Being a pathologist is an important specialty in the medical field that is critical to understanding how diseases affect the human body. It is a specialty that is particularly applicable as the healthcare industry grapples with treating those affected by the novel coronavirus (COVID-19), according to Nicholas Boire, MD ’19, a pathology resident at the Mayo Clinic in Rochester, MN.

“Infectious disease pathology has never been more relevant than now, when we’re actually in a situation where we have a new disease and we, as a science community, are not yet sure how this disease functions,” Dr. Boire said. “We’re still uncovering how COVID-19 affects each body system and its pathophysiology. There are a lot of unknowns with the disease and that’s where my specialty comes into play.”

As an anatomical and clinical pathology resident in the Department of Laboratory Medicine and Pathology at the Mayo Clinic, the top hospital in the United States according to the U.S. News 2020-21 Best Hospitals Honor Roll and Medical Specialties Rankings, Dr. Boire is already making strides within the specialized field. The Long Island, NY, native was part of a team of the institution’s pathologists who performed some of the early autopsies on COVID-19 patients. The group recently published a case report citing its findings.

“COVID-19 (as a pathogen) has been fascinating with regards to my specialty,” he said. “What we saw [in the findings] was a spectrum of neuropathology, including white matter hemorrhages, acute axonal injury, and some lesions that resemble acute disseminated encephalomyelitis. All of this has not been documented before. As our research and understanding of COVID-19 continues to evolve rapidly, it’s helping to highlight what could happen over a clinical course in patients who are hospitalized, which will ultimately help to identify and manage the disease.”

At the Forefront of COVID-19 Research 

The Mayo Clinic has been doing its part to provide critical COVID-19 information and education to the public, to physicians, and to laboratory scientists. In February, the institution developed its own test and had it validated within three weeks—an “incredible and daunting task to those that know how the process works,” Dr. Boire said. In the following days, the institution brought in other commercial tests, and now has those at its disposal as well.

By the end of August, the institution expects to be able to perform up to 30,000 tests a day on the COVID-19 virus, with results within 48 hours if not sooner, according to Dr. Bobbi Pritt, MD, MSc, DTM&H, chairperson of the Division of Clinical Microbiology at the Mayo Clinic and director of the clinical parasitology laboratory at the institution. As an international reference lab, the institution has been asked by the state of Minnesota and nationwide to help out with testing patients.

In terms of research, the Mayo Clinic has concentrated on four main areas, according to Dr. Pritt: finding new ways to detect the virus itself; finding new ways for detecting antibodies to the virus; looking at ways to detect protective immunity from the virus from those who are infected so that their plasma could be given to other sick patients; and also looking at innovative ways for those who are possibly infected to collect a specimen for testing from the comfort and safety of their own home.

COVID-19 has “really brought pathology to the forefront,” Dr. Pritt said. “It’s a powerful opportunity for us as pathologists to be at the table as part of the team making decisions about testing and treating people.”

Working under Dr. Pritt, his mentor, Dr. Boire has thrived in his residency.

“He is a very enthusiastic, innovative, and an intelligent resident. He is very passionate about microbiology and pathology in general. I can see he has a very promising career ahead of him,” she said of Dr. Boire.

A Dream Come True

Obtaining a residency at the Mayo Clinic was a dream come true for Dr. Boire, given the institution’s extensive facilities and strong commitment to patient care and research impressed him.

“The size and scope of their microbiology department is incredible. Each individual pathology subspecialty here is larger than most hospital’s entire pathology department,” he said. “But it’s not only the facility; it’s about the individuals I work with. No matter how difficult a case, there’s always someone to help and one case can be shared with five or six pathologists—each one an expert in a different specialty.”

Dr. Boire spends his days reviewing cases alongside attending physicians involved in his specialty.

“The guiding principle of the Mayo Clinic is that ‘the needs of the patient come first.’ If they believe something will help a patient, they will invest,” he said. “When people around the world don’t know what they have, they come to us. It has been an incredible educational opportunity.”

A Scientist from an Early Age 

Growing up, Dr. Boire was always interested in science and wanted to be a research scientist. With a natural curiosity to learn more, he gravitated toward biology and chemistry. Dr. Boire received his undergraduate degree in biochemistry/molecular biology at Gettysburg College.

Following undergrad, he decided to tackle one of his bucket-list items—by spending time in Africa to serve in the United States Peace Corps. It was while in Africa, volunteering in various clinical settings and shadowing physicians who were providing care to local populations, that Dr. Boire became fascinated with pathology, specifically that of infectious diseases, which were prevalent in the area.

“Pathology interested me because, in medicine, it’s the closest thing to basic science research—uncovering the how and the why of diseases,” he said. “Pathologists are considered the doctor’s doctor.”

Upon returning to the states, he obtained his master’s degree in molecular biology and immunology from the Johns Hopkins Bloomberg School of Public Health. Soon after, Dr. Boire decided to take the next step in his career path by entering St. George’s University School of Medicine MD program.

“SGU got me to where I am and made sure I had the foundational knowledge to be considered competitive during residency interviews,” Dr. Boire said. “The school gave me a foot in the door by helping me get a residency position in one of the best, if not the best, hospitals on the planet, doing exactly what I want to do.”

 

— Laurie Chartorynsky 

As a medical doctor, a health policy researcher, and a lecturer on health systems, Firas Khalid, MD ’09, finds himself in the perfect position to utilize the knowledge and experience he’s acquired to address the present health crisis and its urgent population health needs.

Currently a research manager at Evidence Aid, Dr. Khalid’s expertise in health policy, specifically in health and humanitarian emergencies, is put to good use, as he dedicates his time and effort into translating research evidence to inform policy and practice since the beginning of the pandemic. He spends most of his days ensuring that review summaries relevant to COVID-19 displayed on the company’s website are robust, high-quality, clearly-written and accessible to all users.

“I was always keen to pursue a career in healthcare and in health systems,” said Dr. Khalid, who’s originally from Jordan. “I was particularly drawn to learning how to better strengthen health systems’ response to emergencies. Although I no longer practice medicine as a clinician, I utilize the medical knowledge and experience I acquired from SGU daily in all the roles I play—as an educator to my diverse set of students and as a health policy researcher and advisor on key health issues.”

On a professional level, for Dr. Khalid and many others in the medical community, the pandemic has had a significant impact on his life. He finds himself on the news almost daily, answering COVID-19 pressing questions by the public and utilizing his social media platforms to help disseminate the best available evidence. Meanwhile, as an educator, he’s used this time to push himself to create a new course for his students at McMaster University in Hamilton, Ontario, Canada that addresses current health issues related to governance in health and humanitarian emergencies.

“However, it is on a personal level that I feel this health crisis has had an even bigger impact on my life,” shared Dr. Khalid. “It has brought me much closer to my family and friends, especially my colleagues from SGU that are currently practicing in the US in various specialties, who I turn to daily for their expert insights on major health issues.”

Today, Dr. Khalid is currently leading a monitoring and evaluation research project on COVID-19 evidence summaries to better understand how to support knowledge needs in crisis zones. While in addition to his course at McMaster, he is also teaching two other health policy and systems courses in the fall at Wilfred Laurier University, and York University located in Brantford and Toronto, Ontario respectively.

“COVID-19 has tested my medical and health policy knowledge to the maximum,” added Dr. Khalid. “Hence, I am forever grateful to SGU for the exceptional medical education and experience I received. It has served me throughout my professional and personal career, and I am especially grateful for the lifelong friendships I developed during my time there. My colleagues are my go-to source for the most up-to-date medical insights on a diverse set of critical health issues and they are also part of my extended family. We developed a strong bond because of SGU and the experiences we shared in Grenada and beyond.”

Are you an SGU doctor succeeding in your career? Send us your story ideas. You can also share your story with us on social media by tagging SGU or using the hashtag #WeAreSGU and #SGUAlumni. 

– Ray-Donna Peters

All of those who attend St. George’s University are warmly welcomed to the SGU family. But for many, the pursuit of a career in medicine is truly is a family affair—fathers, mothers, and then years later, their children. There are also brothers and sisters, aunts and uncles, and many more familial connections that are linked in the history of SGU.

To commemorate Father’s Day, SGU caught up with several physician graduates who either led the way for their children, or followed their father’s path to medicine.

Michael (’88) and Alexandra Lacqua (’20)

All her life, family and friends told Alexandra Lacqua, MD ’20, that she was just like her dad, Dr. Michael Lacqua, MD ’88, a reconstructive plastic surgeon in Staten Island, NY. Except she didn’t see it—at first.

The first inklings of her interest in medicine happened in high school, when she began to notice more often when patients would see her dad out in the community and thank him for his help. When Dr. A. Lacqua was in college, her dad founded a nonprofit organization—Healing Hands Abroad. The organization provides volunteer surgical care for underserved communities, scheduling trips to countries like the Dominican Republic, Ecuador, and Belize, among other places.

Dr. Lacqua, who is a triplet with two brothers and also has a younger sister, travelled to Belize several times with her dad to help with the mission work. It was during these trips that she began to envision herself in a career in healthcare.

“The first trip was the first time I saw him in that doctor role,” she said. “It was the first time I was ever in an OR with him and that’s when it started to click for me. I had always seen my dad as my dad, but now I was able to see him as the doctor everyone told me he was. And I could see he truly loved it.”

Dr. Lacqua is about to start an internal medicine residency at Florida Atlantic University in Boca Raton, FL, on Monday. “The biggest thing I learned from him—especially on the mission trips—is to be an advocate for your patients,” she added. “He speaks up for them and always make sure their voices and their concerns are heard and validated. Patients know that and they really value that. That’s the biggest thing I want to take with me. I want patients to know that I am their doctor, and whatever it may be, we are going to work together to fix it.”

Dr. Michael Lacqua actually recognized that his eldest daughter had an interest in medicine when she was just a little girl.

“When she was younger, she saw me excited about going to work and the stories I told. She always asked about my emergency room visits—how did it happen, is the patient OK, how many stitches, etc.,” he said. “As I got into more elective surgeries, and she got older, she would ask more mature questions—they became more medically focused.”

And he noticed the dedication and perseverance in his daughter that it takes to be a good doctor.

“The best advice I could give her was to treat people as if they are your sister, brother, mother, or father, to treat them like they were your own family,” he said.

Dr. M. Lacqua said St. George’s University provided many opportunities—not only with the education but the exposure to variety and diversity on and off campus. “I began to realize that there is more to the world and appreciated more of what was happening in the world,” he said.

He hopes one day that Alexandra will take over the Healing Hands Abroad organization and mission work—and offer additional ways to support underserved communities around the world.

Dr. A. Lacqua said going to SGU was an easy decision for her, after seeing the success her dad has had as a surgeon. “I knew I would be in good hands going to Grenada,” she said.

Following her residency, Dr. Lacqua said she is considering specializing in endocrinology. “I like how comprehensive it is; I am interested in how hormones can really affect every part of the body—especially with diabetes and thyroid issues. I also like how you really get to follow your patients. l like having that time with the patient and being able to have those long-term relationships with patients,” she said.

Two weeks ago, Dr. Lacqua marked her graduation from SGU by having a small graduation ceremony in at her grandmother’s house with family, where her dad hooded her. Despite not being able to attend graduation at Lincoln Center due to COVID-19, “it was nice to mark to the day,” she said.

Rajiv (’89), Samir (’19), and Karan Narula (Term 4)

Rajiv Narula, MD ’89, is proud to keep the SGU legacy alive through both of his sons. His older son, Samir, is a 2019 graduate of the School of Medicine and a current surgical resident at Brooklyn Hospital Center in Brooklyn, NY. His younger son, Karan, is currently a Term 4 student at SGU.

“I am super proud to have them doing what they are and of course going to SGU,” said Dr. Narula, associate section chief of occupational health at Mid-Hudson Regional Hospital and medical director of International Travel Health Consultants, located in Poughkeepsie, NY and New York City.

“SGU gets you ready for the real world of medicine by pushing you to succeed in a very competitive environment with all the needed resources, be it the physical layout of the school, access to study aides, clinical instructors, small study groups, etc.,” he said.

According to Dr. Narula, his son, Samir, is enjoying his surgery residency, while his son Karan aspires to be a cardiologist. Dr. Narula also has a daughter finishing up her undergraduate degree who aspires to go into dental medicine.

“My wife is a nurse, so naturally we have a special interest in health issues,” he said. “I am blessed to have gone to SGU and the life that it opened up to me. I showed them the positive sides of medicine—healing and comforting of people who are at a vulnerable stage in their life.”

Dr. Narula began his career practicing family medicine and made the transition to occupational health. Through the move, he was able to show his children that, in medicine, one can always make a transition into other areas of interest as long as you continue to study and learn.

When asked about the changes between when Dr. Narula started residency and now, he said: “I started residency in June 1990 when healthcare was very different. Managed care was about to start and change the field from fee-for-service with its own issues, to the issues that we see now with insurance overreach into healthcare decisions etc.”

He added: “Today, healthcare is driven by policy, the price of care, and technological advancements—everything is geared toward empowering the patient and toward the prevention of illness. Additionally, patients have much more access to information through the internet, and so it’s much more collaborative now. It makes things easier in a way.”

Despite all these issues in healthcare, the key relationship that matters is the special ones that exists between the doctor and the patient, he added.

Steven (’81) and Sarah Falk (’18)

When Sarah Falk, MD ’18, sat in lectures at St. George’s University, she was taught by some of the same professors who instructed her father, Steven, more three decades earlier as part of SGU’s charter class. It was special for her. When she was just 9 years old, he passed away due to a spreading infection stemming from a hairline fracture in his tooth, and now she too was journeying into medicine.

“Because he passed away when I was so young, my connections with people who actually knew him are very few,” she said. “It was such an honor to come to know people who knew him and were also part of my career path—like Dr. Rao, who remembered so much and said he used to ride motorcycles with him around Grenada. Every person I talked to had such a fondness for him. It was incredible to hear the memories they had of him.”

Sarah Falk seemed destined to become a doctor from a young age—her father an internist, her mother a psychiatrist. Even at a young age, she remembers the impression that her father made on his staff at his convenient care clinic in St. Petersburg, FL.

“I didn’t know the exact hierarchy there, but I do remember how much his staff just adored him,” she said. “I know that he found medicine to be very fulfilling, and I’m just so happy to be walking in his footsteps.”

March 12, 2018 was an emotional day for Dr. Falk—not only was it the anniversary of her father’s death but also the Monday of Match Week. She rejoiced upon learning that she had secured a psychiatry residency at East Tennessee State University’s Quillen School of Medicine in Johnson City, TN. This month, Dr. Falk completed her first two years during which residents provide inpatient care. For her third year, she will undertake outpatient services beginning this summer.

She hopes to further her career by entering a child and adolescent fellowship at this time next year. Dr. Falk is also passionate about fighting for equal healthcare access and rights for marginalized populations, including members of the LGBTQ community. She is proud to continue the legacy of physicians in her family.

“When I was young, I remember my parents coming home and how energized they were about how much they had helped their patients. And I wanted that,” she said. “So when I was deciding what I wanted to do with my life, medicine was always at the top and I never kind of strayed away from that.

“I think about my dad frequently and hope that I’m making him proud.”

– Laurie Chartorynsky and Brett Mauser