Faculty Bibliography

Heartland [Television Program] -- The premise: At St. Jude's Regional Transplant Center in Pittsburgh, transplant surgeon Nate Grant (Treat Williams) is having difficulty finding a heart that is the proper size and match for 14- year-old heart failure patient Leslie Walker. Grant's ex-wife Kate Armstrong (Kari Matchett) is the transplant coordinator, and she approaches the parent of a dying potential donor who turns her down. Walker's mother then attempts to overdose on her daughter's morphine so that her own heart can be used. Armstrong finally finds a match, Sarah Evans, 24, who is dying from car accident injuries, and obtains consent from Sarah's father. During the transplant operation, however, the harvested heart becomes ischemic (doesn't get enough oxygen), and after the operation, Walker develops an irregular heartbeat, for which she's given mechanical support as well as anti-rejection drugs. Grant considers performing a new transplant, but Dr. Bart Jacobs, former chief of surgery, recommends Grant give the current heart 'a chance to take.'

We're about to head full-force into the hurricane season, and invariably the country will spend a few moments revisiting the stricken Gulf Coast region, but particularly New Orleans. It's the city's biannual checkup (the other being on the anniversary of Hurricane Katrina). We'll hear questions about levies, rebuilding and the city's economy. Kathleen Crapanzano, medical director for the Office of Mental Health for Louisiana, acknowledges that the state has primary responsibility for helping to restore mental health care to New Orleans. But she also recognizes that the city is virtually starting over. 'We lost the whole mental health infrastructure in the storm,' she says. 'It was inadequate before. Then we lost the clinics, the hospitals, the staff and the administration.' 'Some progress is being made,' says Fred Cerise, secretary of the Department of Health and Hospitals in Louisiana. But 'some,' in this case, won't do. Many good people are working to heal this wounded city, but the problems are too pervasive and too dangerous to allow for gradual solutions

Speaker suffers from the extensively drug resistant kind of tuberculosis, which is quite rare, with only 49 cases reported in the United States since 1993. TB itself is common, infecting one-third of the world's population, with more than 8 million people getting sick from it every year. Even with billions of airplane passengers every year, the plane is an unlikely place for TB transmission. There have been several small studies that have followed exposure to active TB on planes. From 1992 to 1994, the Centers for Disease Control and Prevention followed six passengers and a crew member who had TB in their sputum and exhibited active symptoms. Of the 2,600 contacts of these TB patients (two were deliberately flying without alerting the airline, the other five didn't know they had TB), only a few people showed subsequent transmission of TB and none got sick

In several studies, transmission of TB has been demonstrated only in flights much longer than the ones Speaker took. In the early 1990s, six passengers and one crew member who had active TB (two knew they had TB but didn't inform the airline; the others found out after the flight) were studied by the CDC, and their 2,600 contacts were followed. Only a few cases of TB conversion were found from close contact - on flights longer than eight hours. These patients (as opposed to Speaker) were all highly symptomatic and had TB in their sputum, and yet no one got sick from the exposure. Although Speaker is the first TB patient to be quarantined in 44 years, according to the Centers for Disease Control and Prevention, he doesn't pose a significant risk to others. Consider that there have been fewer than 50 cases of this extremely resistant TB in the United States over the past 14 years. Catching any TB requires very close contact. The risk is 20 percent for close contact with someone sick with active TB. But the risk is probably much less than 1 percent for passengers on any of Speaker's flights because he wasn't coughing, had no fever and was receiving some treatment. There has not yet been a single case of active tuberculosis resulting from exposure on a plane

The premise: On an island off the north coast of Australia, as surfer Charley Williams begins to cough, he is unaware that several dead seagulls and a dead dog lie near him. They are infected with a new form of flu virus, later determined to be an H3N7 mutated variant named 'Riptide.' Fellow surfer Ames Smith leaves the island and boards a plane to Los Angeles. While on board, he develops a high fever, coughs up blood and dies. The plane and its passengers are quarantined by the Centers for Disease Control and Prevention. A passenger escapes and spreads the virus. Five days later, as several more passengers escape, L.A. has 154 dead and 1,400 sickening. Schools and shops are closed, paper masks are everywhere, mass graves are dug. The city is placed under quarantine. The anti-viral drug 'Tana-Flu' is found to be largely ineffective, and a more useful newer drug, 'CoToxil,' is in short supply. As Riptide spreads, the governor declares martial law and brings in the National Guard. The CDC finally determines that antibodies against tuberculosis bacteria prevent this virus from attaching to the lung, so the blood of TB survivors can be used as a vaccine. The world is saved

Over the next few years, the author is certain that statins will emerge from the false and unsubstantiated rumors of associated memory loss and receive the full recognition they deserve for battling heart disease before it ever becomes clinically apparent. Of course, the first such study has slipped below the media radar. The METEOR trial and future studies with larger cohorts may prove beyond a doubt that the author is right, but he is already sure of it, based on his clinical reasoning combined with the clinical trials conducted on sick patients

As [Kevin Moretti] gets ready to transfer the patient to the ICU, an X- ray reveals that she has 'air under the diaphragm,' an indication that the bowel has perforated, leaking bacteria into the abdomen, the cause of the sepsis. The patient is rushed to the OR for surgery then moved to the ICU. She sustains a cardiac arrest, leading to brain damage. Gram-positive cocci are usually pathological staph or strep bacteria. [Greg Pratt] is wasting time in thinking a blood contaminant is a possibility in an unstable patient. It is also likely that a careful physical exam would have revealed a highly tender 'surgical abdomen,' which, with an X-ray, would have located the infection source and expedited surgery. As for cardiac arrest, it can lead to inadequate blood and oxygen flow to the brain, a type of brain damage called 'hypoxic encephalopathy.'

Stranger's Heart [Television Program] -- Another patient in the ward, Jasper Kates (Peter Dobson), reassures her that she will soon have a heart because type A blood is easier to match. Jasper, a big man who loves to dance, says he has been waiting three months because large hearts are more difficult to find. Ultimately, they receive their hearts around the same time. [Callie Morgan] recovers quickly, complaining only of bleeding gums and some emotional difficulties, but Jasper develops a life-threatening infection, a risk of the immuno-suppressive therapy (cyclosporine). It turns out that Callie and Jasper have received their hearts from a married couple who died in a car accident, and when they are drawn to each other and to the couple's surviving daughter, Callie calls it 'cell memory.'

'Dr. [Albert Herrera] talked to me for over an hour and asked about my job,' [Andrea Untrojb] told me by e-mail. 'He not only wanted to know about my physical pain, but wanted to find out what else could be causing my emotional distress. I told him that my job put such a strain on me that I was coming home crying every day, yelling at my kids and arguing constantly with my husband. Dr. Herrera reassured me that many suffered with this problem. He gave examples from his own life and told me what I could do to relieve the stress,' including routines, meditation and exercise. While doctors often blame their lapses in attention and rushed demeanor on time pressures exerted by managed care, others say they can only preserve their identity as healers by remaining engaged and caring, regardless of the reimbursement. Pauline Chen, transplant surgeon and author of 'Final Exam: A Surgeon's Reflections on Mortality' (Knopf, 2007), writes: 'That honor of worrying -- of caring, of easing suffering, of being present -- may be our most important task, not only as friends but as physicians, too.' As for the personal approach, [Linda Donald] is sold. 'If a physician is able to completely focus on you as a patient, the likelihood of an accurate diagnosis and appropriate treatment individualized to you is much greater. Not just an 'it seems like this, and therefore let's try that and see what happens -- come back next week.' '