Fall 2012

The Baystate Chronicles

We pay a visit to our westernmost affiliate, where first-rate medicine rules

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Baystate Medical Center in Springfield, Mass. Photo: Alonso Nichols

There’s something big out there. One hundred miles west of Boston, amid a landscape of former mill towns and gently rumpled hills on the eastern bank of the Connecticut River, lies Springfield, the fourth largest city in New England and the home of Baystate Medical Center, a 650-bed colossus and major Tufts affiliate that ranks among the brightest stars in our medical constellation.

When clerkship satisfaction among third-year students is scored, Baystate Medical Center consistently ranks as one of the top sites. Being in a single location for the whole year gives many students the chance to benefit from multi- and interdisciplinary classes.

Baystate, which is exploding with growth at a time of national belt-tightening, is in the final stages of a successful $300 million capital campaign designed to expand and deepen the medical center’s already profound regional impact. The hospital employs 10,000 people in an economically depressed area. Medically speaking, Baystate’s punch is even greater. It offers the only Level 1 trauma facility in western Massachusetts; it runs the state’s second busiest emergency room; it performs more than 80 percent of all regional cardiac surgeries; and it has helped train roughly one-third of the primary care doctors in the area, among other distinctions.

Our report contains two parts. In the first, Tony Zhang, ’13, writes about his enthusiastic (and, in truth, somewhat accidental) immersion in Baystate culture during his clerkship last year. His experience proved life-changing. The second part concerns the successful surgery that Springfield resident Donald MacKay, age 84, underwent in May in the freshly christened Davis Center, where a surgeon and an interventional radiologist combined their skills seamlessly to prolong his life.

 

 

Tony Zhang, '13

Tony Zhang, ’13. Photo: Alonso Nichols

My Big Surprise

Who knew that a year spent in training at Baystate would pay off in so many ways, from superb mentorship to fine dining

By Xiao Chi (Tony) Zhang, ’13

To those interested in learning more about this hospital in western Massachusetts, I must admit upfront that I have a bias. After training at Baystate Medical Center last year, and getting to know this unfamiliar corner of the state, I can say that my experiences there were wonderful and irreplaceable.

I first heard of the hospital—sometimes called “the Western Campus of Tufts University School of Medicine”—as a second-year student through word-of-mouth (the most reliable form of communication). Before I had time to register for where I would spend my clinical years—the third and fourth years of medical school—I had nearly missed the deadline! With impulsivity and blind faith, I opted to camp myself at Baystate for the entire year, unaware that it would be one of the best decisions I’ve made since coming to Tufts. So when I was asked to write about my experiences there, I felt as if I were being tasked to recreate the splendors of the Sistine Chapel using nothing but crayons and finger paint. Nevertheless, I will try my best.

From day one of every rotation, I was immediately welcomed into the “family” of physicians as a valued member of the team. The residents frequently offered sage advice to a newbie like me, who arrived brimming with preclinical knowledge but not knowing how to apply that in a hospital setting. Even before learning medication dosage, electronic medical records or even the names of our weekly supervising attending, I was let in on the secrets of hospital survival: 1) “EAT when you can”; 2) “PEE when you can”; and when possible 3) “ALWAYS take care of yourself first.”

The Greatest Lesson

Working at the only Level 1 trauma center in western Massachusetts, I witnessed on a weekly basis some of the most fascinating trauma and surgical cases—cases that my colleagues based in Boston may only see once or twice during their entire clerkship year. A specialized trauma center such as Baystate has been shown to increase a patient’s chances of survival by up to 25 percent, compared
to a typical ER.

During the first two weeks of my surgical rotation, I assisted on an open thoracotomy (an emergency procedure in which the physicians make a bold incision across the patient’s chest to gain access to the internal organs) and observed a team of surgeons, anesthesiologists and scrub techs perform a 10-hour pancreatoduodenectomy (a.k.a. Whipple Procedure) on a patient with pancreatic cancer. In the face of insurmountable odds, the trained healers at Baystate worked seamlessly in the operating room, all performing in synchrony, like a well-rehearsed symphony.

However, more than surgeries, it was my teachers who endeared me to this hospital. Most important, David Page, professor of surgery and director of student programs in surgery, taught me about being a great physician. At first glance, Dr. Page presents as a white-haired sage with an eclectic taste in ties and a wealth of knowledge about Canadian hockey teams. But a five-minute conversation brings you to his core: You will be hard-pressed to find another individual as compassionate and as knowledgeable.

Kind and intelligent, he always took time in his busy schedule to give me feedback, great teaching vignettes and appropriate amounts of encouragement. He always challenged me to see past the pathology and treat my patients along with their ailments. As I struggled to find my true passion in medicine, Dr. Page listened patiently and caringly. Even after I had declared my career choice, emergency medicine, Dr. Page remains one of my closest advisors and mentors, in medicine and in life.

The Dean’s Outstanding Mentor award for 2012 was given to Adam Kellogg, assistant professor of emergency medicine at Baystate and director of medical student education there. Baystate faculty members and residents win teaching awards  year after year.

There were other great teachers, too. The tall and gentle Bryant “Bear” Benson, assistant professor of pediatrics, taught me to meet “eye to eye” with patients, even if it meant carrying a stool during three hours of rounds every morning, and Gurmuk Singh, a nephrology fellow, taught me to “treat the patient, not a bunch of labs.” Lucienne Lufty-Clayton, assistant professor of emergency medicine, personally introduced herself as the new supervising physician to every single patient before her shift began, and always asked if there was anything she could do to make visiting family members more comfortable.

While these tiny details may seem trivial, collectively, these doctors taught me the greatest lesson in medicine: The little things make the biggest difference in patient care.

Already a huge enterprise, Baystate Medical Center is moving to complete its ambitious expansion project, aptly named the Hospital of the Future. Of all of the departments, I was most impressed with the 48-bed emergency department, which sees 120,000 patients each year. Take a stroll through the Baystate ED and you immediately notice the command center of emergency medicine physicians, nurses, paramedics and consultants tending to a deluge of incoming patients. Despite these large influxes, I was amazed at the efficiency of these scrub-topped, khaki-wearing healers as they deftly stabilized each patient and organized the appropriate consults and admissions for sicker patients. You have to appreciate the subtle signs of order within the chaos.

As an aspiring emergency medicine physician, I strove to be versatile with my medical knowledge. Fortunately, I was able to take full advantage of the hospital’s simulation centers, which included multiple high-fidelity patient simulators—lifelike mannequins that can blink, sweat and even bleed—that function as anatomic models for placing central lines, treating lumbar punctures and practicing intubation. There are also multiple stations where students can practice suturing and laparoscopic procedures.

These teaching aids proved invaluable. Initially, I had difficulty performing subcutaneous closures (an advanced, but aesthetically favorable wound-closure technique), but I was able to hone my skills after spending many hours in the lab, running suture after suture. The availability of this facility not only sharpened my procedural skills, but also boosted my confidence.

Out There

At first I was skeptical about spending an entire year removed from the bustle of Boston. I ended up being pleasantly surprised at the wealth of activities in the Springfield area. I rocketed through space at 90 miles per hour at the Six Flags amusement park, hiked the serene hills of Mt. Tom, rocked out to live music at the Iron Horse in the hipster town of Northampton, ate an embarrassing amount of fried Oreos (and even butter) at the nationally acclaimed Big E Fair, chilled out with the locals at the Springfield Hoop City Jazz & Arts Festival and even dined with Chef Wayne, owner of the popular Cajun restaurant Big Mamou, which serves up crawfish étouffée, mouth-watering Memphis-style short ribs and freshly mashed seafood mofongo, all just a few blocks from the hospital.

You could say Baystate—and Springfield, too, for that matter—was not, for me, just a place to work. It has become my new “home away from home.” This year I elected to return to the hospital for most of my fourth-year rotation, hoping to take further advantage of the terrific teaching environment, diverse patient population and intriguing case presentations. Baystate is a hidden gem, chock-full of surprises and treasures waiting to be discovered. I promise you will find something memorable and unexpected here. I did.

Zhang is a fourth-year student who intends to specialize in emergency medicine.

 

David MacKay recovering at home after surgery for an abdominal aneurism. Photo: Alonso Nichols

David MacKay recovering at home after surgery for an abdominal aneurism. Photo: Alonso Nichols

A Patient’s Story

The design of surgical suites in the Davis Center, the first installment of Baystate’s Hospital of the Future, provides for faster, safer treatment

By Bruce Morgan

Springfield, Mass., resident David Mackay had a problem that his doctor had been watching and monitoring through ultrasound for a decade. Technically, it was an abdominal aortic aneurysm, but MacKay, 84, who worked for years helping to build printing presses at a company located just across the Connecticut River in Agawam, calls it simply “this thing that I’m happy to have taken care of.”

MacKay entered the sparkling new Davis Family Heart & Vascular Center for surgery in May to head off a potentially fatal rupture of the bulging artery in his abdomen. Assistant Professor of Surgery Neal Hadro, ’90, and Sidney Lowell Kahn, assistant professor of surgery and radiology, were the doctors who meshed their talents during the operation. Both men say they love the operating room design in Davis, which has been thought out and implemented in a way that means everything they need is both state-of-the-art and within easy reach, in effect smoothing the rough edges of contemporary surgical practice.

“They have a new method of operation there, and it worked quite well,” says MacKay, who certainly noticed the newness of the place without necessarily understanding or needing to understand all the implications of its design.

One architectural innovation of the approach at Davis consists of the hybrid endovascular suites that incorporate a fully outfitted OR side by side with the latest fluoroscopic imaging equipment, thereby increasing the speed and efficiency of any operation. So, according to Hadro, instead of needing to wheel MacKay to the radiology department wway off in another wing of the hospital for imaging tests on his aneurysm, and then having to wheel him back, as would have occurred before—or alternately, needing to use sub-par portable radiologic devices in the OR, as is often the case in a more conventional layout, MacKay never budged. The top-notch equipment surrounded him where he lay. In his role as interventional radiologist, Kahn could access the superb technology and help complete the endovascular procedure.

 

Sidney Kahn and Neal Hadro meshed their talents to repair the patient's abdominal aneurysm. Photo: by Alonso Nichols

Dr. Sidney Kahn and Neal Hadro meshed their talents to repair the patient’s abdominal aneurysm. Photo: Alonso Nichols

“Baystate is so far ahead of the curve—that is what drew me across the country,” says Kahn, who was practicing in Florida until a year ago. It’s more than gadgetry he’s talking about. Kahn cites the spirit of collegiality he’s found at Baystate, where interventional cardiologists, vascular surgeons and interventional radiologists like him pitch in together, devoid of ego. This is all too rare, he suggests.

Hadro, who came to Baystate from the Cleveland Clinic three years ago (he did a clerkship at Baystate during medical school), concurs, pointing out that the perfect blend of radiology and surgery in the Davis Center ORs is “good for the patient and speaks to the way we practice today. It’s a lot safer and more efficient.” Both Hadro and Kahn add that having a facility like the Davis Center enlarges the pool of patients they are able to take on, because tougher cases no longer need be referred to a Boston hospital. “It ups the ante in terms of the complexity of cases we’re able to do. There’s not much we would shy away from,” Kahn says.

That’s nothing but good news for patients like MacKay. Abdominal aortic aneurysms, most often seen in men over age 60, occur when the aorta, the largest blood vessel in the abdomen descending towards the pelvis and legs, grows too large and balloons outward. Although the exact cause is unknown, some common risk factors are obesity, smoking, high blood pressure and elevated cholesterol. The condition develops slowly over many years and can be fatal if the vessel ruptures and goes untended.

MacKay’s operation went smoothly. Through two small incisions at the groin, Hadro and Kahn inserted a covered stent graft into the artery and guided it to the appropriate site. They then deployed the device, shutting off blood flow to the aneurysm and virtually eliminating the chance of rupture. This minimally invasive endovascular approach meant that instead of enduring a prolonged recuperation of days or weeks after the surgery, MacKay was home and up on his feet the next day, puttering around the house in the company of his wife, Jean.

“I feel very grateful and happy,” he says of his experience at Baystate. “I feel fine, and I get around quite well.” With any luck he’ll be back soon, helping to run bingo games on Thursday nights at the local Moose lodge, just a few miles down the road.

 

Davis Center at a Glance

 

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Cross-functional surgical/endovascular suites for complex and hybrid cardiovascular procedures bring technology and care teams to the patient.

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Room-care units that allow patients undergoing outpatient procedures to go from pre-op to discharge in the same room, with the same nursing team.

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Private medical-surgical rooms, each equipped with telemetry, accommodate less critically ill patients who require an overnight stay.

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Cardiovascular critical-care rooms create comfortable environments for patients, with plenty of room for visiting family and friends.

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