THE PHARMACOLOGIST
INTERACTION MAN
For over a decade, Dr. David Juurlink has been Sunnybrook's master in demystifying dangerous drug mixes.
While the New Glasgow, N.S., native works with patients, and as a clinician, researcher, teacher and administrator, some of his most vital work involves analyzing large-scale patient data to uncover dangerous drug interactions.
"[We]study disease on a large scale, a large number of patients, as opposed to patients one by one, using their health-care records," says Dr. Juurlink, head of the division of clinical pharmacology and toxicology.
His work aims to ensure what a doctor prescribes is truly what a patient gets, and that drugs are safe to take.
A graduate of Dalhousie University and with a PhD from University of Toronto, Dr Juurlink's research in the field of drug safety is supported by a New Investigator Award from the Canadian Institutes for Health Research. He also studies adverse drug events, the epidemiology of drug interactions, and the epidemiology of suicide.
Dr. Juurlink has played a critical role in key findings, including that some heartburn medications can raise the chance of a repeat heart attack, that some blood pressure sufferers taking calcium channel blockers could experience critical blood pressure drops while on certain antibiotics, and that the antidepressant Paxil may interfere with the breast cancer drug tamoxifen.
"When a new drug is on the market, in some ways it is a bit of an experiment on the population, and we use data available to use to see if it's a safe or unsafe thing," the physician explains. "Once on the market, the side-effects of drugs become more apparent because so many people are taking them.
"My colleagues and I … try to give patients and clinicians insights into the safety of drugs in the real world." He adds: "Drug safety is something that has always been important but it's especially important nowadays. It is a natural intersection of pharmacology and epidemiology, but it's not a really big specialty – not a lot of people focus on drug safety, so there are a lot of important contributions to be made."
THE NURSE
THE VETERAN'S BEST FRIEND
Registered practical nurse Monalisa Page starts every shift at the Sunnybrook Veterans Centre asking herself: "How do I treat my veterans better?"
Since May 2007, Ms. Page, also a medical technician in the army reserves, has been spreading joy to the war veterans who become residents at the centre when they can no longer live at home independently.
Ms. Page is a member of an interprofessional care team of nurses, physicians, occupational and physiotherapists, pharmacists, audiologists, speech-language pathologists, social workers, chaplains, dietitians, creative arts and recreation therapists.
The average age of residents of the largest veterans- care facility in Canada is 88, and to Ms. Page, being on the job is like being at home. "I enjoy it because I was raised by my grandparents, and I still live with my grandmother," says Ms. Page, who was born in Spain and raised in the Philippines before her family moved to Stouffville, Ont., in 1989.
She didn't start out with the goal of becoming an RPN. While in the social sciences program at McMaster
University, she realized it wasn't her career path, so she joined the military and then got the urge to try out nursing. She joined the Sunnybrook Veterans Centre after earning her RPN credentials at George Brown College.
Ms. Page, whose husband, Capt. Jason Page, is an artillery officer in the Canadian Forces, has many stories about how veterans have touched her heart, but befriending one particular resident stands out. The hearing-impaired man in his late eighties normally kept to himself, but about three years ago Ms. Page walked into his room, tapped him on the knee and said, "I just wanted to say hello."
"Something as simple as making an effort to say 'hello' is so important," she says; after her initial exchange with that veteran, he opened up, and their friendship continues today.
This summer, Ms. Page will become RPN co-lead for cognitive support for the annual June Camp trip to the Lake Joseph Centre in Muskoka that is a highlight for many veterans at the centre. Her goal within the military is to become a nursing officer (RN), but she hopes to continue at Sunnybrook in some capacity.
THE PHYSICIAN ASSISTANTS
NEW KIDS ON THE BLOCK
Zlata Janicijevic and Maureen Taylor's idea of success on the job is to get patients fixed up and back home as efficiently as possible.
Ms. Janicijevic, Ms. Taylor and other physician assistants – newcomers to the health care scene in Canada – are trained to support doctors in ERs. They conduct patient interviews, take medical histories and perform exams and procedures - from suturing cuts to setting broken bones, sedating patients, and advising on preventive health care.
Ms. Janicijevic was the first PA hired at Sunnybrook, in September 2009, and oversees three other PAs, all from the first graduating class produced by McMaster University – including Ms. Taylor, the oldest of the 21 graduates.
They are among 140 certified PAs in Canada, most trained in the military, and some 70,000 in the U.S., where they've been part of the health care system for six decades. The Ontario government says PAs have helped boost quality of care and reduce hospital and ER wait times, which is especially important at Sunnybrook – Canada's largest trauma centre.
"It's never a wonderful thing to be in the emergency department, so if I can make that experience for patients better, easier, less time consuming that's a good thing," says Ms. Janicijevic, who on a typical shift may handle up to a dozen patients. "It really shows the initiative and innovation at Sunnybrook as a whole, the fact it is willing to take on this new profession."
Ms. Taylor, who spent some two decades as a health journalist with CBC-TV's The National and five years producing a weekly health show for TVOntario, was looking for a new challenge. At age 48, with her two children grown and the support of her husband, infectious disease specialist Dr. Donald Low of Mount Sinai Hospital, she turned in her microphone for medical books. Admittedly slightly intimidated that the other McMaster PA applicants were younger and fresh from earning their undergraduate degrees, she dove into the course and joined Sunnybrook last fall – using the communication skills honed as a journalist.
"It's a great role because you're challenged to listen to the patient's story, do a physical exam, come up with a differential diagnosis, order the tests that need to be done and go to the physician and see if I'm on the right track," she says.
THE FUNDRAISER
JUMPING FOR A CAUSE
Derek Walton, ALS patient and Sunnybrook donor, has been jumping out of planes for a cure for ALS. Amyotrophic lateral sclerosis (also known as Lou Gehrig's disease) is a fatal neurodegenerative disease that Derek says ultimately "buries you alive."
Derek founded Jump for "PALS" (People with ALS), an event that he has held twice, most recently this past August, to benefit the ALS program at Sunnybrook, the largest of its kind in North America. Through these events, Derek, along with dozens of other skydivers, has raised over $150,000 by jumping out of planes at 12,500 feet.
"In order to have a life of purpose, you need to have a purpose in life," he says. "I am living with ALS. I am not dying of ALS. After all, life itself is terminal. I want to leave a legacy behind with Jumping for 'PALS', and would like this event to continue every year after I am gone."
He adds, "We don't have a Michael J. Fox for this disease because we don't live long enough to have one."
ALS attacks nerve cells and pathways in the brain and around the spinal cord. Total paralysis eventually takes over.
Derek's case is rare. The majority of ALS patients have an average lifespan of less than three years - Derek has now been living with ALS for nine years.
"As my arms and legs weaken, so too does my energy level, but not my heart," says Derek. "I feel that because ALS affects around 3,000 Canadians only, compared to some other conditions which affect hundreds of thousands of Canadians, there isn't enough awareness or funding for this disease."
Derek's purpose is to raise more than money. He wants to raise awareness of the disease. With his event being duplicated in several cities in North America, he is succeeding. And he has every intention of continuing his fundraising jumps with Jumping for "PALS" 3 scheduled for August this year where he expects over 60 skydivers to join him. Details can be found on his web site, www.waltoncure4als.ca.
Says Derek, "As my symptoms progress, I remain positive that a cure will be found. Maybe not in my lifetime, but one day. In the interim, I continue to raise awareness through public speaking engagements and my annual fundraiser for ALS research."
THE MARRIED MEDICS
AFRICAN ADVENTURES IN MEDICINE
Togetherness takes on a whole new meaning for married couple Dr. Michael Schull and Dr. Josée Sarrazin – whose 18 years since meeting in Sunnybrook's emergency room have seen numerous personal and professional highlights.
Dr. Schull, a senior scientist, and Dr. Sarrazin, who works in the medical imaging department, have three children, whom they uprooted for a year in 2009 to volunteer their medical expertise in Zomba, Malawi. The densely-populated southeast African country is blighted with low life expectancy and a high prevalence of HIV/AIDS.
"For us as parents it's important to preach by example," Dr. Sarrazin says of the sabbatical. "Not only did it teach the children appreciation of what they have, but it has opened their minds."
Born in Montreal, Ms. Sarrazin trained and has practised at the University of Montreal and the University of Toronto. Besides performing abdominal and pelvic radiology, she is an assistant professor in the department of medical imaging at U of T, and is involved in undergraduate teaching and specialty exams at the Royal College of Physicians and Surgeons.
While Ms. Sarrazin's extraordinary efforts in Africa – including working with Malawi's sole radiologist and training ultrasound technicians at two hospitals – marked her first experience volunteering abroad, Dr. Schull has a long history of helping impoverished countries.
Trained at Queen's University, with a masters in epidemiology and biostatistics from McGill University and a FRCPC in emergency medicine from the U of T, Dr. Schull is a staff emergency physician at Sunnybrook and a senior scientist at the Institute for Clinical Evaluative Sciences (ICES), where his research focus is health services, emergency services and quality of care.
He first volunteered abroad in 1991, in a hospital in South Africa. He then went on missions for Doctors Without Borders for a number of years, joining the organization's board of directors in 1997 and serving as president for five years. In 2004, he became a member of the Canadian board of Dignitas International, which helps people affected by HIV/AIDS in the developing world, and is now the board's chair.
The focus of Dr. Schull's work in Malawi was research and helping implement an innovative training and guideline program to integrate HIV/AIDS care with primary care. That work continues today, as he collects data to determine the effectiveness of the program.
The year in Malawi entailed many adjustments, especially for his three children, but Dr. Schull says the family sees it as a valuable experience. "The kids now have an understanding of poverty and Africa that they wouldn't have had otherwise," he adds.
THE EPIDEMIOLOGIST
ACCIDENTS DO HAPPEN, AND HE KNOWS WHY
Dr. Donald Redelmeier earned the moniker "myth buster" for a quirky, eclectic brand of research studying the lifespan of Academy Award winners, how the weather might alter medical school admissions, and the effects of democratic elections on driving habits.
About 24 more people die in car crashes on U.S. election days than on an average Tuesday, as it happens. And the Director of Clinical Epidemiology at Sunnybrook considers voter queues more lethal for drivers than New Year's Eve celebrations or Super Bowl Sunday. It could be that drivers speed up to make up for lost time lost, take unfamiliar routes home, or become complacent on a day not normally associated with increased fatalities.
"Driving is such a commonplace activity and it seems so banal…misconceptions abound, which leads to driver over-confidence and the failure to take preventative actions," Dr. Redelmeier says.
At Canada's largest trauma centre, he meets the consequences of these inactions every day. "Unlike patients with pancreatic or uterine cancer, where it's hard for me to figure out where they could have done things differently…I see so much suffering and it all could have been prevented." He makes a list: buckling up, staying off of cell phones, and avoiding unnecessary lane changes.
"If you were my kids you'd have stopped me by now." None of his three children are old enough to drive, he says, "but I make them look both ways before they cross the street."
Dr. Redelmeier was drawn to the study of accident prevention in part due to the limitations in medical science to rescue trauma victims. "In half of all road crashes, the patient is dead within five minutes, leaving no opportunities for life-saving heroics." Survivors are often left with permanent damage.
Over more than two decades of research, first at Stanford University, where he did his medical residency and fellowship, and then at the University of Toronto, Dr. Redelmeier has challenged the way we think about driving. He was the first to study the effects of cell phones on drivers, and found that phone calls can be as dangerous as alcohol consumption.
THE ECO-MANAGER
GURU OF ALL THINGS GREEN
If you're a patient undergoing surgery, you're probably not thinking about the size of your surgery's carbon footprint — or that the body only absorbs about five per cent of administered anesthetic, while the rest is sucked out of chimneys, making hospital operating rooms a major source of greenhouse gas emissions.
"Hospitals are up there with factories ... We want to be cognizant of that and mitigate the risk," says Beverley Townsend, manager of environmental sustainability at Sunnybrook. Part of her green mandate is something called gas scavenging, in partnership with an Ontario-based company, Blue-Zone. A machine installed in ORs now absorbs the excess anesthetics, which are then broken down to produce new ones.
Beverley has been the green leader at the hospital for four years, the last two of which saw Sunnybrook win one of Canada's Greenest Employers awards.
Take composting: "Something that seems so simple is actually quite drastic." It's complicated with a staff of about 10,000 dispersed over 100 acres of facility comprised of different departments. There are food scraps, commercial packaging in gift shops and biohazardous materials. Beverley works with purchasers to incorporate more eco-friendly materials into hospital products and educates staff about waste management strategies.
Other key environmental strategies Beverley helped implement include transportation for a large staff of commuters, and energy conservation. Her background in chemical engineering and hospital management came in handy when she helped draft her own job description that was initially limited to energy management. "We decided to expand it," she says. Sunnybrook's energy initiatives will reduce CO2 emissions by 8,965 tonnes annually — comparable to taking 1,410 cars off the road.
Numbers aren't the only change Beverley has noticed: "It's people's attitudes. It's a huge behavioral change and it didn't happen overnight. There's a lot more awareness surrounding environmental impacts."
THE RESEARCHER
CANCER ON HER HIT-LIST
Dr. Chloe Milsom has fifteen minutes to spare before a timer goes off; then the plasma samples drawn from her lab mice should be checked for protein levels.
The award-winning scientist is doing her postdoctoral fellowship at Sunnybrook Research Institute on a team under the direction of Dr. Robert Kerbel. The Kerbel group and Dr. Milsom's experiment are part of a research paradigm that might one day change the way anti-cancer treatments are administered.
Cancer is the leading cause of premature death in Canada. And while anti-cancer drugs like chemotherapy are generally effective, shrinking tumors significantly, the group has discovered what Dr. Milsom calls a "counterproductive effect." During recovery, she says, "there's an increase in growth factors. The host's cells are recruited to the tumour, enabling it to grow."
It usually takes three weeks for the body to recover from the toxic dose of chemo, which also depletes healthy cells. But it's during this recovery stage that the patient's cells mobilize toward the tumour. Dr. Milsom is looking for the source of these growth factors. She suspects blood platelets might be the cause, and she's one of the first.
"This is novel, because although platelets are known to play an important role in tumour progression…they have not been considered in terms of host response to treatment."
Administering higher doses of chemo several weeks apart has been standard practice for decades. But recent studies suggest a "low-dose regular interval therapy" could be an alternative to conventional chemotherapy, counteracting the tumour growth in the recovery stage.
At Leeds University in the UK, Dr. Milsom did her undergraduate degree in genetics and developed an interest in cancer. She moved to Canada with her husband ten years ago. She's since completed her PhD at McMaster University, where her supervisor inspired her research focus: blood vessel development in tumours. She calls the meeting "life-changing."
Now, her work could eventually support the case for low-dose chemo treatment, even if decades of standard practice don't change overnight. "You see success and it triggers clinical trials, but I think it will be some time before it's adopted routinely in the clinic."
THE PARENT COORDINATOR
MOM IS IN THE HOUSE
Kate Robson is taking the arduous task of a full-time mom to new levels, sanctioning it with an official job description at Sunnybrook's Neonatal Intensive Care Unit. Kate's job as parent coordinator is a new NICU position created just four months ago to help relieve some of the stress from anxious families, making her one of the first professional parents in Canada.
Kate and her husband began volunteering at Sunnybrook in 2006, after they were discharged with their first daughter. Maggie, now 5, was born a micro preemie at 25 weeks. Another parent lifted Kate's spirits after her first few days with Maggie left her "full of question marks." She says; "To understand that tomorrow might be very different, that it might be wonderful…that was life-saving."
When her second child, Grace, now 3, was born premature, a "typical feeder and grower," at 33 weeks, Kate worked on a parent project at Mt. Sinai, the hospital where Grace was born.
Parent coordinator wasn't an obvious transition from her job as managing editor at a mobile messaging company, but Kate feels a special empathy for parents of preemies that makes her eminently qualified. "I've had two different experiences at two gestational ages at two different hospitals. You have an idea of how it's going to go, and it doesn't always go that way, and that's what I want to help people to deal with."
Kate works as a liaison between Sunnybrook staff, parents, and the 1,200 babies admitted to the NICU every year. She organizes events for parents and advises staff on how to communicate with a family in crisis.
A master's in adult education and studies in dispute resolution at York University helps Kate broach difficult subjects and teach staff how to approach fretful parents, many of whom are thrust into a confusing situation. She focuses on "recognizing moments of joy," cherishing the milestones that mark a premature baby's first weeks and months — reaching a kilo and kangaroo carrying for the first time (each comes with a certificate Kate helped design), or the first time baby comes off of the ventilator. "We're not talking or walking or getting teeth yet. But there's a lot of joy in the NICU. It can be really wonderful."