness, which is not true at all, he said. An analogy is that you can get hurt doing fitness or sport activities, but those activities aren’t unhealthy to pursue. Lewis so believes that creative outlets can be therapeutic that he has submitted a grant to use an improv curriculum to treat people suffering from social and performance anxiety. The proposed study also will measure the treatment’s effects on depression and anxiety. He and Tavares also are putting together an interdisciplinary training seminar using improv to help health professionals in developing trust, empathy and decision-making.
“What I love about improvisation and acting is the same thing I love about psychotherapy. It’s all about character study and learning how people think and why they think what they think. The ultimate expression of that is improvisation — the ability to become someone in a moment and do what you think that character would do. It’s the ultimate character study.” Improvisation as a discipline combines many of the elements that appear to be therapeutic in treatment curricula for anxiety, including the concept of exposure, mindfulness, cognitive restructuring, role–play, insight into motivation, and social skills training, he said. Likewise, creative outlets, such as music, comedy and writing can be beneficial. Studies show that people who have creative outlets tend to be overall healthier, with boosted immune systems that make them more resistant to coronary and cancer risks. The caveat is that creative outlets are not a cure–all. In psychology the term “defense mechanism” is used to describe actions used to self–protect. Acting out can be a defensive mechanism where instead of feeling sad or shameful, you get mad and lash out at people. “Utilizing humor to deal with problems and issues is considered one of the highest orders of defense mechanisms. I think what we forget is that it still is a defense mechanism. It still is an attempt to defend yourself against something that is hurting you. I think what happens a lot of times with comedians is that they are using their humor to deal with their demons and most do it incredibly successfully. But to think you can use your humor to always deal with your demons might not be true.” Lewis said he gets writers who keep journals to bring them in so that he can help them process their emotions in a therapeutic setting. “You see that in some creative people. If you’re depressed, and you’re a storyteller, your story is likely to be even more depressing than it is in reality. Creative people are good at taking reality and making it bigger than reality.” Sometimes people, creative or not, just get caught in a rut where they are unable to see a solution. There are ebbs and flows for people who suffer from depression. “Cancer is the same way. You get treated, and it can go into remission for a long time, and come back. Or you can be cancer free. I think mental illness and cancer have a lot of parallels to one another.” A positive effect of Williams’ death is the conversation it is generating about how depression is more of a silent killer than society admits and how there needs to be more funding for mental health treatment and awareness of how it is a brain disorder that people are fighting, he said. “I never assumed Robin Williams was fighting demons every day of his life. I think the vast majority of his life was brilliant and fun and happy. But when those demons come, much like cancer relapses, it can become overwhelming and even possibly take our lives.”
The CaTalysT, Sept. 5, 2014 7
suiCiDe
Continued from Page One
equivalent of at least one entire medical school). “If we had another disease taking out doctors like this, we would be talking about it. So I’m glad you’re here,” he said to colleagues. It’s a natural topic for George, who is a distinguished professor in the Department of Psychiatry and Behavioral Sciences and director of MUSC’s Brain Stimulation Laboratory. The lab is spearheading important treatment options for mental disorders that can predispose patients to suicidal impulses. This may be the last truly stigmatized area of medicine. “Suicide we don’t talk about. It used to be that way with cancer, epilepsy, substance abuse and other conditions.” George talked about two colleagues who died by suicide. He’s dedicated the last few years trying to get more data about effective treatments to have more to offer patients experiencing a suicidal crisis. In the spirit of destigmatizing this, he spoke of his own struggle. “I have researched depression all of my life and tried to understand it for patients. And back in 2004, I found myself in an episode of depression, first one ever. It was funny — you study something forever, but then it happens to you, and it’s a whole different perspective.” George knew what to do. He consulted a psychiatrist and got on medication and was doing talk therapy. “But before I actually came out of the hole, I will never forget one Sunday morning when I felt acutely suicidal. I just felt like life was not worth living.” Living out on Sullivan’s Island near Breach Inlet, George thought through the details, including how he would ride down on his golf cart to the bridge. “I had the whole plan. It was a moment when I actually, rationally thought that was a reasonable thing to do. I discounted totally my life’s work, the impact on my family and all the other stuff. I slipped into this state.” It was a distorted way of seeing things, he recalled. “I think what happened to me for those few hours, happens to a lot of other people.” Fortunately, George confided in his wife and got through the crisis. The experience renewed his commitment to finding better treatments and raising awareness to decrease the stigma of suicide. A slim percentage of suicides fall into the category of being a reasoned, moral decision relating to endof-life, terminal illness. Those types of suicide are rare and cloud the real issue, he said. “The vast majority are impulsive acts and what I call a suicidal crisis. If you look at the epidemiology, about 80 percent of suicides arise in patients with a diagnosable depressive disorder or bipolar disorder that is often compounded by substance abuse.” One in five people will experience depression during his or her lifetime. Fifty to 60 percent of people can be helped with medications. “That’s me.
Illustration/Emma Vought
The right hemisphere of the brain. Arrows represent the communication, dysfunctional in depressed people, between the frontal cortex (in pink) and the limbic system. I’m in that group. I got better over a year and am now off medications.” Not all people respond to the medications, though. “That group really struggles with their lives and has a very, very high risk of suicide.” George said there seem to be three systems in the brain that don’t work well in a suicidal crisis. The limbic system, which supports a variety of functions including emotion, behavior and motivation, involves the nucleus accumbens, the amygdala and hippocampus. It also is tied to the hypothalamicpituitary–adrenal axis, which is dysregulated in depression. In a suicidal crisis, signaling from the prefrontal cortex, which is normally the part of the brain used to regulate the limbic system and help someone ‘get over it,’ simply cannot do its job, he said. Brain disorders can be a function of an over-limbic drive, an under pre–frontal cortex regulation, or dysfunction in the orbital–prefrontal cortex, which allows someone to inhibit impulsive behaviors. The categories may overlap, or operate alone, but they can provide a helpful framework for doctors to view neurological disorders, which may predispose patients to depression and potentially suicide. The limbic drive gets involved when there’s intense psychic pain. Disorders of increased limbic drive that can predispose people to suicide include anxiety disorders, epilepsy, intense periods of grief and loss, bipolar disorder and limbic tumors, he cited as examples. A limbic tumor was the case with Aaron Williams, a local teen who died just shortly before his 17th birthday after setting himself on fire in a local school parking lot. “This was a tragedy in our own neighborhood,” George said, remembering the sadness his family felt since his daughter attended the same school. “Everybody talked about it as a metaphysical, moral problem we’ll never understand. They couldn’t understand it… Did anybody
talk about the brain? No.” It turned out the teen was born with a rare congenital condition called neurocutaneous melanosis that had been treated when he was a child but then developed into a recurrent tumor in his limbic region and orbitalfrontal cortex, right in the area that can drive suicide, he said. “It’s important to talk about this as a brain disease.” Researchers know that they can stimulate an area of the brain through DBS, or deep brain stimulation, to induce suicidal thoughts in a patient. George plays a video of a patient who had an electrode implanted too deeply into the nucleus accumbens in the brain. She instantly experienced suicidal emotions when stimulated and had never before suffered depression or had suicidal thoughts. “Is this a brain disease? Can we immediately create suicidal crisis? Yes. There is an anatomy here,” he said. “We can create it with DBS. We can knock it out with TMS (transcranial magnetic stimulation) or a medication. It’s a brain disease.” George referred to another study that showed that patients who suffered a traumatic brain injury, or TBI, that required hospitalization will go on to develop depression within a year, and a subset of those will attempt suicide. “It sets the stage.” The good news is that there are new treatments that show promise, including forms of neurostimulation, such as TMS, and the anesthetic drug ketamine, which for some reason in lower, subanesthetic doses, seems to be able to quickly knock people out of a suicidal crisis. MUSC has a small clinical service involving ketamine to test its effectiveness in helping treatment–resistant depressed patients, led by Baron Short, M.D. In the future, he hopes another promising, treatment area for research is the use of responsive stimulation to help depressed, suicidal patients. This technology already is being used to treat epilepsy. Epileptic patients have a device implanted that is able to detect problems in the brain and fire electrical signals through implanted wires to stop a seizure from happening. “We need to talk about suicide and not brush it under the rug. We can’t ignore this. Suicide attempts and completions commonly arise in a crisis that sits on top of another brain disease. To the degree that we can treat the underlying brain disease, we can take people away from being at risk. That is important.” As new treatments continue to develop, it changes the way doctors practice, which changes public awareness and decreases stigma. “If we come up with new treatments, it re–enforces that this is a brain disease. So people shouldn’t sit at home and be embarrassed and suffer in silence. Go see a doctor.”
See Suicide Tips on page 9
8 The CaTalysT, Sept. 5, 2014
SC senator awards The Order of the Palmetto to development VP By mikie hayes Public Relations
J
im Fisher, MUSC vice president of Development and Alumni Affairs, received South Carolina’s highest civilian honor, The Order of the Palmetto, on Aug. 14. David J. Cole, M.D., FACS, MUSC president, James B. Edwards, D.M.D., MUSC president emeritus, South Carolina Senator Paul Thurmond and Thomas P. Anderson, chief executive officer of the MUSC Foundation, were on hand to participate in the event. While all in the room, save one, knew the purpose of the day’s celebration, the guest of honor had no idea what was in store for him. Tucked in the agenda of an MUSC Foundation reception, the award would be the highlight of the event, unbeknownst to Fisher. Sen. Thurmond revealed to the audience he was there by special request of Gov. Nikki Haley and added that it
was “for reasons that were all good.” “The Order of the Palmetto,” Thurmond said, “is presented to people who, through their service, have helped turn this state into the unique and wonderful place that we’re all so proud to call home.” “I’m here tonight,” he continued,” to help present The Order of the Palmetto to someone here, whom you all know very well and have worked closely with for many years. I’d love to present this award myself, as I’ve known this person for a while on a personal basis. But I will yield the floor to MUSC former president and South Carolina’s former governor, Dr. James B. Edwards, to do the honors.” When presenting the award, Dr. Edwards told guests, “Tonight is a special pleasure for me because of my long and unique professional relationship with the honoree. We’ve known and worked with each other for 32 years. For the first
photo provided
Development and Alumni Affairs’ Jim Fisher, second left to right, is congratulated by S.C. Sen. Paul Thurmond after receiving The Order of the Palmetto. Also at the presentation was President Emeritus Dr. James B. Edwards, left, and MUSC President Dr. David Cole, second right, and Fisher’s wife, Chris. 18, I was his boss. For the last 14, he was mine.” Fisher was surprised and humbled to have received the honor. He was quick to share credit with his entire staff and asked them to join him up front to accept the award. Family, including
his father, retired U.S. Navy Capt. Bill Fisher; wife Chris; and two of his three children, John and Rebecca, attended the special celebration. Thurmond closed the event reading a letter of congratulations to Fisher from Gov. Nikki Haley.
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Chairman shares personal reflections about actor Robin Williams By Thomas w. uhDe, m.D. Department of Psychiatry & Behavioral Scinces Three weeks later, the country still mourns the loss of Robin Williams, a truly inspirational actor and comedian who in so many ways brought laughter and self–reflection into our lives. While most people will remember his extraordinary wit, I was always impressed by the thoughtful, caring and sobering side of his creative works. Through his intelligent humor and improvisation, Mr. Williams was able to stimulate serious discussions about controversial social issues. Part of his creative Uhde genius was his ability to make each of us confront our own personal biases and prejudices in a non–threatening manner. For me, Mr. Williams often elicited “why am I laughing” questions. His humor did not denigrate others, as can sometimes be the case in comedy; but rather, his work often challenged us to scrutinize our
suiCiDe PrevenTion TiPs q See it as a brain disorder in reaching out to loved ones, said Mark George, M.D. When someone is in a suicidal crisis the part of the brain that helps us size up who we are and how we fit in the world, and our self-worth, is simply not doing its job. They often fail to see all of life’s blessings and actually think that they are worthless and the world would be better without them in it. This is not like an hallucination, but it is clearly the brain distorting reality in a funny way as doctors sometimes see with strokes or in patients with eating disorders, who, although they are rail thin, actually think they are fat. Someone in a suicidal crisis is distorting their own worth in the world at a terrible cost to him or herself. q Eighty percent of people who commit suicide have depression or bipolar depression, often compounded by alcohol or other drugs. If you see someone who looks
own beliefs, life challenges and insecurities. Perhaps more effective than many psychotherapeutic modalities, Mr. Williams was able, through his characterizations, to promote self–exploration and encourage us to consider other possibilities without our even knowing that this was taking place. And, he accomplished this for so many of us for only the price of a movie ticket or a cable subscription which is considerably less expensive than psychotherapy. Mr. William’s death elicits sadness and anger. I get the sadness! But, why does his apparent suicide elicit anger? Maybe because: q Our society fails to recognize that depression is a serious, disabling, potentially life-threatening medical illness; q There is a public perception that depression is a personal weakness rather than the 8th leading cause of death in the United States; q Only a minority of people suffering from major depression, including those with a past history of suicide attempts, are able to obtain or receive evidenceinformed treatments; q Insurance providers fail to abide by the true intent of the federally mandated Mental Health Parity and
depressed and they are not getting treatment, encourage them to. If they can get that treated, then they stop the risk of falling into a crisis. People with terrible depression or anxiety will often turn to alcohol to stop the pain. This can slightly help, for a few hours, but then they set up a cycle of addiction and chronic alcohol actually turns off the prefrontal cortex. In the long-run drinking is the last thing they should be doing. q If you suspect someone is depressed and thinking of harming themselves, simply ask them about it. There is no harm in doing that, and it can do a world of good in terms of opening up a conversation, George said. Ask them if they are safe. If they are not safe, they will often tell you. If they refuse to answer, then call a suicide hotline (1-800-273-TALK - 8255) or take them to a clinic or emergency room. Don’t delay, just like you would not delay if you thought someone was having a heart attack or a stroke.
Addiction Equity Act, which, if appropriately enforced, would “really” provide improved access to mental health care; q Highly creative people have an increased prevalence of mood disorders (including, and perhaps, especially, bipolar disorder), and we as a society fail to provide appropriate mental health care; q There remains, even among many health care providers, a stigmatization about people suffering from mental illness, as well as mental health providers themselves, which leads to a failure in seeking and providing satisfactory mental health care; and q There is a decrease in research funding for the causes and treatment of brain–based mental illnesses. In Robin Williams, we have lost a creative genius from an apparent suicide. If he had remained with us, he perhaps one day would again (Good Will Hunting) been able to employ his creativity, humor and intelligent wit to uncover and reduce our society’s widespread harmful and largely oblivious prejudice against those suffering from major depression, addictions and other mental illnesses. Editor’s note: Thomas Uhde, M.D., is professor and chairman of MUSC’s Department of Psychiatry and Behavioral Sciences and the Institute of Psychiatry
MUSC psychiatrist Dr. Lee Lewis studies depression and offers these helpful tips:
What Can You Do to Help? 1. Reach out. It’s difficult to recognize depression in yourself. Your cognitive schema becomes altered. Break the silence if you see someone struggling. If they isolate themselves and are getting more irritable, reach out to help. Notice if you see someone who is creative shy away from his or her creative outlets. That can be a “loss of the lust of life” or anhedonia, which is a key sign of depression. 2. Break privacy. If you’re hesitant to reach out to someone, Lewis recommends considering: “What’s the best that can happen? What’s the worst that can happen?” Even if you share your concern and they get mad, it may plant the seed for future action. It’s better to reach out. 3. Mobilize on a community level. Find ways to mobilize to get more funding for mental health care, which has much lower funding than many other health conditions despite having a higher prevalence rate in the general population. “I hope as a society that we are moving to a place where everyone who needs and wants mental health treatment can get it and that we will be empowered and mobilized to make a difference on a community level – not just on Facebook,” according to Lewis. 4. Take advantage of new treatments. If you’re suffering from depression or suicidal impulses know there are new treatments and that traditional ones can work as well. Lewis also recommends behavioral activation – to make yourself do things you enjoy doing even if you’re not feeling it. “Fake it until you make it.” If you don’t have the energy to fake it, then at least call to get another perspective. (National suicide hotline: 1-800-784-2433).
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MUSC Urban Farm celebrates MUSC Excellence healthy behaviors through workout phases Coupons for Crops is an MUSC from warm–up to sprints Urban Farm initiative that provides and climbs. You control an exciting new opportunity for the resistance on your managers to recognize outstanding bike. Free day pass to the staff behavior. It’s summertime and MUSC Wellness Center the Urban Farm has an abundance for all participants. Check of produce to share with employees in at the Wellness Center who have distinguished themselves membership desk for by either exemplifying MUSC information or email Excellence or healthy behaviors. musc-empwell@musc.edu The Coupons for Crops can to register. be used as a tool to encourage or q Worksite screening reward staff efforts. It is up to the Susan Johnson — Thursday, Sept. 18, individual managers to determine Colbert Library, room what accomplishment qualifies and there is space on the back of the coupons 109, Colbert Library. This screening, valued at about $350, is available to to fill in those details, for anyone who employees of the State Health Plan would like to share their story. (including the MUSC Health Plan) Coupons are redeemable for MUSC for only $15 (covered spouses also can Urban Farm produce that’s been participate for $15). Employees and specially harvested and packaged for spouses without this insurance can the program. Pick up locations include participate for $42. Register at www. Tuesdays at the MUSC Urban Farm, musc.edu/employeewellness. or Wednesdays at the Horseshoe, 12 to q Chair massages: Free massages 1 p.m. Coupons don’t expire, but due are offered to employees on midday to fluctuations in yield, fulfillment may on Wednesdays. Look for broadcast be delayed at times to future weeks. messages for locations and times. Managers can email urbanfarm@musc. q Farmers Markets: Enjoy fresh fruits edu to have coupons sent via interoffice and vegetables from local farmers on mail. Initially 20 coupons will be Tuesdays, 8 a.m. to 4 p.m. (Harborview); forwarded, though there is no limit to Wednesdays and Thursdays, 8 a.m. to 6 the number that can be distributed so p.m. (ART); and Fridays, 7 a.m. to 3:30 repeat requests are welcome. p.m. (Horseshoe). New vendor: The A secondary objective of the program Clean Soap Company. is to raise awareness of the MUSC Urban Farm for those who have not MUSC Urban Farm had a chance to visit or attend an q Farm hand training — Farm Hands event there. There is a link on the are volunteers who participate in MUSC redcap survey (https://redcap.musc. Urban Farm activities on a regular basis edu/surveys/?s=8LVmzTiugi) which and have received additional training. invites coupon recipients to fill in Email urbanfarm@musc.edu to indicate a few responses to help with future the session you’d like to attend: 4 to 5 programming efforts. p.m., Sept. 11 or 9 to 10 a.m. Oct. 4. Training is free or no prior experience is Wellness Events required q Take the monthly Mindful Challenge q Sunset Work & Learns – Thursday, and be eligible for prizes by completing 4 to 5 p.m. Take home fresh produce a short survey at the beginning and end in return for work efforts. Open to all of the month. The September challenge employees, students and the community is to take a walk, indoors or out, during q Third Thursday Lunch & Learn the work day. Take the Monthly Mindful — 12:15 to 12:45 p.m., Sept. 18. Join Challenge survey at http://tinurl.com/ The Bee Cause executive director and omfw3vb (A link to final survey will be journeyman beekeeper Tami Enright sent at month’s end to those who take who will give an overview of the the first survey). importance of honeybees and discuss the q Employee Fitness Series: Wednesday, growing trend in beekeeping. There also Sept. 17, 12:15 to 12:45 p.m. Spin: will be a honey sampling celebrating the Katie Blaylock will guide participants
Health at work
end of summer q Saturday Family Friendly Work & Learn — 9 to 11 a.m., Sept. 20 Bring a plastic bag and take home fresh produce and please wear closed toe shoes. Open to all MUSC employees, students and the general community.
Challenge
Continued from Page Three
so dedicated to the kids and my management team and the staff are just beautiful people. If you see someone like me at my age with cancer, it's not a great thing, but is it that uncommon? No. But if you see a 3–year–old with cancer, I think most people would think
q Early Bird Maintenance — 7:30 to 8:30 a.m. Get your day started at the farm. q Bee Cause Honey is still available for $15 per bottle. Email the urbanfarm@musc.edu to purchase. For information, contact Dr. Susan Johnson via email at johnssa@musc.edu or whela@musc.edu. that just doesn't make any sense. And so, again, to work in pediatrics, you've got to really want to. I think there's a passion with the staff in the Children's Hospital. It's very infectious and it's an amazing thing to watch. Editor’s note: The article ran Aug. 22 in The Post and Courier and is reprinted with permission.
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ARROW establishes new diversity group, plans Sept. 24 networking event The Diversity and Ethnic Relations Committee recently established the MUSC ARROW Initiative (Advancement, Recruitment, and Retention of Women — formerly Women Scholars Initiative). The group, which is open to all minority women faculty and staff across all the colleges, will serve as the campus’ voice for women of underrepresented ethnic minorities working in academia. DERC’s mission is to retain and promote underrepresented women scholars through research-related resources, collaborations, social support, visibility, and professional development. The group envisions DERC to be a productive, collaborative, fun, and dedicated group of women who participate in activities that bolster
their own professional success as well as the success of those around them. For more information about our group, visit http://academicdepartments.musc.edu/ arrowinitiative/faculty_supports/. ARROW expects the visibility of DERC women and DERC group accomplishments will help advance underrepresented women scholars and help MUSC reach a critical mass of women of color in academic and research efforts. To help with campus awareness, DERC is planning its first social networking event at 4:30 p.m., Wednesday, Sept. 24 at Halo restaurant, 170 Ashley Avenue. Food and drink specials will be included. All are welcome to participate and join. For information, contact Cristina López, DERC chair, at lopezcm@musc.
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