JUST BREATHEA N E S T H E S I A , C R I T I C A L C A R E A N D PA I N M A N A G E M E N T

D E PA RTM E N TA L T I M E O U T

V O LU M E 1 I S S U E 6

D E C E M B E R 2 0 1 7

Wednesday Morning Meditation

with Dr. Bala Subramaniam 6:30 am • Wednesday mornings

Trustman Boardroom, East Campus, near Cafeteria Please join us.

A R C H I V E D N E W S L E T T E R S C A N B E F O U N D O N T H E A N E S T H E S I A I N T R A N E T

Take NoteTO DO & UPCOMING EVENTS

WEDNESDAY MORNING GRAND ROUNDSDEC 6 Mindful “Awareness during Anesthesia”

Enhancing Vigilance and Resilience 7 – 8:30am Speakers: Zev Schuman-Olivier, MD, Edwin T Ozawa, MD Morbidity and Mortality Conference 8 – 8:30am

DEC 13 Faculty Meeting 7 – 8:30amDEC 20 Performance Measurement in 7 – 8am

Anesthesiology Speaker: Elena Bukanova, MD Yale University Morbidity and Mortality Conference 8 – 8:30am

DEC 27 No Grand Rounds or M&M

CLINICAL EVENTS Wed, DEC 20 ANESTHESIA RESEARCH ROUNDS

Speaker/Location TBD 4:30pm

☞ Ground Team Strategic Planning Sessions: All invited. See schedule below, right.

☞ Feld 4 Opening Soon! Waiting on final inspections. Details to come.

☞ Anesthesia Week: A week-long celebration of our entire department from February 12–16, 2018. Schedule coming soon.

OTHER BIDMC EVENTS (See BIDMC Portal for details)

Fri, DEC 8 HOLIDAY TEMPTATIONS SEMINAR: THE GOOD, THE BAD AND THE BETTER! Noon–1pm Be Well Conf. Rm. Make healthier choices this holiday season. Learn about healthy ingredient substitutes, cooking methods, and recipes which will allow you to have your cake and eat it, too!

Thurs, DEC 14 BIDMC’S HOLIDAY STAFF APPRECIATION EVENT 7am-7pm (brief closure 9-10am and 2-3pm) Enjoy cocoa and a holiday treat with colleagues and receive your appreciation gift at this year’s winter wonderland event! East and West Campus cafeterias.

GROUND TEAM STRATEGIC PLANNING SESSIONS

(ALL INVITED AND ENCOURAGED TO JOIN)

DEC 14 Clinical Session, Sherman Auditorium DEC 15 Quality, Safety and Innovation Session, Yamins DEC 18 Education Session, Yamins DEC 19 Research Session, Yamins

An Admin session will be scheduled at a later date.

Light snacks and beverages served. Sessions will be run by our Strategic Planning consultants and leadership. We look forward to your participation!

TEAM 1: Drs. Mark Jennings, Syed Owais, and Ivan Urits

Dr. Urits reported, “The goal of the project was to dissect

an adverse event so as to identify all possible sources of

error which may have contributed to it’s occurrence. In

our case, the adverse event was a code which occurred

post operatively secondary to respiratory failure. A cause

and effect map was subsequently formed which helps

to elucidate potential root causes of the adverse event

and thus areas for improvement. Ultimately we proposed

changes to policies which may in the future help to

prevent the reoccurrence of like events.

Overall, the RCA project was an invaluable learning

experience that I can build upon, moving forward in my

career. I enjoyed tremendously working with our men-

tors to create our finished product.

TEAM 2: Drs. Vwaire Orhurhu, John Kaminski, PJ Kelsey

Dr. Orhurhu reported, “The goal of our project was

to identify the underlying etiologies that increased

the likelihood of transporting a patient to the wrong

operating room.

We had several lectures, meetings, interviews, and some

delicious free meals (which is always a plus on long OR

days). The best part for me was spending time with col-

leagues and attendings outside of the operating rooms.

We had time to think about healthcare/patient safety

from a systems approach, which is very infrequent in the

daily practice of anesthesia.

It was an invaluable team work experience with Peter

Kelsey, John Kaminsky, Sarah Neves, and Scott Zimmer.

RCA PresentationsRoot Cause Analysis Resident Presentations

is a program Dr. Cindy Ku put in place a year

ago under the direction of

Dr. Krish Ramachandran to give residents

a valuable experience in. Presentations

occur several times a year. Residents work

in small teams with mentors over a 12 week

period. RCA are typically used as error

analysis tools that analyze serious adverse

events in health care. Two teams of resi-

dents each choose a quality improvement

project to research, analyze and provide

possible solutions. The following two teams presented their projects at the Nov. 22 Grand Rounds. Response was

positive, with congratulations from peers for well-thought out, successful presentations.

Department Promotion

Thank you for celebrating with us at this year’s Holiday Party!Warmest wishes for a wonderful holiday season and New Year!

SPOTLIGHT ON OUR TEAMMATE:

Nate Beyer is Practice Manager at the Arnold-Warfield Pain Management Center. He provides support and direction to the pain administrative staff including training and schedules. He also oversees communication between administrative and clinical staff to ensure communication is flowing appropriately. Nate worked in the ED before his current role and has worked at BI for seven years.

What do you love about your job?

I love the opportunities to coordinate care. I believe health care today has gotten so complicated that a lot of patients are wandering through this very complex landscape hoping to get something that they need (pain control) and a lot of them present with a variety of issues. Let’s face it, it’s not just, “My back hurts.” It’s “My back hurts, and I’ve been out of work for 8 months, and I have diabetes, and I have heart disease, and, and, and.” Making sure every physician involved with this patient knows what’s going on is crucial. So...yes, I like to intervene and get multiple physicians who are involved with the patient on the same page to share notes. PCPs who have a relationship with their patient, should be in a position to advise us. But if we never go to the PCP and ask the question, then we are stuck and the communication caves in. The patient is left hanging with the thought, “I went to the pain clinic and they didn’t do much for me. Now I’m going to go back to my PCPs office and I’m not going to be happy.”

A special layer of my job is that I deal with patients who are unhappy. Patients on the phone or in the clinic who are unhappy generally get routed to me. And that’s actually one of the things I like, because if you don’t listen to the people who are complaining about what you’re doing, then you’re not gathering the right information. You’re not getting the full picture. So those people have a very valuable piece of information to give me. And then I also feel that half the time they just want someone to listen to them. So if I can defuse that frustration by listening and acknowledging what’s going on and then saying look, I have a lot more information about how BIDMC works than you do because I’ve worked here for 7 years, I get the organizational structure and what’s going on. I can explain to you why you’re here and what to do next.

Dr. Wooten is also very helpful as there is a huge psychological component to pain, Psychiatric diagnosis becomes the hot issue that often needs to be addressed before the underlying physical issue is addressed, because they won’t be compliant with therapies you are suggesting until their emotional, psychosocial issues are addressed. Whether it’s CBT, Sending a note to the PCP saying the patient could benefit from more

psychiatric help, more accurate diagnosis in terms of emotional state and treatment. For most patients pain management is going to take time. That’s the nature of pain management, it’s not magical pain curative medicine. It’s walking patients through a number of steps that will reduce their pain over time.

Any goals/dreams professionally?

I’d love to be more involved in multidisciplinary clinics. Integrative medicine, I think that’s just the way… and I’d love to work on the patient education piece. Because beyond just their physical health there is so much about the organizations and institutional structures we’ve created to help people that they don’t understand, or don’t understand the benefits to them. So helping them navigate this system…”this is why you’re going here/there. This is what you can get out of it. This is what your insurance will pay for.” Too many people are just wandering in the wilderness, in a health crisis, and not understanding their options. They need education and they need an advocate.

What do you like to do in your free time?

I do a bunch of things. I do comedy, stand up and improv comedy around Boston and Cambridge.

When’s your next gig so we can come see you?

I’ve got a couple of improv shows in December. One of which I’m putting on as a producer and the other is a student showcase through a class I’m taking. I’ve got my own little improv show based on family dynamics called “50 Ways to Leave Your Mother” and that’s coming up on Dec.27th at ImprovBoston in Cambridge, and I continue to do standup wherever they’ll let me--which is just a lot of fun. And I also write (generally fiction) in my free time. I also recently became a grandfather and I see my daughter and granddaughter a couple times a week. My life is very full, and generally speaking, very good. BI has been a great place to work for me. I bike in from Arlington, about eight miles. There is nothing that’s gonna make you want to be more active than working at a pain clinic where you see what happens when people stop using their bodies.

Who would you say are your influences in the comedy world?

There is a comedian named Maria Bamford who I like a lot, she is very funny, she’s got a very quirky style and sense of humor, she is also very open about her struggles with mental illness--which is awesome because I think that’s the kind of thing that’s really helpful for people to be open about. If we make it this secret shameful thing we can’t talk about, we really do a disservice to everybody. She has a show on Netflix called Lady Dynamite and it details some of her experience with

mental illness, as well as just being a funny show. Tig Notaro and Marc Maron are also very funny.

Do you ever use material from work?

Generally…no. I work with a lot of great people. The pain clinic is not a hilarious place. A lot of people are in pain. It’s sort of a separate world for me to be in comedy, it’s kind of my own thing. I use a lot of stuff from my childhood.

What happens if there are hecklers or people don’t laugh?

With hecklers, you either engage and try to get the best of them if you think you can, or you ignore and move on. You have to have a thick skin and go out there and give 100%. If people don’t laugh, they don’t laugh, but you can’t internalize it in the moment. You’ve just got to be like a freight train and keep it going.

Do you every get stage fright?

I have a lot of experience being on stage as an actor when I was younger. But sometimes I do and I might say, “Guys I don’t know what happened or what I was going to say next, but anyway...I was thinking about...” If one thing doesn’t work, move on to your next bit. Have about five bits to pick from. The audience wants to feel that you’re in control, and even if you forget, they will generally go with you if you can project some confidence.

Favorite event in history and why? Well the Big Bang was great... but I’d have to go with the invention/discovery of Renaissance Humanism, the idea that each human life is actually worth something, that we are not separated into different categories, and by virtue of the different category we are born in we are worth something or worth nothing. Every human life has a value…which goes back to the Renaissance. We’re still trying to grasp the implications today in human rights and civil rights, and in our national health care debate: What is the value of a life?

Favorite place to hang out in Boston?

I’m gonna say ImprovBoston in Cambridge. They have shows that go on all the time, I’ve gotten to know a lot of people there, so that’s kind of my comedy community. They’re very nice, open people—not comedy with an attitude or ego. They’re a non-profit org. and really into community building, giving people an education and allowing them to take it where they want to take it.

Nate Beyer

Nate Beyer, keeping a captive audience at the Pain Clinic.

CONGRATULATIONS!ALL CA3 RESIDENTS APPLYING TO FELLOWSHIPS MATCHED AT THEIR TOP CHOICE!

Three BIDMC anesthesiologists were named to national leadership positions as committee chairs for

the American Society of Anesthesiologists earlier this year by incoming ASA President James Grant

MD, FASA, and began serving their terms at the ASA Annual Meeting in Boston this October.

Mary Ann Vann, MD FASA was named Chair of the Occupational Health committee (her 5th year as

chair), and Chair of Annual Meeting Subcommittee on Ambulatory Abstracts (her 1st year as chair).

She serves as the Vice Chair of Newsletter committee (her 2nd year as vice chair) and is a member of

the Committee on Scientific Advisory, and the Annual Meeting Ambulatory Track Subcommittee.

Fred Shapiro, MD, FASA was named Chair of the Patient Safety committee (his 5th year as chair).

Dr. Shapiro is also a member of the Committee on Ambulatory Care, Communications Committee,

Annual Meeting Ambulatory Track Subcommittee, and Annual Meeting Professional Issues Track

Subcommittee.

Sheila Barnett, MD, FASA was appointed Chair of the Committee on Outcomes and Performance

Measurements (her 1st year as chair). Dr. Barnett also is a member of the Committee on Geriatric

Anesthesia, which she previously served as Chair, and for Anesthesiology 2017 served on the Refer-

ence committee for Professional Affairs.

All three BIDMC anesthesiologists, Drs. Shapiro, Barnett and Vann are past Presidents of the

Massachusetts Society of Anesthesiologists.

In the September 2017 newsletter, we announced Selina Long MD, FASA received the designation of

Fellow of the American Society of Anesthesiologists.

CONGRATULATIONS!

We are happy to announce Matthias Eikermann, MD has

been promoted to the rank of Professor of Anaesthesia

at Harvard Medical School, effective October 1,2017. This

promotion recognizes Matthias’s huge contributions to

our specialty around the safe care of severely ill surgical

patients. Most of Matthias’ research is clinical, focused

in perioperative medicine and critical care with an

emphasis on respiratory medicine.

Matthias emphasizes inter-professional collaboration

in his work ( bringing PT, respiratory therapy, nurses,

rehabilitation, and surgeons together) with an expansive

transcontinental network of anesthesiologists to create

and implement QI projects designed to improve patient

outcomes. In the area of perioperative respiratory

medicine he is known for quantifying the effects of

anesthetics and NMBA on airway patency.

He was trained at two German University clinics in An-

esthesia and completed two Fellowships (Pain Medicine

and Critical Care Medicine) and a PhD in Pharmaco-

physiology.

Matthias first came to BIDMC in 2005 to work as a Visit-

ing Faculty Member in the Department of Medicine.

He joined our department this August as the Vice Chair

for Faculty development. His first few months have been

spent getting acclimated to the department, oriented

clinically and reestablishing his research program.

Matthias has brought a team of six research fellows and

assistants to support his work.

Moving forward, Matthias’ role will include coordinating

a comprehensive faculty development program within

the department, expanding our pool of mentors for junior

faculty and coordinating grand rounds.

Beyond his many accomplishments he is an extremely

generous man, a wonderful mentor void of selfish mo-

tives, and a natural fit for our department.

Please join me in congratulating Matthias on his

well-earned promotion!

– Danny

Dr. MATTHIAS EIKERMANNAppointed Professor of Anaesthesia

National Leadership Positions: ASA

We are happy to announce Melissa Quinchia is the recipient of the 2017 Chayet Scholarship.

The application process included an essay and supervisor recommendations, and Melissa

was one of 14 (out of 25) applicants selected. The Chayet Scholarship Trust was set up

by patient Donald Chayet in memory of his parents, and was founded in October 1987 to

provide assistance to any “employee who wishes to advance their skills in any way that will

improve care at the Medical Center or advance medical knowledge.” The scholarship will

help Melissa complete a Masters of Science and Management degree at Lasell College in

Newton by the fall of 2018. Melissa hopes to use her degree to forward her career within the

anesthesia department. Congratulations Melissa!

Also worth noting...Melissa just became a Notary Public, conveniently accessible to anyone

on West Campus.

Thank you to everyone for your participation and creative input in producing a worthy name for our beautiful new space!

Many contenders rose to the top but none quite so relevant as Flo’s suggestion—The Sandbox—a nod to Dr. Steve Loring,

who at the recent Loring Scholar’s Dinner addressed the room:

“ Danny and everybody that I have been lucky enough to work with here, knows that research is a team effort and

it has just been so much fun. In the beginning when Jeff (Drazen) and I were working together in a lab at HSPH,

people would say I was running off to the sandbox every day to just play. And that’s pretty much how it’s been. You

can do wonderful, wonderful research that you really can’t do by yourself by being a good team player and that’s

how I regard all the people here in this room, we are all in that mold and it’s been great. Thank you very much. It is

a great honor to be associated with this program.”

In addition to reading in the October Newsletter about the Tribute to Dr. Loring, Flo recalled the early weeks of her employ-

ment 10 years ago: “I felt like I had been swallowed up by a tidal wave. An enormous department compared to my prior

places, so many names, everyone smarter than the other. Well, the Feldberg lounge was my place to breathe and where I met

a pleasant man named Steve Loring, as it is how he introduced himself. Well, over the next few weeks I met Steve making

coffee and having his break. I had no clue who he was, or where he worked but he always sat down and wanted to know how

I was doing. “This is a great placed with good people,” he said. “I know you will do fine.” So we continued to run into each

other for coffee and I inquired about my coffee friend. Without being melancholy, the Feldberg lounge area represents that

friend who cared enough to share cups of coffee with me, a place I could use a computer, and a location that you can get any

question you have answered. Just a small tribute and a thank you to Dr Loring...” And so, The Sandbox seems to just fit.

Kiran Belani, MD Duke University Adult Cardiothoracic Anesthesia

Anna Budde, MD MA University of Chicago Critical Care

Eric Buell, MD Cincinnati Children’s Hospital Pediatric Anesthesia

Meredith Colella, MD BIDMC Obstetric Anesthesia

AWARDS & RECOGNITION

THE WINNER OF THE EAST BREAKROOM NAMING CONTEST:

FLO EGAN!

TheSandbox

TOM SIMOPOULOS, MD, was recently appointed permanent Division Head for Pain Medicine and the

Director of the Arnold-Warfield Pain Management Center. As interim director for the last 15 months Tom

has been exceptional. Under his leadership a number of excellent faculty have been recruited, services

have been expanded at Needham and Milton, and we have increased throughput at AWPC. We are now

poised to greatly increase the area of the AWPC by adding a new suite of E&M space (6 more exam

rooms) slated for completion by March. Please congratulate Tom on this well-deserved appointment!

“I am excited about leading our very dedicated pain team. We have grown significantly

and now have a great opportunity to shape our center in a manner that will allow us to

adapt to the current healthcare environment. Having been a part of this division for many

years gives me the inside advantage of understanding our strengths and areas in need of improvement. I hope

to offer support and guidance to all on our team so as to bring out the best that we all have to offer.” –Tom

Joseph Foley, MD BIDMC Pain Medicine

Scott Gilleland, MD BIDMC Adult Cardiothoracic Anesthesia

Tanya Keverian, MD BIDMC Critical Care

Sarah Maben, MD BIDMC Critical Care

Francisco Narvaez, MD New York University Pain Medicine

Chinedu Otu, MD Boston Children’s Hospital Pediatric Anesthesia

Bijan Teja, MD University of Toronto, Canada Critical Care

(View more photos on the Anesthesia Shared Drive: S/Anesthesia/Pictures/Eikermann Professor Appt)

View more photos on the Anesthesia Shared Drive: S/Anesthesia/Pictures/Holiday Party 2017