What's Behind Curtain No. 2?

At the University of Maryland, the campus medical staff couples patient treatment with healthy doses of compassion, humor and dedication to students.

In a cramped space in the University Health Center that is awhirl with activity, a somewhat unusual operation is in progress. The call goes out for needle-nose pliers and a screwdriver. There's a momentary lull between patients in the Urgent Care area and several staffers are struggling with an errant privacy curtain that has come unhooked in one of the two curtained bays that allow two patients to be seen at a time.

On this day in May, Marife Oria, a second-year resident from Fairfax Hospital, David Wang, a fourth-year medical student from University of Maryland Medical System, as well as several nurses, roam in and out. A white board with grease pencil notations records who is on duty and the day's patient load. "Sometimes, it can be a real zoo in here," says Art Roach, an affable physician assistant who has been with the center for 14 years. The best part of his job? "Working with this age group."

Stepping behind curtain No. 2 next on this Monday morning is Steve Fahey, M.D., whose patient is an overzealous weekend warrior who injured his right ankle going for a lay-up. He tells Fahey that it's the second such injury to that leg, both received the same way. "Did you hear a snap?" asks Fahey. "No," says the student. "That's a good sign," responds Fahey.

It's a good thing, because the center is responsible for the health and well-being of some 33,000 students plus another 12,000 university employees.

On a typical day, about 300 patients visit the center across Campus Drive from the Adele Stamp Student Union building. Inside, they might encounter one of the eight primary care physicians, four psychiatrists, six nurse practitioners, three physician assistants and 10 nurses who make up the center's medical team. Or perhaps they're making a quick trip to the full-service pharmacy to pick up medication prescribed by the allergy or asthma clinic. Better yet, they might sit down to a therapeutic massage, a part of the center's alternative medicine program. After all, it's not as if most students can see their hometown doc while at school. This is their hometown health service.

Karen Powell, an R.N., chimes in: "Be sure you mention how hard the nurses work." No argument there. "They are the ones who run the place," says Roach, who worries about the national shortage of nurses. "The average age of nurses is in the 50s. Worse yet, faculty who teach nurses are dying away."

Dr. Oria's patient has a complaint about dark spots on a toe. The diagnosis: warts. She reminds the patient to carefully file the affected area. "The emery board should not be used for anything else," she cautions.

Suddenly, a nurse opens the swinging door into the Urgent Care area to say that a patient wants a special blood test, which requires a sign-off by a doctor or a physician's assistant. As Roach signs the order, he says that this is actually a genetic test, one that the center is equipped to handle. "Many people use the lab services and don't even see us," says Roach. Physician assistants can perform many of the duties of a physician--they can see patients, write prescriptions, sign for tests--but they can't open their own practice. Their license is dependent upon (and co-signed) by a physician. In the case of Roach and the other physician assistants, it's that of the center's clinical director, Sacared Bodison, M.D.

Meanwhile Carol Vilas, another physician assistant, wants it to be known that she always makes a fashion statement. Today, she's wearing white pants with embroidered flowers, and "threatens" to wear her vegetable pants tomorrow. She dishes up Carol Burnett-style comic relief. Vilas steps behind curtain No. 2: "So what's cooking with your poor throat today?" she quips to a patient.

Stepping behind curtain No. 2 next on this Monday morning is Steve Fahey, M.D., whose patient is an overzealous weekend warrior who injured his right ankle going for a lay-up. He tells Fahey that it's the second such injury to that leg, both received the same way. "Did you hear a snap?" asks Fahey. "No," says the student. "That's a good sign," responds Fahey. Upon examination, the doctor reassures him that it's not broken and recommends an ankle brace--the air kind some athletes wear while playing. It will let him get back in the action quicker.

The center provides sports-related care for the university's 648 student-athletes, but the vast majority of such injuries are among the student-at-large population. The center also handles 90 percent of all work-related injuries on campus, plus medical services to people attending games at Cole Field House and Byrd Stadium, where fans range in age from babies to 90-year-olds. "We see people complaining of everything from trouble breathing to burns," says Bodison, who also serves as sports coordinator for health services at such venues.

Meanwhile, behind curtain No. 1, an asthma patient is breathing into an apparatus that will measure her lung capacity. The reading: a respectable 440. With pollen counts hovering about 2,000 in the College Park area, compared to a normal count of 80 or 90, this has been a particularly bad season for allergy and asthma sufferers.

In strolls John Lucas, family practice physician, who tells everyone within earshot about the continuing medical education class on Tuesday. The topic: Internet Addiction. In addition to seeing patients, he organizes the CME program for staff members. Lucas, who arrived in 1999, chose to work at a university health center because he wanted to have time for his two young children and wife. (He's already done the 80- to 100-hour-week routine as an intern and wanted a life beyond his practice).

Close by, nurse M.J. Waite is working the phone, fielding a request by a student about to graduate for a wheelchair for his grandmother who will be attending the ceremony. "We coordinate everything at the Health Center," says Waite.

Lucas is seeing a patient--a dancer--concerned that she might have a strep infection. She has been feeling bad, then better, then bad again for weeks. Her energy level is low. "Allergies are typically waxing and waning. My suspicion is that this is allergy-based," he says. Lucas takes great care in answering her questions and advises her that she needs to do things--short-term and for her life--that allow her to chill out.

Whispers Fahey: "He'd go broke in private practice. He's too nice--he answers all of their questions." It doesn't take long to realize that this is the norm. The rapport between patient and practitioner at the center is a comfortable one, filled with trust.

Some members of the university community have a far more difficult time in expressing their aches and pains. Sacared Bodison is most proud of a program that has nothing to do with students directly. It's called the Healthy Workers Program, whose aim is to provide health care services to the 700 contractual, hourly-wage employees without health benefits. Most are employed through Dining Services and Spanish is their native language. Students from College Park Scholars and the Department of Spanish Language serve as volunteers. Begun in 1999, the program is now staffed 40 hours a week. It is just one of the ways that student volunteers--numbering some 300--play a vital role throughout the center to augment the services of the 100-member staff.

Funding is cobbled together through a stipend from Dining Services, a small grant for a Spanish language brochure and free services by center providers. "I'm forever beating the bushes to get some more grant money," laments Bodison, who is concerned about keeping the whole university well. She joined the university fresh out of a fellowship in adolescent medicine at Children's Hospital in Washington, D.C., and has been here for 23 years. Along the way, she earned an M.B.A., a valuable background in times of shrinking resources and increasing demands.

The center's outreach efforts extend into nearby Langley Park, a largely Hispanic community where many of these workers live. Bodison believes that the university has a responsibility to educate this population about the need for vaccinations. "One of the things September 11th taught us was to be concerned about bioterrorism. ... Many people, particularly immigrants, don't know where to get vaccines."

When asked about the program, physician Fahey responds: "There is so much need on this campus for a program like this that even the least generous of us are willing to go out of our ways to make it work." This effort is helping to eliminate what could potentially be a huge blot on the campus. "She invented it out of thin air," says Fahey, with obvious admiration.   --CP