(Left) Rishi Rane, MD, at his FIU Herbert Wertheim College of Medicine White Coat Ceremony. (Right) Dr. Rane performing in Il Mondo Della Luna in Cincinnati. Pre-Covid photos courtesy of Dr. Rane.

On March 14, 2021, the 63^rd Annual GRAMMY Awards aired on CBS and one University of South Florida (USF) emergency medicine resident was particularly interested in who would win Best Opera Recording.

Music and medicine share the ability to heal and transform, and Rishi Rane, MD, emergency medicine resident, and trained professional tenor, practices both. Dr. Rane studied at the University of Miami (UM) Frost School of Music, and after graduation in 2009, moved to New York to pursue a career as an opera singer. The first year was rough, but eventually he landed several roles at the Bronx Opera and Opera America, at local places of worship, and even at the world-renown Metropolitan Opera, where he joined the company’s production of Aida, his favorite opera, as a non-singing supernumerary. “That was a really big deal because it was a dream of mine to sing at the Met,” Dr. Rane told Ileana Varela, associate director of marketing and PR at Florida International University (FIU).

Rishi Rane, MD, trained professional tenor, singing “Maria” from West Side Story. Pre-Covid Video.

After five years in music, Dr. Rane was starting to feel the burnout and decided to pursue a steadier and more reliable career in medicine. Medicine has always been part of Dr. Rane’s life since his mother is a Registered Nurse (RN) and his sister is a Physician Assistant (PA). Dr. Rane even worked in music therapy at the University of Florida (UF) Health Cancer Center in Orlando and found it to be an amazing experience where he could really connect with patients and help relieve their stress and anxiety. His path to a career in medicine began with a move back to his home state of Florida and enrollment into the FIU Herbert Wertheim College of Medicine. “As an opera singer, you memorize tons of lines and music,” Dr. Rane said. “I guess you could say that practice got me ready for med school.”

During his fourth year of medical school, Dr. Rane’s music career came knocking in the form of an “out of the blue” email from the director of the Met. An old castmate recommended Dr. Rane and he was being asked to audition for George Gerwin’s classic American opera, Porgy and Bess. With the support and encouragement of his medical school advisor, Dr. Rane auditioned and was chosen to be in the show’s ensemble. “This was obviously a great opportunity and one that I couldn’t pass up, but that being said, medicine is what I saw myself doing,” Dr. Rane said. “After all, I’d come a long way and felt like I’d found a new passion in life.”

With special permission from his advisor, Dr. Rane finished up his last year of medical school remotely while preforming at the Lincoln Center, completing an emergency medicine rotation at New York Presbyterian Hospital, and applying for his first residency program. “I’ve managed to find a way to keep music in my life through what may very well have been the most stressful time in medical school,” Dr. Rane said.

After three weeks of music and staging rehearsals in rehearsal rooms around the Met opera house, the cast of Porgy & Bess gets ready to move their final rehearsals to the stage. Pre-Covid photo courtesy of the Met opera chorus’ Facebook Page.

A scene from the final dress rehearsal of the Met’s production of The Gershwin’s Porgy and Bess. Pre-Covid Video.

According to Amazon’s editorial review for the 3-CD set audio recording of The Gershwins’ Porgy and Bess, the show was returning to the Met stage for the first time in nearly 30 years and ended up breaking company box-office records. The show was extended for an unprecedented three additional performances in February 2020. The production was also seen in cinemas around the world as part of the Met’s Live in HD series and seen by more than 325,000 people, making it one of the most successful transmissions in the series’ history.

The 3-CD set audio recording of The Gershwins’ Porgy and Bess as sold on Amazon.

Dr. Rane’s unique life experiences wouldn’t end there. He came back to Florida to start his prestigious three-year residency at Tampa General Hospital (TGH) as a part of the USF Health Morsani College of Medicine (MCOM) Emergency Medicine Residency Training Program. Only a few months into the coronavirus pandemic, Dr. Rane was stationed in TGH’s emergency department, among “the sickest of the sick, people on ventilators,” Dr. Rane told Joel Rozen, staff writer for the Met. “There are a lot of challenges the virus presents, but it also offers the opportunity to be creative. You’re multitasking and thinking on your feet, and the need to communicate with a lot of people at once reminds me of what I loved about performing.”

Now, almost a year into Dr. Rane’s residency, one of his notable memories is, “getting the opportunity to run a successful code in the ICU and intubating and managing the care of a critical patient in the trauma bay for the first time,” Dr. Rane shared. “Some of my favorite memories outside of work have been simply having a meal and good conversation with faculty members, spending time with my amazing co-residents, going out on boat rides in Tampa Bay and exploring all that Tampa has to offer.”

While continuing to endure the anxiety of the COVID-19 crisis, Dr. Rane’s music career came back around for more exciting news – the 2019 Metropolitan Opera recording of Porgy and Bess won the 2020 Grammy Award for Best Opera Recording. The recording was conducted by David Robertson and starred Angel Blue and Eric Owens. The cast also included Latonia Moore, Ryan Speedo Green, Alfred Walker, Golda Schultz, Denyce Graves, and the Metropolitan Opera Orchestra and Chorus. Dr. Rane and the rest of the members of the chorus and orchestra will receive a Grammy certificate while the 6 leading cast members and conductor will receive the iconic trophies. “I was overjoyed,” Dr. Rane said about the win. “We had all poured our heart and soul into that production, so this was just a testament to all of the hard work. Over the course of rehearsals and performances, I feel like my cast at the Metropolitan Opera became more like a family. Being part of that production as a fourth-year medical student was truly an incredible gift, and I feel so lucky to be given the opportunity to do it.”

The Metropolitan Opera closed during the height of the pandemic in New York City and has remained closed to this day with plans of reopening in the Fall with the same production of Porgy and Bess. Dr. Rane and the original cast have all been invited back to perform in it, but unfortunately, Dr. Rane doesn’t think he is going to join. “I unfortunately don’t see my participation in it a possibility right now as residency is my priority,” Dr. Rane said. “That being the case, I have developed a good relationship with directors at the Met, so hopefully the door will remain open and I will be invited back to perform there again in the future.”

At the end of a busy day at the hospital, Dr. Rane often sits down at his piano and sings to help de-stress. “I do see continuing to perform as a real possibility in the future and plan to continue singing and performing in some capacity after residency,” Dr. Rane said. “Whether that be putting on concerts or performing in a local theater company, I feel it’s important to find balance in life, and music certainly does that for me.”

The diagnostic blood test being developed is intended to speed treatment critical to improving  ischemic stroke outcomes

Stroke survivor Lauren Barnathan was one of the first patients to donate a blood sample for the pilot study of a stroke diagnostic test under development by VuEssence Inc and USF Health Neurology.

Lauren Barnathan, who routinely works with stroke patients as a speech pathologist at Tampa General Hospital, is athletic, maintains a healthy diet, and meditates.

And in January 2018, at age 30, she suffered a life-threatening stroke. A tear in the right carotid artery in her neck led to blood clot that dislodged, blocking blood flow to part of her brain.

Barnathan was among the first patients to donate a blood sample for a pilot-feasibility study teaming USF Health Neurology with VuEssence Inc., a Tampa Bay area medical device company with a laboratory based in the USF Research Park.  The ongoing study aims to develop a blood test that can accurately and rapidly detect when a person is having an acute ischemic stroke based on measurable biomarkers in the blood – and, ultimately, help guide treatment decisions for better outcomes.

“On the night of my stroke, when they were consenting me to be part of the study in the emergency department, I remember thinking how great it would be to have a test like that,” said Barnathan, whose fiancé Adam Barnathan, an ER medicine physician (now her husband), called 911 as soon he saw symptoms: facial droop and an inability to use one side of her body. Her timely and successful treatment at the TGH Comprehensive Stroke Center included the blood clot-dissolving drug tPA and a minimally-invasive procedure (mechanical thrombectomy) to physically retrieve a clot from the vessel blocked in her brain.

W. Scott Burgin, MD, professor and division chief of vascular neurology at USF Health Morsani College  of Medicine, leads the Comprehensive Stroke Center based at Tampa General Hospital.

A potential “game changer” for stroke neurology

No reliable early-detection test exists to identify a stroke – the fifth most common cause of death and the leading cause of long-term disability in the U.S.  Most strokes are ischemic, meaning that blood flow to the brain is obstructed by a clot in an artery. Once deprived of oxygen-rich blood, brain cells begin dying. And, stroke outcomes – including recovering the ability to walk, speak, see, understand, reason and/or remember — are generally worse the longer treatment is delayed.

“When I look at all the things that could change the way I’ve practiced stroke neurology all these years, this new diagnostic test would be one of the biggest game changers,” said W. Scott Burgin, MD, professor and division chief of vascular neurology at USF Health and director of its Comprehensive Stroke Center based at TGH.

A one-hour delay in treating stroke equals more than 450 miles of nerves cells, the approximate distance from Tampa to Atlanta, Dr. Burgin said. “And that’s a lot of brain tissue lost. So, any technology that can improve our ability to diagnose accurately and quickly would likely translate into a huge improvement in patients’ functional outcomes.”

USF engineering alumna Maha Sallam, PhD, is president and founder of VuEssence Inc., a Tampa Bay medical device company

Dr. Burgin (a clinical advisor to VuEssence) has been consulting with Maha Sallam, PhD, president and founder of VuEssence, on development of the early-detection stroke test. This applied research project between the university and industry partner VuEssence is funded in part by a Florida High-Tech Corridor Matching Grant, which supports stroke investigator efforts, scientific input into trial design and administration, and study logistics.

So far, about 200 blood samples have been collected for analysis from consenting patients who arrive at TGH’s emergency department with a suspected stroke, and the researchers plan to collect 200 more.

Doctors currently use clinical assessment, including a physical examination and obtaining a medical history, and brain imaging with MRIs and CT scans to assist with stroke diagnosis. Combined with ambulance transport to the hospital ER, these standard diagnostic methods can take hours, increasing the risk of serious brain injury.

“Getting someone treated within a short time period can be complex.” Dr. Burgin said.

Adding stroke-specific gene expression to diagnostic arsenal

Other diseases, such as low or high blood sugar, epilepsy, or migraines affecting one side of the head, can mimic stroke – and may need to be ruled out before specialized treatment by a multidisciplinary stroke team begins. And in the earliest stages of stroke, Dr. Burgin said, CT scans of the brain often appear essentially normal.

Blood samples are analyzed for stroke-specific gene expression at the VuEssence laboratory in USF’s Research Park.

“Right now, physicians really don’t know how the underlying biology in the body, the gene expression, is changing for a particular patient exhibiting acute stroke symptoms,” said Sallam, a USF graduate with a doctorate in computer engineering. “We hope to add that avenue of new information to existing diagnostic tools.”

VuEssence scientists analyze blood samples for specific products made by genes (gene expression) in response to the trauma happening in cells during stroke onset. Such genetic information may help doctors detect a stroke versus a condition that mimics stroke. The technology may also help differentiate the type of ischemic stroke – for example, indicate high probability of emergent large vessel occlusion that could benefit from a mechanical thrombectomy to remove the clot.

The company continues to reduce the time required to identify stroke-specific gene expression in the blood, with promising preliminary results, Sallam said. “Our goal is to get the system to process the patient’s blood (for stroke detection), so that critical test results are available less than 15 minutes” from the time blood is drawn.

To speed stroke treatment, diagnostic test results need to be available soon after a patient arrives at the hospital – if possible, even before.

Blood is collected from consenting patients who arrive at Tampa General’s emergency department with symptoms indicating high likelihood of stroke.

Long-term goal: Portable test device on ambulances

Both Sallam and Dr. Burgin agree that, ideally, the diagnostic blood test would be incorporated into an easy-to-use, portable device that paramedics and other first-responders could carry for pre-hospital detection and differentiation of strokes.

That would provide emergency medical services a much-needed tool to identify individuals with likely severe strokes, so those patients can be directly transported to the closest facility equipped for immediate endovascular therapy, Dr. Burgin said.

“If we get the test to work, the (long-term) goal would be to make it universally available on ambulances, whether in rural Montana or New York City,” he said. “In Montana, getting a patient to a specialized stroke center can be a significant endeavor. But, if the patient’s dizziness is caused by a stroke mimic, such as low blood sugar, they can probably go to the nearest hospital.”

First, though, VuEssense is focused on developing a streamlined test to be FDA approved and implemented in hospital settings and emergency departments, Sallam said. “If all goes well,” she added, “it will take some time before the point-of-care diagnostic technology could be available in ambulances.”

***

This February, Barnathan finished her first half-marathon at the Gasparilla Distance Classic in Tampa.| Photo courtesy of Lauren Barnathan

Barnathan, who overcame mobility and balance challenges after hospitalization, made virtually a full recovery. She returned to work about a month after her stroke, danced at her wedding several months later, and this February ran her first half-marathon, the Gasparilla Distance Classic, with her husband.

But in her professional role she sees stroke survivors who have not been as fortunate.

“Anything that can help expedite the process of intervening to minimize stroke damage would be a huge win,” she said.

Dr. Burgin with Tara McTigue, research nurse in the USF Health Department of Neurology

Dr. Sallam with Christy Larkins, PhD, a senior scientist at VuEssence

Lauren with her husband, Adam Barnathan, MD, an emergency medicine physician| Photo courtesy of Lauren Barnathan

-Photos by Allison Long, USF Health Communications and Marketing