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Alumni Spotlight: Dr. Andre P. Cap MD PhD

in Alumni, Alumni Spotlight, News

Andre P. Cap, MD/PhD

BUCASM MD/PhD Class of 2003

Colonel, US Army (retired, November 2023)

Subject matter expert advisor to Joint Trauma System (JTS), US Pacific Command & US Special Operations Command (SOCOM)

Consultant: Velico Medical

Volunteer faculty member: Uniform Services University and Brook Army Medical Center

Borkan: How did your career unfold after BUSM?

Cap: My career took turns that I could not have predicted. It began as an M3 on the BMC Heme/Onc wards back in the day. we were giving a [chemotherapy] “martini” for CML…and they were dropping like flies... it was really a profound experience for me. Being 30 years old and wanting to do public service before I was “too old”, I substituted my MD/PhD fellowship for the Army for the last two years, did an Army residency in internal medicine and a hematology/oncology fellowship in Washington D.C. I thought I was going to be a bone marrow transplanter. But the Army asked, “Are we storing blood right and how can we make it more available in the battlefield?”. The DoD moved the Institute of Blood Research to San Antonio, Texas and they said, “You have PhD, why not take over the institute?” I became division director and then director of research for the whole institute right out of my fellowship. It was just pure luck…right place at the right time. I spent the next 15 years at the Army Institute of Surgical Research, mostly building and running the lab, and doing part-time clinical work at Brook Army Medical Center. So, I oversaw a $60 million per year research program and nearly 300 researchers. I did not intend to make it a 22-year career.

Borkan: What were your challenges?

Cap: In the beginning, it was “Whoa”. I was overwhelmed and there was skepticism. “You just finished fellowship, buddy”. I had to just sell my plans for the lab and myself as somebody who could execute those plans. It was wartime [in Iraq].  In the middle of a war, my superiors said, “Well, all right, let’s give this guy a try because what the hell, we’ve got to execute and execute now. So, let's see what he does”. I had trained in Joe Loscalzo’s lab, the former head of cardiovascular medicine, studying homocysteine and its effects on nitric oxide, bioavailability, and on endothelial function and platelets. Though it wasn't directly related, he gave his students independence, and it was self-driven research work...good for me to prepare for what lay ahead, even though I didn't know it at the time.

Borkan: What did you discover at the Institute to help our soldiers?

Cap: In the “old days”, people who were bleeding mostly received refrigerated (cold) whole blood, but people stopped doing that because of the fear that cold platelets wouldn't work. Well, it turns out they work just fine in whole blood, just like stored platelet concentrate…this observation led to the rebirth of whole blood, which is now all the rage in trauma management across the world. Instead of giving people emergency saline, we now give group O, low anti-A, anti-B titer whole blood as a universal product to improve oxygen delivery and hemostasis. Randomized DoD funded clinical trials show better outcomes with whole blood than components. I “backed into” the field of transfusion medicine from Heme-Onc and my fellowship training in bone marrow transplant.

Borkan: What motivated you to stay in research?

Cap: I did an elective during my PhD at the Brigham in vascular pathology. The medicine teams and surgery teams would present clinical cases in the “bowels of Brigham” where the pathologist showed autopsy specimens and labs like “very old school medicine”! The pathologist ran the meeting and you “touched the disease”, like aortic atherosclerosis...making what we did in the lab very real by handling the body. My PhD was actually in the department of Pathology. More than anything else, this motivated me to stick with research.

Borkan: How did BUSM training help your career?

Cap: I got a tremendous clinical training at BU that prepared me well for all the crazy things I enjoyed being in the army partly because it wasn't all just lab work. I deployed to Iraq… as chief of medicine of a combat unit at an Iraqi support hospital where I oversaw massive transfusion and really bad coagulopathies upfront in patients. I launched to Germany and worked in the ICU where I took care of many trauma patients. Now I get calls from all over the world about critically ill patients with hematologic problems or requests to help set up research programs. That's because of the synergy between the research and the clinical interest.

Borkan: What is your advice for our current MD/PhD students wondering how the use their dual degrees?

Cap:  If you are open to trying to use both degrees and open to unusual opportunities that that might present, you can have a super interesting career. Accept a fair amount of uncertainty… it's hard to do both clinical medicine and research but not impossible. We can be the triple threats as a great administrators, clinical leaders and researchers but not all at the same time… When I joined the Army, people thought I had lost my mind. “You’re not doing anything interesting”. I think it was pretty interesting. There are also tremendous opportunities using your tools to work in the clinic and in the lab. I said to myself “I'm going to do this now” and this created opportunities along the way that capitalize on “what is great”. That's my advice.

Alumni Spotlight Interview: Milissa Kaufman MD PhD

in Alumni, Alumni Spotlight, News

Dr. Milissa Kaufman is a graduate of the combined MD/PhD program at Boston University. Dr. Kaufman is the medical director at the Hill Center, a clinical program specializing in the treatment of trauma-related disorders.

SCB: Describe your journey to BUSM?

MK: Honestly, I thought entering BUSM from Arizona State as an undergraduate was an unachievable dream. I nearly flunked out of high school. Then I went to a community college, where I struggled with undiagnosed learning disabilities. I was not someone who was prime for academia or medical school…but I had this burning interest from an early age to understand people's minds… I started to read about psychiatry, and I knew that was what I wanted to do. But I wondered, “How am I ever getting into medical school?” I did not know any doctors. I had to take fewer classes at a time than most students because it was harder for me to study. But I worked very hard, switched my degree from a BA to BS ( I could not learn a foreign language), and entered the Honors college. There, I had to write a thesis. A friend suggested his mentor, a Reproductive Biologist as my PI, so I worked in her lab and even stayed there for a few years after college. The lab became family to me. I loved the environment…that we were all working together, focused on a Quest. We published my thesis, which was a gigantic thrill to me. It was then I finally realized I maybe could become a doctor. But I did not go to medical school for 3 years. I was nervous to take the MCAT, but my PI continuously encouraged me. My first score was not great, and I did not get accepted. So, I took an MCAT course and increased my score just enough. I had not yet said my dream aloud to anybody…I wanted to study psychological trauma and dissociation and become a psychiatrist. Without thinking I had much of a chance, I decided to pay the $75 fee and apply to BU. Boston was where many of the trauma researchers whose work I had read worked. The day I day I got accepted to BU was one I will never forget! Such a thrill! I entered the MD program and was asked to join the MD/PhD program my second year. I struggled with anatomy…the Dean met with me and casually said, “Oh, this happens every year”…So, they sent me for testing, and this confirmed that I had a learning disability. Now I finally understood why school has always been so challenging! One part of my disability is “visual spatial,” which explained why I could not do gross anatomy. But this realization changed my life.

SCB: After medical school, how did you transition to your PhD years?

MK: I ended up doing behavioral neuroscience for my PhD studies. I was truly fortunate to be accepted at the National Center for PTSD to do my dissertation research, located the Boston VA Hospital, headed by Terry Keane. Dr. Keane is an expert is psychological trauma and one of my heroes. I remember nervously walking into his office for the first time. I let him know I was interested in PTSD, and I had read all his work. I also told him that what I really want to study was trauma-related dissociation. He told me: “Do you really want to study dissociation and ruin your career?” However, he almost immediately told me he would support my goal, “as long as you do good science, the field needs it!” Dr. Keane was so wonderful. I was his first MD/PhD student, and he was excited about that, too. I spent five and a half years in graduate school working with pioneers in the trauma field. They threw me right into ongoing clinical studies and I learned about psychiatric diagnostic assessment, interviewing, and psychometrics. This experience set me up for success in a later psychiatry residency. The most important part of my training at VA was working with combat veterans who had PTSD. From them, I learned how to identify traumatic dissociation. Some vets were “doubly traumatized” with childhood abuse and combat-related PTSD. Many of them were dissociative and that was what I wanted to understand. As an aside, but an important part of my story: A bonus part of my training was that the atmosphere at the VA was very accepting. I came out in graduate school. I came out as gay. It seemed like it was an okay thing to do…That was a gift that I did not expect, to be okay in my skin for the first time.

SCB: How did you find your psychiatry residency…and how did they find you?

MK: The MGH/McLean Psychiatry Training Program was another career dream! It was a terrific training environment. The faculty is devoted to supporting residents. Plus, McLean Hospital was only one of maybe 2 or 3 units in the country that had specialty programs for women with PTSD and dissociative identity disorder (DID). My passion really was to study and treat the dissociative subtype of PTSD and DID, and at MGH/McLean, I found like-minded people. It was a long journey from being a college kid in Phoenix, Arizona who could barely get through high school to MGH/McLean! During residency, I worked with trauma experts including Dr. Sherry Winternitz, who ran the clinical trauma programs. She was highly supportive when I told her I wanted do a neuroimaging study to understand the brain basis of traumatic dissociation in DID. Despite there only being one project on dissociation ever supported by NIH, she was determined to help me. Dr. Winternitz facilitated seed funding for my lab through a significant philanthropic donation. This donation was from a family who care deeply about child abuse survivors.

SCB: What jump started your independent research into trauma and dissociation?

MK: It seemed like synchronicity! Following residency training, I became the medical director of a treatment program for women with PTSD and DID. There, I began recruiting patients for our first study exploring the brain basis of traumatic dissociation. Then, as luck would have it, soon after, trauma expert Kerry Ressler, MD/PhD came to McLean and became the chief scientific officer. He arrived with a generous spirit, and he paid for my brilliant Post-Doc, Lauren Lebois, PhD. My little lab - which at the time was doing only a single neuroimaging study – suddenly grew. I had my ideas about the brain basis of dissociation and, thankfully, Dr. Lebois could really write! Within months, she received an F32 training grant. We then started working with an NIH program officer who was open to studying dissociation in traumatized individuals…soon after we got an R21. This was the project that I have been fantasizing since I was in college --- identifying biomarkers for traumatic dissociation. We began publishing our findings and then received RO1 funding. Many had said to me, “You'll never get NIH funding to study traumatic dissociation.” But it was my passion, and I also had so many mentors along the way who were saying, “Do what you want to do!” That is my story. I now have a research program. The dual degree program at BU started this whole career for me. BU believed in me. It really has been a dream come true.

SCB: How did BUSM help your career goals?

MK: I had wonderful experiences everywhere I trained. But there was something special about BU and the Mission. BUSM draws a particular type of person, and the faculty at BU always had this passion, this Mission to serve. Important to me, they were not driven by ego but by the Mission itself. BU felt like home to me…there were always ups and downs, yet the faculty made it seem like it was okay. It was okay to be a little different and to go your own way. Some of my colleagues who also had challenges along the way turned out to be some of the most accomplished students. The faculty were so proud of them! BU training emphasizes doing things...it is a “doer’s program.” And many of my colleagues had dreams like me and went on to do exactly what they had dreamed possible. I am so glad to be able to finally say, “Thank you. BU.” Being at BU changed my life in in so many ways…it changes who you are as a person.

11/24/2023
Interviewer: Dr. S. Borkan