Thursday, May 16, 2013

Dr. Colombani: A New Hand That Shapes ACH Leadership, An Old Hand That Saved a U.S. President




Dr. Paul Colombani
Dr. Paul Colombani
Reagan Thank you letter
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The man who quietly walks All Children's surgical floors these days is more than a valued mentor to physicians, more than a doctor who enjoys getting out of his office to mingle and observe, more than an embodiment of new hospital leadership on a vital mission for the future.

Dr. Paul Colombani, named Chair of Pediatric Surgery in January, is a key addition to the hospital whose leadership ability was forged under fire in a dramatic and unforgettable page from the past.

Thirty-two years ago, on what began as a mundane day for a young chief resident at George Washington University Hospital, he helped save the life of the most powerful person on the planet.
In fact, Dr. Colombani played a pivotal role in pulling President Ronald Reagan and White House press secretary James Brady out of danger on that tumultuous Monday afternoon of March 30, 1981 in the nation's capital.

The fates of the 40th U.S. president and his press secretary - frantically rushed to George Washington's emergency room, clinging to life with gunshot wounds from a would-be assassin - depended on the skill and calm nerves of the then-29-year-old chief surgical resident and a talented medical team.

Only moments earlier, Dr. Colombani had been sitting with several residents upstairs in the call room, going over medical articles in preparation for their weekly journal club meeting at 5 p.m. He had actually been on call the previous seven days and had not been home since Friday. So he was looking forward to going home after the journal club meeting for a special steak dinner his wife had been planning.

The prospect of a hot meal at home suddenly vanished in the heat of an unfolding national crisis.

Yet there was no time to think about the extreme gravity of the situation, how the flow of world events now hinged on each move he and his colleagues would make.

"The way we saw it," reflects Dr. Colombani, "we were just doing our jobs. "

With their hands firmly placed in history.
. . .

It was 2:27 p.m. when a deranged man, John Hinckley Jr., stepped from the shadows outside the Washington Hilton Hotel and opened fire on the President and his entourage.

In an era when nonstop cable news was in its infancy and social media was non-existent, news of the assassination attempt had yet to reach Dr. Colombani and his associates in the call room in the harrowing minutes after the shootings. Instead, their reading session and discussion was interrupted by a standard trauma call over the loudspeakers.

He and fellow chief resident Dr. David Gens, alternating his on-call shift each week with Dr. Colombani, initially dispatched a senior resident they supervised to see what was going on. When they didn't hear back from him, and the trauma call continued, Dr. Gens dialed the emergency room.

Almost instantly, he overheard a clerk on the other line requesting four units of uncross-matched O negative blood - the kind used for transfusion in emergency situations, since it lessens the chances of an adverse reaction to the transfusion.

"As soon as Dave said they were asking for uncross-matched blood, I said, 'We better get down there - there's something going on,' " Dr. Colombani recalls. "We go running down this long corridor though radiology. And you can see there's a limousine out front with the presidential seal on it."

They turned the corner and ran directly into a Secret Service agent with an Uzi submachine gun who stopped them and demanded to know what they were doing. "We're the trauma team," Dr. Colombani responded.
And then they entered a room with two beds. Brady was stretched out on Bed 2, his vital signs indicating he was in the process of dying from the bullet wound to the front of his head, exposing his brain matter.

Working frantically, Dr. Colombani managed to stabilize Brady within 10 minutes, and 25 minutes later had him in the operating room - speed that helped save the secretary's life.

Next he turned his attention to Bed 1, where Dr. Gens, as the on-call chief, had been working on the President. Dr. Colombani will never forget the image.

"He looked like he was going to die," he says. "He had this gray look to him and the gray means you're both hypoxic and hypovolemic. You're in shock and you're not oxygenating well.  And he had no breath sounds on the left side.  He kept saying, 'I'm not shot, I'm not shot. I'm not shot.' "

Every second and minute counted as the two doctors worked furiously to save the president, who was suffering from a collapsed lung and profuse internal bleeding in his left chest. The wound was caused by a knife-like slash from a flattened, deflected bullet that had gone unnoticed by the President and others as he was rushed from the scene.

All the while, the young doctors were guided by a simple tenet from their training as they hurriedly worked to pull the rapidly deteriorating Commander-in-Chief out of his tailspin.

"At George Washington, we saw the poorest of the poor," Dr. Colombani says. "I saw vagrants who came in with trauma but I also took care of Justices of the Supreme Court, U.S. Senators and diplomats. Our philosophy was that everyone got the same care. If you start making adjustments because of this person or that, you start making mistakes. So we always followed the same rules and the protocols for every patient we treated."

The story of what happened next - and in the days that followed -- is only part of a distinguished career that Dr. Colombani has enjoyed over the past 30-plus years practicing medicine.

He has followed a path to a leadership position at Johns Hopkins University School of Medicine as Children's Surgeon-in-Charge, status as a fellow of the American College of Surgeons, serving as a consultant and committee member for many national organizations and now All Children's.

It is here that Dr. Colombani plays an integral role in nurturing physician involvement in the hospital's leadership process. All Children's President and Vice Dean Jonathan Ellen announced his appointment as Chair of Pediatric Surgery in conjunction with that of Dr. Anthony Napolitano as Chair of Pediatric Medicine, hailing the two moves as important milestones in the academic transformation of the hospital.

"I'm thrilled with the appointment of our two chairs and look forward to their leadership in the growth of clinical programs, research and education and the full integration of these three arms of our mission," Dr. Ellen said in unveiling the appointments six months ago.

For Dr. Colombani, coming to St. Petersburg was a natural step in his medical journey.
. . .
For the record, he traveled to Tampa Bay in 2011 as part of the original JHM delegation that met with top All Children's officials about the details of merging the two institutions. He never imagined at the time that he would wind up playing an integral role in ACH's future, but the timing for a change was just right.

After 32 years at Johns Hopkins, 22 of them as division chief, the veteran surgeon was immediately intrigued when Dr. Ellen later called to discuss the position of Interim Chair of Pediatric Surgery.

"I'd done most of what I could do there and maybe it was time for new blood," he reflected. "I felt I could do more for the Johns Hopkins health system and the mission here at All Children's than in Baltimore. So when Dr. Ellen explained that the hospital had never had a chair of surgery, and asked if I'd serve on an interim basis, I said yes."

His decision was rooted in several factors. For one thing, he believed the ACH surgeons needed a mentor to help them develop clinical research, teaching programs and fellowship programs, while also helping them further develop specialized areas of expertise. Yet he also recognized a higher goal.

"The reason I said yes is that I think All Children's Hospital potentially could be a leader in the Southeast, if not the nation, in children's care," he said. "It has all the qualities to do that. Great clinical people. Great facility. And everyone is focused on children."

Dr. Colombani has already made strides in furthering the research and academic mission that has become a driving force of All Children's in its new role within Hopkins. The flagship component is a new educational model to help develop future physician leaders as medical care moves to population health - a preventative approach that explores the biological aspects of a patient's condition against a backdrop of social, environmental, psychological and genetic factors.

"I've been working with the general pediatric surgeons primarily," he explains. "And what we've done is initiate a fellowship in pediatric surgery, and we have an international fellow (Jamir Arlikar). We've made our application to the residency review committee of the ACGME (Accreditation Council for Graduate Medical Education) for a formal U.S.-sanctioned training program in pediatric surgery. We've been site-visited and we'll know in June whether we have approval or not. If we don't get it, they'll tell us what we need to work on and we should be able to get it within the year."

In addition, a new research fellow in pediatric surgery (Sandra Farach) will start work on clinical research in July. Dr. Colombani has brought several clinical trials to ACH from Hopkins and hopes to take some clinical trials from St. Petersburg to Baltimore. He travels between the two hospital campuses frequently, lately every other week, and recruitment for his replacement at Hopkins will begin this summer.

Meanwhile, Dr. Colombani, who also serves as ACH's chief patient safety officer, is excited by the strong leadership foundation already in place at the hospital.

"Historically, the physicians who worked here were in private practice and weren't really part of the decision-making process," he says. "The idea with Jonathan Ellen becoming Vice Dean and President is to have a physician at the helm for the first time in the history of the institution - then bring in Tony Napolitano and myself as physician leaders. There are plenty of people who have been working here, both in private practice and as All Children's specialty physicians, who have been leaders. But they've not really been given a chance to shine. I think making a conversion to a physician-led organization is going to take time, but it will develop leaders."

Dr. Colombani enjoys working with his counterpart, Dr. Napolitano, in orchestrating the shift, and feels they complement each other well.

"We're working together on joint projects like safety and quality and he's helping me, because he knows the culture and people here," Dr. Colombani says. "And I can give him advice on Baltimore. So it actually works very well. Because I know all the pitfalls and work-arounds in Baltimore, and he knows them here."

. . .

Wherever Dr. Colombani finds himself, the memories of the day in 1981 remain crystal clear. He doesn't make a habit of talking about his role in the momentous incident unless asked, as he was for the 2011 bestseller about the event entitled "Rawhide Down: The Near Assassination of Ronald Reagan."

"For most of those 10 days that President Reagan was in the hospital, I have immediate recall - no one has to give me any prompts," he says.

He thinks about it if he happens to read a newspaper story tied to the assassination attempt or an update on Nancy Reagan. Indeed, the former First Lady became a daily part of life for Dr. Colombani and Dr. Gens in the aftermath. She would visit them at 4 p.m. during the 10 days to get an update, then go spend time her husband.

And it was Nancy Reagan who was the reason the President was ultimately taken to George Washington - and stayed there after being shot.

Her step-father was Dr. Loyal Davis, who taught and later worked with the man who served as Reagan's White House physician, Dr. Daniel Ruge (pronounced Roog-ee). When the Reagans moved to the nation's capital in January 1981, her step-father gave her some advice.

 "He said, 'When you go to Washington, tell them you want to go to a civilian hospital if you ever get sick,' " recounts Dr. Colombani. "So after Reagan took office in January, the Secret Service asked what hospital they would prefer: Bethesda Naval or Walter Reed. And Nancy goes, 'neither.' Dan Ruge was sitting there next to her and says, 'No, we want to go to George Washington.' " The agents countered that the hospital couldn't be used because it wasn't secure, but Nancy Reagan responded that the matter was closed.

When Reagan was shot - pinned beneath Secret Service agent Jerry Parr, who pushed him back into the limousine - he insisted he was fine. He attributed the pain in his side to the force of the agent jumping on him for his protection. Accordingly, the limo headed for the White House. But the razor-sharp bullet had imperceptibly pierced his clothing and sliced into him.

When Parr noticed that the President was looking pale and not himself, he immediately ordered the limo to head to George Washington University Hospital - in accordance with Nancy Reagan's previously expressed wishes.  Parr's decision likely saved Reagan's life in a race against the clock.

"He could have been dead if they'd gone to the White House and then came to us," Dr. Colombani says. "They basically arrived unannounced. When Reagan first came in, he stood up and tried to walk, but then passed out. So the nurses threw him on a stretcher and took him into Bay One. He was in shock."

Dr. Ruge insisted that the President be treated by GW's trauma team rather than personally taking command or calling in top surgeons from other hospitals - thus setting the stage for Drs. Colombani and Gens to go to work. "We got a chest tube in, got him IV fluids, got the blood going and got him resuscitated," Dr. Colombani says. "He was awake and talking, but we knew he needed to go to the operating room quickly."

In the whirlwind that followed, a third gunshot victim was rushed into the ER for Dr. Colombani to treat: Secret Service agent Tim McCarthy, who had bravely taken a bullet in the chest intended for the President. The doctor repaired the agent's extensive wounds in the operating room, and then went back and retrieved the bullet lodged in the man's right flank - only after Secret Service agents said they needed it as evidence.

The bullet Dr. Colombani retrieved was in good condition, unlike the other two. It had a hollowed out point filled with metal - a "devastator'' bullet meant to explode on impact and cause maximum damage. Fortunately, none of the three bullets that struck the agent, Reagan or Brady had done so.

The day after the shootings, the Secret Service returned in hopes of persuading Mrs. Reagan to move the President to Bethesda Naval or Walter Reed. "She goes, 'He's staying right here - deal with it,' " Colombani says. "So to deal with it, they put a SWAT team on the roof and took over a medical ward."

That entailed installing bullet-proof glass on the windows, putting up bullet-proof partitions - complete with a high-security check-point to gain entrance. Only three doctors with special white star badges were allowed through the entire 10 days: Dr. Colombani, Dr. Gens and Dr. Benjamin Aaron, GW's chief of cardiothoracic surgery who operated on Reagan and removed the bullet from his lung.

Even as they cared for the President, the doctors were subjected to extensive, precautionary background checks. The journal club room was turned into a White House communications office. A sitting room was created for Nancy Reagan, a conference room established for Dr. Colombani to provide regular briefings and a room with a bed was set aside for the Air Force officer who carried the briefcase containing the ever-present nuclear warhead codes.

All the while, Dr. Colombani was struck by the President's determination to get back on his feet.

"He was very motivated, and didn't want to take any medicine - he wanted to get up and move around, get going, get the show on the road," the doctor remembers. "You could sit down and talk to him. He'd be watching the Today Show in the morning - they'd be interviewing Pat O'Brien and he'd go, 'Hey, Pat, how ya doin'?' We'd sit down with him in the morning for a while and talk to him, and then his staff would bring in papers for him to sign."

Later, after Reagan was discharged from GW, the three primary doctors paid what amounted to a house call, more specifically a White House call, giving him a check-up at 1600 Pennsylvania.

 "We sat and talked to him in his private quarters on the second floor for about an hour," Dr. Colombani says. "It was very nice."

Soon after, the President sent Dr. Colombani a letter of appreciation and a signed photograph. It was a prized keepsake for a job well done, and more than made up for the nice dinner he'd missed out on.

As it turns out, his wife, Linda, who ran a first aid room in a U.S.  Senate Office Building, had told a friend earlier that fateful Monday that she'd defrosted a steak for her husband three days earlier - and if he didn't make it home for dinner as promised that night, she was giving it to their dog.

"Needless to say," Dr. Colombani recollects, "the dog got the steak."

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