by Nikki Buccina
August 14 2018
Dr. Susan Manzi, Chair of the Medicine Institute at Allegheny Health Network (AHN), always keeps a photograph with her. The image captures the essence of vitality, and of youth. The picture is of a former patient.
“Her name was Jessica, she was diagnosed with lupus when she was 12, and this picture I carry is of her — she has a rash on her face and strawberry blond hair with freckles. A classic young lupus patient,” says Dr. Manzi.
When Jessica was 27 years old, she arrived at the emergency department complaining of shortness of breath. Dr. Manzi received the call right away from the hospital staff, explaining Jessica’s condition and relaying that she was desperate to go home. It was the night before Thanksgiving, after all.
“I told them, ‘Put her on the phone.’ And then I told Jessica that she couldn’t go home, even though she was begging me to go,” continues Dr. Manzi.
Dr. Manzi had co-authored a study published in the American Journal of Epidemiology that found that young women with lupus have an increased risk of cardiovascular problems, including a 50-fold increased risk of heart attacks between the ages of 35 and 45. Dr. Manzi knew Jessica had no choice — she must be admitted. The chances of her shortness of breath being related to a cardiac problem were high.
“We had a heightened sense of concern — otherwise, she’s 27, she would have simply gone home,” Dr. Manzi recalls. “We kept her, but that night she died from a cardiac event. Her young innocent face, that picture, it motivates me to never let that happen again. The last 20 years of my career have been dedicated to research to better understand why young women with lupus have premature heart attacks and strokes.”
She continues, without pause, “I was drawn to a career caring for and conducting research in lupus, not only because of the science behind what causes these types of autoimmune conditions, but because lupus impacts young people, especially young women — I thought to myself, this is where I need to be.”
Susan Manzi grew up in Westmoreland County, Pennsylvania, in a small town named Crabtree. In a 2000 census, the population was 320 people comprising 98 families — a very small town. Dr. Manzi’s roots were formative, and pasta-filled.
“My family was first generation Italian immigrants and my father owned an Italian grocery store,” she says. “We went to my grandmother’s house every Sunday for dinner. All of my aunts, uncles and cousins crammed into a little space. There was a time in my teenage years that I dreamed of getting away from it all. Everywhere I turned, I was either related to someone or they knew my family.”
She and her sister were the first of their family to go to college. Dr. Manzi enrolled at the University of Notre Dame without any defined path to follow. Her Italian roots, paired with a love of the sciences, eventually steered her toward medicine. Being away from home and living in a different part of the country also gave her a growing appreciation for how lucky she was to have a large, extended and supportive family.
“I think people would describe me as compassionate and empathetic,” Dr. Manzi explains. “I always felt like I had a sensitivity to people’s suffering and that I genuinely cared about them. As a junior in college, I made the decision to go to medical school. Some say that you become hardened to human suffering once you practice medicine for a long time, but not me — I still find myself fighting back tears when I have to deliver a difficult message to my patients.”
She adds another truth that many live with but don’t dare to say out loud: “You’re pushed to make decisions when you’re very young and you just hope that you make the right one — that you make one that will turn into the right career for you, that it’s not a job but it’s a passion,” she says. “I have to say, I feel like I did. I got lucky. It’s been the best ride and I’ve loved every minute of it.”
Dr. Manzi’s type of “luck” was built on long nights hitting the books, work days that didn’t seem to have an end, and conversations, presentations and publications that had purpose, and an empathetic touch.
She was intrigued by immunology — the study of the immune system.
“Your immune system is your defense against bacteria or foreign bodies,” she says, then goes on to explain what are called autoimmune diseases. “Typically, your immune system will detect this bacteria, or foreign body, and get rid of it and that’s a good thing. However, for reasons we don’t understand, the immune system can begin to recognize ‘self’ as foreign and it mounts an attack.”
According to the American Autoimmune Related Disease Association, more than 50 million Americans have an autoimmune disease. It’s estimated that there are more than 100 different types of autoimmune diseases, which mainly impact women; for example, 90 percent of people diagnosed with lupus are women.
In 1997, Dr. Manzi and her peers published the seminal article mentioned above on the links between lupus and increased risk of heart attack — one of Manzi’s 200 published materials.
“That article changed the field in the sense that everyone started focusing on premature heart disease in these young women. From there, my career truly took off, especially in terms of looking at heart disease in autoimmune diseases,” she says. “Finally, it culminated in the American Heart Association in 2011 recognizing lupus as a high-risk population. That was fulfilling for me — to be on a mission to spread the word that young women can die from this and we need to know that. The AHA gave us that recognition.”
Dr. Manzi joined AHN in 2010.
As AHN’s Chair of Medicine, she was instrumental in establishing the world’s first Autoimmunity Institute. Introduced in February 2018 and located at West Penn Hospital, the AHN Autoimmunity Institute combines multispecialty care with cutting-edge research, patient education and advocacy to advance the treatment of autoimmune diseases and accelerate discovery of a cure for more than 100 different disease types.
“We realized that patients diagnosed with an autoimmune disorder often need more than one specialist in their care, and as a result, many were getting lost trying to navigate the health care system,” she explains. “So, we set out to create an institute that brings together more than 25 clinicians representing 12 different specialties, including but not limited to cardiology, pulmonary, rheumatology, gastroenterology, allergy, dermatology, nephrology, nutrition, and behavioral health. This team-based approach is the future model for all health care. The Autoimmunity Institute has already had a major impact on people’s lives — patients are coming from all over the world. It facilitates care not only for our patients, but for their families, too.”
In addition to her work with the Institute, Dr. Manzi works across various disciplines to help clinicians develop innovative programs and initiatives to advance care and increase accessibility for patients. Committed to a holistic, team-based approach to health care, she is also leading care model transformation for those impacted by chronic diseases like diabetes, congestive heart failure and chronic obstructive pulmonary diseases for Highmark Health.
“We need to change the way health care is delivered in the United States,” she says. “The experience for patients and their families is not optimal and the cost is too high. We have to move away from focusing only on treating diseases, to addressing all of the needs of the people impacted by these diseases, such as mental health and social determinants of care like transportation, cost, housing and other potential barriers to good health outcomes. We are doing that at AHN with support from Highmark Health. I love my job. Even with the challenges, ups and downs, I look forward to coming to work every day.”
Her passion for her work isn’t boastful, but it radiates from Dr. Manzi with a sense of pride and has an infectious quality — there is an undercurrent of encouragement, a whisper of “you can do it, too.”
When asked what advice she would bestow on her younger self and to young women getting started in their career, she responds like she’s thought of it before — clear, concise and quick.
“First, you have to find your passion and go after it; the first job may not be right, and the second one may still not be it. Life is long, so find what makes you want to get up in the morning and don’t feel like you’re stuck in whatever path you took,” she says. “Second, negotiate for yourself. In my job, I sit across the table from hundreds of doctors who negotiate — I see that men do it and women don’t do it. It’s okay to ask for what you want, don’t ever shortchange yourself. Lastly, we as women need to help one another — embrace each other and help each other advance.”
In other words — find your own version of Jessica’s picture. Find it and hold onto it and stay close to what motivates you to make a difference.