Dr. Philip Gutin
Actually, it is Brain Surgery: Not all brain tumors look alike. “Some arelike slime,” says Dr. Philip Gutin. “Others are hard, like golf balls.”Gutin is making this observation as he cuts into the pink, pulsing surfaceof a patient’s brain. And the patient, mind you, is listening, anesthetizedbut able to count down from twenty on request. “Awake-patient brain-mapping”ensures that Gutin’s knife doesn’t slash vital areas like speech or motorfunction. “Patients used to be stunned when I told them I could do this,”Gutin says. “Now they all know about it because it was on ER.”
Real-Life Drama: Even on ER, doomed Dr. Green eventually died. “Brain tumorsare still among the most hopeless tumors,” Gutin admits. Which is why, since being lured by Memorial Sloan-Kettering from UCSan Francisco six years ago, he’s launched a lab for gene therapy (to maketumors more sensitive to radiation) and another to use embryonic stem cellsto replace brain matter harmed by stroke, radiation, or Parkinson’s disease.He’s also working to bring an MRI into the OR for real-time brain scans. The endless tinkering “is entirely consuming,” headmits. “He can look at a scientist’s discovery and recognize how it can bemoved into patient care – that’s unique,” says Dr. Murray Brennan,Sloan-Kettering’s chairman of surgery, adding that “he’s managed to retainempathy and perspective.” To blow off steam, he races on the Sound. (Hisyacht is called Brainstorm.)
Cliffhanger: Once he gets a piece of the tumor, Gutin rushes it to apathology lab. If it’s cancerous, “it’s hopeless,” he says. Twenty minutescreep by before the OR phone rings. He uses the speakerphone to protect hissterile hands. “Speak softly,” he mutters, knowing his patient might hear.Fortunately, today’s news is good – a benign low-grade glioma. And the patient, wide awake, says he’s feeling fine. “In the old days,” Gutin says,”we’d wait for them to wake with our hearts in our throats, wondering ifthey’d be paralyzed.” –ROBERT KOLKER
Dr. Ilene Fennoy
First Person Singular: As St. Luke’s-Roosevelt’s sole pediatric endocrinologist, Dr. Ilene Fennoy is literally one of a kind, with a schedule to rival themayor’s. “My patients love her,” says Dr. Diane Hochlerin, a St. Luke’spediatrician who refers patients to Fennoy. “She’s kind, and she treats thewhole person.”
Mission Possible: For the past 23 years Fennoy’s speciality has been juvenilediabetes. “We are in the middle of an epidemic,” she says, referring to theType 2 variety, which is linked to obesity. Patients produce some insulin,but not enough, which must be enhanced with pills and, eventually,injections. “When budgets are tight, schools use vending machines with snackfoods and cut gym. We lead a sedentary lifestyle; TV is the baby-sitter.Parents don’t want kids to go out in the street and get into trouble, soit’s computers and Game Boys.”
On Call: Cheryl Tidwell met Fennoy one frantic night two years ago in StLuke’s ICU ward. “My son’s sugar was at 543,” she says (normal range is 60to 90). “They told me he had diabetes. I was devastated. We’re into ourthird year now, and we’re not great at it yet. His sugar levels have toomany highs and too many lows. But she’s so patient. I’ll call herfrantically, with something I hear on the radio – ‘You mean my kid can’t havekids?’ – and she’ll say, ‘Cheryl, now, where did you hear that?’ I even calledher after I saw Panic Room – Jodie Foster’s diabetic daughter is trappedwithout her insulin. But she has this GlucoWatch that takes her sugar-level reading three times an hour and has abuilt-in alarm. I thought, Is that something my son could have? So I calledDr. Fennoy.”
A Family Affair:You have to like interaction with children,” says Fennoy,whose own daughter is now 21. “Chronic disease in children is very hard todeal with. Kids could be taking three or four shots a day. They have toconstantly adapt their lifestyle to their medication and be thinking howeating affects their blood sugar, how exercise affects it.” Which is whyFennoy teaches everything from food to stress management and leads bimonthlysupport groups for children on Sunday afternoons. “It needs to be a familychange. A lot depends on how parents handle it.”
– SARAH BERNARD
Dr. Swayam Sadanandan
Claim To Fame: In the eleven years since she started up the BrooklynHospital Center’s Pediatric Hematology-Oncology program with the limitedresources of a community hospital, Dr. Swayam Sadanandan has made itcompetitive with local behemoths like Kings County and Maimonides. With astaff of nine (including three doctors), her program now treats about 350young patients for sickle-cell anemia alone. She is also on the Make-a-WishFoundation’s board of directors.
Rising To The Challenge-Modestly: When Dr. Michael LaCorte became head ofpediatrics here in 1991, he knew whom to turn to first. “The moment I signedmy contract,” he says, “I grabbed Swayam and said, ‘How about coming to workwith me?’ ” At the time, the Bombay-educated Sadanandan was the associatedirector of pediatrics at Booth Memorial Medical Center in Queens, a verycomfortable practice not far from her home in Port Washington. The onlydoctor in the Brooklyn Hospital program at first, she didn’t take a vacationfor years – but Sadanandan shrugs off the sacrifice. “I just did what I likedto do, and it evolved. That’s my whole life.”
Infectious Optimism: “Swayam doesn’t spend much time railing against thegods,” says former colleague Dr. James McKinnell. Unlike generalpediatricians, Sadanandan faces the gravely ill, from debilitatingsickle-cell cases to children suffering from every type of cancer. “It’shard to get me depressed,” she says. “Maybe that’s my strength.” Thatattitude is practically a job requirement for working with sometimesterminal children. “My approach to it is that however small the chance is,we need to take it, and we need to fight for that chance.”
Social Services: Among the city’s hot spots for sickle-cell anemia, BrooklynHospital Center’s surrounding areas presented Sadanandan with anotherchallenge. “We need to be working more with the families here,” she says.”Sometimes we become their surrogate family, actually.” Sadanandan hasattended patients’ weddings, become a godparent – even at one point acted asguardian for a boy. “If it hadn’t been for Dr. Sadanandan, I would neverhave gotten through high school,” says Sikiru Fahm, a shy 20-year-oldsickle-cell patient with a broad smile who came into her care at age 14.Causing potentially fatal complications, sickle-cell requires frequent,lengthy in-hospital treatment and renders patients nearly immobile for weeksat a time. Sadanandan did her best to limit his hospital stays and connectedhim with social services that helped him keep up with schoolwork. Fahm nowattends Brooklyn College and hopes to be a doctor working in hematology oneday. “I want to be a part of this,” he says, “help patients go through thethings I have. They really knew how to take care of me here. I’ve had a lotof doctors in my life, and she’s one of the best.”
– BORIS KACHKA
Dr. James “Butch” Rosser
MINIMALLY INVASIVE SURGEON
Claim to Fame: “Putting a stethoscope to someone’s chest just gives youvoodoo information,” says Dr. James Rosser – Butch to his friends andpatients. “We’ve basically declared war on the stethoscope.” Having been apioneer in laparoscopic surgery in Ohio and made Yale a superpower in thefield, Rosser has just arrived at Beth Israel Medical Center to establishthe Advanced Medical Technology Institute. A 10,000-square-foot complex onEast 16th Street – which Rosser points out will be shaped like the StarshipEnterprise – AMTI will provide training in high-tech surgery, telemedicine(house calls via laptop), and any further research-and-development Rosserdreams up.
The Medium is the Message: It was Dr. Anthony Antonacci, the chairman of BethIsrael’s department of surgery and a onetime Rosser trainee (“I’m thechocolate Yoda, and he’s one of my Obi-Wan Kenobis,” Rosser says), who hiredhim for AMTI. “He has reinvented the way we educate in surgery,” saysAntonacci. “We’re changing our entire program, and he’s going to be a truefoundation piece.” A week into Rosser’s new position, his equipment is stillin boxes, his research center still a blueprint. But the outsize formeroffensive lineman (120 pounds lighter after a laparoscopic gastric bypasslast year) talks excitedly over a video of him assisting live laparoscopicabdominal surgery in Ecuador via laptop. “This technology,” he pronounces,”will allow Butch Rosser to be in more than one place at one time.” With araft of training CDs and not one but three memoirs planned, he’s practicallyubiquitous already.
Humble Beginnings: “It was earth-shattering,” says Rosser of the firststirrings of his technophilia. “It was The Jetsons. Elroy had this thing inhis room with a TV screen that helped him with his lessons. That was a PC!”He was born in rural Mississippi, in 1954. “I didn’t have any role modelsthat looked like me. I couldn’t even drink from the same water fountain asyou.” Rosser finished high school at 16 and played football at theUniversity of Florida before giving up a potentially glorious athleticcareer to graduate from the University of Mississippi. “I didn’t grow upshackled with hatred of white people,” he says. “I thought if you gave me anhonest chance, maybe you’d like me.”
Spreading the Word: “He’s taking laparoscopy to the common man, theday-to-day surgeon who has a busy practice,” says Dr. Richard Satava, aprofessor of surgery at Yale who’s known Rosser for almost a decade. “Ibring a lot of old-time country doctor to the twenty-first century,” Rossersays. “He was very compassionate,” agrees patient Marjorie Rife, 79. “He puthis arms around me and told my daughter he was going to treat me like hisown mother.” Another doctor had told her he’d have to remove her colon;Rosser removed a polyp laparoscopically and had her home in a week.
Dr. Sonia Cheng
Claim to Fame: Only two years out of her residency at NYU, Dr. Sonia Cheng, a28-year-old pediatrician, has already completed one mission for DoctorsWithout Borders, in Angola, and is “itching” for her next assignment.Sitting at a restaurant a few blocks from her office at the Charles B. WangCommunity Health Center, a nonprofit clinic that serves mostly immigrants,Cheng – who was raised in Wilmington by Chinese parents – orders off the menu influent Mandarin. She talks about enrolling at the London School of TropicalMedicine for an intensive semester “on parasites and bugs and stuff.” She isremarkably buoyant considering that not too long ago she was administeringemergency medicine to starving toddlers and gunshot victims. She jokes thatthe mosquitoes in her apartment off Herald Square are worse than the ones inAngola.
Tropic of Discussion: “There was a big part of me that wanted to see the realworld,” she says. “I had everything blown wide open for me: I don’t have anyloans, I have the opportunity, I want to go.” And the need certainly exists.”The first week I worked there I saw more kids die than in my entiremedical-school training.”
Family Matters: For now, Cheng is happy working in Chinatown, which has itsshare of Third World medical problems. “There’s a lot more hepatitis, a lotmore tuberculosis,” she says. “Both are endemic in China, and when they comehere, it becomes our problem.” “I think she identifies very well with ourpopulation, Asian-American kids,” says Dr. Loretta Au, chief of pediatricsat Wang. “She’s able to interact with them, understand their families’priorities.” Cheng agrees: “When I see a mom at the clinic, an immigrantmom, that’s like my mom.”
Teen Spirit: Cheng is working with Au to develop a clinic for Asian-Americanadolescents. Since many immigrant parents are unprepared to talk to theirchildren about matters like STDs and birth control, Cheng believes it shouldbe a parent-free zone: “I’d like to get a room where they can hang out, makeit cool, put up tapestries, bean bags.” That is, until she heads out on hernext mission. “I try not to plan too far ahead,” she says. “When the rightopportunity comes, everything will fall into place.”
Dr. Michael Argenziano
Claim to Fame: Dr. Michael Argenziano is as devoted as a man can be to hisda Vinci – in his case, a robot used to perform intricate cardiac surgery.Not only is he the first doctor in America to use this technology inclosed-chest bypass surgery, but the Jersey-born 35-year-old, who is thedirector of robotic cardiac surgery at Columbia-Presbyterian Medical Center,is currently the principal investigator in two more FDA trials of advancedrobotic procedures on the heart.
Robodoc: The way da Vinci works is simple: The machine has three sleek armsthat enter the chest cavity via small punctures made in the rib cage. Onceinside, one arm holds a 3-D camera while the other two use standardinstruments like forceps and a scalpel to work on the heart, leaving onlythree tiny scars. “I basically sit at a large video-game console through thewhole thing,” says Argenziano, who’s also an assistant professor of surgeryat Columbia University.
Full-Hearted Thanks: Last July, Susan McSwiney became da Vinci’s firstclosed-chest patient in America when the robot repaired a hole in her heart.”I was very nervous at first,” recalls the 34-year-old. “They introduced meto da Vinci beforehand and assured me that if anything went wrong, they wereready to finish the operation the conventional way.” It went off without ahitch: “I have two small kids, and I was picking them up just a few weeksafter the surgery. Dr. Argenziano is truly amazing.”
Open Heart, Open Mind: While acknowledging that he’s still in “the Model TFord phase of all this,” Argenziano sees this method becoming commonplaceover the next decade. Which, according to division chief Dr. Craig R. Smith,is entirely possible with Argenziano at the helm: “He has an ability toidentify new developments long before other people.” Some doctors, however,are skeptical about the technology. “You see more of an emotional problemthat occurs – doctors can’t allow a machine to do what you were trained todo,” says Argenziano. But younger doctors like himself are less worried: “Igrew up in the Nintendo generation, so I was used to a virtual reality at avery young age.” –DAVID AMSDEN
Dr. Lawrence Newman
Heal Thyself: “My headaches started when I was about 12 years old,” says Dr.Lawrence Newman. “Every time I took a step, I thought my head was going toexplode.” Newman is the director of the Headache Institute at St.Luke’s-Roosevelt Hospital Center and attending neurologist there – and he’salso a migraine sufferer. “The diagnosis my parents were given was that ithad to be stress. It wasn’t until I was in medical school that I diagnosedmyself.”The Pain Event: “Cluster headaches are called suicide headaches, becauseuntreated, people will kill themselves,” says Newman. “The pain is soexcruciatingly severe that sufferers will pace, scream, and bang their headagainst the wall. I ask patients to rate their pain on a scale from 1 to 10.A tension headache is a 2 or 3. Migraines are between 7 and 10. Clusters are40.” Cluster headaches can occur up to eight times a day, and the cause isstill uncertain. “It has to do with an area of the brain that is thepacemaker for the brain,” says Newman, “the part that makes you wake up andgo to sleep. Some patients have been misdiagnosed for years. We put them onthe right medication, and in one day their headaches are gone for thatcycle.”
Head Case: “He’s done outstanding research on unusual headache disorders,”says Dr. Richard Lipton, professor of neurology at the Albert EinsteinCollege of Medicine and president of the American Headache Society. “He’sdescribed some very rare but treatment-responsive ones that most cliniciansdon’t recognize.” For Ingrid Rossellini, a professor of Italian literatureat NYU, her headaches worsened in her late forties. “With the change ofhormones,” says the twin sister of actress Isabella Rossellini, “it’s theworst time for women.” She came to Newman last month after six trips to theER. He began intravenous treatment with DHE, a drug that also weans patientsoff medication they are overusing – in Rossellini’s case, the drug Fioricet, acombination of Tylenol, butalbital, and caffeine. “Like a plant you give alittle water to,” she says, “I just bloomed back to life.”
Phone Home: “People with pain need to speak to you,” says Newman. “I spoilthem in a way. My patients know that if they call me, I will not leave theoffice until I’ve returned their phone call. I’m the old-time doc usingnewfangled techniques. “–LAUREN DeCARLO
Dr. Robin Herbert
Work Hazards: In any given year, Dr. Robin Herbert, co-director of MountSinai’s Center for Occupational and Environmental Medicine, treats thousandsof New Yorkers – from financial analysts and journalists to garment workersand cleaning women – for work-related problems like asbestos exposure andcarpal-tunnel syndrome. But in the months since September 11, her clinic hasseen a new group of patients: hundreds of rescue and recovery workerssuffering from health problems stemming from exposure to caustic dust atground zero. “We’re seeing irritant bronchitis, severe sinus problems, andasthma. Many of the patients I see, when you look in their nasal passages,the skin is bright, bright red, almost as if the top layer was burned off,”she says. “And we’re still seeing this now, eight months later.”
Road Trip: In the early seventies, still in college, Herbert got a job on avan offering medical exams to cannery workers throughout California. It wasan exciting but sobering experience for a girl from Westchester. The workingconditions she saw at the canneries were deplorable: One man had lost an armwhen it was caught in a cutting machine. “That accident could have beeneasily prevented,” says Herbert. “Seeing that got me interested in workersafety and health.”
Treat the Cause: Herbert frequently acts as an advocate for her patients,helping them navigate the workers’-compensation system and intervening withtheir employers. When a garment worker came to her complaining of pain inher right shoulder, Herbert quickly identified the cause: The woman spenteight hours a day in a sequin factory turning a crank with her right hand.She investigated further and found that there were 60 other women at thefactory doing exactly the same thing. Herbert worked with thegarment-workers union and the factory owner to have the hand cranks replacedwith foot pedals and to provide adjustable seats for the women, preventingdozens of potentially disabling injuries.
Ground Zero: Some workers’ advocates have charged that the EPA withheldcrucial information in September about the causticity of the dust from thecollapsed towers – some of which had the pH of liquid drain cleaner – thatrescue workers were exposed to. Herbert diplomatically says only that theinformation released at the time “does not explain the health problems we’veseen clinically.”
Truth Squad: Herbert will serve as co-director for a large-scale medicalscreening program being established by the National Institute forOccupational Safety and Health to examine approximately 8,000 ground-zeroworkers, beginning in July. “I think the question of how widespread thesehealth problems may be has not yet been answered,” says Herbert. “We need tosay, ‘If something else happens – God forbid – how can we be better prepared thenext time around?’ “– EMILY GITTER
Dr. Florida Olivieri
Good Neighbor: On a Friday morning at Linkage House, an East Harlemsenior-citizen-housing complex, the elderly residents are waiting in thecommunity room for Dr. Florida Olivieri. Each week, she comes to do theirblood work and deliver a health talk. Today’s topic is calcium, andOlivieri, a chief geriatrician at Mount Sinai, speaks first in English andthen in Spanish. “It’s important to reach out to the community and makehealth care accessible,” says Olivieri, whose mother was a pediatrician inGuatemala, and who came to geriatrics by way of an earlier career in familymedicine. “It’s hard for the elderly to get around.” Olivieri spends asmuch time as possible out of the hospital, either in patients’ homes or inMount Sinai’s clinic at Linkage House.
Patience Rewarded: Since 65 percent of the geriatric population is female,”Flori was the ideal choice for doing community-related work because she isone of the few bilingual woman geriatricians in the city,” says Dr.Frederick Sherman, medical director of senior health programs at MountSinai. Most doctors don’t have the patience for elderly care. “Often youcan’t make big improvements,” Olivieri admits. “But you can make multiplelittle ones that really make a person feel better.” There are benefits forthe doctor, too. “The elderly are more pleasant to work with,” she says.”They become very loyal.”
Open Classroom: Olivieri calls herself a “clinical educator.” She writes amedical column in Spanish for Siempre, on topics ranging from diabetes toanthrax. And she insists that Mount Sinai’s third-year medical studentsspend time with seniors in the context of their lives, preferably in theirhomes. “She’s the front-runner in making people realize that the bestmedical care isn’t only in hospitals,” says Dr. Reena Karani, now a fellow in geriatrics.– AJA MANGUM
Dr. Nasser Altorki
Where There’s Smoke: There’s a hole as big as a pineapple in the chest of Dr.Nasser Altorki’s patient – a 69-year-old ex-smoker who, during a routine chestX-ray, was found to have a tumor in her right lung. “The black stuff in thewrinkles of the lung?” Altorki says, slicing out potentially cancerous lymphnodes where the right upper lobe used to be. “That’s carbon from cigarettes.And she looks better than most.” Altorki is performing a sleeveresection – the lung equivalent of a bypass – in which he patches togetherbronchial tubes that have a cancerous section cut out.
Necessary Targets: Outside the OR, Altorki, the director of cardiothoracicsurgery at New York Presbyterian Hospital, works with the Ludwig Institute,an international research group, on a lung-cancer vaccine. Unlike vaccinesthat give patients a tiny dose of a disease, Altorki’s is meant to stimulatethe immune system to fight antigens on tumors to keep them from growing. “Weneed to lower our sights a little,” says Altorki, a Saudi, born in Beirut,who speaks fluent Italian and Arabic. “Our attempt to kill the tumor cansometimes kill the host.”
Cancer Powwows: At New York Presbyterian, Altorki is now running two separateclinical trials of vaccines; so far, 35 patients are participating. Twice amonth, he meets with Ludwig’s team at a summit of immunologists, biologists,surgeons, and oncologists: After reviewing the trials, he presents data onantigens he’s discovered in other patients; the researchers then formulateways to target those antigens. “Not all lung surgeons are willing to workwith new therapies like he has,” says Dr. Eric Hoffman, Ludwig’s director ofclinical trials. “You need lung surgeons to recruit patients. And patientslove him.”
Clearing the Air: “There are 45 million former smokers in America alone,”Altorki observes. They did their part; he’d like to prevent them fromgetting cancer anyway. “The problem is some nasty cell is wandering aroundthat can cause trouble years later. If I can target that son of a gun, maybeI can win!”– ROBERT KOLKER