Residents at URMC: Some Personal Profiles

Dr. David Guzick, M.D., Ph.D.

September 19, 2008

This newsletter is Part 2 of the series on our entering students and trainees. Residency training is the specialized, step in the long educational process that immediately precedes one's first position as a practicing physician, whether in private or academic practice. Like our medical students, house officers at URMC come from far and wide to Rochester to receive this critically formative training. (See previous newsletters on this topic from June 30, 2004 and May 4, 2007.)

What follows are the personal stories of five residents who made the decision to take their specialty training in Rochester? Residency training is where science and practice collide—our residents contribute greatly to the rich intellectual environment that characterizes Rochester medicine. They challenge the faculty to follow the University's motto of "Meliora," and, after graduation, care for patients in the local region, in their home towns, or elsewhere throughout the nation (and sometimes beyond our country's borders). Many will make their marks nationally in innovative practice, research or education. We are very fortunate indeed to attract residents like the ones highlighted in this newsletter.

Matt Fernaays, M.D. (Department of Family Medicine)

I was born and raised in the rural western New York town of Pavilion. Looking back at my childhood, the foundation for the structure of my life was laid at a very early time. The love of family, the value of quiet conversation shared between people, the importance of justice to society as whole as well as the individuals in it, a fascination with science and the natural world, and the joy of life in the country: crisp, undisturbed and without excuses; all sprung up from my roots in that place. After graduating from high school in Pavilion, I attended Niagara University with the full intention of pursuing a career in medicine. While at Niagara, I engaged in research in a microbiology lab for about a year and a half and found that I enjoyed the scientific process a great deal. In light of these two parallel interests, I entered the M.D./Ph.D. program at the University at Buffalo following my graduation from college in 2001.

My Ph.D. research was in microbiology with a strong clinical correlation, involving the genetics and genomics of lung pathogens in COPD patients. I was fortunate enough to work under the direction of Dr. Tim Murphy in Buffalo, an outstanding clinician scientist who had the forethought to establish a longitudinal study of COPD patients, resulting in many years of patient samples, from which we could study not only bacterial colonization and infection but also immune responses. My involvement in the scientific process was beneficial not only in its own right but also in the way it informs my career as a clinician. I feel like I was well prepared to examine the literature in the contemporary world of evidence-based medicine. Additionally, I feel as though it has given me an insight into human physiology and pathophysiology as part of complex systems (not only biological but also psychological and social) as opposed to individual units of disease and treatment.

As I neared the end of the long dual degree program, with a broad spectrum of career possibilities in front of me, I found that my interests and values were drawing me toward a career in primary care in a rural area, a returning home of sorts. I realized how much I enjoyed the personal interactions and patient-centered care of primary care medicine. Also, I had an ever-present and growing desire to work, live and raise my family in the country. Further, I felt like I had an obligation to service in an underserved area of our society with which I had particular experience and comfort. I feel like those that live in rural areas have their own unique set of challenges (financial, social, geographic, etc) that are not often addressed by main stream medicine. I feel that training in Family Medicine is uniquely suited to this inclination. Addressing medical problems in patients on an individual basis within their unique context from biological, psychological and social perspectives is an emphasis for Family Medicine in Rochester and is absolutely essential to addressing the medical needs of a rural population that is more prone to loss to follow-up and reduced access to specialty care based on geographic, social and economic barriers. Further, there is exciting potential to bring my experience in basic science to perform clinical/translational work in this geographic area. This would not only bring greater representation of this segment of society in clinical/translational study but would also bring evidence-based medicine to communities that may feel as though research is done with and for "big city" people.

My choice of residency in Rochester was an easy one. Not only do I have a life-long love of western New York, but the national respect of graduate medical education at the U of R is well known. Further, the U of R/Highland Hospital program in Family medicine is perfect for my interests. It is based at a University center, with the associated patient volume and academic opportunities, but also has an emphasis on holistic bio-psycho-social care that is essential for comprehensive Family Medicine. I certainly hope to make the most of my opportunities here, and translate them to a rewarding career serving rural western New York.

Adam Jeursivich, M.D. (Department of Neurology)

When I entered medical school I planned on becoming a pediatrician. My father had a rather large Catholic family so I grew up with an endless supply of toddler cousins and second cousins to entertain and play with. It wasn't until my pediatric clerkship that I realized a large part of the job meant working with ill, temperamental children and very stressed-out parents. I knew then that I was destined to work with adults. The field that I came to love was Neurology. The sheer elegance of the nervous system intrigued me, the profound effect on a patient's life from a tiny lesion awed me, and the algorithmic approach to neurological disease suited me.

As it came time to apply to residency programs, I had several requirements: a strong neurology program, a small city/large town environment, and an affordable area. Furthermore, my wife was in the process of writing her dissertation and needed to have mathematics and math education programs nearby for her career. After creating a list of programs that I felt might fit this bill, I discussed it with many faculty and residents in the neurology department at my medical school, the University of Virginia. Time and time again the University of Rochester was named as a strong program. When I interviewed here, I discovered that not only did the program offer everything I was seeking, but also had the added benefit of focusing on creating strong teachers. My plane ride home was canceled the evening following the interview due to snow. Since I was able to laugh off the experience, I knew I had found the right place for me.

One of the bonuses of the University of Rochester neurology residency is the combined intern year. The Internal Medicine program here is extremely strong and very resident oriented. Prior to starting as a neurology resident, the neurology interns have the opportunity to meet residents in other departments, learn the computer system, and get acclimated to the area. There is also no additional stress of moving between the PGY1 and PGY2 years. Thus far the experience has been great I am very pleased with my choice.

Andrew Sherman, M.D. (Department of Pediatrics)

I grew up in West Fargo, North Dakota. I worked in corn fields, in a hardware store, in a corndog stand, on a construction team, behind a deli counter and in a warming house next to an outdoor skating rink. North Dakota winters were brutal, but they forced me into seeing a silver lining of that freezing feeling. Extreme cold always reminds me of home. After high school, I attended DePaul University in Chicago. I studied biology as a degree, but was always interested in storytelling. I loved and still love talking to people around me and traveling around the United States. During the summers, I worked as an usher at Wrigley Field. I fixed betting machines at a horse racetrack. I worked at a small cinema and sold tickets for the Chicago Symphony Orchestra. I graduated from DePaul in 1999 and joined the Peace Corps in 2000.

I was a rural health Peace Corps Volunteer in Senegal, West Africa from 2000 to 2002. There, I concentrated my efforts on diarrheal diseases, AIDS/HIV, malnutrition, perinatal health and malaria. I lived in a small mud hut in a village of about 400 people. I spent my time learning the local language, called Pulaar. Over two years spent asking "what's that and what's that?" I built enough language skills to become proficient in the language. As volunteers, we taught about preventing the major causes of illness in the area. We taught other people in the villages to teach these concepts. The locals also formed a theater troupe, which still tours the area, teaching about malaria. But talking about malaria was often frustrating. During our teaching sessions, people would often ask about how to prevent malaria. I would respond with, "You should save some money and buy a mosquito net." Saying this was almost a taunt in my mind. I knew that most couldn't afford a net. Nets were also in short supply.

When I completed my Peace Corps service, I moved to Washington D.C. and worked in a post-baccalaureate program with the NIH at the National Cancer Institute. During my time there, I was accepted to Saint Louis University School of Medicine. While in Saint Louis, I met and fell in love with the most amazing person in my life, Chrystal Jenkins (Department of Family Medicine). We became engaged and couples matched to the University of Rochester programs.

While in medical school, I also decided that I wanted to go back to Senegal, but not as a tourist. I started looking into buying mosquito nets for distributions in the area of my old village. That spring, I started up the outreach organization Netlife with the help of my fellow medical student, Jesse Matthews. We raised enough money to buy just over 600 nets, and that summer, we traveled to Senegal with uncertain expectations. We scouted out villages by bike and selected 7 villages to target. We provided free nets, giving access to every person in those villages. The work was exhausting, but immensely rewarding.

After our return, we decided we were going to keep Netlife going. With the help of Saint Louis University, we were given elective time and other support to return to Senegal in 2007. We coordinated with new other organizations which provided us with access to cheaper nets and improved coordination with other, larger organizations. We purchased 1,100 nets. We rode further into the most rural areas, distributing nets to the entire inhabitants of 17 villages. We also coordinated with the present Peace Corps Volunteers in Senegal with the hopes of working with them in the future.

Back in medical school, I was processing all of my experiences and travels with the idea of being a doctor. On my rotations, it was clear I was interested in being a primary care physician. I wanted to be on the front line of health care to serve underserved communities as exotic as in West Africa and as necessary and practical as here at home. My medical school rotation in pediatrics verified my interest in helping children and adolescents. As in West Africa, children here in the U.S. seemed most susceptible to harm when in difficult situations. These situations caused an emotional response for me that I could not ignore. I knew I must be a pediatrician.

This year in Senegal, Netlife built a new partnership with the Peace Corps. Through this partnership, we were able to send volunteers in Senegal 4,000 nets, which as of this summer, are almost entirely distributed. It's encouraging now to hear the successes of the last distribution. If Netlife progresses, we can cycle our distributions to cover every inhabitant of one of the worst malaria endemic regions in West Africa. I find myself very lucky to stumble upon the idea that two people can start up a seemingly small organization that turns out to make such a dramatic difference against one of the worst diseases in the world.

Jeffrey Toothman, DDS (Eastman Dental Center, Division of Orthodontics)

I come from a long line of—believe it or not—dental professionals. My great-grandfather, Dr. Plennie George Toothman, was trained as a general dentist at the University of Pittsburgh in the early 1900's. His son, Dr. George Toothman, also did his dental training at Pitt, graduating in 1944. He then received his orthodontic training at Pitt and was later a member of the orthodontic faculty there. Dr. Ronald Toothman, my father, was a 1973 Pitt dental grad also. Following dental school my father moved to Rochester to be trained at the Eastman orthodontic department under Dr. Daniel J. Subtelny, graduating in 1977. He currently practices in Hagerstown, MD, the town where I was born and raised.

I graduated from Bucknell University in 2001 with a degree in physics and in philosophy. I had figured all along that I would go into dentistry after undergrad – not simply because my name suggested it or that I was especially enamored of teeth, but more from the fact that I appreciated the time that my father was afforded by his job to spend with his family and that I wanted to give the same thing to my family. I received my degree from the University of Maryland Baltimore College of Dental Surgery before moving to Rochester in the summer of 2005.

Upon starting my training with a fellowship in orofacial pain under Dr. Ross Tallents in the Division of Orthodontics at the Eastman Dental Center, I began to understand why my father spoke so fondly of his own experience here in Rochester. The academic atmosphere at the Division of Orthodontics at Eastman Dental Center, chaired by Dr. Stephanos Kyrkanides, strongly promotes academic, scholarly and research activities in addition to providing clinical programs that are world renowned.

The emphasis placed on research in the Division of Orthodontics not only serves to expand the trainees' critical thinking, but also provides a biologic basis for clinical treatment. During my 4 years in Rochester, I became involved in pain research under the mentorship of Dr. Stephanos Kyrkanides employing a novel transgenic mouse model of osteoarthritis and joint pain developed in the Kyrkanides laboratory. My initial research explored inflammatory driven pain in mice, looking at synaptic plasticity in the dorsal horn and the dorsal root ganglia. I am currently investigating the interaction of TGF-β and IL-1 β in articular cartilage homeostasis in the hope that it will offer insight into a possible mechanism for ameliorating osteoarthritis. This project is based on a long standing collaboration between Dr. Kyrkanides and Dr. Tallents of Eastman Dental Center and Dr. Ed Puzas, professor of Orthopedics in the School of Medicine & Dentistry.

I began my orthodontic education in the summer of 2007 and have been fortunate to learn under some of the same instructors that my father had the opportunity to be taught by. My experience here has been invaluable towards my professional development. My hope remains to return to Maryland when I finish here to practice orthodontics with my father and continue a legacy that has offered me great insight into what type of professional and, more importantly, person I should be. Additionally, my educational experience at Eastman has developed in me a desire to stay in the academic field, with the plan that I will join the as a part-time faculty member in the Department of Orthodontics at College of Dental Surgery - University of Maryland at Baltimore upon my return to Maryland after my graduation next June.

JoAnna M. Wawrzycki, MD (Department of Obstetrics and Gynecology)

When my husband Ben and I met in college at the University of Albany, we had no idea we would both become physicians. I had originally aspired to be a musician, though other than a couple of small stints at local coffee shops I was not pursing this passion too aggressively. Ben was a Biology major without a particular career in mind but had explored everything from plant biology to veterinary medicine. We spent a summer working out on Block Island, Rhode Island, which somehow turned into a cross-country trip and winter in Colorado. While we were there we snowboarded, tuned skis, and worked at local restaurants and got a little bit more motivated to return to college and pursue a more meaningful path. I was also excited to come home because I was anticipating the birth of my nephew. It happened that my mother was also having surgery around the time that my sister had a cesarean section and they both landed in the same hospital at the same time. After visiting them both, I was struck by the amount of trust and faith that we placed in the physicians who were caring for my family members. That planted the seed of what an amazing responsibility a physician has in caring for patients and I became enamored with the idea of being a physician and an advocate for women's health. I tried out a couple of jobs in patient care and research and the calling stuck. My husband had also come to the conclusion that medicine was the best fit for him and accepted a spot at Stony Brook School of Medicine. A year later, I joined him there and four years and three kids later we landed here in Rochester.

I found out I was pregnant with twins in the beginning of my second year of medical school. We were very excited but knew it would be quite a struggle with both of us in medical school and neither of us with any income (thank goodness for student loans!). My parents sublet an apartment nearby for a couple of months after the twins were born to ease the transition into our clinical years.

It was no surprise when I fell in love with my rotation in Ob/Gyn. I had come in to medical school with the dream of becoming an obstetrician and indeed, no matter how many deliveries I saw, each one was magical. However, what was more, I really loved the variety of the field. I thought it was amazing that you could spend a morning in clinic listening to a baby's heartbeat or counseling an adolescent on sexually transmitted diseases, and an afternoon, doing a hysterectomy for uterine cancer. I knew that I had found my calling, however, my only hesitation was what it would mean for my family if I pursued such a challenging path.

My family has been the most wonderful part of my life, but finding a career that means so much to me is a close second. Luckily, I was able to keep them both. I am very fortunate in that my husband is truly a great partner, and we have managed to juggle responsibilities, with him cooking and packing lunches more than his fair share despite his also very busy life as an intern in internal medicine.

However, what has been the biggest blessing of all is that my parents, who are both retired schoolteachers, agreed (or possibly were coerced) into coming with us to Rochester this year to help out with our now two year old twins, Eddie and Anabel, and our five month old daughter, Lily. Thanks to them, and intermittent rescue babysitting by Ben's parents, we are able to make it all work. Our house can get hectic at times, but we are thriving in Rochester. Ben and I love what we do for a living and get to come home to a house full of energy and play. Eddie and Anabel love to run downstairs to find Grandma and Poppy in the morning and Lily always has someone to hold her.

One of the biggest reasons we came to Rochester is because it was a great place to bring our family. Many of the residents here have children, and the ones that don't still manage to have a good balance in their lives. Ben and I interviewed at many programs, and for the most part felt that we had to choose between a strong, prestigious academic program or a family-family program with happy residents. Rochester was the one place where we didn't feel we were compromising. It was our top choice and we are truly ecstatic to be here. We know the next few years will be packed, both with work and with memories, and we are lucky to have the support to make this journey possible, and despite the challenges, even enjoyable.

Meliora,

David S. Guzick, MD, PhD
Dean, School of Medicine and Dentistry
University of Rochester

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