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Monday, April 2, 2018

The Fresh New Faces of Neurology

BY JAMIE TALAN

One day after Match Day, Neurology Today reached out to programs across the country to learn more about the newest group of neurology trainees. Many had overcome great obstacles to get where they are. They are immigrants and children of immigrants, world travelers and 'Renaissance' men, and first-generation college graduates. What they have in common is an unbridled idealism and curiosity that drew them to neurology. Their stories resonate. We think you'll agree. Read their stories here:

EARLLONDRA BROOKS: ON TO HARVARD

Earllondra Brooks, a fourth-year medical student at Vanderbilt University, talks in exclamation marks since the day she opened her envelope and read that she matched at Harvard. She applied to Partners, she said, because it has an impressive neuro-ICU and she wants to be a critical care neuro-hospitalist. She called her parents on Match Day: "I'm going to Harvard!"

She is the first doctor that has emerged from this immigrant family. Her father, who immigrated to the US from Guyana, and mother, a US citizen, raised their four young children in Fort Lauderdale, FL. She was the only one drawn into science. Her mother signed her up for a science camp when she was 12. By high school, she was already on a science track and switched schools so that she could take her high school classes on a local college campus. She got her associate of arts degree in biology before she finished high school. She was accepted at Johns Hopkins and studied neuroscience and anthropology. She intertwined the lessons from both majors into her desire to understand illness and eventually practice medicine.

The first two courses in college were The Introduction to the Nervous System and Making Kin, Thinking Family. "I became particularly interested in the role of the nervous system in functional and behavioral expression," she said. She couldn't wait to get to medical school to finally come face-to-face with neurology patients. She credits many of her teachers for believing in her vision.

"I want to help people manage disorders that changed who they are in very fundamental ways," she explained. A critical care course and a rotation of the neuro-ICU were the two events that would transform her life and lead her to applying to Partner's in Boston. A mentor at Vanderbilt had done his residency there and recommended that she apply. Partners also emphasizes teaching and has a certificate in diversity and inclusion that she wants to pursue. "I have a trajectory! I love neurology!"

We are looking for people like Earllonda, who are passionate with a wide-range of interests, said Merit Cudkowicz, MD, chief of neurology at Massachusetts General Hospital and the Julieanne Dorn professor of neurology at Harvard Medical School. She's been involved with the residency program since she was a resident in the early 1990s. At the time, she said, only two people in her graduating class at Harvard Medical School applied for a neurology residency. She was one of them. "Things have changed dramatically," Dr. Cudkowicz said. "The number of applicants to our residency has gone up dramatically."

When she first entered the residency, there were five or six spots a year. Today, there are 18. The program also offers a career path for clinical educators who want to stay in academia.

"When we met Earllonda we were blown away by her enthusiasm when she talked about taking care of her patients," added Dr. Cho, the BWH/MGH neurology residency program director. "A lot of students come with a pedigree of academic medicine, but this young woman carved it out on her own. She is the first in her family to go to medical school."

SARAH LEVY: STAYING PUT IN NEW YORK CITY

A year ago, Sarah Levy, a student at the Icahn School of Medicine, thought she would spend her career in emergency medicine. She was drawn from one crisis to the next and she felt that she delivered a large dose of grounded reassurance: a calm in the throes of the chaos of the emergency department. But then came her six weeks on the neurology service. She watched a headache doctor conduct the most extensive history she'd ever seen. She listened to an epilepsy patient's fear of flying, a Parkinson's patient too shaky to stand up on his own. She saw a new direction that was filled with uncertainty of diagnosis and treatment and a longevity in the relationship with her patients. She wants to focus on the narrative, her patients' stories.

"Through neurology," she said. "I hope to help patients feel whole despite hard changes in their lives."  She also loves the neurological exam. During medical school, Levy was involved in research to identify depression in elderly people who made their way into the emergency department. She began to make connections between a patient's symptoms of depression and the more obvious physical signs that brought them in for treatment. "I want to be a bridge for knowledge," she said.

Shanna Patterson, MD, the medical director for neurology at Mount Sinai West and Mount Sinai St Luke's Hospitals, arrived at New York's Columbia University College of Physicians and Surgeons for a neurology residency in 2005, stayed on for a fellowship in EMG/neuromuscular medicine, and then started her practice at St. Luke's. She became involved with the Icahn residency program after St. Luke's-Roosevelt merged with Mount Sinai. When she started working for the program there were eight positions to fill. In 2017, they added two more. Everyone at the medical school knew Sarah Levy before Dr. Patterson and her colleagues opened her application. "Sarah has a focused passion and eye for detail…she's two steps ahead and understands what it means to help patients and their families – on all levels."

SUNG DAVID JEON: IN SICKNESS AND IN HEALTH  

Sung David Jeon was always sprinting towards a finish line. His family moved from Seoul, South Korea, to Atlanta when he was in elementary school, and the young boy – everyone calls him Dave – was so interested in the world around him that he never wanted to rest.

At 13, he was diagnosed with Crohn's disease, and he was forced to take it easy. The disease persisted but he didn't let it stop him from his studies, sports, flute lessons. He didn't want to miss out on anything. He went off to Amherst College and majored in English and neuroscience. In his sophomore year, caught up with him. His intestines ruptured. It took him down for a year. But it was during his hospitalizations that he realized that the doctors had restored his health, and it fueled his drive to go into medicine.

"My whole perspective on life had changed," he said. He switched to pre-med and never looked back. In medical school at the University of Rochester he joined an acapella group. Being ill taught him the importance of the patient story – and preserving identity. He decided on neurology because he believes the field offers him the opportunity to help people maintain aspects of their lives, even when so much has been lost to disease. "It will be a worthy goal to understand neurology," he said. 

He wanted to match at the University of Colorado because he found the faculty and residents "curious, caring and engaging. I could tell they share my love of neurology." He will be moving west this summer and will start his internship and continue into the neurology residency next year.

MICHAEL STANLEY: A RENAISSANCE MAN FROM MAINE 

Eleven generations of the Stanley family have lived on or near Stanley Road that winds through pastures and pine woods of the sleepy mill towns of York County, ME. Michael Stanley grew up in Springvale, a town full of cousins. Early on, he found that science was a great way to answer a lot of his questions. After high school, Mr. Stanley went off to Harvard and studied science and literature and politics and religion. He had been in the thick of a course on Greek proto-novels when the phone rang from his hometown. It was Gary Sullivan, a family friend who had been diagnosed with amyotrophic lateral sclerosis (ALS) and he was in town for an appointment at the ALS clinic. He invited him into the clinical exam. The neurologist, Merit Cudkowicz, MD, guided Stanley through the clinical exam and allowed him to practice testing Gary's strength and reflexes. 

"It was not a gloomy discussion about inevitability that I heard," Stanley said.  "They talked instead of lighter-weight sheets that could help him turn more easily in bed, special orthotics to keep his foot up when walking in the woods, and of his eligibility for clinical trials. I left the hospital that day knowing that I wanted to be a neurologist." (Stanley and Gary Sullivan's son produced a poignant interview with Gary and recently submitted it to the AAN Neuro Film Festival.)

Dr. Cudkowicz was so impressed with Mr. Stanley that she called some colleagues to see if they could put him to work. He began splitting his research time working on neuroregeneration with Harvard neurologist Ole Isacson, and ALS research in the Cudkowicz lab.

Here is where the Renaissance man comes in: He was involved with life around the Eliot House, one of a dozen residential houses that were named after Charles William Eliot, president of Harvard from 1869 to 1909. In his senior year, Stanley won a travel fellowship to explore the world, which he did. He built an itinerary that included following travel itineraries of 18th century writers Samuel Johnson, Edward Burke, and Oliver Goldsmith, breaking bread with potato farmers, and feeling the icy waters of the Outer Hebrides, an island chain off the west coast of mainland Scotland. He flew to South Africa, studying the turn of the 20th century architecture of Herbert Baker. He also scored an invitation to the Groote Schuur Hospital in Cape Town, where cardiac surgeon Christiaan Barnard carried out the first human-to-human heart transplant. He talked to nurses about apartheid.  His last destination was Australia, where he convinced the Royal Flying Doctor Service to fly him to Cape York to talk to Aboriginal communities about medicine.

Once his travel fellowship was over, Stanley was accepted to Tufts University School of Medicine's Maine Track Program. His first two years were spent in Boston and the last two years was up in rural Maine. He always returned to neurology and picked up mentors everywhere he worked. He continued to do research throughout medical school. He's also a poet and writer of children's books.

Dr. Cudkowicz was one of his mentors who wrote a recommendation for his residency application to Partners. He matched. "I cannot think of a branch of medicine or domain of knowledge that so completely captures my attention and inspires me to ask more of myself than neurology. I thank Gary for that."​

SAFA ABDELHAKIM: A FAMILY LEGACY, MILES FROM HOME

Safa Abdelhakim was raised in the small city of Mansoura in Egypt. Both her parents are physicians – her father is a neurologist and her mother is a radiologist – and she always knew she wanted to be a physician. She was accepted to Mansoura University medical school right after high school, which was down the street from her home. After her first week, she was beginning to wonder whether she was living her own dream and whether that's how she wanted her path into medicine. Her brother had just left for dental school in the United States, and she yearned for an experience of growth that could challenge her and expand her horizon beyond Mansoura. She sat down with her parents, who had always filled their home with the belief that knowledge and curiosity trumps all. Her father would say: "Seek knowledge even in China," and what it means is that it doesn't matter how far you travel to learn life lessons, she said.

Her uncle lived on Long Island and had always supported her and guided her to apply to Stony Brook University. She got accepted and after completing two months in medical school in Egypt, she packed her bags and headed to New York.

At Stony Brook, she took classes in business, poetry, and political science. She still wanted to be a doctor, but she wanted to find her own way there. Her pre-med advisor was honest: "Your chances of getting into medical school as an international student on a student visa are slim."  She wanted her to know what she was in for. She worked hard and got straight A's but always remembered that perfect scores and passion don't make you a stand-out applicant for medical school.

In her sophomore year, she found her niche in a neurobiology and behavior research lab. She helped develop an animal model to study micturition in rats and study the role of sodium and calcium channels blockers in external urethral sphincter activity. The work ended up as her honors thesis.

She developed a program called "English Pal," that would help pair local students with international students to practice English. As the daughter of two doctors, she was keenly aware of the health disparities in Egypt, which motivated her to pursue global health. She joined the Global Medical Brigades at Stony Brook and would go on medical relief missions abroad.

Despite being in a foreign country, Abdelhakim turned campus into home and became part of the student leadership. In her junior year, she applied to 40 medical schools, and got three interviews. In her senior year, she was asked to give the biology commencement speech. She was also the keynote speaker for the 4.0 Ceremony.

She stayed on for medical school at Stony Brook. She was chosen by her classmates to be on the medical school admissions committee and to be a Dean's liaison. That meant that she became his eyes and ears at student Town Hall meetings where her classmates' concerns were addressed. She was also co-president of American Medical Women's Association chapter. She pursued her research interests in medical education. As part of the scholarly concentration program, she received a scholarship to design a course called Business of Medicine to teach fourth-year medical students about high value care and quality improvement and to study whether the course model is effective. She is also a peer adviser for first year and second year medical students.

She found mentors and learned how to be a clinician educator. Her interest in neuroscience and neurology never waned and she continued to be inspired by her father. She loved neurology patients on her rotations.  "I want to serve these patients" she said. Yale University School of Medicine was at the top of her list. Still, she was mindful of the competition and she applied to about 24 other programs. She went on 15 interviews.

Jeremy Moeller, MD, an epilepsy specialist, has been running the neurology residency program at Yale for four years. This year, 500 applications poured in. Almost a hundred students were brought in for interviews. They had ten spots to fill.  What his team looks are people who seem good at taking care of patients, have a natural ability to get along with others, and humility. They are looking for academic leaders, researchers, game changers in the politics and practice of medicine. Each student is interviewed by six faculty members.

What he saw in Safa is this: "She has a constant desire to be better and she could not imagine doing anything else. She will move the field forward. She is a perfect fit for our program."

MANOUELA VALTCHEVA: BECOMING A PHYSICIAN/SCIENTIST

Manouela (Mani) Valtcheva matched into a residency program at Washington University School of Medicine where she learned how to surgically extract and culture adult primary human sensory neurons from human autopsy tissue to figure out the sensory experience of pain and itching. It was there that she did a neurological exam on a patient whose speech was so slurred that it was impossible to get a good history. (A yellow writing pad and the patient's beautiful cursive handwriting solved the problem.)

Hours later, her patient was diagnosed with bulbar-onset amyotrophic lateral sclerosis. Two months later, she died. This was the translational world of an MD/PhD student at Washington University, and Valtcheva wanted to stay put. "My graduate work has strengthened my interest in translational research, while my medical school experiences have cemented my passion for caring for patients with neurologic disease." 

Valtcheva was born in Plodiv, Bulgaria. When she was 12, her mother won the Green Card Lottery (through the Diversity Visa program) and the family of four packed everything they could and traveled halfway across the world to their new home in Atlanta. As a high school freshman, she immersed herself in science and psychology. (That was the year she lost her younger brother in an automobile accident.) At 18, she went off to University of Georgia and merged her passions into two majors: Pre-med and psychology. She started doing neuroscience research in schizophrenia and this led to a summer research stint at Washington University School of Medicine. She would be accepted into the school's MD/PhD program the following year. "There is a big need for research in neurology," she said. "And there is no other place that I would want to train in neurology."

Joy Snider, MD, directs the neurology residency program at Washington University and has been a practicing neurologist for 25 years The school received 500 applications and interviewed 108 students to fill 11 positions, she said. "It is a challenge with so many talented people who are doing such creative things. We place a lot of value on the interview and the time spent with faculty and residents. We want people who value communication with their patients and understand that neurology is a team sport." 

JUAN CAMILO CORTES: AN INTERNATIONAL FAMILY AFFAIR 

Juan Camilo Cortés followed his father and siblings into the family business. His father was a fisherman before going to medical school. A geriatrician, he would become the first Afro-Colombian to serve as a dean of medicine at a top university in Colombia. Juan Camilo Cortés was raised in South America and graduated from medical school in 2006. At the same time, his brother was finishing a doctoral degree in neuroscience in the University of Maryland. His sister was also in the United States, working as a pathologist at the New York Brain Bank at Columbia University. Dr. Cortés started his doctoring career at a nursing home in Colombia, but soon realized that he wanted more. His brother's research seemed so exciting that he packed his bags and started working with him at the University of Maryland. They studied the neural correlates of executive dysfunction in schizophrenia.  

He was hooked on research, and Jean Paul Vonsattel, MD, his sister's boss, found him a position at the brain bank in New York. This led to a clinical rotation with Stanley Fahn, MD, FAAN, founder and director emeritus of the Morris K. Udall Parkinson's Disease Research Center of Excellence at Columbia University. He went on to work in another lab studying Huntington's disease, and then joined physician/scientist John Krakauer, MD, who was studying stroke. He began looking through records to understand upper extremity recovery in stroke, and the team went on to develop new approaches to therapy. They were running a clinical trial evaluating the effects of early intense robotic therapy and immersive video gaming on recovery of the upper extremity after stroke. Dr. Krakauer was leaving Columbia to direct the Brain, Learning, Animation, and Movement Laboratory at Johns Hopkins, and asked Dr. Cortés whether he would stay on as a post-doc on the project. He said yes, of course.

His father always told his children: Follow your dreams. In 2014, his mother had multiple small strokes triggered by an aggressive malignancy, and this experience made him realize that it was time to apply for a neurology residency. The following year, the physician/scientist was missing patient contact, and he signed on to a rotation on the stroke service at Columbia University. Then, he went down to Hopkins to wrap up the stroke study and spent a month with stroke patients on the neuro-critical care unit and on the inpatient stroke service. His number one choice was Hopkins, which is where he matched. His wife had just been accepted into a doctoral program in neuroscience, also at Hopkins.

Rafael Llinas, MD, director of the neurology residency program at the Johns Hopkins Bayview Medical Center since 2012, said he has been seeing a lot more residents entering the field who already want to specialize in one disease. A deeper understanding of the brain and new treatments have brought more medical students into neurology. They had eight positions. "We look for people who want to contribute to making the field better," said Dr. Llinas. "The people who were accepted have strong research and clinical backgrounds." The stroke neurologist loves teaching and mentoring residents and hearing from them once they have left to start their careers. "The relationship that we build never goes away."    

JENNY (JINGJING) CHEN: LESSONS FROM HER FATHER

Determination has always defined Jenny (Jingjing) Chen. The only child of a neurobiologist and obstetrician/gynecologist, her father decided to pursue a doctorate in neuroscience at Ohio State. She was nine when they left Hanzhou, China, for Columbus, OH. She did not speak English. That year, she carried around a soft-cover Chinese-English dictionary everywhere she went. She would look up every word and figured out how to translate it, and what it meant. Eight months later, she passed a statewide English language proficiency test. By high school, she joined the marching band, painted, and worked with her team to win the Science Olympiads and math competitions.

Chen's love for neurology began with ongoing lessons from her father. He would provide detailed explanations on the ways of the world, especially as it related to science. He studied taste buds and inculcated in his daughter a sense of commitment and purpose and a huge appetite for all things brain. She knew by junior high that she wanted to study medicine. She was pre-med at Harvard University, but she was interested in so many things that she took advanced courses in French and psychology. One of the coolest courses was on brainwashing, and they read scientific papers and historical accounts of mind control. 

Then, in her junior year a pre-med advisor asked her the question: "If you didn't do medicine, what would you do?"  She was stunned. She did research. She volunteered. But did she have a compelling reason to be a doctor? For the first time, she wasn't sure of the answer.

She decided to go find the answer, but it wouldn't be in medical school – not yet. She took a job at a health care consulting company and spent two years learning about the management of health care. She worked on launching a new drug, figuring out how to roll it out across world, how much it should cost, what message they would use to talk about the drug. At the end of her tenure, she knew the ins and outs of health care systems around the country – and it was time to head to medical school. But she wanted a school that offered an MD/MBA program because she believed that she wanted to have a hand in change – not just one patient at a time but the systems that serve our all patients. She ended up in a joint program at NYU School of Medicine. She chose a neurology residency because at the end of the day she comes home to the brain. She loves the clinical exam, the patient's story, and the challenge of taking care of diseases that affect the very nature of who we are.

"I am amazed at the quality of the medical students," said Neil Schwartz, MD, director of the Stanford neurology residency program. "They are entering neurology with extra skills that will help them become quality neurologists. We are looking for a love and dedication to the field, a fascination with the brain and a commitment to learn clinical medicine. Jenny was selected because she is interested in systems level neurology. She is saying: How can I improve the health care system, rather than just complaining about the problems?

"These students are applying with experiences that shape who they will become as neurologists," added Nirali Vora, MD, associate residency director at Stanford. She was also a Stanford resident and started a global health experience for residents interested in doctoring abroad. During her residency, she created a stroke unit in Zimbabwe, and they are now working in Kumasi, Ghana. The program has worked to spark interest in neurology residencies abroad. The Stanford program now has ten spots for residents. There were five when she matched in 2010.