A Miracle Worker
A Top-notch Neurosurgeon Transplants Big-city Medicine To A Community Hospital

Kicked in the head by a horse one night last February, half her skull turned to dust and gravel, her brain swelling from its smashed shell, Sue Ann Curtis is alive today because her neurosurgeon, Dr. Ramsis F. Ghaly, was where one would not expect him to be.

Ghaly was available to Curtis almost immediately, in the small window of time in which surgery can be done to avoid permanent brain damage. Her brain surgery was not done at a major university hospital but at Joliet’s Silver Cross Hospital, a small community hospital a few miles down the road from her Lockport horse farm.

Curtis, who has a doctorate in cultural anthropology, is in rehabilitation–and thinking about riding her horses again–because of Ghaly’s singular ambition. He would like to reverse the tide of medicine today: Rather than send all the complicated cases to downtown hospitals or university medical centers, higher quality, more sophisticated medicine should be offered closer to home. On the night Curtis was injured, I was the anguished friend at the scene who called paramedics. Desperate, I called a retired physician friend for input while the ER team hovered over Curtis, whom they said was dying.

"If it’s a head injury, Dr. Ghaly is the best neurosurgeon there is," said the retired doctor, who once worked at Silver Cross. I raced back to the emergency-room desk and asked for "Dr. Ghaly" to be called.

"Oh, Dr. Ghaly! He’s the best neurosurgeon there is," said the attendant, lifting the phone.

Moments after the call, the ER team burst from the cubicle and began running down the corridor with Curtis on a gurney. "Where are you taking her?" I shouted after them.

"You’re very lucky" an ER doctor said over his shoulder. "Dr. Ghaly is going to operate, and he’s the best neurosurgeon there is. He’s going to try to save her life."

I interlaced the mantra of recommendation I had just heard from three people with prayers for 6 1/2 hours until I learned that Ghaly had indeed saved my friend’s life.

The 43-year-old Egyptian-born physician’s career is filled with similar stories of last-minute saves from strokes, aneurysms, tumors and other assaults on the brain. He also is known for resolving mystery maladies, some of which had been misdiagnosed for as long as 20 years, including nerve tumors, trigeminal neuralgia (tic doloreux), spinal infections and more.

One would expect a physician with his credentials to be found in an exclusive private practice where the waiting list is six months long.

He is board certified in three disciplines–neurosurgery, anesthesiology and pain management–the only physician in the United States so qualified, said Dr. Fady Charbel, acting head of the residency program at the University of Illinois Hospital, where Ghaly did his residency in neurosurgery.

Ghaly joined the Chicago Institute for Neurosurgery and Neuroresearch (CINN) in 1995 after completing a residency in neurological surgery with special training in complex cranial and spinal surgery. He received a medical degree from Ain Shams University School of Medicine in Cairo. In 1991, he completed a residency in anesthesiology and critical care and pain management at Cook County Hospital, where he also completed fellowships in neurophysiology and neurotrauma. He also is an assistant professor of neurological surgery and anesthesiology at Rush Medical College in Chicago.

He arrived at Silver Cross six years ago, a year after the hospital established a relationship with CINN.

"Silver Cross Hospital was CINN’s first satellite," said Leslie Barna, a case manager at Silver Cross who works closely with Ghaly. They (the institute) were based at Columbus Hospital. It was their interest to provide care outside of the city in outlying areas."

During his training, Ghaly said he felt "really challenged" by what he found. "I went to medical school and saw how easily people die or are misdiagnosed," he said. He wanted to do something about that, a drive that has been with him since he was very young.

As one of eight children, "I saw my parents and my grandparents suffer from no-good care or average care. I became very sensitive to suffering. This is a gift; it’s the way I look at it," he said. "I put myself in the patient’s place."

Deeply spiritual, a member of the Coptic Christian Orthodox Church, Ghaly’s personal role model is the biblical Good Samaritan, who he said, was a foreigner, like himself.

Kathleen Prunty, director of patient support services at Rehabilitation Institute of Chicago, cites Ghaly’s spiritual charisma as an inspiration both to co-workers and patients.

"He’s in a category of one," she said. "You’re not going to find many people who will abandon everything to focus with sacred devotion on the patient.

"He’s a healer to the community," added Prunty, who met Ghaly at Silver Cross when she worked there in patient support. "He could go the way of the rest [and become] the big downtown personality, but he believes these are beautiful people in this kind of sleepy community, and they deserve the best."

Of all Ghaly’s recent cases, Robert Wals of Romeoville perhaps best personifies the advances the doctor and the CINN satellite program have made at Silver Cross.

In March 1998, Wals was acting abnormally, said his wife, Virginia, and the family doctor found a brain tumor through magnetic resonance imaging. At that time, Wals said, Silver Cross did not have the proper facilities to care for him, so he was referred to Columbus Hospital in Chicago, where Ghaly removed two tumors, one the size of a lemon, one the size of an orange, from his brain.

"In and out, no problems, operated on Monday, home Saturday," Wals said.

‘Let him die’

In October 1999, problems returned and Wals went to a downtown hospital, where bleeding from another tumor in his brain was discovered. His family was told there was nothing to be done for him.

"Take him home and let him die," they were told. Wals was transferred to Silver Cross, where he lingered in a coma until early January 2000, when he startled the night nurse by talking to her. "I came back to life," Wals said.

"This time there was a lot more equipment at Silver Cross to do this type of surgery than before," he added. The family contacted Ghaly, who operated again, this time in Joliet.

"Not once but twice he saved my husband’s life," said Virginia Wals.

Now her husband is doing a lot of things he did before, hanging blinds and playing with grandchildren Ashley and Jake.

"They pushed me out the window downtown, and I came back to Joliet, they take care of me and here I am, living yet," said a grateful Wals.

Changing the mentality

"I’m bringing a high medical-center expertise to a small community," Ghaly said. "It’s the best for the community, but I was really challenged when I came," challenges that he said should not be underestimated in today’s cost-conscious climate.

"But I decided this is where my heart is. This is where my patients want me. I think it is time to make the community hospital an excellent facility, ready to give good care, to have good people on staff, and reward them," he said. "It cannot be treated differently than a university hospital."

"The mentality in the community hospital has to change. No in-between treatment. I’m a hospital or I’m not a hospital, "I'm a walk-in clinic.

"Just go one hour from the city of Chicago, and the quality of health care diminishes," he said.

The reasons why are complex, with serious deficiencies in equipment among them. Ghaly would like to see the government give more support to community hospitals to improve care. Proper equipment is essential and expensive, even an average-quality MRI machine can cost $1 million.

But most important to Ghaly are human resources. "Nothing replaces the eye and hand of the physician," he said. Yet, often, today, there are "not always a lot of physicians available in the hospital," he said.

And ironically, when there are, it can be a problem.

The big picture

"The fragmentation of medicine is an extreme disadvantage today," Ghaly said. "Everyone is subspecialized. Physicians look at each part, and who is looking at the overall picture? The patient as a total is forgotten."

For him, it is foremost.

Dr. Thomas Hurley, Ghaly’s partner in neurosurgery at Silver Cross since the end of 1996 and a CINN member, said, "I’ve always been impressed how he looks at the patient globally. He is excellent at being the complete physician."

Ghaly found that one way to decrease fragmentation of medicine within the hospital is the multidisciplinary meeting he has held every Wednesday for the last five years for all medical-care providers.

"We all sit around and talk about the patient. We all interact and try to solve problems in the care of the patient," said Barna, who has been employed at Silver Cross for 20 years.

"It is a wonderful service that we can provide a high level of neurosurgery in a community hospital and maintain the level of personal care at the same time, as in the case of Mr. Wals," she added.

But creating this best of both worlds for the patient can be what Ghaly calls "a sword with two sharp edges."

Up close and personal

"You demand a highly skillful type of work in a place that might not have everything they have in a university hospital," he said. "What I did to compensate for that, instead of doing my surgery and going home, I made myself available 24 hours a day."

Unlike most surgeons who operate, then hand over the patient to other doctors, Ghaly stays with them through their recovery and even beyond. He calls on them at home to see how they are doing, gets to know the family.

This is his prescription for what he thinks is another great disadvantage in today’s medicine: "the ongoing practice of limited time doctors spend with patients. It takes more than 15 minutes to see a patient," he said. Pain is hard to describe; that takes time."

Chicago lawyer Annie Lopez, a patient who suffered with a tumor in her leg for many years while being treated for lower-back pain, expressed gratitude that Ghaly took the time to listen carefully to her complaints in order to solve her problem.

Even if a patient at the point of death can’t be cared for near home, by increasing standards in the community hospital, it will decrease complications in the interim period. That is the period during which everyone is asking, ‘what should we do next? Should we transfer the patient?’ when there is a difficult problem due to a lack of knowledge or equipment," Ghaly said.

In either case, "the community has the right to say, this is our hospital, we want it to be the best," he added. The way to give a community this kind of self-esteem, he believes, is to educate it "so its members don’t die in the system."

Leading by example

Ghaly regularly gives free lectures to the public on health issues, even goes to local factories to talk about how to prevent or treat carpal-tunnel syndrome "so people can be their own health advocates." (He will present a symposium on strokes at Silver Cross on June 16.)

Ghaly’s strongest impact, however, is the example he sets. "Ghaly is a model for us all," said Dr. Walter J. Levy, in private practice in Ithaca, N.Y., who has worked with Ghaly on papers and presentations.

Ghaly’s colleague Hurley thinks the public isn’t getting the quality of doctors they got years ago. "There is no incentive. Ramsis and I are working harder and making less, with government and insurance companies cutting back. It is becoming a hard field, as far as being rewarded for what you do. "If you don’t love medicine, find something else," Hurley said. "I think our society in general has been blinded quite a bit to the fact good health care, or life itself, doesn’t come cheap."

Ghaly, who has had to accept "a lot of financial compromise" to practice as he does, would like to see the idea of medicine as a business career disappear. "I am sure I am not unique," he said. Other physicians like him exist, and "as a society we need to encourage and motivate them to go the extra mile."

"I would like to see this model reach other communities, to help the patient in extreme need," Ghaly added. "These are hard-working people here. I feel they do their best for the community, therefore they deserve the best medicine there is. I was sent on this mission because of Sue Ann and other people like her."