Pulse Magazine Fall 2022

How

Institutional

JOHN EMERSON

A Message from the Dean

Rutgers New Jersey Medical School has long enjoyed a fabled history of innovating in the treatment of liver disease. Dating back to when NJMS’s renowned hepatologist Carroll M. Leevy, MD, identified new strategies for treating alcoholic liver disease and founded the NJMS Liver Center, our school has been home to some of the nation’s top doctors and surgeons celebrated for their work in the areas of liver care and transplantation. In fact, we were gratified when the Scientific Registry of Transplant Recipients once again rated the liver transplant program at University Hospital’s Center for Advanced Liver Diseases and Transplantation—which is led by NJMS doctors—as the regional leader in one-year survival rates. You can read more about the program and the doctors who run it on the pages that follow. While you’re perusing this issue of Pulse, be sure to also read about:

• Valerie Fitzhugh, MD’04, the new joint chair of pathology at NJMS and Rutgers Robert Wood Johnson Medical School

• How NJMS has been navigating COVID-19

• David Livingston, MD, NJMS’s longtime professor and the newly elected president of the American Association for the Surgery of Trauma

• NJMS anesthesiologist and pain specialist Akwasi Amponsah, MD’08, who has established a neuromodulation center in northern New Jersey for the treatment of chronic pain

These features and more serve to tell the stories of the faculty, students, and staff who help to make NJMS the special place that it is. They are the reasons why, as an institution, our school has been on the leading edge of medical education, patient care, scientific research, and community service for 68 years and counting.

In health,

Robert L. Johnson, MD, FAAP’72

The Sharon and Joseph L. Muscarelle Endowed Dean Rutgers New Jersey Medical School

DEAN

Robert L. Johnson, MD, FAAP’72

The Sharon and Joseph L. Muscarelle Endowed Dean, Rutgers New Jersey Medical School

ASSOCIATE EDITOR

LaCarla Donaldson

Interim Director, Marketing and Communications

SENIOR EDITOR

Mary Ann Littell

CONTRIBUTING WRITERS

Merry Sue Baum

Maryann Brinley

Amanda Castleman

Katherine Gustafson

Genene W. Morris Nancy A. Ruhling

DESIGN

Sherer Graphic Design

PRINCIPAL PHOTOGRAPHERS

Keith B. Bratcher, Jr. John Emerson

KEEP IN TOUCH

Pulse is published twice a year by Rutgers New Jersey Medical School. We welcome letters and suggestions for future articles.

Send all correspondence to: Marketing and Communications Rutgers New Jersey Medical School ADMC Building 11, Suite 1110 30 Bergen Street Newark, NJ 07107 or via email to: njmsmarketing@njms.rutgers.edu

ON THE COVER

NJMS faculty member Akwasi Amponsah, MD, uses neuromodulation technology to help patients coping with chronic pain.

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Get Social with Rutgers NJMS

PHOTO BY JOHN EMERSON

KEITH B. BRATCHER, JR.

Levounis Elected APA President

Petros Levounis, MD, MA, has been elected president of the American Psychiatric Association (APA). He is professor and chair of psychiatry and associate dean for professional development at NJMS. He will assume his role as president in May 2023. His priorities as president will be to expand the workforce by creating more psychiatry residencies; fight for equity in the reimbursement of psychiatric clinical services so it is on par with other specialties; and strengthen psychiatrists’ voices on such critical social issues as racism, homophobia and climate change.

“I am honored and grateful to have been elected president by my fellow members of the APA,” Levounis says. “I look forward to helping build APA’s leadership role in mental health.”

An Ounce of Prevention

A fresh, chocolatey brownie is hard for anyone to resist, but for an unattended child, there’s no thinking twice. It will be gone in minutes. That’s why cannabis edibles that resemble sweets, now more prevalent in homes than ever, should be safely locked away.

That advice comes from Diane Calello, MD, medical and executive director of the NJMS New Jersey Poison Control Center. Calello says calls about New Jersey kids who consume cannabis edibles continue to rise. In 2021 alone, 150 children, ages 5 to 12, were accidentally exposed. “When kids see what they think is candy or brownies, they usually eat the entire thing,” she says. “There are a range of effects, from the child being sleepy or acting goofy to having hallucinations and seizures. In very rare cases, the child may even stop breathing.” Calello says if a child ingests cannabis, call the Poison Control Center at 800-222-1222. Prevention, however, is the best medicine. “Buy products that don’t look like treats and keep everything locked up tight.”

Meet the New Chair of Surgery

Daniel B. Jones, MD, MS, has been named the new chair of surgery at NJMS and chief of service for University Hospital. He will also serve as assistant dean for simulation, innovation and scholarship.

Jones has been at the forefront of doing minimally invasive laparoscopic surgery. At the University of Texas Southwestern Medical Center, his team performed the first laparoscopic gastric bypass in Texas.

He initially has two major initiatives: integrating the medical and surgical weight loss programs and obtaining American College of Surgeons accreditation for NJMS’s bariatric program. He also champions simulation and skills training, with the goal to have an accredited  Level 1 education institute to teach across multiple learners. As a surgical educator, he has championed team training and advanced quality and patient safety.

“We have great leadership in our deans and a deeply dedicated faculty and staff,” he says. “We provide the highest quality care to all our patients, and we aspire to offer the best surgical education as well. I’m confident we can achieve our goals and continue to make our department even more exceptional.”

Anesthesiologist Receives Inaugural Award

Andrew Kaufman, MD, professor and chief of the division of pain management in the Department of Anesthesiology, received the first Rutgers Presidential Award for Excellence in Teaching. He was the only NJMS recipient of an award at this year’s ceremony.

Presenting the award, Rutgers President Jonathan Holloway, PhD, cited Kaufman’s exceptional teaching and mentoring. He’s received two Golden Apples from graduating NJMS classes and one from anesthesia residents. “In addition to patient care, my focus here has been the students,” he says. “I have always loved being a physician, but the opportunity NJMS has given me to teach and mentor students has become a true love of mine.”

Kaufman’s Presidential Award also honors the work he did to “reboot” the outpatient pain management center. He successfully implemented a new service model, and there are now three attending physicians, a nurse practitioner and a pain management procedural suite at University Hospital. “I am very proud of the work we did,” he says. “We have been able to greatly increase the number of patients we are now able to help.”

New Director for New Immunity Center

Ricardo Rajsbaum, PhD, has been appointed director of the new Rutgers University Center for Virus-Host-Innate-Immunity (CVHII).

He joins Rutgers as an RBHS Chancellor Scholar and Rutgers Presidential Faculty Scholar. His faculty appointment is in the Department of Medicine at Rutgers New Jersey Medical School.

As a component of the Rutgers Institute for Infectious and Inflammatory Diseases, the CVHII will engage faculty with interests in virology and associated host responses, including inflammation and immunity. Rajsbaum will help build collaborations among scientists with expertise spanning basic, translational, and clinical research. In addition, his new center will provide an essential platform for recruiting new faculty for the purpose of building a strong research program at the crossroads of virology, innate immunity, and inflammation.

Removing precursor anal cancer lesions in people living with HIV significantly reduces their risk of getting full-scale anal cancer.

These findings were the result of a Phase III clinical trial known as ANCHOR, or Anal Cancer Outcome Research. The results were published in the New England Journal of Medicine in July by the researchers, including Mark Einstein, MD, MS, professor and chair of the Department of Obstetrics, Gynecology and Reproductive Health and assistant dean of clinical research at NJMS.

The clinical trial involved some 4,500 participants at NJMS and 20 other recruitment sites across the country. “This is the largest cancer-prevention trial in a vulnerable population that has ever been conducted,” says Einstein. “People living with HIV are 80 times more likely to get anal cancer. By treating pre-cancerous lesions, we can stop the progression of the cancer.” He adds that the trial was clinically definitive and was stopped early because of its success.

ANCHOR Clinical Trial is a Success

Easing the Pain

BY MERRY SUE BAUM

alumni focus

COVER STORY

JOHN EMERSON

Pain finds all of us at one time or another. While acute pain from an injury usually is short-lived, some 50 million Americans suffer from chronic pain that never goes away. Whatever the cause, pain erodes a person’s quality of life. After trying everything, usually these sufferers finally give up and “just learn to live with it.” But there is good news: innovative technology and treatment options can help control chronic pain and improve quality of life.

Akwasi Amponsah, MD’08, NJMS assistant professor of anesthesiology, is using a technology known as neuromodulation for patients coping with chronic pain. To make this technology more widely accessible for those who need it, he is working on establishing a neurostimulation center at NJMS. It would be the first such facility in a northern New Jersey academic center. “We want to become a beacon of relief in the pain management field,” says the physician.

What is neuromodulation? It is technology that acts directly upon the nerves. It alters painful nerve activity by delivering electrical impulses to a targeted area. Similar to the way a cardiac pacemaker corrects abnormal heartbeats, neuromodulation therapies help to modify pain transmission in the body.

One of the most common examples of neuromodulation is the use of spinal cord stimulation (SCS) for chronic pain management. SCS uses a very thin electrode that is

placed on the spinal cord and attached to a small generator implanted under the skin. The generator delivers frequent, low-voltage electrical impulses to the spine, which alters the pain signals that are on the way to the brain. The impulses feel like a gentle tingling or buzzing. The neuromodulator itself is about the size of a matchbox and contains a battery that lasts about ten years. The patient has a remote control that is used to either increase

they understand all that is involved with neuromodulation.

The last step is completing a five- to sevenday trial. “We put similar electrodes on the spine with a trial battery,” Amponsah says. “If the patient feels at least 50 percent less pain after a week, we will do the permanent implantation.” It is a same-day surgery done in the operating room, and the recovery time is usually about a week.

or decrease the stimulation, depending on the level of pain.

“We use this to trick the brain and the spinal cord into thinking that a painful sensation is either less painful or even pleasant,” explains Amponsah, who is also program director for the pain medicine fellowship at NJMS. “This is a minimally invasive therapy that can be used if conventional treatments become problematic because of intolerance, addiction, or other adverse side effects.”

The pain specialist says neuromodulation is used most frequently in people with what’s known as failed back surgery syndrome. It is not uncommon to see patients who have had spinal surgery on their necks and mid- and lower-back areas still experiencing pain. However, neuromodulation can be used on almost any type of pain, including severe chest pain, leg pain, pain after amputation, and arthritis, to name only a few.

Patients who are interested in trying the therapy must complete three steps. First, they need medical clearance from their primary care physicians to have surgery. Next, a psychiatrist will work with the patient to ensure

Neuromodulation therapy is not new. However, upgrades to the technology have made it much more effective. A new type of neurostimulation, known as dorsal root ganglion (DRG) stimulation, is designed to manage difficult-to-treat chronic pain in specific areas of the body, such as the foot, knee, hip or pelvis. “It’s actually a subset of neuromodulation,” explains Amponsah. DRGs are structures along the spinal column made up of densely populated sensory nerves that act like traffic lights, regulating signals and sensations that travel through nerve fibers along the spinal column to the brain. The spinal column has a number of different DRGs, each of which is associated with a different area of the body. This type of therapy targets the DRG that is associated with the specific area of the body where a patient experiences pain.

Amponsah is excited about opening a neuromodulation center at NJMS. “Helping people with pain who have finally found relief is so rewarding,” he says. ●

“We want to become a beacon of relief in the pain management field.”

Relishing ‘A Noble and Meaningful Role’

BY NANCY A. RUHLING

What makes the study of infectious diseases so fascinating, says David Cennimo, MD’01, is the fact that there simply aren’t many facts.

“Whether it’s HIV or COVID-19, there are so many unknowns that we all have to learn about them together,” says Cennimo. “I love the idea that there are no experts and we have to figure it out together.”

Cennimo, an associate professor of medicine, practices clinical infectious diseases and infection control at one of NJMS’s major teaching affiliates, the VA New Jersey Health Care System, where he is also the associate chief of staff for education and associate program director of medicine-pediatrics.

He relishes his roles as teacher and clinician; the combination, he says, “is more humanistic than bench science.”

Although he always had an interest in science, it wasn’t until he was at NJMS that he found his true calling. “Around the time when HIV drugs came out and the disease was chronic instead of fatal, I was studying with Professor James Oleske, who discovered pediatric AIDS,” he says. “I was a star-struck first-year med student. And I was hooked.”

He sees being a doctor as “a noble and meaningful role” and working with students as an opportunity “to teach people to care.”

For his work, Cennimo recently received the Drew University Alumni Achievement Award in the Sciences, given to those, who, “through exceptional and sustained success in the field of natural or quantitative sciences, outstanding character and loyalty to Drew, have most personified the basic ideals of the university.”

Cennimo, who was not aware that he had been nominated for the award, was, to say the least, surprised and shocked to receive the honor.

“When they called to ask me whether I would accept it, my initial inclination was to say no,” he says. “There are so many people who are more deserving.”

(When he was told that Pulse wanted to profile him, his first reaction was, “Why? There’s nothing interesting to write about me.”)

In nominating him for the award, retired NJMS faculty member Elizabeth Alger, MD’64, noted that he’s “the kind of physician-educator who is admired by students, trainees and

peers alike,” and he’s an “exceptionally warm, generous and dedicated individual…who never says ‘no’ to a task that will benefit others.”

She also wrote that “as an educator, David is revered by students and colleagues, having received numerous awards, not only for his teaching, but also for his humanistic approach to the practice of medicine. As a clinician, he is widely respected for his expertise in infectious diseases.”

Her words of praise, Cennimo says humbly, are “sweet.”

Cennimo, who was born in Bayonne and grew up in Union, where he still lives (he likes to say that he’s back where he started), got

KEITH B. BRATCHER, JR.

his first taste of the medical profession as a teenager, when he apprenticed with his family doctor, who also served as his mentor. “I said to myself, ‘That’s what I want to be.’”

After graduating from Drew, where he double-majored in biology and chemistry, he enrolled at NJMS. When he’s not on duty—he estimates he puts in 50 to 60 hours each week—you’re likely to see Cennimo cheering on the New Jersey Devils (he has season tickets) or attending theatrical productions, an interest he acquired while at Drew University.

“I’m not married and I don’t have children, so the hallmark of my career has been my ability to run into the office on a Saturday if I’m needed,” he says, adding that he often does just that.

He finds that his “hybrid” career—it’s 50 percent clinical, 50 percent teaching—suits him.

“No matter what else I’ve done, at the end of the day, I’m a doctor,” he says. “I have a lot of other administrative duties, but it’s the doctor and patient in the room working together to get the best outcomes that I really love.” ●

Protecting Women’s Health

BY NANCY A. RUHLING

“Women’s health is not just about pills and pregnancy,” says Mark H. Einstein, MD, professor and chair, Department of Obstetrics, Gynecology and Reproductive Health. “It’s about the complete care of reproductive health, not just below the belt.”

By complete care, Einstein, an expert in gynecologic oncology, means obstetrics, gynecology, gynecological oncology, urogynecology, infertility, and family planning.

He adds that it is only natural that ob/gyns play a key role in overall health, “be cause if you ask any woman between 18 and 55 who her primary care physician is, she will say it’s her ob/gyn.”

This department is in a pre mier position to do so, he adds, because “we are nationally and internationally renowned experts in many of the reproductive health specialties, including maternal-fetal medicine, gynecological oncology, anogenital cancer prevention and state-of-the-art clinical trials focusing on some of our most challenging reproductive health ques tions. We are experts in cervical and anal cancer prevention, especially in individuals living with HIV, who are most at risk for anal and cervical cancer. We were one of 22 U.S. sites who led the NCI-supported ANCHOR trial focusing on women and men with HIV infection at risk for anal cancer. This trial will change how we screen for anal cancer.” (For more on the ANCHOR trial, see page 3.)

Under Einstein’s leadership, the department takes a proactive role in ensuring the health of some of the sickest pregnant mothers and their babies, as well as women with complex gynecologic disorders or cancers of the gynecologic tract.

In addition to offering top-notch medical care, the department sends students and staff members into local communities not

“Whether it’s HIV or COVID-19, there are so many unknowns that we all have to learn about them. I love the idea that there are no experts and we have to figure it out together.”

JOHN EMERSON

When Latina Women Work Together

BY MARYANN BRINLEY

This is a recipe for success.

“I was born in Sincelejo, Colombia, and when I was four, my family left with nothing but two suitcases,” recalls Maria Vega-Garces (MS3, NJMS). “Watching my family struggle to communicate with health care providers, I dreamed of bridging the language gap by bringing diversity to the medical field.”

“I was born in Bogota, Colombia, and came to the U.S. with my family when I was five,” explains Maria Suarez (MS4, NJMS). “I attended college with the idea of medicine in the back of my mind but at the front of my heart. Once I arrived at NJMS, I realized I could do something on a bigger scale to help Spanishspeaking patients like my family.”

“My family is Puerto Rican and when I was growing up, I heard countless stories of how our health care system failed to provide appropriate medical care. Close family members and relatives would describe how a doctor just wrote them off, or didn’t address symptoms, which led to a worsening of illness,” reports Kailyn Ramirez (MS2, RWJMS). “I will be the first doctor in my family and hope to be a home source of medical information and a voice for my community.”

Medical school is a challenge under any circumstances. So why did these students choose to take on a huge research project? The answer was obvious: “We want to make a change.” Now, in the final writing stages of their research, “Social Determinants of Health, Medication Adherence, and Glaucoma in Vulnerable Patients,” these authors explain, “Research has allowed us to think beyond the classroom and to develop our critical thinking skills.” It has pushed them to see how different variables can impact patients in the very diverse and widely uninsured population served in Newark.

“Many current guidelines and reference values for physicians were created using a white population that has been blanketed to all patients,” say the three students. “This is our way to advocate for patients using quantitative data.”

Glaucoma, the focus of their study, is one of the leading causes of irreversible blindness in the U.S., affecting nearly 3 million

As if medical school wasn’t demanding enough, these students have added glaucoma research to their to-do lists. Left to right: Maria Suarez, mentor Albert Khouri, MD, Kailyn Ramirez, and Maria Vega-Garces

people and expected to rise to 6.3 million by 2050. They wondered: could these cases be predicted, stopping that critical loss of vision, using social determinants? They went looking for ways that clinical researchers could spot trends in patients’ presentations that, if analyzed, could tell a story and predict the risk of severe glaucoma.

It all started when Maria Suarez mentioned her interest in eye research to Maria SotoGreene, MD’80, executive vice dean of NJMS and director of the Hispanic Center of Excellence (HCOE), who has championed under-

blindness. So why are certain minority populations six times more likely to go blind?

Working with 61 participants, the student researchers formulated an approved research protocol under the mentorship of Khouri and used multiple social determinants of health to understand why these patients were going blind. They focused on: primary language spoken, live in public housing or shelter, live alone, low health literacy, unemployed or on disability, no diploma or high school graduate only, and other factors. They also asked participants about their medication adherence

Women’s Health

Continued from page 7

for food insecurity, free breast and cervical screening, and healthy beginnings for moms with substance use disorder,” he says.

Through See, Test & Treat, a program funded by the College of American Pathologists Foundation, the school offers free cancer screenings and health education, including a pelvic and clinical breast exam, Pap tests, and mammograms with same-day results.

“We have identified cancers during the screenings, saving lives,” says Einstein, who manages complicated gynecologic malignancies and performs surgery and reconstruction for gynecological cancers and conditions.

represented students and faculty for decades. Through HCOE, which funded this research and its publication, and its Centers for Excellence Consortium, Soto-Greene reached out to Albert Khouri, MD, director of the Glaucoma Division in the NJMS Department of Ophthalmology and Visual Science. Along with his busy clinical practice, Khouri directs the Applied Vision Research Laboratory, where he supports student-driven research to lay the foundation for “lifelong learners.” As Khouri explains, “Research is also a great team-building exercise. These three students learned not to take medical evidence at face value, but instead built their research to bridge gaps in our existing knowledge. They wanted to answer questions on health inequity affecting patients with glaucoma.”

Glaucoma can’t be cured but can be controlled by eye drops or pills, and conventional or laser surgery. However, if left untreated, vision loss is permanent. Only early detection and treatment can slow or stop this risk of

and regular eye examinations. Three tests were used: the Short Assessment for Health Literacy (SAHL), the Medical Usage Self Efficacy (MUSE) and the Eye-Q. “The associations between glaucoma severity, education level and health literacy were significant,” they found. “Shining a light on these social determinants of health could allow for patient interventions to preserve vision. Heads-ofhouseholds who risk blindness could save their sight and continue to provide for their families, a factor of the utmost importance in a low-resource community.”

Excited about how their collaboration is going and where it will lead, all three say that Soto-Greene has been their role model. SotoGreene, in fact, has just received a renewal for the HCOE grant that makes all this possible.

Her belief in the strength of mentorship is so powerful that Maria Vega-Garces helped found a new organization at NJMS: FEMME (Fostering Empowered Minority Mindsets EveryDay). ●

School leaders, working with University Hospital Newark, participate in the World Health Organization’s Baby-Friendly Hospital Initiative, which promotes breastfeeding. NJMS also conducts state-of-the-art clinical trials using novel agents supported by the National Institutes of Health and pharmaceutical companies. The trials have included an experimental drug for pre-term labor and an immunotherapy drug to treat ovarian cancer. There also is a study on genetic profiling for preeclampsia and novel approaches to treating diabetes in pregnancy.

In addition, Einstein is leading a national task force to assist in the World Health Organization’s campaign to eradicate cervical cancer by 2030. “This campaign is significant not just globally, but in our back yard, as Newark has one of the highest disparities for cervical cancer because people don’t get screened or have access to treatment,” he says.

Einstein says that despite all the advances in the area of women’s health, there is still a lot of work to be done to create gender parity.

“Women and children traditionally have been marginalized as a group for funding and advanced scientific studies,” he says. “The number of instances of pre-term births and the deadliest cancers haven’t changed dramatically in decades. Rather than trying to maintain things, we are actively trying to improve them.” ●

“Research is also a great team building exercise. These three students learned not to take medical evidence at face value, but instead built their research to bridge gaps in our existing knowledge about glaucoma.”

ALBERT KHOURI, MD

BY GENENE W. MORRIS

Consider, for example, the time that Fitzhugh joined her high school’s fencing team on a dare. It was a fateful move that brought this natural athlete prominence as an all-state fencing champion and earned her a scholarship to Rutgers, where she captained its fencing team her junior and senior years. Or the time she reached out to the publisher of the Survival Guide series—books aimed at practicing pathologists—to ask why there wasn’t one concerning bone pathology. Her note landed her a deal to co-author the “Survival Guide to Bone Pathology,” published earlier this year.

It should, therefore, come as no surprise that when Fitzhugh learned in July 2020 that applications were being accepted for a permanent joint chair of pathology at Rutgers New Jersey Medical School (NJMS) and Rutgers Robert Wood Johnson Medical School (RWJMS)—a position that she’d held on an interim basis since March 2020—the pathologist and NJMS grad threw her hat into the ring.

“I thought, ‘I can do this. I’ve been doing the job. So, why not take the shot?’” says the diehard sports fan and former basketball player whose life and career have been defined by making bold moves. “You have to shoot your shot.”

After an exhaustive national search, Fitzhugh received a call in April of 2021 from longtime NJMS Dean Robert L. Johnson, MD’72, who was also serving as interim dean of RWJMS at the time, informing her that the job was hers.

Valerie Fitzhugh, MD’04, is not one to shy away from a challenge.

Fitzhugh’s appointment is a monumental one, as she is the first African American woman to chair a department at NJMS and only the third black woman in the nation to be named chair of a pathology department in academia.

In a statement announcing Fitzhugh’s selection, Johnson said, “I am delighted that Dr. Fitzhugh has accepted this position and I look forward to working with her to further develop the Department of Pathology, Immunology and Laboratory Medicine at New Jersey Medical School, as well as the Department of Pathology and Laboratory Medicine at Robert Wood Johnson Medical School.”

soon after and “we have been in contact ever since,” Fitzhugh says. “It’s just nice to have somebody who understands what you’re going through. She is one of the kindest people I have ever known.”

From Pinn, Fitzhugh says she’s learned not to be afraid to ask for help and to delegate. “When you’re a chair, you almost want to give the appearance that you’re indestructible and can do all things. That’s not realistic.”

Now settled in her role, Fitzhugh dreams of “making these departments nationally, if not internationally, renowned and recognized departments of pathology,” she says. “That

she strives to support faculty and their goals, especially if those goals include taking on leadership positions. “I think it’s really important to know within your group and outside of it who your potential leaders are, to groom

‘You Have to Shoot Your Shot’

The fact that the news came from Dean Johnson, another trailblazer who Fitzhugh describes as “an NJMS legend,” was markedly poignant. “I remember so fondly the day that he called me to tell me that he was selecting me. I cried ugly tears,” says the associate professor. “It’s hard work, but it’s also fulfilling.”

One of the first things that Fitzhugh did after her appointment was contact fellow pathologist and former Howard University College of Medicine professor Vivian Pinn, MD, who made history by becoming the first African American woman to ever chair an academic department of pathology in the U.S. Fitzhugh, who specializes in cytopathology and musculoskeletal pathology, admits that she didn’t know Pinn prior to emailing her for advice. But, she says, she figured “given that there haven’t been that many of us, I’ll shoot my shot and reach out.” Pinn responded

may take five to six years to get all the pieces in place…but I think it can be done.”

To achieve this, Fitzhugh—who, between the two departments, oversees a total of 66 staff and faculty members—has set her sights on fostering more cross-campus research collaborations between the two departments and bringing more pathologists on board.

“The most important hiring I need to do right now is on the clinical side; bringing on people who can do the clinical work from day to day.”

This has proved challenging since COVID-19, which Fitzhugh says has hastened what was already a looming shortage of pathologists. “We’ve had some retirements and resignations, but we have a really talented core group and I want to enhance and grow that talent.”

As joint chair, Fitzhugh, who has made Pathologist magazine’s Power List of top pathologists in the world four times, says

and cultivate that. So, when the time comes, they are ready to step up.”

For Fitzhugh, supporting faculty means also promoting wellness within her ranks. In fact, her emails end with the message: “My working day may not be your working day. I respect your boundaries around personal time, well-being, caretaking and rest. If you receive correspondence from me outside your working hours, please do not feel obliged to reply until you are at work.”

By including this note, Fitzhugh wants her faculty and staff to see her as a leader who makes their well-being a priority. “Work is only a part of who you are. There is a life outside of work and it’s important to embrace that.”

As for Fitzhugh’s life outside of work, she says she enjoys spending time with her

Valerie Fitzhugh (right), fencing as a Rutgers undergraduate.

How the Top Liver Transplant Team Saves Lives

BY MARYANN BRINLEY

Nine years ago, Nikolaos Pyrsopoulos, MD, PhD, MBA, took the autotrain from Florida, heading north with his wife and children, ages 8 and

5. “We tried to make it feel like a vacation and they loved it. The train attendants kept bringing them cookies and milk,” he laughs.

But this trip to New Jersey was not for vacation. Pyrsopoulos was starting a new position as medical director of liver transplantation at University Hospital (UH) and Rutgers New Jersey Medical School (NJMS) in June 2013. He was following in the footsteps of leaders in the world of liver disease, physicians he had discovered as a medical student when he decided to specialize in hepatology, treating conditions affecting the liver, gallbladder, biliary ducts and pancreas.

He and his team have been busy since then. “Liver transplantation is definitely a team sport,” he states. “It is not a one-man show.” Pyrsopoulos earned his medical degrees at the University of Athens and completed two residencies and fellowships in Athens as well as at the University of Miami School of Medicine. “Everything starts with a team of exceptional, world-class and passionate physicians, surgeons, nurses, coordinators, nutritionists, social workers, administrators, researchers, financial counselors, staff assistants, patient navigators…and our collaboration with the New Jersey Sharing Network, our organ procurement organization.”

The results are in. In January 2021, the Scientific Registry of Transplant Recipients (SRTR), a federally supported research group, identified the Rutgers–UH Center for Advanced Liver Diseases and Transplantation as the national leader. UH shared this top spot with only one other center at Harvard, scoring a 98.7 percent one-year patient survival rate. This is spectacular news for residents of New Jersey.

James V. Guarrera, MD, FACS, who joined the team in February 2018 as professor of surgery and chief of transplant and hepatobiliary surgery, couldn’t have been happier when the ranking was announced.

“People already knew University Hospital as a leading academic medical center and for its Level 1 Trauma care. We were so pleased to add the liver transplant program as another point of pride and marker of the excellence of our program.”

Guarrera, who was recruited from New York Presbyterian Hospital, has published more than 100 scientific papers, reviews and book chapters. The holder of seven patents for his innovative bench-to-bedside research in donor liver preservation, Guarrera believes

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that clinically preserving human livers using machine perfusion could take the transplant community out of the “Ice Age.” He is expecting FDA approval for his remarkable perfusion device.

“Coming here was a great opportunity for me to take a leadership position in what has historically been a busy liver transplant program,” he says. His first year at UH he predicted performing 20 transplants but quickly tripled that number. “There is a great referral base of liver disease patients and many opportunities for growth in New Jersey.”

“Patients come to your door ready to die,” Pyrsopoulos explains. “They are very sick and the chances for them to succumb without a transplant are high. Given a new liver, they leave the hospital able to live long full lives.”

One of the largest organs in the body, the liver is like a laboratory, processing the blood leaving the stomach and intestines; breaking down, balancing and producing nutrients and proteins; and storing vitamins while removing, metabolizing and filtering things like prescription medications, alcohol and fat. You can’t live without a functioning liver. “One of the first things we do is sit down with a patient and explain in simple language what may be happening,” Prysopoulos says. Unlike other organs in failure, there is no supportive alternative treatment for a non-functioning liver except a new liver.

Kathleen Ruping, RN, BSN, MBA, CCTC, administrative director, agrees. “When patients come to us, they are scared and unsure of

Left to right: Nikolaos Pyrsopoulos, MD, PhD, MBA, and James Guarrera, MD

Kathleen Ruping, RN, BSN, MBA, CCTC

JOHN EMERSON

COURTESY OF UNIVERSITY HOSPITAL

this. Initially it was diagnosed as a type of cirrhosis but I was also told it could be fatty liver disease.” By May 2018, Ascione had been referred to Pyrsopoulos. The judge tired easily, with enzyme numbers that had changed for the worse. Still able to travel, enjoy family activities, and do his legal work, he hoped to put off the inevitable surgery until he retired. That was not to be. One day at work in Trenton, “I just didn’t feel right and actually started crying in the middle of the day. It was scary. I called my wife. I was afraid I would not remember how to drive home. Ammonia in my system was building up and starting to affect my brain.”

Pyrsopoulos told him, “We’ve got to get you in here to see if we can do something.”

Ascione was put on the liver transplant wait list. Holding his own, he remained optimistic all summer, even when fluids built up and he was rushed to the hospital to have nine liters drained. “Two days later, they took

what to expect. We explain what’s going to happen every step of the way and what we are doing to keep their liver functioning until we get them closer to a transplant.” That can take months.

Ruping came to Newark from Florida, where she helped Pyrsopoulos build a successful liver transplant center at the University of Central Florida’s Lake Nona Medical Center. “I’ve been a nurse for 39 1/2 years but I fell in love with transplant surgery 31 years ago,” she explains. “We revamped the program here in 2018 and brought it to the highest standards with top-notch experts. We have streamlined our processes and improved our one-year survival. I can’t tell you how rewarding it is to watch every member of this fully committed team working together, taking ownership for what they do. Truthfully, it takes the entire multidisciplinary team to get one patient through the process.”

This is no day job either. Calls about available donor livers come in any time of the day or night to Ruping and her assistant administrative director, Joel Lindower. “You have to know who’s on your list and what size liver will fit each patient,” she explains. “Among our

most satisfying moments is phoning a patient to say, ‘I’ve got a liver for you.’ The comments from recipients and their families on that call reinforces why we do this job.” UH has approximately 100 patients on its list right now. One of the busiest of the 131 liver transplant centers in the U.S., this program has completed more than 80 successful transplants in the last two years.

Sometimes recipients, like Joseph Ascione, JD, of Westfield, have warning signs. An administrative law judge who turned 70 this year, he explains, “I had a history of high liver enzymes. No one knows exactly what caused

another five,” he recalls. By Labor Day, Pyrsopoulos admitted him into the hospital, “just to be safe.” Sent home, he got a call the following weekend: ‘We have a liver.’ Forty minutes later, he was back in the hospital.

Now four years post-surgery, Ascione is doing well, with good liver numbers. He worked full time until retirement and recently returned to work part-time. His only frustration might be the custom-made suits he splurged on when his post-surgery weight dropped from 250 to 180. They no longer fit. “As my body

“Patients come to your door ready to die. They are very sick and the chances for them to succumb without a transplant are high. Given a new liver, they are able to live long, full lives.”

NIKOLAOS PYRSOPOULOS, MD, PHD, MBA

JOHN EMERSON

recovery Institutional

BY AMANDA CASTLEMAN

Health care workers faced unprecedented challenges when the pandemic first hit New Jersey in early March 2020. “I’ve never done anything harder in my entire life,” says Anne Sutherland, MD, assistant professor of medicine, who directs University Hospital’s ICU. “COVID was like a beast consuming everything.

“It’s like you didn’t know where to put your worry. You worried about the patient in front of you like doctors do all the time. But you were also worried about giving enough care to each, because at one point, we had 50 intubated, critically ill COVID patients. You were worried for yourself and whether you were bringing home this disease. And then as a teacher, you worried about the physicians in your charge and that they were going to sacrifice their own health to take care of others.

“You really had to emphasize to learners: ‘You are a precious resource. Protect yourself, not only for your patients today and tomorrow. But we need you to be doctors for the long haul!’”

ery from COVID

Left to right: COVID recovery team members Lewis Nelson, MD, chair of emergency medicine; Christin Traba, MD, associate dean for education; and Justin T. Sambol, MD, senior associate dean for clinical affairs

THE BEGINNING: pivoting in the surge

Early on, the emergency department (ED) saw patient volumes fall dramatically. “Heart attacks, strokes and injuries plummeted,” says Lewis Nelson, MD, chair of emergency medicine. “It was like the drawback when water recedes before a tsunami. Then we saw the surge and every patient was exceptionally sick, many needing intubation, high-flow oxygen or other breathing machines. We were packing people in like sardines,” he recalls. “And we didn’t understand the disease or how it could affect us.”

a medicine that works and they feel better! We were so desperate for a win, and they were few and far between then.”

The outpouring of love from her chronic patients lifted her up enormously too. “It was like they were taking care of me, which was lovely,” she says.

State-owned University Hospital had access to resources—like military help—that private facilities didn’t, explains Neil Kothari, MD’00, associate dean of graduate medical education. But it was still an all-hands-ondeck situation, he explains. Non-frontline workers pivoted to telehealth, and remote research projects on quality and patient-safety.

Testing became possible, thanks to efforts of people like David Alland, MD, professor of medicine, chief of infectious diseases, and director of the Center for Emerging Pathogens and of the Rutgers Center for COVID-19 Response and Pandemic Preparedness. In March 2020 the FDA gave emergency authorization for his team’s PCR test for COVID. A pilot grant program also pulled “the power of Rutgers investigators into COVID research,” he says. Projects ranged from the lockdown’s psychological impact on people with autism to engineering ways to sterilize the virus and examining new drugs.

During an intense 24 hours in early 2020, NJMS sent medical students home and converted to e-learning, explains Cristin Traba, MD’06, associate dean for education. The faculty had to innovate quickly to teach topics like anatomy via Zoom.

Justin Sambol, MD’97, senior associate dean for clinical affairs, helped reshuffle staff. “We even had radiologists and ophthalmology residents doing critical care,” he notes. Meanwhile surgical techs helped with proning (placing patients on their stomachs to combat respiratory distress).

Telehealth deployment also took priority, and both doctors and patients praised its flexibility, especially for people with limited mobility and those lacking good transportation options. Sutherland says outpatient care also brought welcome bursts of normalcy and stabilization, like: “Oh, yeah, I can give people

The school also accelerated its graduation date so more doctors could join the workforce, and allowed residents to start early. Two rules remained, regardless of the crisis’ urgency: they couldn’t work more than 80 hours a week and anyone in harm’s way had to have access to appropriate personal protection equipment, or PPE. “Nationwide, much attention has been paid to the first responders and doctors in general,” Kothari says. “But look below the surface and resident physicians were really the backbone of care for COVID-positive patients.”

Traba recalls that our students were “boots on the ground.” They manned hotlines and hospital temperature-screening stations,

“Nationwide, much attention has been paid to the first responders and doctors in general. But look below the surface and resident physicians were really the backbone of care for COVID-positive patients.”

NEIL KOTHARI, MD

Neil Kothari, MD, associate dean of graduate medical education

KEITH B. BRATCHER, JR.

and helped schedule telehealth visits and walk people through the technology. “Others were dealing with worry or ill loved ones at home and felt very isolated.”

Sambol adds: “A lot of [health providers] may never fully recover psychologically. We talk about wellness and provide support. But health care just doesn’t stop. It’s not like a restaurant that could take two weeks off. The hospital never closes, the practices never close. A lot of people have left the health care workforce because of it.”

MID-PANDEMIC: students return, patient triage and its knock-down effects

In 2020, frontline workers had 12 times the risk of contracting COVID than the general community, according to a Harvard study. But staff unflaggingly pushed forward and by summer they had found a new rhythm, Sambol says. “We started developing protocols about what [non-coronavirus concerns] took priority while still delaying less life-threatening problems until the hospitals cleared out.

“Over time, we did see the effects of the delayed care, such as cancers that might have been curable but have now spread, and can’t be treated as effectively,” he notes.

In the ICU, junior colleagues faced heartbreaking conversations with desperate and grieving families, as attendings fought to direct care and save as many patients as possible. Sutherland recalls, “we set up video conferencing so at least they could see their loved ones and everything we were doing.”

The students returned in June 2020, once safer practices emerged and the school had PPE to spare for non-essential workers. However, until January 2022, they weren’t allowed to see COVID patients, partly for safety, but also to minimize traffic through infectious rooms. Traba says: “The restriction was lifted during the next surge in January 2022. At that time, the students were vaccinated and boosted with access to appropriate PPE across clinical sites.”

But she said an unexpected silver lining emerged: “Applying to residency is extremely expensive, with a large part being traveling to various states for interviews. [Teleconferencing] knocked down some of the inequities.”

TODAY: moving towards endemic

Hospital workers no longer run an elevated risk of contracting COVID, according to a JAMA study. The ED sees fewer infected patients now and two-thirds arrive for other reasons, then test positive at intake. “We wear masks and gloves, but don’t really talk about COVID anymore,” Nelson says. “There’s a kind of ‘been there, done that’ survivor mentality.”

He reports little burnout among those remaining, but difficulty hiring nurses and ancillary staff—part of a nationwide staffing crisis. Around 15 percent of hospitals are dealing with shortages and the situation has reached critical levels for another six percent.

Kothari’s team continues many of its pandemic best practices, including a psychiatry hotline, text support groups, and mental and physical health resources. He also keeps producing roundup emails, since “communication was the most important thing residents wanted.” Once daily, but now weekly, these include COVID statistics—national, statewide, and hospital-specific—plus where to find boosters and PPE.

“We’re not really seeing COVID deaths at all now,” he says. But the fatigue of this emotionally fraught marathon remains for workers. “Some people are just done. They’re exhausted.” This includes nurses, as well as housekeepers, transport workers and other support staff, who “suffered the most throughout the pandemic.”

Still, Kothari finds cause for celebration in how NJMS rose to the challenges. “I’m proud of how well everyone responded. I’m sure they were scared every day. But still, every frontline worker showed up every day. It’s amazing.” ●

Anne Sutherland, MD, assistant professor of medicine

Above: David Alland, MD, professor of medicine and chief of infectious diseases

KEITH B. BRATCHER, JR.

High-Tech Prostate Biopsy: Greater Accuracy, Less Infection

BY AMANDA CASTLEMAN

Prostate cancer has been on the rise since 1975, and men now face a one in five chance of a diagnosis. Fortunately, mortality has declined by 30 percent in that period, thanks to more effective screening and treatment. Now that forecast could get even brighter, as NJMS has launched a high-tech new program under the oversight of urologic oncologist Evan Kovac, MD, associate professor of urology in the Department of Surgery.

The first prostate biopsy occurred in 1926 via an incision in the perineum, the area that marks the lower boundary of the pelvis. This evolved into samples taken with 18-gauge needles, which had an 88 percent accuracy rate. But in the 1950s, doctors instead began approaching via the rectum, which provided better access to the area most implicated in cancer, the prostate’s peripheral zone.

“Transrectal prostate biopsy is a very effective diagnostic technique,” says Kovac. “But it’s fraught with dangers, because you’re directing a needle through the rectal wall, which is full of bacteria and stool, carrying a significant infection risk [between one to five percent, depending on the study].”

This transrectal technique typically requires not just one, but two, prophylactic antibiotics to prevent infection—and even then, some risk remains. “It’s not good stewardship,” Kovac points out. “Bacteria are becoming increasingly resistant, and we’re not developing any new antibiotics. Accordingly, there is a shift to other diagnostic techniques.

“Britain has Brexit and we have Trexit, an exit from transrectal biopsy,” he adds with a smile.

Instead, doctors like Kovac have returned to the perineum: a process known as transperineal prostate biopsy. “For most patients, antibiotics aren’t necessary, and the infection risk is very low [0.9 percent] … comparable to the transrectal approach with two antibiotics,” says the physician. He’s found the patient experience to be superior too. “They’re experiencing fewer side effects, such as less blood in the urine and reduced post-procedural pain.

“I believe we’re the only center performing this type of prostate biopsy in northern New Jersey,” Kovac says. “And we’ve got one

KEITH B. BRATCHER, JR.

extra twist: we use ultrasound to guide our needle through the gland to take tissue samples. Unfortunately, ultrasound doesn’t see cancer very well. But magnetic resonance imaging (MRI) does.” Patients now receive MRIs prior to their biopsies and radiologists target likely places to look for cancer. Then urologists superimpose that data over real-time 3D ultrasounds while performing the procedures, called “fusion” biopsies. “This technology is increasing our diagnostic accuracy even more,” Kovac says.

A small company, Koelis—based in southeastern France’s Grenoble and Princeton, NJ— makes these prostate fusion biopsy systems. Kovac also uses a PrecisionPoint device that allows for fewer punctures in the skin, further reducing the infection risks.

Since NJMS began its transperineal prostate fusion biopsy program in April 2022, no patients have suffered an infection. Many

procedure (an option for the older method too, but one often avoided, as doctors could perform more biopsies swiftly on alert patients in their offices than on anesthetized ones in operating rooms).

“I’m so happy to promote this, especially in a community like Newark, where prostate cancer is endemic,” Kovac says. The city’s rates of this disease among Black men rank among the nation’s highest, and overall that demographic has a mortality rate nearly 2.5 times that of whites.

“This is the first step in turning the tide on prostate cancer outcomes here,” adds Kovac. “I’m proud that we’ve begun this program and I want to give a lot of credit to University Hospital, and the Cancer Institute of New Jersey,

3-D ultrasound rendering of a prostate (grid) containing several suspicious lesions identified on MRI (areas in color). Yellow and green cylinders represent individual tissue biopsies of the lesions and organized sampling of the remaining gland.

which supported me in bringing it online.” ●

Dr. Kovac welcomes referrals and questions from colleagues via evan.kovac@rutgers.edu (973) 972-1745 and @EvanKovac on Twitter.

Patients undergoing transperineal prostate biopsy don’t always need antibiotics and also experience fewer side effects, such as less blood in the urine and reduced postprocedural pain.

COURTESY OF EVAN KOVAC, MD

Leading the Way at AAMC

BY KATHERINE GUSTAFSON

Academic health systems save millions of lives. Physicians and other health providers care for critically ill patients and perform innovative surgeries, while their colleagues in the lab bring groundbreaking discoveries from the bench to the bedside. And let’s not forget the behind-the-scenes contributions of nonmedical staff, who deserve their share of the spotlight.

Longtime NJMS employees Pamela Edwards (right) and Courtney Terry (left) are two such individuals. Both have excelled in their respective professional roles. Edwards, executive director of facilities and logistical services, keeps NJMS’s large, complex physical plant running smoothly and safely. Terry, assistant director of information technology, oversees the academic systems, educational technologies and initiatives for the school.

Recently, both Edwards and Terry were named to leadership roles within the American Association of Medical Colleges (AAMC), the leading nonprofit organization that represents the academic medicine community. They are serving on two of AAMC’s affinity groups: Edwards, as chair-elect of the steering committee of the Group on Institutional Planning (GIP); Terry, as part of the steering committee of the Group on Information Resources (GIR).

Affinity groups bring people together around shared interests: promoting professional growth, leadership development, and collaboration. “It’s inspiring to see the effort both Courtney and Pam make on behalf of NJMS by getting involved with external peer organizations such as the AAMC,” says Jim Boyce, deputy chief operating officer and executive director of information technology and operations. “And not just getting involved, but by taking leadership positions within their respective areas, as chairs, and as advocates for DEI (diversity, equity, and inclusion).”

Edwards first became involved with AAMC’s GIP in 2017. The GIP engages with strategic planners and facilities managers at academic medical centers to enhance their skills, knowledge, and sharing of best practices. She will serve one year as chair-elect, then assume the chair position in July 2023. As chair-elect, she chairs the planning committee for AAMC’s spring meeting in Puerto Rico. As chair, she’ll be involved in planning the programming for the next meeting, as well as webinars and meetings focused on topics ranging from strategic planning to facilities management.

Edwards appreciates the group’s welcoming nature and willingness to share information. With NJMS about to embark on a multimillion-dollar renovation of its Medical Science Building, Edwards has consulted with colleagues at sister institutions via the GIP to learn how they have managed similar projects.

“Being a part of the GIP has boosted my confidence in terms of being a leader,” says Edwards. “It makes me feel good to be a woman of color who is able to take the reins of the GIP in this role.”

Terry has been involved with the GIR for nearly a decade. The GIR promotes the use of IT and information resources in academic medicine. “I joined to collaborate and see what other schools were doing,” she says. “You always want to know what’s out there. And we’re doing great things at NJMS. We can show others what we’re doing and how they can benefit from us.” For example, she is particularly proud of leading the change in technology from paper-based to online-focused medical education at NJMS in 2006 with the rollout of the Education Management System. During the pandemic, Terry led the revamp of this system with the IT@NJMS team.

She hopes to take on a more engaged leadership role as she works with colleagues from other schools on the group’s priorities.

“I’ll have an understanding from a different perspective about how programs and initiatives get started, and it’ll be exciting because I’ll be part of that process,” she says. “I’m interested in learning what happens in collaborating with other people and seeing how they put all the pieces together.” ●

KEITH B. BRATCHER, JR.

New Joint Chair

Continued from page 11

family, which includes husband Raivo Kull, an engineer; 8-year-old daughter Mari, a budding artist; and 6-year-old son Viktor, a natural athlete like his mom.

Listed among Medscape’s 20 Top Black Physician Social Media Influencers in 2020, Fitzhugh is a prolific Twitter user, with some 72,000-plus tweets to her name and more than 33,000 followers, which include celebrities like former heavyweight boxing champ Lennox Lewis; racecar driver William “Bubba” Wallace; and actors Pedro Pascal, Mark Hamill, and Rosanna Arquette, among others. She admits there was a time, however, when trolls made her consider leaving social media, but Lewis wouldn’t hear of it, she says. “Lennox Lewis was one of the first people who was like, you can’t leave. Think of the kids who see you and aspire to be like you. And then he posted a tweet saying, ‘Convince her not to leave.’ So, I stuck around.”

The three-time winner of the Golden Apple Teaching Award who says she uses Twitter as “a megaphone for good,” sees the platform as a tool to educate society about pathologists and what they do. Fitzhugh hopes her posts will inspire aspiring doctors to enter the field of pathology, particularly those from backgrounds underrepresented in medicine. She says she’s grateful for the opportunity that her role affords her: to show younger people, especially those who look like her, what’s possible.

“I applaud the leadership at NJMS and Robert Wood and, of course, across the health system within Rutgers Biomedical and Health Sciences to be progressive enough to say … we’re going to take the chance on somebody who, when you look at her, would not be the first person you’d say, ‘oh, that’s the chair of the department,’” Fitzhugh says. “People don’t expect a relatively young black woman to be doing such a big job. But that shouldn’t be. I shouldn’t be a unicorn.” ●

Valerie Fitzhugh is on Twitter: @DrFNA

Top Liver Team

Continued from page 15

recovered, my appetite returned and lo and behold, I grew out of those suits.”

His size, however, may have saved his life. “I wasn’t number one on the list but the donated liver was large. It couldn’t be cut down to fit the number one person. So I jumped ahead.” An eternal optimist, he adds, “How lucky was I?”

Other patients have little warning of liver failure. Look at Blaine Mantor, a healthy 21-year-old from Sidney, Ohio. In September 2021, after Hurricane Ida left New Jersey flooded with thousands of cars washed away and abandoned, an emergency request went out to tow truck operators. Blaine, who works with his father Brian in the family business, Mantor Auto & Truck Repair, volunteered.

“I wanted to help,” he says. “I’ve watched my father tow cars and haul equipment since I was a little kid, and I always knew this is what I wanted to do.” His parents said yes, but insisted that he rent a room in New Jersey and not use a pop-up tent. Another local tow truck driver, Chuck White, was going too and would be next door in the motel, a factor that ultimately saved Blaine’s life.

When he left on September 3, Blaine planned for 20 days, but it would be a month before he returned home. On September 19, he felt sick with nausea and headaches. “Nothing really too bad, but I couldn’t work,” he says, “I apologized to Chuck, who stopped by. We’d been in a friendly competition for how many cars we could tow.”

The next morning, Blaine was delirious and texting nonsense. Chuck called Blaine’s parents and the race to save his life began. An ambulance took Blaine to Robert Wood Johnson University Hospital with acute liver failure. As Guarrera recalls, “We just don’t know why this happened. It could have been a virus but sometimes there are things we can’t detect.” At UH, he was known as “the boy from Ohio.”

On September 20, Blaine’s mother, Michelle Mantor, and grandfather, Randy Sloan, took the last flight out from Dayton to Newark. Unconscious, Blaine had been flown by helicopter to UH in Newark. His body was shutting down because his liver was failing. Doctors didn’t expect him to live through the night. With this catastrophic news, Blaine’s father drove 614 miles straight through, arriving by 8:30 AM on the same day. Blaine was still alive, but barely.

By September 23, Blaine was moved to the top of the list in record speed. Three days later he went into surgery. “The boy from Ohio” would live. The statistics for surviving acute liver failure had not been in his favor, with a mortality rate of 65 to 85 percent. What saved Blaine was being near a number one liver transplant center. “If this had happened in Ohio, I wouldn’t be here now,” he admits.

Kathleen Ruping notes, “Joe Ascione and Blaine Mantor are but a couple of patients who have second chances to live life to the fullest, thanks to the team of skilled professionals at the University Hospital Liver Transplant Program.” ●

“THE BOY FROM OHIO” Transplant patient Blaine Mantor received a lifesaving new liver.

Treat the Whole Patient, Not Just the Trauma

BY AMANDA CASTLEMAN

David H. Livingston, MD, is on a mission to extend trauma treatment beyond patients’ hospital discharge.

The physician, an NJMS professor emeritus of surgery and former chief of trauma and surgical critical care, has made this issue a pillar of his 2021–22 presidency of the American Association for the Surgery of Trauma (AAST). He’s challenging his peers to build and oversee long-term trauma survivor clinics, since they have expertise and a big-picture perspective to guide much-needed aftercare.

“If you’re brought into a trauma center— and you don’t have a lethal brain injury or advanced age or serious underlying medical problems—your chance of walking out is well above 95 percent,” he notes. “It’s one of the unsung stories in America!”

Following their admission to the trauma center, Livingston noticed that many of these patients continued to come back for needed care. “It was my unscientific impression that those I saw repeatedly did better. I’d wind up treating their gallbladder disease, their hypertension, sometimes even their mother….I’d say, ‘You need a regular internist!’” Still, they returned, struggling with PTSD, depression, chronic pain and other complications.

“Patients who are severely injured often don’t have great long-term outcomes,” he says. “There is an accelerated death rate and its reason is unknown.” Infection and suicide play a role, but other factors need to be addressed. Livingston believes trauma surgeons should be driving this improved and more integrated aftercare.

“Maybe they just need more help, instead of telling them to see their internist or a

consultant,” he notes. “In an ideal world, a Center for Trauma Survivorship would help coordinate efforts and support primary care providers with expertise.”

Livingston has put these ideas into practice at University Hospital’s Eric Munoz Trauma Center. “I took a center that provided astounding inpatient care and hopefully made it better and more complete,” he says. “It’s thanks to the excellent staff!” This team broadened its scope to include caregivers and dependents, since trauma disrupts entire families. “The goal is to provide patient-centric, holistically driven care, and also to serve as a navigator: an advocate, a case manager.”

Livingston has plans to extend this type of care. He says, “My presidential address to the AAST will challenge that group’s trauma surgeons from around the country and the globe. We’ve been successful in creating a lot of survivors. But when they walk out, they have the rest of their lives to live. If we’re really dedicated to care of the injured, that care doesn’t stop at discharge.”

The only doctor among a family of engineers, Livingston started his medical education at 18 with a six-year program at Rens-

selaer Polytechnic Institute. “I liked science, biology, and people. It seemed like a good idea at the time,” he says. But if he had a do-over, he would trade the accelerated program for a healthier pace with summers off and more intellectual exploration as an undergraduate.

During his surgery rotation, everything clicked. “I loved being in the OR,” he says. He followed a residency at New York’s Bellevue, the oldest operating hospital in the U.S., with a critical care fellowship at the University of Louisville, where he saw a vast spectrum of trauma. In 1988, he was hired by Ben Rush, MD, founding chair of NJMS’s Department of Surgery.

He has graduated more than 250 surgical residents and 50 trauma fellows and received numerous grants. He has also been inducted into the Alpha Omega Alpha medical honor society and the American College of Surgeons Academy of Master Surgeon Educators.

“Two things have been my guiding principles: patient care and education,” he says. “The last phase of my career is trauma survivorship. It’s the next step in trauma care. Aftercare is important. We need to take this on.” ●

KEITH B. BRATCHER, JR.

Celebrating Pride Month Building a Strong LGBTQ+ Community

Pride month is a time to celebrate the LGBTQ+ community and be proud of living openly and affirmatively. This past summer, members of OUT@NJMS, the school’s LGBTQ+ group, came up with a way to recognize Pride month, bring the school’s gay community together, and reaffirm NJMS as a LGBTQ+ friendly campus.

In the spring, student members of OUT@NJMS approached Ondrea McKay, MD’13, assistant professor of physical medicine and rehabilitation and assistant dean of diversity and inclusion. “The students felt the LGBTQ+ presence on campus was lacking,” she notes. “To raise awareness about OUT@NJMS and call attention to important issues facing this community, they suggested kicking off Pride month with a social and educational event.”

On June 1, the first day of Pride month, students, staff and faculty came together to celebrate at a reception held at the Medical Science Building. Dean Robert Johnson, MD, gave an opening speech highlighting the significance of Pride month. The Pride flag was raised and other attendees shared their thoughts about the difficulties LGBTQ+ people face pursuing careers in medicine.

Those at the gathering agreed that Pride celebrates what the LGBTQ+ community has achieved so far, but it is more than a celebration. Pride is also the recognition that more work needs to be done to achieve genuine equality. LGBTQ+ individuals face discrimination and cruel, persistent efforts to undermine their human rights. State legislatures continue to advance bills that target transgender people and limit local protections. These efforts cause tremendous pain and undermine the same civil liberties and rights afforded to others.

Building on this event, OUT@NJMS plans to develop events, workshops and programs supporting the experiences of LGBTQ+ students, faculty, staff and residents. “Many of us came to NJMS for the inherent sense of community that exists here,” says McKay. “While we have enjoyed being a part of the broader community on campus, we hope that we can begin to develop a new sense of belonging among fellow members of the LGBTQ+ community.”

PHOTOS BY KEITH B. BRATCHER, JR.

185 South Orange Avenue

Newark, New Jersey 07103 njms.rutgers.edu

Medical

Non-Profit Organization US Postage Paid Rutgers University Permit No. 5287

“Once I arrived at NJMS, I realized I could do something on a bigger scale….”

–NJMS student Maria Suarez

students Maria Suarez (NJMS), Kailyn Ramirez (RWJMS), and Maria Vega-Garces (NJMS), with mentor Albert Khouri, MD