Quick thinking and an eye for detail are crucial elements on the resume of Dr. Hunter Rittenberry, an Emergency Room Physician at Methodist North Hospital.
“Every day is different. It’s not like working clinic days and seeing the same patients over and over again,” he says. “It’s definitely at a faster pace and more stressful. You never know what might come through the door.”The Middle Tennessee native migrated to Memphis seeking a job with a bit more variety than a typical family doctor.
For Rittenberry, finding out the intricacies of what’s going on in patients is the highlight of his job. Aided by an array of X rays, CT scans and ultrasounds to assist in diagnosis, Rittenberry is often the first and last line of defense for patients when things take a turn for the worst. “I take that information gained from those tools and I tell someone what they need to do to improve their health,” Rittenberry says. “About 25 percent of the patients I see end up being admitted to a room upstairs for further treatment.”
With such a strict regimen, time management is an important skill for the staff of Methodist North. In a hospital stocked with 45 beds in constant rotation, Rittenberry sees as many as 5,000 patients a year. “It’s all kind of a blur after 13 years of that,” he says. “I sometimes work 7 a.m. to 7 p.m., or sometimes they switch it up and I’m working the opposite. It’s not very good for the sleeping habits but I wouldn’t have it any other way.”Most of the issues Rittenberry deals with relate to heart attacks, stroke and abdominal pain, while severe trauma incidents are directed to the Regional Medical Center, though he’s seen his fair share of injured patients. “Every now and then we have someone who gets shot and thrown in the back of a car and we have to deal with it,” he says. “We work to stabilize them and eventually transfer them to The MED.”
His duties can vary between 12-hour shifts — from treating wounds to providing patients with a brief moment of comfort or understanding of their affliction. “The worst things are gunshot and stab wounds,” he says. “But they’re not incredibly common here — you always keep the zebra in the back of your mind—common things are common, uncommon things aren’t.”Patient-physician relations have made strides at Methodist in recent years, even going so far as to allow a degree of family observance in the ER. “A while back, a mother was having CPR performed and the family chose to watch,” he says. “It wouldn’t be my choice to see my mother in the ICU, but we leave that decision up to the patients’ families. We want them to know that we’re doing all we can down here.”
In addition, Rittenberry prepares patients for life-changing scenarios by printing off a comprehensive diagnosis and detailing the best and worst possible scenarios. “Half of what I do is social,” he says. “Communicating with the patient, telling them things and explaining — making them feel like they have a grasp on what’s going on. As fast as things happen down here and despite the fact that we don’t have endless amounts of time, with the time we do spend, we want to make them feel like we gave a damn.” For Rittenberry, this and breaking the news of an inevitable loss are the toughest parts of his job. “It’s rough, particularly when someone’s family member dies en route to the hospital on board the ambulance and there wasn’t a lot we could do,” he says. “Or when they come in for a light cough and it turns out to be cancer. You try not to say it right away but in the back of your head, you know. It’s the toughest news to deliver and there’s not really a good way to do it.”
Many times, it’s simply phrasing things in a way that can easily be understood by the layman or relating a similar experience from his 13 years as a specialist. “Sometimes, I try to personalize the experience for patients,” he says. “My father passed away from lung cancer when I was younger and that’s something I really notice and talk to my patients about.”While he didn’t always plan to become a doctor, his path took him from working for a small-town drugstore as an undergrad at UT Knoxville to a lengthy career in the medical field. Ambitions to become a pharmacist eventually coalesced into dreams of being a professional healer. “I love the job I do but it wasn’t quite a childhood dream,” he says. “I kind of fell into it over the years and haven’t looked back since.”
The Faces of Good Health
Four MidSouth health specialists healing hearts and minds through groundbreaking treatment and empathetic bedside manner.
Feature | January 2014
Hunter Rittenberry Methodist North
Story by Casey Hilder
In 2005, gunfire nearly ended Dr. Holger Salazar’s American dream.
The place was Tulane University Hospital, a few days after hurricane Katrina famously broke the New Orleans levees. With no power, the hospital’s pharmacy was an attractive target for looters, who began a days-long gun battle with hospital police. Inside, Salazar tried to ignore the gunfire, maintain his sanity, keep his wife and young son safe and keep his patients alive.“We could hear the gunshots all the time;” Salazar remembers. “And I couldn’t just stay with [my family] all the time, I had patients to take care of, so I just told them to stay away from the windows and stay in one place.”
Fortunately, life isn’t always so stressful for the 47-year-old cardiologist. Salazar now works at the swanky Stern Cardiovascular Center in Germantown, a place traditionally devoid of looters and gunfire. The Ecuadorian-born doctor is lean but not lanky, rigid but not stiff. His collected demeanor, professorial attention to detail and South American accent give his speech the rhythmic regularity of a healthy heartbeat.The consistent rhythm belies the severity of his situation as he describes the incidents surrounding the devastation of Hurricane Katrina.“I remember it clearly,” he says. “I was on call so I had to go into the hospital and, of course, stay in the hospital. I had my son and my wife, already had tickets for them so they could leave but she didn’t want to leave.” He repeats the last sentence. “She… didn’t WANT to leave.”
Salazar’s wife and son went to the grocery store for supplies, and then came to the hospital to hunker down until the hurricane arrived the next morning. When that did happen, the early results looked promising. “Nothing really seemed to be happening,” he remembers of the storm itself. “There were some winds but they were not bad winds; there were some windows that appeared to be broken in some buildings in the surrounding areas, but nothing else than that. Then all of a sudden, everything was gone and everybody was happy and no problems.”
On the day of Katrina, at least for Tulane, there were no problems. That changed quickly though.“Monday night, and I was awoken around probably three in the morning by another physician saying that we have to meet,” Salazar says.“At that point, we were told that the levees broke and it was a matter of time before the city was going to be flooded. So we have to organize our patients for evacuation at that point.” For nearly 48 hours, the hospital retained most of its functionality. Every one of the more than 300 patients and family members, along with 50-plus staff and family members, were eating three meals a day. Tests could be run; patients’ progress, input and output checked; and temperatures controlled.
However, the tone quickly shifted when flooding drowned the power.Indoor temperatures spiked to more than 100 degrees. Hydrating patients of varying needs became a guessing game — that is, when potable water could be found. IVs, EKGs, X-rays, lab work and pretty much every mechanical test were now unavailable. The doctors and nurses were left with only the bare essentials — their physical exam skills — to evaluate and treat patients. And for this, Salazar was uniquely qualified.
In Ecuador, Salazar’s medical programs stressed physical evaluations because the medical schools and hospitals in that county did not have the same “infrastructure” as modern facilities. The fourth year of Ecuadorian medical school is almost entirely devoted to physical examinations, and it was during this year that Salazar was taught by one Dr. Guarderas, who he calls “probably the best teacher I have ever had.”Guarderas was known to be tough. Students who made academic mistakes were punished with weekend shifts supervising interns. At least, that’s what Salazar thinks — he says he was never punished. Guarderas taught Salazar the importance of knowledge, observation and communication in a physical exam. He also inspired Salazar to become a cardiologist.“Ever since I was six, I knew I wanted to be a doctor or a soccer player,” Salazar says. “But I didn’t know which kind of doctor.”His fourth year fixed that. Every week, Guarderas would assign a part of the body to a student;that student would give a detailed presentation on the subject, including anatomy, embryology and biochemistry, to the class before the professor would speak. Salazar was assigned the heart and that presentation inspired a career.
In New Orleans, with no power, no instruments and a battle raging outside, the lessons of fourth-year medical school became more prominent than ever.Without powered IVs or labs to monitor the patients’ blood, a keen eye and feel for physical examination was required. For patients with potassium issues, Salazar and the nurses would monitor the amount of sweat coming from a patient, on both the skin and the bed, and use that to make an estimate for a dose. As long as the pharmacy stayed protected, most stable patients were kept that way.It was a tough situation but Salazar is no stranger to difficult odds.. Early in his training in Ecuador, Salazar decided he would study in the United States.“Everyone told me I was crazy,” he says. “Not many people had done it before, and no one around me really knew how to do it, but I knew the United States had the best training. Everyone around the world, if you ask them about the best medical training, will say the United States. I had to train here.”The road was not easy. Salazar used a top-class placement in Ecuador to earn himself a five-year cardiology residency in Madrid. While in Spain, he used his nights and weekends to study for the appropriate boards and exams required for acceptance in the US. And accepted he was. He completed a three-year internship and residency at New York Medical College and was recognized as the top resident in his third year. From there, he worked through a cardiology fellowship at Tulane and an advanced cardiac imaging fellowship at the Cleveland Clinic Foundation.He then returned to Tulane in 2003, this time as a professor. And that led into Katrina.
The storm had come on Monday morning. The power went out Tuesday night. While adaptive physical evaluations were sufficient for most patients, some, particularly those with ventricular assist devices — a type of artificial heart — would need a more creative solution.The heart pumps needed power or the patients would die. One was just two years old. Using a barely-alive cell phone and some American ingenuity, Salazar and his team were able to keep the devices functional using diesel generators. It would hold for a few days, and that proved to be enough. On Thursday, the helicopters finally came. After the patients from Tulane and nearby Charity hospital were evacuated, Salazar, his wife and his young son boarded a helicopter and escaped the city.Describing the moment, Salazar remained characteristically level.“That was probably the best time of the last two or three days,” he says. “While there were a lot of shots being fired outside and people making a lot of comments that hospital police may not be able to hold out for much longer. So it was a relief. It was one of the best moments of the four days that I was there.”After escaping, Salazar landed in Memphis.
Within a week, he had interviewed at Stern, and after a few months of going back and forth between Memphis and New Orleans, Stern is where he settled. Now, he specialized in patients rather than research, in lifestyle and diet rather than danger. And it suits him just fine.“I’m happy with what I did,” he says. “Will I do it again? The answer is ‘yes I think I will.’ But would I like to go back to an academic setting right now? The answer is ‘no, I’m happy right here.’”
Story by Doug Gillon
As she walked through the brightly colored hallways of St. Jude Children’s Research Hospital for the first time, Shawna Grissom realized, like so many others, that there was something special about the place.
“I was probably here for about two hours before I realized this was different from any place I had ever been,” she says. “There was a very warm, welcoming feeling and the culture felt very different.”The 37-year-old healthcare specialist, who would soon become St. Jude’s Director of Child Life, was so taken by the atmosphere surrounding St. Jude that she would pack her bags and move from Nashville, Tenn., to Memphis, where she would begin the arduous yet rewarding task of forging a connection with young people and coaching them through the most difficult periods of their lives.As a Child Life Specialist, Grissom works to usher patients and family through the lengthy treatment process, which entails understanding the diagnosis and treatment of a particular form of cancer. She works with children and young adults who may need help coping with the hospital experience during treatment and afterwards. “Children who come here have either been told something very stressful or are about to hear something very stressful,” she says. “We help to break down the information for patients and family in a way they can understand.”
Most of the patients at St. Jude are treated through a combination of chemotherapy, radiation and surgery. Grissom works to prepare nervous patients through the use of sensory-based coaching methods that focus on what the surgical equipment look like, what it smells like and how cold or hot the equipment might feel. While this seems like a small part of the overall St. Jude experience, Grissom says that knowing what to expect works wonders in ensuring patient comfort. “I remember sitting in a doctor’s office before a checkup making up stories about how it’s 10 times worse than it actually is,” she says. “Well, with kids it can be about 100 times worse.”
If St. Jude is a school, Grissom can be seen as equal parts of coach and counselor. Grissom’s individualized approach to patient education entails a myriad of methods to prepare for the trials ahead. Because her patients are divided by age and developmental level, this can mean anything from bringing in teaching dolls, medical equipment, anatomy manuals or iPad presentations to better understand what will happen in the months ahead. She also works to build coping skills through relaxation techniques like guided imagery or meditative breathing exercises. “We’re teaching them about the diagnosis, as well as preparing them for obstacles they might encounter in the future,” she says.And when a young life is put on hold due to a chronic illness, she is among the first specialists that a family meets. While treatment is a necessity in these situations, Grissom and the staff at St. Jude believe that’s no reason to miss major milestones in life. “We don’t miss birthdays. We don’t miss prom. We don’t miss holidays, either,” Grissom says. “Santa Claus knows these guys are here.”
This mindset is perfectly apparent during St. Jude’s annual formal in April. The event is like any other prom in the United States; girls choose their dresses and guys pick out a tuxedo before being transported via limousine to the St. Jude Pavilion for a unique procession surrounded by peers. “There are pictures, food, dancing — everything you would expect at a prom,” she says.Grissom recalls one story in particular that stood out of a young woman who checked her prosthetic leg at the door. “She must’ve decided to go without it for the night. The girl’s father came in to check and he started bugging her about the leg and she shouts ‘No! Take my leg, I don’t need it right now,’ as she was cutting up on the dance floor and doing wheelies in her prom dress.”
For Grissom, that’s what her job is all about. Through a combination of empathetic treatment and life coaching, the girl was able to normalize her environment and momentarily cast off the weighty shackles of cancer treatment to live life as an ordinary teenager. And St. Jude provides this all free of charge, with no family ever seeing a hospital bill. The hospital’s primary operating cost of $1.8 million a day is funded largely through public contributions. Due in large part to the efforts of St. Jude staff, overall survival rates of various forms of childhood cancer have risen nearly 60 percent since the hospital opened its doors in 1962.
Story by Casey Hilder
As Memphis’ foremost orthopedic oncologist, Dr. Mike Neel has pioneered changes in a myriad of procedures that were once guaranteed to end in amputation. Neel specializes in limb salvation and the diagnosis and treatment of various kinds of bone cancer.
Through his treatment and research, he has saved countless lives and limbs in the battle against osteosarcoma and other forms of malignant bone growth.Neel’s role as one of less than 150 orthopedic oncologists in the country attracts patients in need of highly specialized care. With the aid of a team of nurse practitioners, he has divided his time as an orthopedic specialist between OrthoMemphis and St. Jude Children’s Research Hospital for 19 years. “It’s about a 50/50 split,” Neel says. “It’s a challenge, but I have a lot of people to help me bridge the two worlds.”Neel’s work alongside 16 other specialists at the OrthoMemphis clinic in East Memphis consists of surgical procedures to remove malignant bone tumors, while avoiding amputation in the process.
Limb-sparing procedures at this location are often performed on adults seeking total hip and knee replacements, as well as those with oncological issues such as metastatic tumors associated with other forms of cancer that may have spread to the skeletal system. “With adults, the orthopedic problems are usually secondary to their primary cancer,” he says. “We see a lot of patients with other forms of cancer, where it has spread to the bone.”While much of Neel’s work at OrthoMemphis focuses on adult reconstructive surgery, his time at St. Jude is spent developing new and innovative surgical techniques and methods of treatment for younger patients. At St. Jude, Neel deals with the removal of malignant tumors, as well as the application of various prostheses and management of complications associated with leukemia and subsequent chemotherapy.In adolescents, the problem usually begins within the musculoskeletal system in the form of malignant tumors caused by osteosarcoma, the most frequently contracted form of bone cancer in the United States.
Neel’s research also deals with Ewing’s Sarcoma, another form of bone cancer that primarily affects the arms and legs. Both are especially prevalent in younger cancer patients.Aside from the research and obvious age discrepancy in patients, Neel’s job at St. Jude carries a few added bonuses. “I tend to get more hugs from the kids, I think,” he says.Neel’s other duties include treating bone lesions and making strides to shape larger invasive surgeries into smaller, more manageable procedures with less lingering trauma. However, simple pain management is often key for the day-to-day rigors of treatment. “Sometimes, you’re doing nothing more than making the patient comfortable,” he says.
In 2005, Neel performed a first-of-its-kind surgery involving the implementation of the bone transport rod, a high-tech tool that eschews the traditional bone-graft method in lieu of a state-of-the-art metal rod. This procedure is unique in that it allows for a patient’s prosthesis to grow along with them by moving the tumor along the bone and adjusting by centimeters as it scales to a patient’s exact height. “We’re able to move the defect down the bone – like a napkin ring – and new bone is filled in behind it,” Neel says.Patients return periodically for a noninvasive lengthening procedure. This provides newly formed native bone that adapts to a patient much easier and presents a safer, less invasive alternative to traditional bone grafts. The recipient, a young osteosarcoma sufferer, eventually made a complete recovery. “Right now, he’s back to lifting weights, jumping rope and doing everything he wants as an 18-year-old kid,” Neel says.Stories like this have become the hallmarks of Neel’s career.
A native Memphian and father of two, the University of Tennessee graduate is familiar with the characteristics that make a superior surgeon. “The most important quality is somewhere between compassion and energy – nobody goes into this business without a healthy dose of both,” says Neel.Pain management with a focus on comfort seems to be the central theme of OrthoMemphis, which provides a variety of services in addition to Neel’s oncological offerings, including treatment of the spine, hand, foot and athletic injuries. “We’re big enough to provide a lot of services, but small enough to have a lot of professional interaction among the different surgeons,” Neel says.
Story by Casey Hilder