By Lillien Waller

In an overtaxed healthcare system, personal connection can feel like a luxury. But for these alumni/ae, knowing and treating patients as individuals is core to their practice, whether they’re redefining palliative care, breaking down health disparities in communities of color, blending math and biochemistry to improve clinical trials, or caring for HIV patients three decades after their initial diagnoses—a miraculous feat, in retrospect. Keep reading to step inside four radically different doctors’ shoes to learn how they’re elevating patient care.

Living Through Crisis: Elizabeth Kass '76

In June 1981, the CDC published an article on the first known cases of a rare lung infection called pneumocystis carinii pneumonia among five gay men in Los Angeles. By December, 337 cases of severe immune deficiency had been identified, with a mortality rate of nearly forty percent. By 1989, more than 100,000 cases were reported in the United States; that number reached half a million just six years later.

Elizabeth Kass, M.D., a physician working in internal medicine at Atrius Health Kenmore (Harvard Vanguard) in Boston, remembers that era well; she saw her first patient with the disease in 1983, while still in medical school. “She was a woman, an injection drug user,” Elizabeth recalls. “She would have been labeled something much more stigmatizing then.” Elizabeth was doing a cardiology rotation at Worcester City Hospital, which served lower-income populations in the city. At that time, women weren’t thought to be significantly affected by HIV, but by the start of her residency at Yale-New Haven Hospital in 1985, Elizabeth notes, a lot had already begun to change: what the medical community knew about the disease, the populations affected by it, the opportunistic infections to which these patients might be prone, even the terminology.

“Things really changed radically between ’85 and ’88 when I was in training, but we still didn’t really know much,” Elizabeth explains. “It took a while to figure out that people could have been infected and not necessarily be sick, because we were testing and seeing people who were hospitalized, and those people usually came in with one of a number of bad opportunistic infections. In ’88, AZT, which was the first somewhat effective antiviral [medication], became available. Initially, we had to get people into studies to gain access to it. Turned out the story was much more complicated than we understood.”

Elizabeth still works with patients who have HIV, some of whom have been in her care for decades—a fact that would have been unimaginable thirty years ago. The COVID-19 pandemic brings up obvious parallels for marginalized and lower-income populations: fear of contamination, proliferation of mistrust and misinformation, and the many ways human culture has been irrevocably altered. She notes, however, that the pandemic affected all of us, including those who have not suffered a (serious) bout of COVID personally.

“I still take care of people with HIV who acquired it in the late ’80s, early ’90s,” Elizabeth says. “While they survived because of effective medications, they’re all scarred by the consequences of having lived through that and what that did to their community, what they saw, the choices they made in terms of jobs and life, and the physical consequences. For me, it’s always really important to be informed by what those older people in particular have been through, that I understand in a different way by having lived through it with them.”

How Healthy People Can Be: Resa Caivano '95

Ever since she was a five-year-old in the delivery room waiting for her brother to be born, Resa Caivano, M.D., M.P.H., A.F.P., has wanted to be a doctor. It is the only thing she has ever wanted to do, she says, and serving marginalized communities is her passion and her honor. In her early days as a practicing physician, Resa and other doctors like her were charged with treating just the ailment at hand: for example, if her patient was diabetic, Resa was expected to treat the diabetes—not the social factors that may have determined that patient’s access to healthy food and exercise, exposure to stress, ability to afford medication, or access to basic healthcare in the first place. Medicine, dispensed on an individual basis, with the doctor as absolute authority, was routine. Expected.

Now a specialist in family medicine with the Southern California Permanente Medical Group (SCPMG), Resa has been a physician long enough to see a shift in that conventional wisdom, both inside and outside the medical community, addressing health disparities as well as the role and responsibilities of physicians. Effective medicine is a holistic practice and a partnership. It is built on trust. And it requires an all-hands-on-deck approach from the healthcare providers, policymakers, and patients.

“It all connects. The psychosocial aspects of people’s lives really impact their health and their living situation and the situation they were born into that they don’t have much control over,” Resa explains. “It really does impact how healthy people can be. I saw that at a very early age in my medical career, and that’s why I also do all the policy work and the government relations work, because as much as I can tell someone how to take their diabetes medication, if I can’t provide them with the ability to access healthy foods and green spaces for their kids, then I’m just going to be continuously fighting childhood obesity on a one-person basis. Caring for communities and caring for people is essential, because individuals are a part of larger communities that are impacted by all of these things.”

In addition to practicing family medicine, Resa is an assistant professor of health systems science at the Kaiser Permanente Bernard J. Tyson School of Medicine, the Director of Government Relationsand a board member for SCPMG, a trustee for the California Medical Association, and one of the tri-chairs for the Health Equity Council for the Los Angeles County Medical Association, among other roles—each one an opportunity to engage with the many stakeholders in community patient care.

Resa specializes in the care of adult sickle cell anemia patients, an interest she developed and nurtured as a student at Howard University College of Medicine, which had a sizable sickle cell population. After working at a number of federally qualified health centers in New York City; Washington, D.C.; and Los Angeles, she came to Kaiser Permanente’s Sickle Cell Center of Excellence in Southern California, one of only a few such programs for adults in the country.

At Kaiser Permanente for nearly a decade, Resa continues to focus on addressing health disparities in communities of color. She divides her time between the Inglewood clinic and teaching at the medical school where a unique, two-year mandatory course in service learning essentially passes the torch. “We talk about the impacts of structural and systemic oppression on communities and health and how to engage in community research and community advocacy in a partnered way,” she explains. “So, that’s what I teach folks about, getting them to really think about how to address health-equity issues with physicians by starting them young.”

More to Discover: Sarah Kolitz '97

Sarah Kolitz, Ph.D., can still recall the moment, long before she worked in biopharmaceutical research and development, when reading about polypeptide translation in a Commonwealth biology class brought her a feeling of joy and (somewhat misplaced) certainty.

“It’s funny, because the name is really similar to my current field [translational medicine]. But I was reading about the process of protein synthesis…I just remember thinking, ‘It’s so cool how they figured this out. And it’s neat how it works, because there’s this clear description in the textbook,’” Sarah recalls, laughing. “And then I got to grad school, and I ended up working on one tiny component of that exact process for so many years. That’s when I fully understood that it’s not figured out. There are so many aspects of this that are really not known. It’s as if my worldview shifted.” Curiosity has since replaced the certainty Sarah felt in her Commonwealth class, and that drive to discover now shapes much of her current work as Vice President of Translational Medicine for Cambridge biotech firm Immuneering Corporation. There is always more to learn.

The path that led Sarah to biopharmaceuticals was also not a direct one. After Commonwealth, she focused on math at MIT, graduating with a minor in music. A longstanding interest in biology remained, however. Even as she pursued graduate programs in mathematics, she wanted to apply her studies in a way that would be useful to biologists, ultimately arriving at The Johns Hopkins University School of Medicine, where she pursued doctoral work in biophysics and biochemistry.

“I felt like it was language immersion. I had no idea what anyone was saying for a year,” Sarah says. “But, I learned a lot about biology. At a certain point, I realized that I might not be useful if I didn’t learn how to actually do the experiments. So, instead of working as a computationalist in graduate school, I worked as an experimental scientist in the lab. That combination of computational and experimental backgrounds could, potentially, be really useful for patients.”

Sarah has indeed figured out a way to make that combination useful in her work at Immuneering, which develops medical treatments for oncology patients. Drug development can take years. Her role is to use modeling systems to create an effective bridge between preclinical data and the results of clinical trials that determine how drugs might perform in real-world situations when they are used by doctors to treat people. “So many times there’s this disjointedness between what happens in early research and development and what happens in the clinical trial. Because it’s a big gap between model systems and patients,” Sarah explains. She is charged with narrowing the divide. “Can you make sure that the testing you do ahead of time is going to reflect what will really happen? Part of that is making sure that the data you’re generating from your research is going into model systems that are reflective of the reality you anticipate encountering. I’m the closest that I have ever come to making a difference for patients. I find that really rewarding.”

Talking and Listening: Joshua Hauser '85

By his third year at Harvard Medical School, Joshua Hauser, M.D., was already thinking about specializing in palliative care—but he clearly remembers the two patients who solidified his decision.

The first patient was a man in his internal medicine rotation with advanced scleroderma, an autoimmune disease involving connective tissue. It had spread to his lungs, heart, and other organs. He was in his 30s, and he was dying. Later that same year, during his surgical rotation, Joshua saw an otherwise healthy woman in her 60s, who required a diaphragmatic hernia repair. The typically routine procedure revealed advanced ovarian cancer. Before surgeons found fluid in her abdomen from the cancer, she believed there were years of life sprawled out before her.

Joshua recalls his sense of helplessness, which ultimately propelled him closer toward to palliative care: “What do we say? How do we say it? How do we help these patients in the absence of being able to cure their illnesses? There are things that one can do around supporting patients’ physical symptoms and supporting them psychologically and supporting their families,” he explains. “And I just felt for myself that I didn’t know what I was doing. So it seemed like a big opportunity to think about those topics in this field.”

It’s a common misconception that palliative care, still a relatively young specialty, involves tending only to the dying, says Joshua, who is now professor of medicine and medical education at the Feinberg School of Medicine at Northwestern University and also a leader on the palliative care team at the Jesse Brown VA Medical Center in Chicago. Patients may not necessarily be terminal, or not yet. They may have days, months, or years to live. “It’s caring for patients experiencing serious illness with a focus on treating suffering in any of its manifestations, whether physical or psychological or spiritual. And it involves thinking pretty broadly about what’s important for this patient in front of us and for their family and for anyone whom they love or feel connected to,” Joshua says.

To provide this level of holistic care, palliative medicine is as interdisciplinary as a specialty can be, as critical to emergency medicine and oncology as it is to surgery, psychiatry, or, in Joshua’s case, internal medicine. He collaborates with a team of professionals—a nurse practitioner, a chaplain, a social worker, med students, and more—who together meet and work in consultation with hospitalized patients on a daily basis.

Joshua emphasizes, however, that every healthcare professional, not only specialists, should possess the palliative care fundamentals. “What are the basic communication skills and approaches that everyone can use? What are some of the basic skills of pain assessment and pain management? What are some of the basic understandings of what hospice is, and how do you refer patients to hospice? Because the truth is, in some instances you don’t necessarily want a specialist or have access to one. You want everybody to be able to do some of these basic things.”

These fundamentals, for Joshua, also include things like introducing receptive patients to poetry that might speak to what they’re going through. Combining humanities and medicine is not new, but it is an aspect of his practice that he began a number of years ago and finds fulfilling. Most of this work takes place at the Jesse Brown VA Medical Center. Once every couple of months, Joshua leads a session with his team in which they read and discuss poetry. He and a post-residency fellow have also created a seminar for medical students about poetry and medicine. Joshua and colleagues have also experimented with reading poetry with hospitalized patients, an approach that helps to humanize the patients his team is seeing. This programming is often in collaboration with the Poetry Foundation in Chicago, a relationship that began when Joshua interviewed a patient who happened to be the foundation’s treasurer during a session for first-year medical students. The response from patients has been positive, too. But why poetry? “It allows us to be in an uncertain space,” Josh says. “I think poetry helps us to appreciate ambiguity, which is an important quality of medicine.”

Lillien Waller is a poet, essayist, and editor. Her poems have been nominated for the Pushcart Prize and Best New Poets, and she is editor of the anthology American Ghost: Poets on Life after Industry (Stockport Flats). Lillien is a Cave Canem Fellow and a Kresge Artist Fellow in the Literary Arts. She lives in Detroit. This article originally appeared in the winter 2024 issue of CM, Commonwealth's alumni/ae magazine.

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