FEATURE

A TALE OF TWO ROTATIONS

BY ROBERT MENDELSON CULTURE SAMPLES

hen the Italian airliner’s wheels touched ground in , , one of its passengers—a fourth-year Wmedical student from the University of —felt a bit overwhelmed. Heather Hollowell had never before ventured outside the . She spoke no Italian and knew no one who wasn’t an ocean away. Yet, for two months this island city would be her home while she completed a rotation at a UPMC affiliated transplant center whose name she couldn’t pronounce: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Fourth-year students roll up their sleeves at a new and badly Specializzazione (ISMETT). needed transplant center in the Mediterranean. ABOVE: Cristiana Bertocchi, MD ’01, (middle) at PHOTOGRAPHY | COURTESY ISMETT ISMETT with colleagues. RIGHT: AND HEATHER HOLLOWELL Heather Hollowell, MD ’01, was the first Pitt student to be trans- planted to Palermo.

12 PITTMED OCTOBER  13 Months earlier, in the fall of leg of her trip, her panic returned. There was some third-world country in the dark ages.” 2000, Hollowell received a no English translation on the flight. Oh my Speaking in Italian to her only daughter, scholarship funded by the God, she thought, what am I doing? Bertocchi’s mother would reminisce about Italian company, Nuovo Istituto walking out her door and taking in views of the Sieroterapico Milanese, that ristiana Bertocchi, MD ’01, wasn’t Mediterranean or the Apuan Alps and its would make her the first med- doing anything special to prepare for famous quarries that provided the white marble ical student to do a rotation at Cher two-month rotation at ISMETT, for Michelangelo’s sculptures. She would ISMETT and let her glimpse a which would begin in March after Hollowell, recount the neighborhood open-air markets different way of life: “I had really hoped to a classmate, returned to Pittsburgh. Bertocchi where she could buy the freshest vegetables, expose myself to some cultures outside didn’t need to make special preparations. She cheeses, meats, and fish. She would describe the America during my undergrad days. But then was going home. Not home to where she was readily available yards of leather, wool, cotton, it was either research or go abroad, and I fig- born and raised. That was Kittanning, and linen that she turned into the most elegant ured research was more important for getting Pennsylvania. clothing. Mrs. Wanda Bertocchi missed all of it; into medical school.” As a result, she spent a , though, was the home she always and although her daughter had never known summer in the University of Delaware’s heard about. Her mother had come from a that way of life, part of her began to long for chemical engineering department learning small Tuscan city called Avenza. Wanda those days, too. about the crystallization of cholesterol in Micheli never had any intention of leaving model bile and how it affects conditions such Avenza, not until—just like in the movies— nce on the ground in Palermo, as gallstones. She didn’t learn, however, to say, she met a handsome American soldier who Hollowell was greeted by Claudia How are you feeling? in Italian. was stationed in Italy. It was the mid-1950s OCirillo—ISMETT’s administrative So, in preparation for Palermo, Hollowell and during a weekend leave when Herman coordinator for international relationships. purchased several Italian language tapes and Bertocchi decided to travel around Tuscany; Hollowell was happy to have the Italian guide. books, but her fourth-year medical rotations his parents had emigrated from the region. When they hailed a taxicab to take Hollowell kept getting in the way of her language study One day, as he visited with cousins, aunts, and to her studio apartment, she realized the cab time. About a week before her trip, she felt uncles, he was introduced to a family friend, driver didn’t speak English. more than a twinge of panic. ISMETT staff Wanda Micheli. It didn’t take long for a Hollowell quickly learned that Palermo’s spoke English, she had been told. But she courtship to blossom between the soldier and cabbies make New Jersey’s seem like chauffeurs. wondered, how would she communicate the young woman. The couple was soon tak- Generally, Sicilian drivers tend to ignore stop with the rest of Sicily? During a call back to ing in operas performed in ancient coliseums signs and pedestrians. Their bumper-car size her home in New Jersey, she said to her The center rushed to open its doors before it had its own doors, for good reason. mom, “I can’t believe that in a few days I’m going to Italy for and spending afternoons at nearby freshwater Micras typically race through the city’s cobble- two months, and I haven’t had time to learn lakes. They fell in love, but were separated stone streets—streets that were built hundreds the language. I don’t know what I’m going to when Bertocchi’s two years of duty ended. of years ago for horse-drawn carriages and now pack, and I don’t know where I’m staying.” It took nearly 10 years of convincing, but make up an inner-city beltway with a distinctly Hollowell relaxed a little after her moth- Herman Bertocchi finally enticed Wanda NASCAR flavor. er—a college English professor and frequent Micheli to join him in Kittanning, where he Along Hollowell’s inaugural journey, she did traveler—reminded her that English was a sec- had become a successful certified public manage to peek out the window a few times. It ond language in most countries. Hollowell was accountant. She became his wife and the was like riding into a travel brochure—uninhab- able to get along fine, as her mother had pre- mother of their four children. ited, jagged mountains rising majestically from dicted, when her flight from the States landed “My mom said she was happy,” says the island, the Mediterranean looming in the in . Courtesy of the terminal’s bilingual Bertocchi, “but in many ways it was a huge distance. In the heart of Palermo, the streets Partenze/Departures monitors, she was able to culture shock for her—the fashion, the food. were shuttered on either side with centuries old check on the status of her upcoming flight to And she spoke little English at first; she told three- and four-story edifices bordered by Palermo. However, when she began that final me that neighbors thought she came from flower beds; laundry fluttered in the breeze

Life at ISMETT could be compared to working for a start-up, which made it natural for students to structure their own rotations. LEFT: Lisa Wehner, a nurse, with new friend Hollowell. RIGHT: Salvo Gruttadauria, Res ’98, senior fellow in transplant surgery, with Bertocchi.

14 PITTMED from second-floor balconies like some kind of up company. People juggle multiple roles and (right) is pleased that national flag. incredible responsibilities. Pathology is a good American students now travel to his home The next day, Hollowell officially began her example. Marta Ida Minervini is not just the country to train. rotation. She survived another cab ride, this one chief pathologist. She is the only pathologist. to the hospital. Once there, she tried to figure (On some tough cases she consults with wait their turns while some patients from Italy out where to report. Nobody was sure. The pathologists in Pittsburgh via a secure Internet were given organs from American donors?” he transplant center had admitted its first patient connection.) The center rushed to open its reasons. in July 1999 so protocols for the English-speak- doors before it had its own doors, for good rea- Europe reacted even more dramatically to ing hospital were at a minimum. Hollowell son. Until 1995, southern in need of the shortage. “Belgium, England, France, and sought out Ignazio R. Marino who is on the and other organ transplants would have Germany decided to go suddenly to zero [for- transplant team at UPMC Presbyterian in them performed abroad because the proce- eigner transplants],” Marino recalls. “And in Pittsburgh as well as director of ISMETT. dures weren’t available in the region. All Rome or Milan, they had a subtle way of tak- Marino effectively told her to make herself at expenses were paid by Italy’s national health ing care of the people of northern and central home, Hollowell recalls: care. In 1995 alone, Italy spent for Sicilian Italy first.” “He said, ‘Just talk to different people [on transplant migrations more than 252 billion Nobody, it seemed, was looking out for the staff] and figure out what you want to do lira (more than $125 million). It may not southern Italians. “These people started to and just let us know. Whatever you decide, it’s have been the most cost-efficient system, but be desperate,” Marino says, “because even no problem.’” Then, he flashed a welcoming lives were saved. though the government would pay for their smile and dealt with the three or four hospital The situation changed dramatically in transplants, they had nowhere to go.” Italian employees vying for his attention to discuss 1995 because of an ongoing donor organ government officials decided something had some pressing concern. shortage. That’s when the US Congress stipu- to be done. In 1997, they formed a working ISMETT’s atmosphere, with Marino at the lated that 95 percent of all transplant recipi- partnership with UPMC to create a facility helm, could be compared to that of a small start- ents had to be US citizens. At that time, more with transplant capabilities, along with spe- than 50,000 Americans were on organ waiting cialized surgical and diagnostic services. The lists. Marino, who was born in plans call for Marino to oversee four operating Italy, witnessed firsthand that deci- rooms, 14 ICU beds, and 44 acute care beds, sion’s impact as a transplant sur- to be operational by 2002. geon at UPMC Presbyterian (where It became clear though that southern Italy he was recruited after his residency couldn’t wait that long, so on July 21, 1999, at the University of Cambridge). ISMETT’s first patient was admitted in a There were scarce opportunities for temporary location on the second floor of the Sicilians in need. Palermo hospital Civico. Marino and his staff “How could you tell people oversee two operating rooms, four ICU beds, from Pittsburgh they would have to and 16 acute care beds there.

OCTOBER  15 “In our first year and a half,” notes Marino, him sit up so I could listen to his lungs. I Bertocchi takes a break with junior fellow in “we did 63 transplants, 84 liver resections, would always ask him in Italian how he was infectious disease, Vincenzo Lamonaca, at more than 600 difficult cases, and more than feeling, whether he was in any pain, if he felt ISMETT’s cafeteria (al bar dell’ospedale). 900 interventional radiology procedures. This he was breathing better.” The questions, by was from nothing! And our survival rate is design, called for succinct responses. When Bertocchi excelled in science and had within the best five transplant centers in the the response became more than a yes or no, thought about becoming a doctor in college; world.” Marino is understandably proud. Hollowell would head to the hallway for help. instead, she majored in Italian during her Like any bright new employee at a start- “By the fourth week, I could speak func- undergraduate studies at Pitt, with a minor in up, Hollowell quickly immersed herself into tional Italian; I was finding my way around French and Spanish. After working for a few the hospital’s culture. She decided to spend Palermo without any problems. I could go to years as an interpreter for Pittsburgh compa- her first two weeks in the ICU, followed by the market, things like that, but I couldn’t nies involved in international business, she two weeks in surgery, and the final four weeks speak well enough to have true conversations spent a year in France teaching English to high in infectious disease. She saw some cases she with the patients. I could ask them simple school students. While there she had an would never come across in Pittsburgh, questions like ‘Do you have pain?’ ‘Do you appendicitis attack. For many people, the including a man enduring a mysterious feel better—on a scale of one to 10?’ prospect of being admitted to a hospital in a inflammatory reaction in his liver and lungs. “I must admit it was a little frustrating. It foreign place would be frightening. Bertocchi’s “He was on a ventilator. We didn’t think made me realize the importance of doctor- experience rekindled her desire to become a he was going to make it. We were talking to patient communication.” physician. When she returned to the States, experts around the world, and there was a she took the necessary premed courses and lot of prayer going on,” says Hollowell. She he Italian that once flowed so easily in watched the staff systematically rule out var- the Bertocchi household became stilt- ious causes. Ted when Cristiana Bertocchi was 14. At last, they figured it out. He had strongy- “My mother was thinking words, but she loides from stepping on a rare worm that just wasn’t able to say them, and it upset and thrives in the Sicilian climate. The parasite frightened her,” she notes. had entered his body through his foot, and Wanda Bertocchi was diagnosed with a made its way to the lungs and liver. “We gave brain tumor. “It was developing on her left him dozens of different antibiotics,” frontal lobe, and the left side is what controls Hollowell says. “One of them finally worked. speech,” Bertocchi explains. Her mother He didn’t lose his liver or lungs, and he ended underwent treatment, to no avail. In 1986, up being fine. In the morning, I would have about a year after her diagnosis, she died.

16 PITTMED exams, then attended Pitt’s School of Medicine. uring their respective two-month “We were supposed to do a big abdomi- For her final rotation before graduation, rotations, Hollowell and Bertocchi nal case, but then we were alerted about a she was given the same leeway at ISMETT as Dfound time to enjoy Palermo’s liver. I had stayed on call the night before, Hollowell. Bertocchi segmented her rotation treats such as the local beaches and the daily but I wasn’t going back to my apartment.” into four two-week increments: nephrology, street fairs. The real thrills though were the While a team went to harvest the organ, surgery, ICU, and infectious disease. opportunities to participate in transplants. Bertocchi and the others waited. No matter the specialty, though, her days “I didn’t get to see a liver transplant, bad “We were going to be there all night, so usually began with ICU rounds, and discus- timing on my part,” quipped Hollowell, we kind of rested and looked forward to it.” sions during those rounds began in English. “but I did get to see a couple of living-donor The operation started around 5 p.m., That was necessary, in part, because in order kidney transplants.” One sticks out in her with a Phil Collins CD playing in the back- to fill a number of the medical positions, staff mind. A mother was donating her kidney to ground. “There were six of us: two attend- from Pittsburgh were recruited. Yet, on more her adult son. Once the transplant was com- ings, two fellows, a scrub nurse, and me. than one occasion, those ICU consults would pleted, the son wanted to be discharged. Dr. Marino was heading it up,” says drift into Italian before returning to English. “He didn’t want to stay there, even Bertocchi. “There was a lot of commotion Bertocchi never missed a word, often taking though he still was recovering. I think it was throughout the evening; people were com- notes on the modulo disposizioni medicine just the whole euphoria of getting a trans- ing in and out of the OR, music was play- (physician order sheet). After the morning plant. We were concerned about whether he ing, and there was an aura of camaraderie. rounds, she and some of the Italian trainees would comply with the regimen and medica- It was just a lot of fun.” would often hustle to a nearby diner (called a tions necessary after a transplant.” Hollowell, At 4 a.m. the sleep-deprived student bar) to grab a quick espresso and maybe a cor- in her functional Italian, and the doctors on scrubbed out. Bertocchi had a cold piece of netto filled with apricot jam. staff regularly reminded the patient that his pizza that had been ordered in the middle of the night, then went back to her flat, con- vinced more than ever that she wanted to be The patient slipped out of bed and started shuffling a surgeon. The operation concluded around down the hall in his bathrobe, towing his IV line. 5:30 a.m. Another ISMETT success. oth alumnae are settled into their res- During rounds, patients sometimes would operation was more complicated than some- idencies now: Hollowell in emer- become anxious, lying in bed unable to under- thing like having a hernia repaired. Bgency medicine at the University of stand doctors and nurses as they discussed After his discharge, he returned days Virginia and Bertocchi in surgery at their cases in English. One man with a treat- later with a serious urinary tract infection. Allegheny General Hospital in Pittsburgh. able liver problem found the staid stares of Doctors speculated that it resulted from his Each speaks fondly of days at ISMETT and medical professionals caring for him disquiet- forgetting to take his medication. Hollowell the emotional good-byes from the little ing. So one afternoon as the attending physi- sat down next to him and reiterated the island in the Mediterranean. cian and his sober throng of trainees moved on importance of regularly taking his medica- “My hands were flying every which way to the next room, the patient slipped out of tion. The way she phrased the message must on my last day,” says Hollowell. “My speech bed and started shuffling down the hall in his have clicked. had become a lot more visual in two bathrobe, towing his IV line. Bertocchi spot- “He finally realized how sick he was,” months. I guess I fit right in.” ted him and broke off from the group. says Hollowell. “You never wish sickness When Bertocchi began to say good-bye Signore, stia attento alla linea! She convinced on anyone, but this episode helped him to one of the Italian nurses, a handshake him to return to his bed. understand what we were telling him.” He didn’t seem appropriate. They hugged and “He wanted to make sure he was going to had no further recurrences while Hollowell gave each other a kiss on both cheeks. That be okay,” Bertocchi says. “I told him that bar- was at ISMETT. established Bertocchi’s departing modus ring any complications he would be fine, and Bertocchi won’t quickly forget a transplant operandi. Handshakes for the Americans. he said, ‘God bless you.’” that came up during her rotation: Hugs and kisses for the Italians.

ABOVE: Bertocchi on rounds; scenes from Palermo. Both students made time to enjoy their new surroundings.

OCTOBER  17