I was just a few years out of my residency training when a 28-year-old came to see me because of tingling in his toes and weakness in his legs. These symptoms weren’t alarming; I probably saw two patients a day with tingling in their hands or feet. That’s commonly caused by overuse injury, compression of the sciatic nerve, or even anxiety. But I had just seen this young man three weeks before for an upper respiratory infection, and he didn’t have any neurologic issues then. He said he felt like something was really wrong—he couldn’t really tell me more than that. I did a simple test for deep tendon reflexes, tapping just beneath the knee, and got no response—in either leg. That’s when I knew that he was going to need help. I thought of Guillain-Barré syndrome, a rare condition in which the immune system attacks peripheral nerves, causing progressive paralysis. Most cases start after a viral infection. Though he felt unsteady, he could walk. The hospital was only a couple of blocks away, and he was my last patient of the day, so I decided to drive him there. As the admitting physician, I started the workup in the ER. He needed to lie in the fetal position, with his knees against his chest, for a lumbar puncture to extract and test spinal fluid, but he had begun having muscle spasms. A nurse had to hold him in place. Two hours later, the results came back indicating Guillain-Barré, and we transferred him to the intensive care unit. By the next morning, he could barely move his fingers and needed a ventilator because he could no longer breathe on his own. He remained in the hospital for a month, receiving treatment to reduce the antibodies that were attacking his nerve cells. Fortunately, he had been young and healthy, and with the help of rehab, he regained most of his muscle capacity. I haven’t seen another case of Guillain-Barré since, but it still is a reminder that it is so important to optimize your health because you never know when something might happen.
Russell Maxa, MD
Internist, Primary Care Physicians of Atlanta
When I introduce myself as a dermatologist at a dinner party, the conversation inevitably turns to, What’s my favorite beauty cream? What would I recommend for wrinkles? And have I seen the latest episode of Dr. Pimple Popper? I often must remind people that the skin tells the story of your internal health to the outside world.
I was reminded of this when I met Molly [not her real name]. She was a beautiful, 30-year-old newlywed looking to start a family. However, she had been to multiple gynecologists and dermatologists for an unrelenting “rash” in the groin. She had itching, redness, swelling, and open sores that would not heal. This had been going on for more than two years without relief.
At the University of Virginia, I was trained that all skin should be examined in a dermatologic exam, including genitalia. If we are not the experts in skin, who is? Thus, when I came to Atlanta in 2006, I made the examination of genital skin a normal offering in my exams. Boy, did the flood gates open! I learned that this was an unmet need, as many dermatologists did not examine this area.
Molly’s presentation did not fit neatly with any common condition. She was biopsied, cultured, and allergy-tested, and still, nothing improved. I was empathetic to her condition and equally frustrated with myself. What was I missing? What if this were not just a pure skin disease? I asked her about any other health conditions. Specifically, did she have any gastrointestinal issues like Crohn’s or ulcerative colitis? Rarely, Crohn’s may manifest with skin conditions, including genital swelling. Weight loss, abdominal pain, bloody stool? The answers were all no. Oral lesions? Problems swallowing? Yes! She always had “bad gums” and had needed extensive gum surgeries already at her young age. I realized then that the groin lesions were similar to the inflammatory lesions seen on colonoscopy in Crohn’s disease. The gum disease was likely her GI manifestation, as this disease is known to involve the whole GI tract, “from gums to bums.”
I immediately reached out to my GI colleague Dr. Marc Sonenshine (fellow Atlanta Top Doc) and asked him to see her for a Crohn’s evaluation. After initially giving me some ribbing (I thought dermatologists only did Botox?), he saw her that week for a colonoscopy. Her diagnosis was confirmed: cutaneous Crohn’s disease. Dr. Sonenshine and I worked together to get her on the correct medications. In two years, she has shown great improvement.
This case demonstrated that, especially in dramatic presentations, it is critical to always go back and look at the whole patient. As specialists, we can often get laser-focused on our own organ system, but we must remember that this is one connected beautiful body that must all work together.
Jodi Ganz, MD
Olansky Dermatology and Aesthetics
Piedmont Healthcare and Wellstar Health System
One Sunday afternoon, a young woman in her 30s came into the ER with a racing heart and shortness of breath. There’s an instinct you get when you walk into a patient’s room, and she just didn’t look right. She told me this had been going on for a few weeks but had gotten worse in the past few days. We went through her medical history and family history, and nothing stood out. You think, Does she have a blood clot? Is it her thyroid or something with her heart? I’ve seen people with these symptoms who were having a panic attack, but she didn’t seem to have any big stressors in her life. Her lab results were normal except for an indication that her blood was too acidic, though her vital [signs] were abnormal. I couldn’t pinpoint exactly what was wrong. Her chest x-ray and a CT scan were normal. At the end of my shift, I signed her out to my colleague and informed him to keep an eye on her, as I did not have a good feeling about her. I was about to leave when one of the nurses came running up to me. She said the patient wanted me to look in her ears. I went back in, and she said her ears were ringing. Her ears looked completely fine, but when I was doing the exam, my hand pressed against her jaw and she jumped. She said, My tooth is hurting on that side. I asked her if she had seen a dentist, and she responded no, but she had been taking BC Powder. Then, all of a sudden, the light bulb came on. Ear ringing—as well as acidosis and an abnormal heart rate—is a sign of aspirin toxicity. It turns out she was taking three times the recommended dose. We tested her blood and contacted the Poison Control Center. They said it was the highest aspirin level they had ever seen. With emergency dialysis and a bicarbonate drip, her blood quickly returned to normal. She left the hospital a week later, totally fine. Too often, patients don’t tell us about over-the-counter drugs or supplements they’re taking. It’s amazing how that tiny little clue in the end and a heads-up by the nurse finally helped me put it all together.
Nauman Rashid, MD
Emergency Medicine Physician
Running laps in the ICU
I am a critical care specialist focusing on extracorporeal membrane oxygenation (ECMO), which has gained some notoriety during the pandemic. I had a particularly inspirational patient with Covid-19. Let’s call him Jesus—a Mexican gentleman living in this country for 20 years, an undocumented immigrant, and a painter. His only family here was a distant cousin with whom he lived. He had no insurance.
A ventilator on its highest settings could not help him, so we placed him on ECMO, which acts as an artificial lung for the worst respiratory problems. Jesus spent several days in a medically induced coma, and his muscles became weak in bed. When he woke up from the coma, I did not have many options for him. He could not get a lung transplant with no insurance, and recovery relied on his will to rebuild his strength. He was singular in his determination to get better.
We started getting him up with our mobility team even while he was on ECMO. He would run laps around the ICU. During this time, he had many lung infections, during which he would need to be placed in a medically induced coma to help him conserve oxygen. He would rebound from each of these and go back to running laps. After about 90 days or so of being on ECMO, we knew he had no chance of recovery. When he developed a new infection, we once more laid the cards on the table. He told us to let him go, and he died peacefully.
I have been a critical care specialist for almost 20 years, and I have not seen such a clustering of sickness as I did during the pandemic. In the ICU, I saw my patients, surrounded by death, lose confidence in medicine and my colleagues burn out from the physical and emotional toll.
Jesus inspired the entire ICU, from the patients to the staff, with his singular determination to live during the pandemic. He motivated me to expand our mobility program on ECMO for patients at multiple hospitals in Atlanta. I found hope in my work again.
Asif Saberi, MD
Medical Director, Critical Care Medicine & ECMO
Delivery room rescue
As expectant parents, we imagine that our newborns will have a perfect birth, but sometimes, it doesn’t happen that way. I got a call from a mom who was about 35 weeks pregnant. An ultrasound, and then a prenatal MRI, had found that her baby had tumors in the mouth that would obstruct breathing and feeding—a life-threatening situation. We scheduled a rare EXIT (ex utero intrapartum treatment) procedure to give the baby breathing support, conducted when the baby is just partially delivered. On that day, there were probably 30 people in the room—obstetricians, otolaryngologists, neonatologists, a respiratory therapist, scrub techs, and nurses. Right when we got started, I said aloud, “The baby is going to make it today.” It’s a moment of intense pressure. You go straight back to your training, straight to make-it-happen mode. The obstetricians opened the uterus and exposed her head and one arm. Mom and baby were under anesthesia, and the baby was still receiving oxygen through the umbilical cord. I maneuvered a breathing tube around three tumors at the front of her mouth, then moved it back to the throat and through the larynx. With the help of the Lord, I was able to establish access to the airway. The neonatologist monitored the baby’s vital signs, and once we all felt comfortable with the placement of the tube, the baby was delivered via C-section. They quickly cut the cord and put the baby on the neonatal table with ventilation. Then, the baby was transferred from Northside Hospital to intensive care at Children’s Healthcare of Atlanta. The next morning, I surgically removed the three tumors, which were benign and hadn’t caused any facial deformities. She went home pretty quickly. The mom later sent me a picture of the baby and her older sister. They’re just the cutest little things.
Paula Harmon, MD
Pediatric Otolaryngologist and Head and Neck Surgeon
Pediatric ENT of Atlanta/Children’s Healthcare of Atlanta
A heart-stopping moment
Some years ago, I was leaving my office next to DeKalb Medical Center [now Emory Decatur Hospital, where I also work still] around 5:30 p.m. when I got a trauma call from the ER. A woman had come in with a stab wound to the chest, right in front of her heart, and her blood pressure was dropping quickly, [a possible sign that pooling blood was blocking the heart from pumping]. The only thoracic surgeon on staff was about 30 minutes away. I don’t normally perform cardiac surgery, but I had done hundreds of trauma surgeries in my training. I ran to the ER and then called the operating room. When they said there were no rooms, I knew right away this was going to be a problem. There was no time to do anything but open-heart surgery right there in the trauma bay. I ran to the OR to get a thoracotomy set. I took off my jacket, loosened my tie, rolled up my sleeves, and put on gloves. There literally was no time to change. She would have died within minutes. I splashed Betadine on her chest, made a transverse cut, and divided her sternum. Blood spurted several feet in the air. I placed a finger on the puncture in her heart and closed it with a single suture. Then, I looked up and saw an entire wall of people whose mouths were completely agape. The ER staff was shocked to see this unfold before them. Finally, a room opened in the OR, and an OR team prepped the patient for closure. The thoracic surgeon arrived, looked at the sutured heart, and said, Looks good to me. We closed the patient, and she recovered uneventfully and was discharged several days later. Sometimes, you have to make a split-second decision. It’s the rush of providence that everything came together, and, thank God, I have the skill set. The stars aligned for me to be there to help that person.
Michael A. Quiñones, MD
One of my very first weeks on my new job at Grady, I came across a young Latina woman who came in initially as a hip pain referral. I greeted her via Spanish-language interpretation and then inquired, Can you tell me about your hip pain? She replied: Hips? I don’t have hip pain. I am very weak, and I have a strange rash all over the chest. She explained to me that the weakness was global and affected her job cleaning an office building. Initially, she lacked strength near the end of her shift. Now, the weakness was starting early in the day. This had been going on for months.
I asked if she’d had contact with anyone who was sick, changes in diet or cleaning products, treatments tried, past medical history, and any symptoms prior to this visit. She stated that no other family member had this, and she had no new exposures or sick contacts. She did have type 2 diabetes but was not on insulin. She had attempted hydrocortisone cream for the rash without improvement.
I tested her blood for autoimmune diseases, and I also checked for muscle breakdown and inflammation. From this, I was able to diagnose her with an autoimmune disease called dermatomyositis, which affects the muscles and the skin. I sent her to rheumatology, who found she also had diabetic sensorimotor polyneuropathy and started her on an antibody treatment. Her condition has improved.
Many people without private insurance, like my Latina patient, delay seeking help. Without medical attention, acute injuries can turn into chronic problems. What starts as an ACL tear can turn into a lifetime of arthritis. The healthcare disparities that we often see within certain socioeconomic and ethnic groups come from unfavorable and unjust—inequitable—circumstances.
As I am immersed in a healthcare system that predominantly takes care of those who cannot afford healthcare or health insurance, and who are insured through government assistance, I struggle to keep up with ever-changing requirements for authorization of certain services and how to continue treating patients. It is a perpetual constraint of the healthcare system that seems almost impossible to remedy.
Frazier Keitt, DO
Clinical Medical Director,
Elective Orthopaedic Services
Emory Healthcare at Grady Health System
Assistant Professor, Emory University School Of Medicine
Adjunct Assistant Professor, Morehouse School of Medicine
I was 13 when my mother was in a car accident in the line of duty as a deputy sheriff for Hall County and was instantly paralyzed. Growing up with her injury, and learning about spinal cord injuries, I wanted to help people like her, so that’s really what drove me into the field. One day, the police were doing a kind of celebratory motorcycle charity ride when a young officer was in an accident. He came straight to our trauma center at Northeast Georgia Medical Center with a subdural hematoma, a type of brain bleed which is life-threatening. In a matter of an hour, he could have been dead. I operated on him and removed the brain clot. Then, I went out to the [waiting room to speak to the] entire sheriff’s department and his wife to tell them I didn’t know if he was going to make it. Fast-forward to two more surgeries and rehab, and now, he has fully recovered and is back to normal. He and his wife recently had a child. It was just an overwhelming kind of experience that brought me back to my mother’s injury and why I went into the specialty to begin with. It’s a very full-circle story.
Betsy Grunch, MD
Neurosurgery, the Longstreet Clinic, PC
This past year, I got a call about a newborn that had a little bit of a rash, which quickly turned into a blistering red rash that involved most of her body. Everybody was confused because the baby seemed to be doing well otherwise. While blisters in a neonate always create [suspicion of] neonatal herpes simplex virus, which is a medical emergency, this baby showed absolutely no signs of sepsis or severe infection. There was a vague history of newborn rash in the patient’s mom and aunt, which confirmed the baby’s diagnosis for me right away. One of the neat things about dermatology is sometimes you can look at something for one second and just know immediately what it is. I called the doctor back and told him to ask Mom a few questions: Did the mom have any other children that were girls? Had she had any miscarriages? Was the miscarriage of a boy baby? He went and talked to Mom and was flabbergasted when she said yes [to all three questions]. That confirmed that it was a congenital rash called incontinentia pigmenti. The disease’s classic finding is a rash that progresses through various stages in early life. It can also affect the teeth, neurologic system, and eyes. It is lethal in boys. While this felt to me like a classic textbook case, the hospitalist was amazed at how quickly I was able to give the patient a diagnosis. It’s fun as a specialist when people call you for help and you can really put all the pieces of a puzzle together.
Catherine Warner, MD
Atlanta West Dermatology
I am a physiatrist specializing in treating spinal injuries with noninvasive procedures that have quick and regenerative recoveries. I love my job. Everyday, I treat people who go from debilitated to having no pain in a matter of days, and it’s really gratifying.
I discovered regenerative medicine through my experience in mixed martial arts. I witnessed major injuries to my training partners in the spine and back. Some received noninvasive procedures that helped them come back stronger, and others had traditional surgeries that never left them the same.
Regenerative medicine was budding when I came to Atlanta for my residency at Emory University in 2012. I focused my work on physical medicine and rehabilitation to help other athletes recover quickly through noninvasive procedures and reach their baseline again. The less trauma on the body, the better.
One memorable recent case was a professional female bare-knuckle fighter. After a three-round back-and-forth war that culminated with her knocking out her opponent, she began having severe leg pain, numbness, and weakness. As a former MMA fighter myself, I YouTube’d her fight to look for when the injury may have occurred and was thoroughly impressed by her toughness. Her MRI showed a massive herniated disc filling her spinal canal. She’s now awaiting the next steps and is determined to get back in the ring.
Medicine and mixed martial arts are similar to me. They are about strategy and technique that identify weaknesses and eliminate them as efficiently as possible.
David Tran, MD
Axion Spine & Neurosurgery (page 183)
I met this patient just after my residency. She was a woman in her 60s who had suffered from severe atopic dermatitis since childhood. She had never slept through the night. She had never known a day without itch. From infancy to now, she had inexorable eczema from her head to her feet and red scaly plaques on her face, scalp, chest, and hands. She did her best. She loved her life—she taught part-time and worked with animals—but every minute was spent with an uncomfortable skin disease she couldn’t hide.
People were talking about this game-changing drug for skin diseases called Dupixent that wasn’t on the market yet. I ran a clinical trial unit handling the tests, and as soon as I found out, I notified this patient. The trial was placebo-controlled, and I wasn’t told which participants got the drug and which participants didn’t. During the first part of the trial, the patient wasn’t getting better. I thought she was on the placebo, but I also worried the drug wasn’t working, and I didn’t have anything else to offer her. Fortunately, she’s a positive person so I was able to cheer her through it.
After four months, the treatment and placebo groups switched and the patient improved, confirming that she hadn’t been on the medication. It was magic. Now, after 60-plus years, she’s getting to live the way most of us live. One day, she brought in her mother from the nursing home where she now lived. She came in a wheelchair to thank us for making her baby better. She told us how she stayed up all night with her, applying medications, trying to soothe her, consoling her when children teased her, taking her from doctor to doctor, and promising her that things would someday get better. “It only took 62 years,” she said, holding my hand with both of hers, “but they finally did.”
Jamie Weisman, MD
Medical Dermatology Specialists, Inc.
I once treated a woman who had caught her arm in an escalator [during a domestic dispute]. Her clothing got caught, and she was dragged. Her right arm was completely mangled. When she came to see me, I didn’t even know whether or not we were going to be able to do much for her. She had a lot of wounds. She couldn’t move her arm, she couldn’t move her wrist, her thumb was basically flaccid. I hadn’t seen any injury like this before. I was able to operate on her—it took me more than two hours. Because the tendon that allows the thumb to extend was crushed and barely identifiable, I needed to do a tendon transfer. I borrowed one of the tendons from the index finger and moved it over to the thumb to allow her to be able to move her thumb. In addition, I did surgery to treat the median nerve and all the nerves that are critical to hand and arm function.
I was able to do all these surgeries for her, but I couldn’t do anything about the fact that she was attacked by the person she was living with and became homeless. But that feeling turned when I saw her [recently]. She can now move her wrist, she can move her thumb—her sensation is better. She now has the ability to work, to get a job, to not be homeless, and to not rely on other people who could potentially harm her. As doctors, we can’t control everything, but if we use the talent that God has given us, our patients will be able to live more full and whole lives.
Obi Ugwonali, MD
A proud and involved grandfather, Mr. JL loved nothing more than watching his grandson play baseball. I met him one spring when he came to the emergency room with chest pain. He’d had a small heart attack, and I discovered that all his heart arteries had severe blockages. As we were making arrangements for bypass surgery, he insisted he did not have time for open heart surgery, which requires months of recovery. His grandson’s baseball team was playing at Cooperstown, New York, in the 12U World Series just a few weeks away. He insisted he would just check himself out of the hospital and get surgery when he got back. This was not safe after a heart attack, so I asked him to think about it overnight in the hospital. Later that night, his grandson’s entire baseball team came to his room. The boys cried and pleaded with him to get the surgery, and he finally agreed. Afterwards, we started an aggressive cardiac rehabilitation program right away. Mr JL had an incredible will to improve, and he progressed rapidly. We decided he could go to Cooperstown, but we contacted the baseball fields to make special seating arrangements. When he came back, he gave me a picture of himself with the baseball team that I still keep on my desk.
Mehul R. Bhatt, MD
Heart & Vascular Care, Inc.
I was fortunate to have Dr. Jack Hughston of the famed Hughston Clinic in Columbus, Georgia, as a mentor while completing my sports medicine fellowship. He made it a priority to get to know his patients well. Following his example, I do the same.
One day after a long hiatus, Gail Cohn came to see me. I asked about her family, including her father, Judge Aaron Cohn, whom I knew peripherally while I was in Columbus. She told me he had recently passed away. Gail went on to tell me that the National Infantry Museum at Fort Benning was dedicating the Holocaust portion of its World War II section in his honor.
Puzzled, I asked why. She informed me that her father had served as a major in General Patton’s Third Army, and that he had liberated a concentration camp. Stunned, I told her that my late father, Icek Slodowski (changed to Erving Sloan), had survived the Holocaust and was the sole survivor of his family. I then asked, “What concentration camp?” She replied, “Mauthausen.” My mouth dropped. My father was at Mauthausen and was liberated by American soldiers. Your father liberated my father!”
Not only did this discovery bond Gail and me, but it led to a recent opportunity for the two of us to deliver a keynote presentation at the National Infantry Museum telling our fathers’ stories and how our lives unimaginably intersected.
If I hadn’t emulated Dr. Hughston’s commitment to personally connecting with his patients, Gail and I would never have made this incredible discovery.
Reuben Sloan, MD
About nine months into the Covid-19 pandemic, I received a consult from our emergency department that a patient had swallowed a turtle, and it was stuck in his throat. As a pediatric gastroenterologist, I have often been consulted to use an endoscope to remove swallowed objects, but this was a first for me. It turns out that a two-year-old was playing with a metal souvenir turtle about the size of a silver dollar. His mom was in the other room, and she heard him coughing so she brought him into the emergency room. On the x-ray, there was a little metal turtle in his esophagus. We do a procedure called upper endoscopy. It’s very similar to a colonoscopy, same technology except with a smaller scope. I initially had difficulty grasping the turtle. We have a couple of tools at our disposal to take a foreign body out. The forceps were too small to attach to its head. The basket would not close correctly. Finally, I used a wire snare to snatch the two right legs and orient the object vertically, and we were easily able to remove it. Once it was out, I looked to make sure that there wasn’t any damage from pulling the turtle out. The child was fine, and he was able to be discharged that day—with the turtle. I had a mini-audience watching by the time it actually came out. An x-ray picture with a turtle in the middle of the chest is something that everybody wants to see. It’s become like folklore among the endoscopy unit.
Jordan Weitzner, MD
Atlanta Gastroenterology Associates
Breast cancer breakthrough
On August 10, 2017, my son Jack’s fifth birthday, we were driving home from his birthday celebration when I got a call from a colleague who often refers patients to me for clinical trials.
That afternoon, he had seen a woman whom he’d known well for a while, a 49-year-old pastor who had two teenage daughters. She had just been diagnosed with metastatic triple negative breast cancer. This is one of the most aggressive subtypes of breast cancer, and in Jill’s case, it had metastasized to her lungs. The average duration of survival from the time of diagnosis until death was then about 13 months. As it turned out, we had just opened the study called KEYNOTE-355, a clinical trial that was novel at the time, looking at the use of immunotherapy along with chemotherapy for newly diagnosed triple negative patients. She started her treatment in September, and her cancer melted away pretty quickly—and it stayed away. She became an advocate for breast cancer awareness and has been to Washington several times to lobby Congress for more funding for research. Now, this is a regimen that we’re giving patients as part of the standard care. People participating in studies like this, the way she did, is how we’re able to push the field forward.
Jane Lowe Meisel, MD
Emory Winship Cancer Institute
Patient with multiple personality disorder
A young female patient who was pretty well known to me came in and she just had a short-term illness that we needed to do a treatment plan for. I knew that she had issues with anxiety in the past, but it had never been clear to me that one of her defense mechanisms was a dissociative disorder. She typically presented to me as a nurturing mother but, this particular day, I was giving her some bad medical news, and she exhibited this very aggressive personality. It caught me off guard, but when I didn’t react, all of a sudden, that very dominant, aggressive persona went away and then, there was this little kid speaking in a high-pitched voice. Eventually, I said, “Listen, the person I need to talk to is the person who walked in.” She then felt comfortable enough to tell me that this is something that she’d been working on with her therapist for close to a year. Many years later, we still see each other. We just make sure that when I’m caring for her, the nurturing persona that can help her take care of herself [is present].
Dr. Tina-Ann Thompson
Emory at Rockbridge, Primary Care & Nephrology
Physicians’ stories have been slightly edited for clarity and length.
This article appears in our July 2022 issue.