“Water, water everywhere," lamented the poetic Ancient Mariner. He was marooned in a salty ocean without "any drop to drink." Otherwise he could have been describing the geography in Norfolk - and all of Virginia’s multi-city Hampton Roads, a.k.a. the Tidewater region, with almost countless rivers and creeks, not to mention the saline Atlantic Ocean itself.
All of the above make Hampton Roads the next best thing to nirvana for three newcomers - colorectal surgeon Gregory P. FitzHarris, MD, and pediatric surgeons Ann Kuhn, MD and Robert J. Obermeyer, MD.
"My wife and I just love water," says FitzHarris, who grew up on the East Coast and has lived mostly in water-blessed areas since then, including Honolulu and Tacoma. The "significant humidity" is different from previous locations, but the water, nearness to brothers and sisters and the "rural quality" of Suffolk, where he lives, more than compensate for that. He enjoys "driving on beautiful country roads" to his clinic, Tidewater Surgical Specialists, in Chesapeake and to Sentara CarePlex Hospital in Norfolk, where he’s also affiliated. "I live close enough to the beach to enjoy it but far enough away to avoid the crowds and congestion," he says.
Living in landlocked Oklahoma City, Kuhn’s husband became almost claustrophobic. "My husband likes the East Coast and has a preference to be near water," she says. Their home is practically on the James River, the biggest of the Chesapeake’s three tributaries.
Not even the deluge from tropical storm Ernesto in August could intimidate them. "Even though we are on the water, we have five acres, so our house is out of the flood zone," she says. Her advice to other newcomers: "Research a potential house to make sure you don’t live in a flood zone." Kuhn keeps the problem in perspective: "One or two days out of the year for rotten weather isn’t bad. It beats huge snowstorms!" She does admit, though, that she "had trouble getting the anatomy of the landscape. Highways seem to run in circles, and it’s just weird the way things are laid out. I take maps with me wherever I go."
Neither Obermeyer nor Joel Brenner, MD, considers traffic a problem, despite the potential logjams of traffic funneling through the area’s two bridges and three bridge-tunnels. Both physicians, like Kuhn, are affiliated with Children’s Hospital of the King’s Daughters (CHKD). "I hear about traffic jams in the tunnels and on the bridges," says Obermeyer, "and I just drive happily along." Brenner says, "It’s not bad as long as you pick the right place to live." And, negotiating tunnels and bridges is "a matter of luck and timing."
Home for Ohio-born Obermeyer, his wife and three sons is now on the Lafayette River. Having studied and practiced in Cincinnati, Youngstown (Ohio), Little Rock, and Houston, he says, "We wanted to finally be on the water. We didn’t want a vacation home on the water; we wanted to live on the water." Convenience is important, too. "We’re 15 minutes from Virginia Beach, less than five minutes from the zoo, and four miles from the hospital." The ocean is so near that he’s already taken his daughter, 6, and son, 3, on some charter deep sea fishing expeditions - "but not too far out." And, he adds, "A boat will be our next big purchase."
On any day of the year, there are sightseeing cruises available on various vessels in Norfolk, including the American Rover, a replica of a 19th-century cargo schooner, and nautical museums and sites abound. But for a short time next year, the boat population will multiply when 50 "tall ships" arrive for a pull-out-all-the-stops celebration of Captain John Smith’s arrival in 1607 with a group of settlers aboard the Susan Constant, the Godspeed, and the Discovery. After briefly setting foot at Cape Henry, now part of Virginia Beach, they went on to settle Jamestown 60 miles up the James River, America’s first English-speaking colony.
Never mind that Norfolk wasn’t chartered until 1682. Its citizens will
incorporate "Sail Virginia," a quadricentennial extravaganza, into its annual Harborfest from June 7 to 12. Other communities will follow suit. In fact, says Karen Scherberger, a festival promoter, "There are probably 112 celebrations - or more - throughout the state. The celebration belongs to all Virginians."
Historic home tours, colonial replica villages, and parades also will be part of Norfolk’s gala celebration, as well as tours of the tall ships.
Ever since the first shipyard was established at Jamestown in 1620, Norfolk residents have made the most of their liquid asset. The biggest shipbuilding industry shifted to Newport News, probably because it’s closer to the ocean than Jamestown and because of its position at Hampton Roads, the best natural deepwater harbor on the East Coast. In nautical parlance, the term "road" signifies "a safe harbor where ships may ride at anchor." This road is used extensively by both military and civilian ships.
The Virginia Port Authority is a "cornerstone industry for the Hampton Roads region," says media relations manager Joe Harris. "I don’t know of a single industry in the state, other than the military, that provides the economic benefits of the port operation."
The statistics are mind-boggling: Number two port and largest intermodal facility on the East Coast; works with more than 75 international shipping lines; annual "throughput" of two million 20-foot equivalent units, or TEUs, a
measurement unit adopted for containers; cargo transfers to two major rail lines and 135 trucking companies. Some 240 warehouses and distribution centers help spread the benefits statewide, Harris points out. That translates to 165,000 jobs across the state and $700 million in annual tax revenue.
U.S. cruisers, destroyers, submarines, and supercarriers fill berths at Naval Station Norfolk, the world’s largest naval base, established in 1917. Today, the base has five "brother" installations in Hampton Roads, including an amphibious base, a Naval air station, and the Naval shipyard at Newport News. Other branches of the military are present, too. In fact, the military-related work force - 150,000 - far exceeds every other labor category in the city. And the military retiree population is second only to San Diego. While most military personnel get their care from two large military/veterans’ hospitals in Portsmouth and Hampton, Joseph S. Auteri, MD, says, "We see Navy people and retirees frequently at social events. Everyone here seems to have a military background."
Appealing to civilian pursuits, Norfolk has become a homeport for three major cruise lines and gateway city to Bermuda (only 680 miles away), Caribbean, Canadian, and New England ports. Norfolk old-timers like to say it’s a belated legacy from Thomas Jefferson’s 1789 arrival there after a two-month voyage from Europe. The modern-day cruise partnership will be crowned in March when the mammoth new Half Moone Center opens.
Built on the site of a 1673 fort "in the form of a half moone," the terminal, unlike the warehouse atmosphere of most other coastal facilities, will exude welcome, predicts cruise operations manager Stephen Kirkland. It’s actually on the edge of an enticing downtown, and Norfolk itself is a gateway to dozens of regional historic sites.
The center is practically next door to Nauticus, The National Maritime Center, housing the Hampton Roads Naval Museum, a science center and aquarium, with the battleship/museum USS Wisconsin anchored beside it. Obermeyer considers it such a valuable learning experience that he has a family membership, as well as a year’s pass to Busch Gardens, a mere half-hour away.
Nauticus and the Half Moone Center are among the numerous upgrades in downtown Norfolk. If the "Tidewater town’s" continual growth and vitality are successful, much of the credit goes to consistent government leadership. For almost 30 years, regardless of mayoral and council changes, Norfolk has steadfastly stuck to a master strategy devised in 1980 - the 2010 Plan, with a list of accomplishments almost as long as a Tolstoy novel. As the city’s senior business development manager, Alan Boring, puts it, "My boss has always said that we quietly go about the business of doing business - and we stick to our plans."
Landmark downtown buildings now rub shoulders with new-age condos and apartments. New office and civic buildings have sprung up around the new City Hall. Streets have been extended to improve traffic patterns and a "grand esplanade" opens the way from the refurbished Harrison Opera House to the Chrysler Museum of Art, whose 8,000-piece art glass and 19th-century marble sculptures are world-renowned.
A venerable shopping arcade is home to new enterprises, notably the d’Art Center where 50 resident artists demonstrate and sell their works, and headquarters for the region-wide Virginia Arts Festival, a month-long music extravaganza with region-wide concerts. The arcade doubles as a passageway to the waterfront and Town Point Park, where some 90 percent of Norfolk’s many festivals are held, including the huge International Azalea Festival, Harborfest, Cajun food, wine, and children’s festivals.
Returning to the area after several years away, Brenner, who was an intern,
resident, and chief resident at Norfolk’s Eastern Virginia Medical School, was surprised at the changes. He now specializes in adolescent medicine and primary care sports medicine at CHKD. "The area has grown, and it just offers a lot," he says. "Parts of the city look completely different." And, with so many new restaurants, "there’s all the different ethnic food you could ask for. Every week we try a new place." A favorite is Baker’s Crust, where "you can sit at a crepes bar and watch them made in front of you. We went there three times the first month we were in Norfolk."
Many of Norfolk’s neighborhoods (120 or more) are systematically being revitalized or redeveloped. The city has added a Neighborhood Design and Resource Center where planners and architects offer help to homeowners to assure additions compatible with original styles.
Also part of the mix are restored theaters, including the opera house and the Attucks Theater, once known as the Apollo of the South, whose stage welcomed America’s most famous black entertainers. Old commercial buildings now house unique shops and restaurants, and the huge MacArthur Center, with 140 upscale stores, makes downtown the region’s primary retail center.
The revitalized downtown Granby Street, with its many chef-owned bistros, has become a dining heaven. "You can’t walk a foot without finding a good restaurant," says Kuhn. Hardly taking a breath, she and Obermeyer can run down a list of their favorites - Velvet 25, 456 Fish, Sirena Cucina Italiana, Blue Hippo, Domo Sushi, Luna Maya, and Todd Jurich’s Bistro, which offers "contemporary cuisine infused with French, Asian, and American."
The progressive spirit hasn’t bypassed Norfolk hospitals or those in neighboring
cities, either Norfolk’s three major health-care centers have all taken giant steps in adapting new technology to their services and taking patient care to new levels. So have two other large hospitals in the Hampton Roads area - Chesapeake General Hospital in Chesapeake and Riverside Regional Medical Center in Newport News.
By early September, Riverside neurosurgeons had performed 35 brain tumor treatments using the hospital’s new Gamma knife technique, one of only ten in the country. Besides using it for prostatectomies, surgeons are starting to incorporate a Da Vinci robot into gynecological cases, and by year’s end they expect to add a radiosurgery technique, Synergy S, to treat tumors in the spine and other areas of the body. Ambulances are equipped with technology to perform EKGs and transmit results by cell phone to waiting emergency room physicians at the area’s only level II trauma center.
The hospital also has opened a freestanding cancer center for "beginning-to-end" patient treatments.
Even Riverside’s nursing school, founded along with the hospital in 1915, has swung into 21st-century mode with a new name - Riverside School of Health Careers - and curricula for aides and practical nurses, plus sequences in surgical and radiological technology and a diploma program in nursing. Graduates (216 this year) easily feed into the Riverside family.
Christopher Mosley, Chesapeake’s president and CEO, was recently named one of the U.S.’ 25 top minority health-care executives by Modern Healthcare magazine. Under his tutelage, among other changes, a "patient navigator" now steers cancer patients through the many hoops and roadblocks on the road to recovery. Chesapeake will soon be America’s second hospital to install an IGRT linear accelerator offering the newest technology in image-guided radiation. Its BirthPlace incorporates almost every conceivable care-related component, including "boot camp" for dads, baby massage, and a MomsMobile providing home breastfeeding help. Its women’s component also includes everything from bone densitometry to an R2 ImageChecker system for earliest possible breast cancer detection.
A state-of-the-art Phillips cardiovascular x-ray system is linked to the American Heart Association’s library. Its catheterization archival system is a regional one-of-kind, as is its Geropsychiatric Unit, focusing heavily on services to Alzheimer’s and dementia patients.
To counteract a 13-percent higher cardiac death rate than the rest of the state, local hospitals have been intensifying heart-care services. Exhibit A: Auteri, a cardiovascular and thoracic surgeon, who was cold to the idea at first when Craig Smith, MD, former President Bill Clinton’s cardiac surgeon, asked him to become the director of the new Heart Institute of Bon Secours Maryview Medical Center in Portsmouth. "In Scottsdale it was 75 degrees and February and the sun was shining. I said, ’No, thank you. How are the wife and kids? Goodbye,’" he recalls.
"Then I thought it over and called him back. It was a wonderful opportunity to be in on the ground floor" at a new facility. And, he admits, "It was a little bit selfish. The ability to start a program from scratch is kind of fun - and rewarding. I’ve taken care of a lot of patients who might not have otherwise been served," since moving to the area a year ago.
The clincher was Bon Secours’ tie-in with New York’s Columbia-Presbyterian Medical Center, where Smith operated on Clinton and Auteri trained as a surgical fellow. He and other Bon Secours cardiac physicians hold teaching positions at Columbia. "This allows us to recruit a higher level of physicians, compare notes with top surgeons and avoid mistakes made by others in the past," he points out. "We can piggyback on Columbia’s proven track record of excellent results." Columbia surgeons helped on site with the first surgeries at the Heart Institute, and Bon Secours physicians and nurses received specialized training at Columbia-Presbyterian.
Going from door to door, eight nuns began treating Norfolk victims of a catastrophic yellow fever outbreak in 1855. Soon a wealthy patron offered her home as a hospital, the beginning of the institution that’s now one of 17 operated by the Sisters of Bon Secours (French for "good help"). Five are in Hampton Roads, including a special Center for Colon and Rectal Disease in Suffolk with comprehensive care, innovative technology, and minimally invasive procedures.
A 150th anniversary celebration at Bon Secours last year included commissioning a children’s story, "The Mermaids and Yellow Jack - A NorFolk Tale," by local author Lisa Suhay. The story tells of mermaids from France who swam to Virginia shores during the epidemic (once known as yellow jack) and sprouted legs so they could care for the sick. Today, a mermaid is the symbol of the city, and many beds of yellow flowers are reminders of the once-dreadful scourge.
Meanwhile, FitzHarris says, "Sentara has definitely seen what the future is going to look like and implemented its design and equipment accordingly." Eight "smart" ORs, which listen and respond to doctors’ voice commands, are set up at Sentara CarePlex for high-definition laparoscopic procedures, with ceiling-mounted monitors and towers to optimize efficiency and ergonomics.
The Sentara network incorporates two hospitals in Norfolk, plus facilities in Virginia Beach, Hampton, Suffolk, and Williamsburg. An adjunct, six-story Heart Hospital in Norfolk offers premier heart care, with many area firsts, including minimally invasive heart surgery. It’s currently the region’s sole solid organ transplant center.
Sentara’s innovations include the Da Vinci Surgical System and the eICU, an electronic monitoring system developed by VISICU. Since 2000, according to hospital statistics, the around-the-clock eye on ICU patients has helped save more than 430 lives, reducing mortality by 25 percent and lengths of stay by 17 percent. The system keeps its eyes on 103 beds in 11 ICUs while intensivists and critical care nurses monitor the beds from an off-site command center. According to Rodney F. Hochman, MD, the hospital’s executive vice president, "Around-the-clock reaction time has become a matter of seconds."
Sentara introduced an elaborate, all-encompassing safety system in 2002. In this new regimen, no employee is left behind. Everyone is a team member and a "wingman," or backstop, helping fellow workers to avoid mistakes, whether they involve maintenance, housekeeping, bedside care, or surgical procedures. Shannon Sayles, RN, the director of the safety initiative, says, "From 2002 to 2005, the error event rate decreased by more than 46 percent."
Adding to patient care improvement, a physician communication concierge now coordinates physician care for patients with multiple problems, as well as speeding up message delivery among doctors.
From neonatal intensive care units to the area’s only pediatric surgical facility, which includes heart and reconstructive work, Children’s Hospital of the King’s Daughters covers the gamut of services to youth as the sole independent, freestanding, not-for-profit pediatric institution within a 125-mile radius.
CHKD dates to 1896 when the Methodist-related group hired a visiting nurse who biked to homes of poor families. Services evolved to a private home, health stations, and finally in 1961, Virginia’s first dedicated pediatric hospital.
Today, with 440 physicians on staff plus independent practitioners, CHKD covers most specialties, but its secret weapon is the pectus excavated surgery devised by South African "refugee" Donald Nuss, MD. Even though his German missionary forebears gave him roots dating to 1856, Nuss’ antiapartheid activities angered the government, inspiring him to immigrate to America in 1976. For a non-citizen physician, the going was hard - until a Norfolk doctor hired him. The two became prime movers in advocating for operating rooms at CHKD. Their campaign finally succeeded with the opening of the Surgery Center and eight ORs.
It was after that when Nuss devised the procedure, now named for him, which draws patients from around the world who are afflicted with "sunken chest," a concave breastbone that greatly compresses the heart and lungs. Nuts’ one-hour procedure replaces drastic four-hour surgery involving removing ribs and cartilage and cracking the sternum. Now a flexible bar is inserted beneath ribs and sternum, flipped, and held in place until the bones are reconfigured.
Surgeons Kuhn and Obermeyer are among beneficiaries of Nuss’ OR lobbying - and the size of the service area. "The population is large enough and varied enough that we see a good amount of pathology," says Kuhn. "There’s not one of my partners who feels bored." Since arriving, she’s encountered such seldom seen cases as a tracheoesophageal fistula and "odd hernias that don’t fit the categories they should."
Obermeyer’s family time is important to him, making a large surgical staff a boon. His take on it: "You have to consider how often you want to be on call. In a small town it’s every single night because it doesn’t have the population to support more than one pediatric surgeon. At CHKD, five are on staff full time." And, he added, "I like the fact that CHKD isn’t grafted onto a larger hospital."
Over time, Norfolk residents have managed to mix and match history and contemporary development, although the "new" was sometimes a hard sell to preservationists. The Cannonball Trail highlights some of the city’s major historic events via a walking tour featuring both old and recent landmarks. A handsome guide booklet pinpoints 40 buildings, sculptures, and memorials. A cannonball embedded in St. Paul’s Episcopal Cathedral testifies to its Revolutionary War "purple heart" status. It was the only building to survive an English bombardment. The Moses Myers House is America’s sole historic house interpreting traditions of early Jewish immigrants, and the tombs of the great warrior and his wife are part of the General Douglas MacArthur Memorial. African American historical tours of Hampton Roads reflect the considerable contributions of area black leaders, and include a statue of William Carney, a Norfolk native and the first black recipient of the Medal of Honor.
Despite vulnerability to attack, two major military victories were achieved in the Hampton Roads area. With a French fleet blocking a retreat route, the British finally surrendered at Yorktown, paving the way for American Independence. And federal forces won the day at the famous Civil War clash of America’s first ironclad warships, the Monitor and the Merrimack. Today’s tourists can look down on the site from a bluff at Newport News - and recall the battle as they travel the Monitor-Merrimac Memorial Bridge Tunnel - just one example of how Norfolk residents’ modern-day lives intersect with landmarks spanning our nation’s history.