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Faculty Spotlight: Carmen Graffagnino, MD

Tuesday, June 28, 2016

Last year, Carmen Graffagnino traveled to Kenya to better understand how doctors there were providing stroke and epilepsy care. Before returning to Kenya this July, he spoke with us in this Faculty Spotlight interview, discussing why he’s going back and what he’s looking forward to about returning to Africa. Graffagnino also shares how he applies the wisdom of Yoda to his daily work, and explains how the past two years have been the most exciting years of his career.

What are your responsibilities within the Department? What does a typical day for you look like?
I am the chief for the division of Neurocritical Care and Vascular Neurology. I believe we are the largest division in our department in terms of physicians as well as nurse practitioners. I also serve as Medical Director for the Duke Comprehensive Stroke Center.

What I love about my job is that there is hardly ever a typical day. I am fortunate enough to practice both in the NICU as well as on the in-patient Stroke Service and on the Tele-stroke service. When I am not doing hospital work I have a stroke clinic 1.5 days per week and I am also very much involved in research work on site based clinical trials as well as at DCRI on systems of care work (in partnership with Dr. Kolls). This work involves  integrating clinical care, research, teaching and administrative work for our department as well as for Duke Health System.

This July, you’ll be returning to Kenya after visiting last summer to teach local providers about how to recognize neurological conditions. What is the purpose of this year’s trip? How do the goals of this year’s visit compare to those of last year’s?

Last summer Chen Lin and Ravi Vakani did an excellent job in acquiring data on knowledge gaps in terms of stroke care and epilepsy care. In addition we had a Doris Duke Student working on an ICU database capture project which gave us a sobering view of the status of traumatic brain injury care and outcomes. This summer I hope to use the information we obtained last year to work on a curriculum of education for the medical students and house-staff to close some of the knowledge gaps that we encountered via the survey studies done last year. We are also going to be introducing a simple and pragmatic care path for the management of mild to moderate brain injuries in an effort to reduce the mortality and morbidity in this very treatable group of patients.

What are you looking forward to the most during your trip? What do you think you’ll miss the most while you’re gone?
I am looking forward to once again working with the NICU team at the hospital as well as working much closer with the neurosurgeons and neurologist in order to bring about some of the process changes that I believe will be of help to the stroke and TBI patients at the hospital. I will not miss being paged through the night (no night call in Africa). I will miss my dogs and friends in Durham as well as the many amazing colleagues and residents that I am so lucky to work with here at Duke.

Next year will mark your 25th year since joining Duke Neurology. What’s the biggest change you’ve noticed in the Department since then?
These past two years have truly been the most exciting years of my career. The opportunities that have arisen for creative growth and expansion in our program are monumental and this has only been truly possible since we ventured out and became an independent department. Dr O’Brien has been an energizing force and fully supportive of our ambitious plans for growth within our division. I am so grateful for his support and for the team of colleagues that share this vision.

How has stroke evolved as a public health problem since you began your practice? How do you see this issue changing over the next decade?
Stroke use to be a disease of the old and one that basically gave a neurologist a chance to practice their clinical localization skills. It is now unfortunately one that often affects much younger people (or else I am older and everyone seems younger). On the other hand we have had incredible advances in acute stroke care with tPA and now with thrombectomy. I believe that ICH will soon also be a condition with acute interventional potentials. Our current challenge is in working on our systems of care so that we can deliver this care more effectively across our state and not just in the big cities.

While prevention and acute treatment will still be the most important aspects of stroke care, I believe that regenerative work will be the most exciting and life changing development in the future so we will have things to offer for those patients that still go on to suffer major stroke related brain injury.

Your office has a poster with a quote from Yoda. How have you incorporated the quote into your practice?
In so many ways, Yoda is my spiritual guru. His character is based in many ways on Lao Tzu who is one of the fathers of Taoism. My favorite quote from Yoda is “Do or do not, there is no try” – basically commit to doing whatever it is you are driven to do and do it to your best ability. It was this teaching of Yoda to Luke Skywalker that really spoke to me.

What passions or hobbies do you have outside of the Department?
I love mountain climbing, although the mountains are getting less friendly towards my arthritic hip. I now spend much more time hiking in the Appalachian mountains although I am sure there are one or two 20,000 footer still calling out to be climbed.


"This photo was one of the highlights of my climb up Mount Kenya last year. Not so much because I climbed it but because at around 15,000 feet I ran into a highly respected colleague who is also a Stroke doctor (Dr James Grotta from Texas) and at age 70 is still climbing mountains around the word whenever he isn’t riding in the back of UTs mobile Stroke Unit in Houston."