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A Day in the Life of AUBMC

By May Farah

No day is ever the same at AUBMC. The only constants are the long hours for medical staff, the high-quality patient care, and a commitment to serving the region. MainGate invites you to take a look.

It is the silence that is most noticeable. The stillness of the early, pre-dawn morning hours are a striking contrast to the movement, activity, and commotion that will virtually fill the entire sixth floor, indeed all the floors, of the American University of Beirut Medical Center (AUBMC), in under two hours.

It is during this “calm before the storm” period, sometime around 6:30, that Dr. Youssef Comair arrives each morning, wearing the several hats that he will be called upon to juggle judiciously more than once during the space of the day.

To describe a typical day at AUBMC would be literally impossible; nothing is effectively routine. In fact, for most of the staff surgeons and specialists, no two days are alike. Except, of course, that they are all long. And they are all irregular.

With the busiest emergency room in town—about 100 cases are handled daily—along with 17,600 hospital admissions annually,
and with private clinic specialists treating up to 120,000 patients per year, the center’s 204 doctors and surgeons have their hands full. But they welcome the heavy workload—it never fails to remind them that AUBMC has regained its prewar stature as the main
referral center for the region.
Foremost on Dr. Comair’s mind is that every doctor and specialist in every department be always prepared to expect the unpredictable, remain focused, and remember the essential, the patient. As the head of surgery of the 400-bed hospital for the past six months, he is responsible for 47 surgeons (most of them trained and board certified in the United States), whose specialties cover the full gamut of surgical procedures, from general surgery to orthopedics, neurosurgery, plastic surgery, and cardiovascular surgery. “The surgery department is dramatically different now than it was 10 years ago,” says Dr. Comair, who also oversees the department’s 21 internal residents, as well as the operating room, part of the Emergency Room, and the Intensive Care Unit.

“On a daily basis I have to ensure quality care at the highest level,” says Dr. Comair, who left the United States to return to Lebanon and AUBMC in 1997 as head of neurosurgery. Since then, he has helped usher in a number of developments, including an upgraded standard of care, the latest in state-of-the-art monitoring devices, and new surgical procedures—all the while maintaining an unwavering commitment to his teaching responsibilities and, above all, to his patients.

Dr. Comair is equally committed and most passionate about being
a neurosurgeon specialized in brain surgery. “I dedicate about 65 percent of my time to neurosurgery, patient care, and education, and 35 percent to running the department,” he explains. Because of his
surgical specialty and as the head of neurosurgery, he is a frequent visitor to the emergency room, which keeps him at the hospital until 9 pm many nights, and for half days at least on Saturdays and Sundays.

As for neurosurgeon Ghassan Skaf, before he even begins his 12 to 14 daily hours at AUBMC, he is certain of one thing: the day is going to be “crazy.” He knows this, he says, because “every day is crazy.” Still, as with many of his colleagues, how the day will unfold for Dr. Skaf, who is a specialist in spinal surgery, is largely dependent on what day of the week it is: a clinic or surgery day.

On a clinic day, he arrives at his office around 8:30 in the morning and sees patients “pretty much non-stop until about 6:30 pm.” But his day doesn’t end there. After he has seen his last patient, there are the hospital rounds to do, followed by the inevitable and endless paperwork. Then there are the times when clinic consultations are interrupted by an emergency case, particularly when the patient has come from a distance and opts to wait rather than reschedule, which makes his day even longer. “We have a large number of
referrals coming from Syria, Jordan, Saudi Arabia, and Kuwait,” he explains. “After September 11, we took over many patients from the Gulf countries, as they were no longer going to the United States for medical care.”

On surgery days, Dr. Skaf is usually at the hospital by 7:30 am. Neurosurgery, especially for major cases, can take five to six hours each; and on some days he may do two or even three operations. Then there are the daily hospital rounds, as well as his teaching schedule to fit in. “So, I don’t usually finish until about 9 pm,” he says, noting that on clinic days it’s generally about the same. And the week doesn’t end there. On Saturdays, there is the week’s overflow to contend with, plus emergencies.

From the day it opened its doors in April 2002, thanks in large part to the persistent efforts of its dedicated board and the financial assistance and guidance of St. Jude Children’s Research Hospital in the United States, the Children’s Cancer Center of Lebanon (CCCL) has not, unfortunately, experienced an idle day.

Initially required to take on 50 new cases per year, the CCCL had already exceeded that number one month short of its first anniversary. “There is a constant stream of new referrals and consultations, at least two or three a day,” says Dr. Samar Muwakkit, one of the center’s two physicians, who is in charge when its director Dr. Miguel Abboud is away. “Including chemotherapy treatments and consultations, we see about 13 to 15 outpatients each day.”

The center deals with many different kinds of cancer, including pediatric tumors, bone tumors, and the most common, leukemia. It has two treatment rooms fully equipped to handle all procedures. And because it is the only center in the region equipped to provide certain procedures and surgeries, it has been taking referrals from other countries. “We provide free tests for any child with cancer, no matter where he or she is being treated in Lebanon, and that includes all pathology and diagnostic tests,” says Dr. Muwakkit, adding that while patients are usually below 16 years of age, slightly older patients are admitted on a per case basis. The center includes 12 private rooms, all decorated in bright cheerful colors, plus two rooms specially outfitted for bone marrow transplant cases.

Over at another new, but totally different, AUBMC center is where Dr. Nabil Fuleihan begins his day. It is the Face Center, a multi-disciplinary unit that specializes in facial and plastic cosmetic surgery, reconstruction surgery, orthodontics, oral surgery, and cranial facial surgery, Between the time he arrives, generally around 7.30 am, until he leaves between 9:30 and 10:00 pm, his time is divided among different kinds of clinical activity and surgery.
Dr. Fuleihan, whose specialty is facial plastic surgery, is chairman of the Department of Otolaryngology and Head and Neck Surgery. In explaining the principal benefit of the Face Center, he points out that it encompasses all sub-specializations, including sinus surgery, facial plastic surgery, facial constructive surgery, head and neck surgery, audiology, and speech therapy. “The Face Center essentially looks at and provides a comprehensive solution to a number of very diverse facial problems,” he says, listing just a few: congenital anomalies, accident-related injuries, cosmetic changes that come with aging, and anomalies of the facial bones, among others. “It’s a unique center in the region and was established just a few months ago,” he comments. “ With its comprehensive management of surgical services, it is of major value to the community as the only place that can handle so many different treatments together.”

The center’s multidisciplinary team meets at least once a month to review and discuss all the common cases. It also holds weekly clinic sessions, generally on Monday morning, when the multiple specialists see all the patients at the same time. There are now 14 doctors affiliated full and part-time with the center, including orthodontists, a speech therapist, and a psychiatrist.

Dr. Joseph Ghafari is the head orthodontist at the Face Center and in the Department of Otolaryngology and Head and Neck Surgery. He believes that AUB’s residency in orthodontics, which is recognized by the Lebanese Ministry of Health, is only fitting, since between 1910 and 1940 the University housed a reputable dental school, which was ultimately closed for lack of funding. “Sixty-one years later, dentistry is back, not as a school, but as a presence,” he declares, “as a separate division of orthodontics and dentofacial orthopedics in the Department of Otolaryngology.”

“There is a history of association with dentists in this department,” Dr. Ghafari adds, “because it is inconceivable to deal with the face without dentists…With head and neck surgery, an orthodontist is really at the heart of work at the Face Center.” He believes the
center is also important from the educational angle, saying, “Because of what it offers, it is bound to attract top-caliber people
to come study here.”

Appealing to the best of the best is a constant impetus to Dr. Nadim Cortas, the vice president for Medical Affairs and dean of the Faculty of Medicine and Medical Center. To that end, the Faculty’s new pre-medical requirements are designed to attract students from all undergraduate disciplines. “The process of selection now emphasizes performance in the undergraduate major of choice rather than performance in the core pre-med courses,” explains Dr. Cortas. “This, we believe, will diversify the competencies and skills of the student body.” And in a side comment, he remarks that in just four years, the number of females admitted to medicine has doubled, from 21 percent in 1998-99 to 41 percent last year.

Dr. Cortas noted that as of next year, early decisions for acceptance will be communicated in March rather than in July, in order “to attract students from outside Lebanon.” And when John Rhoder, director of Hospital Administration, says that AUBMC is “the best medical school in the region” and that with all the specializations it offers “its residency program is equal to that of any reputable university in the United States,” he speaks with the sure authority of long experience in hospitals that also serve as teaching facilities.

The faculty’s placement results speak for themselves. With an expanded elective program and thanks to agreements with universities in North America, 60 percent of AUB’s fourth-year medical
students take one to two months of elective study abroad at some of the top US medical schools, including Baylor, Emory, and Columbia. Out of the students that applied for such electives last year, Baylor accepted 20, Emory 15, and Columbia 5. And in return, during the past three years, about 200 foreign students per year have spent elective periods at AUB. “They came from the region, from Europe, Canada, and the United States; and a few even came from Australia and New Zealand,” confirms Dr. Cortas.

Moreover, a recent agreement signed with the Medical University of South Carolina (MUSC) will allow three post-med II students from AUB to join its MD/PhD program, with all academic expenses covered. MUSC came forth with this offer, explains Dr. Cortas, because four AUB students who had joined the program on their own had excelled. “Three ranked first and second in their class and the fourth, in his second year, is doing excellent work,” he says.

And it doesn’t stop there. As Rhoder stresses, a “top-quality medical school education” doesn’t end at graduation, but continues with “top-quality postgraduate training, and it has been that way for a long time.” The School of Nursing, he adds, is also top-notch. Each year, as many graduates as possible are put through the school’s own strong continuing education and training program. And each year, about 30 to 50 new nurses emerge with flying colors. “But, we’ve become victims of our own success, as many of our nurses are sought out by other medical centers and hospitals,” says Rhoder.

In fact, AUBMC, which was founded as a medical school in 1867, has already received its fair share of recognition and accolades. It recently was awarded the Al Maktoum Prize as having the best medical college in the region. And the Medical Center as a whole received an award from the Ministry of Health, when it was rated as number one in both its professional and service components by an Australian team that had been invited by the ministry to classify hospitals in Lebanon.

The major strength of the Faculty of Medicine and AUBMC lies
in its “human power,” says Dr. Cortas. “We have the best mix in the region: physicians with top credentials, a highly skilled house staff, motivated students, deeply committed nurses, and an excellent nursing service that continuously upgrades itself by in-service training.”