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M Teaching death 12 Death done well 20 Weighing end-of-life care 28

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Va nderbiltMedicineWINTER 2009

Extinguished A comprehensive look at the end of life W I N T E R 2 0 0 9 Teaching death 12 Death done well 20 Weighing end-of-life care 28 Van derbiltMedicine :::: :: Read VOLUME 26, NUMBER 1

VanderbiltMedicineWINTER 2009 Vanderbilt Medicine is published by Vanderbilt our online University Medical Center in cooperation with the VUMC Office of News and Public Affairs. publications Copyright © Vanderbilt University Extinguished EDITOR A comprehensive look at the end of life Nancy Humphrey

ASSISTANT EDITOR Vanderbilt Medicine , the alumni publication Kathy Whitney of the Vanderbilt University School of Medicine. DESIGN Diana Duren www.mc.vanderbilt.edu/vanderbiltmedicine CONTRIBUTING WRITERS Carole Bartoo Craig Boerner Jon Coomer Paul Govern Leslie Hast Laurie Holloway

p.4 Uncle Sam: Scientist p .18 Follow the yellow brick road WINTER FALL 2008 09 p .12 Canary in the research lab p.26 Big science in the balance John Howser ... Nancy Humphrey Lens Lynne Hutchison Biren Kamdar Leigh MacMillan Melissa Marino U.S. Brent McNew science: Vaccine Under Wanswershat every parent Elizabeth Older wants to know the gun Jessica Pasley Dagny Stuart Erin Brady Worsham Kathy Whitney

how vaccines taking one guardian 10 work 16for theteam 22 angels A PUBLICATION OF VANDERBILT UNIVERSITY MEDICAL CENTER WWW.MC.VANDERBILT.EDU/LENS PHOTOGRAPHY/ILLUSTRATION Lens , a science publication, pro - On Their Way , a publication of the Dean Dixon duced by Vanderbilt University Monroe Carell Jr. Children’s Hospital Dana Johnson Medical Center. at Vanderbilt. Joe Howell Tommy Lawson www.mc.vanderbilt.edu/lens www.vanderbiltchildrens.com/ Anne Rayner ontheirway Susan Urmy

EXECUTIVE DIRECTOR OF NEW MEDIA

Moving toward a future without cancer. FALL 2008 08 AND ELECTRONIC PUBLICATIONS spring nurse Wayne Wood

IN THIS ISSUE: m momentum CELEBRATING THE PAST 1 4 IN THIS ISSUE: FOUND IN TRANSLATION NAVIGATING CANCER CARE PULLING CANCER'S ROOTS MAKING A DIFFERENCE 2 0 THE FUTURE OF NURSING 2 6 COVER PHOTOGRAPH Joe Howell

EDITORIAL OFFICE Office of News and Public Affairs Looking D-3237A Medical Center North inside a century of nursing Vanderbilt University Nashville, Tenn., 37232-2390 Cancer Hot Spot VANDERBILT MEDICAL Where you live matters when it comes to cancer risk ALUMNI ASSOCIATION D-8200 Medical Center North Vanderbilt Nurse , the alumni Momentum, the magazine of the Nashville, TN 37232-2106 publication of the Vanderbilt Vanderbilt-Ingram Cancer Center. (615) 322-6146 University School of Nursing. (800) 288-0266 www.vicc.org/momentum Fax: (615) 936-8475 www.nursing.vanderbilt.edu/nurse e-mail: [email protected] Visit us at: www.mc.vanderbilt.edu/alum-affairs Van derbiltMedicine WINTER 2009

:: on the cover

“The idea of death, the fear of it, haunts the human animal like nothing else; it is a mainspring of human activity — designed largely to avoid the fatality of death, to overcome it by denying in some way that it is the final destiny of man.” TEACHING DEATH 12 DEATH DONE WELL 20 THE ULTIMATE EXAMINATION 34 — Ernest Becker :: departments :: features

Making the Rounds 2 Teaching death 12 Around the Medical Center 3 It’s a natural extension of life A New Dean 7 Alumni Profile 8 Essay: The four rules 18 A Vanderbilt resident writes about breaking bad news. Canby Robinson Society 49 Alumni Journal 53 20 Alumni/Faculty News 54 Death done well A Kentucky woman makes a difficult decision, but the right one for her.

Essay: Tomorrow 26 A Nashvillian writes about 14 years of living with Lou Gehrig’s disease.

Weighing end-of-life care 28 How do we want to live and how do we want to die?

Taking care of the elderly 33 VUMC’s new Geriatrics Consult Service

The ultimate examination 34 Autopsies are declining, but are still the gold standard for finding what went wrong.

The science (and art) of dying 40 Americans are not used to, nor are they comfortable with, the process of death.

Gilda’s Gang 48 Gail Addlestone, M.D., MD’97, had a vision. LEVI WATKINS , M.D. 8

WINTER 2009 1 :: making the rounds

BY HARRY R. JACOBSON, M.D. Vice Chancellor for Health Affairs

On any given day at Vanderbilt a handful of souls D

E leave their mortal selves behind. We A N

D would hope that we had done everything I X

O we could to keep them with us. Most N could not have been saved with the means we have at our disposal today. Some sim - ply decide on their own that it is their time. And some die through simple human error. Medicine has focused fero - cious attention on identifying the source of error, on designing systems that protect from life to death a meaningful and pow - against those errors and in producing Six erful experience for the people who are Sigma error reduction that matches dying and the family they leave behind. Toyota’s and GE’s. Jonathan Gitlin, M.D., our chairman of The record Vanderbilt has achieved Pediatrics, reminds us every day that there in mortality and error reduction is nothing are children in our hospital who will short of stunning. The severity- adjusted never go home again. What obligation death rate among our patients is among do we have to those children, to their par - the lowest in the nation. Our physicians ents, to their brothers and sisters? When and surgeons believe we can achieve death our tools to cure fall short, what then is rates that are half the national average our mission? even as the national average is markedly In the pages of this issue of improving. No matter how impressive Vanderbilt Medicine we begin to answer this reduction in mortality – it is only these questions. And we begin to answer half the job. them with an affirmation that death is a Doctors are geared to cure illness and process at least as important as healing – injury. It is a focus that has helped us and may be even more profoundly and extend life by 40 years since the turn of deeply meaningful. It has been said that the century. Still, the end point of life, the single most important distinguishing no matter how long and how productive, characteristic between human beings and is death. We fight to save lives. We need the rest of the animal world is our aware - to work just as hard to make the transition ness of death. Medicine needs to make that awareness as much a part of its ethos as “do no harm” and as much a part of its approach as diagnosis. VM

2 WINTER 2009 around the :: medical center

Antibodies from 1918 flu News and happenings at resurrected Vanderbilt Medical Center Ninety years after the sweeping destruction of the 1918 flu pandemic, researchers at the Monroe Carell Jr. Children’s Hospital at Vanderbilt have recovered antibodies to the virus — from elderly survivors of the original outbreak. $20M gift launches Children’s The study, led by James Crowe Jr., M.D., professor of Pediatrics and direc - Hospital expansion project tor of the Vanderbilt Program in Three generations of the family of the late Monroe Carell Jr. have pledged a Vaccine Sciences, and colleagues at the gift of $20 million to the fundraising effort for a new facility to care for children Mount Sinai School of Medicine, was and mothers. published in the Sept. 25, 2008, issue of The Campaign for Children and Mothers, with a goal of $45 million, will support the journal Nature . the building of a 400,000-square-foot facility, adjacent to and connected with the The influenza pandemic of 1918 Monroe Carell Jr. Children’s Hospital at Vanderbilt. killed nearly 50 million people world - “This is truly a family gift from three generations,” said Julie Stadler, the eldest wide, many of whom were young, daughter of Ann and Monroe Carell Jr. She and her husband, George Stadler, are healthy adults. chairing the Campaign for Children and Mothers. “My father inspired many by his In 2005, researchers from Mount example. He believed if you felt passionate about a cause, you should support it Sinai and the Armed Forces Institute of with your time, energy and financial resources to the best of your ability. Pathology in Washington, D.C., resur - “That’s why this gift is from all of us: my mother, Ann Carell; my sisters and rected the 1918 virus from the bodies of their husbands, Kathryn and David Brown and Edie and David Johnson; and from people killed in the outbreak. George and me and all of our children. Our family felt it was important to demon - When the investigators approached strate our own support in a significant way as we ask others throughout the Crowe, whose lab had developed meth - community for their generosity.” ods of making antibodies, to try to Stadler joined John Stein, chair of the Board of Directors for Children’s Hospital; make antibodies to the 1918 flu, he was Kevin Churchwell, M.D., CEO of the Children’s Hospital; and Harry Jacobson, M.D., skeptical, but agreed to try. vice chancellor for Health Affairs for Vanderbilt Medical Center, as they announced The researchers collected blood the gift to the hospital’s board of directors on Sept. 11, 2008. samples from 32 survivors age 91-101 “The generosity of the whole Carell family is a thing of legend,” Jacobson said. years and found that all reacted to the “A gift of this magnitude has the possibility of transforming the way we view care 1918 virus, suggesting that they still for mothers and the babies they carry. But just as important, the generosity of the possessed antibodies to it. Stadlers, the Browns, the Johnsons, and Ann Carell will allow us to expand our Crowe’s team was then able to Children’s Hospital to N O S isolate exceedingly rare B cells — the meet the needs of our N H O J immune cells that produce antibodies — growing region, to expand A N A from eight of those samples and grow our services, and to D them in culture. broaden our mission Seven of those samples produced and build this wonderful antibodies to a 1918 virus protein, sug - new facility.” gesting that their immune systems Monroe Carell Jr., who were waiting on standby for a long- died on June 20, 2008, awaited second outbreak. was a noted philanthro - In addition to revealing the sur - pist and chaired the prisingly long-lasting immunity to such campaign that built the viruses, these antibodies could be Children’s Hospital that effective treatments to have on hand if now bears his name. VM another virus similar to the 1918 flu -CAROLE BARTOO breaks out in the future. On hand for the gift announcement were, from left, Kevin Churchwell, M.D., George and Julie And the technology could be used Stadler, co-chairs of the Campaign for Children to develop antibodies against other and Mothers, and Harry Jacobson, M.D. viruses, like HIV. VM -MELISSA MARINO

WINTER 2009 3 :: around the medical center

Medical students span globe for Emphasis Program projects Blood pressure drug combo may Vanderbilt University School of Medicine students usually complete cut heart attack deaths: study their Emphasis Program projects in a Thousands of patients with high blood pressure could benefit from changing Vanderbilt lab, but during the summer their drug treatment regimen to reduce their risk of cardiac death. of 2008 several performed research at The current U.S. hypertension treatment guidelines recommend using a thiazide various spots around the globe. diuretic — a drug that increases the volume of urine — alone as the initial drug “The opportunity to work abroad is therapy for high blood pressure. But a new analysis of existing clinical trials of a wonderful gift to students and not diuretic drugs calls into question the current guidelines. just because of the exposure to differ - Vanderbilt Medical Center researchers found that combining a thiazide diuretic ent cultures,” said Denis O’Day, M.D., with a “potassium-sparing” drug to treat hypertension reduced both sudden cardiac who directs the Emphasis Program, death and total coronary mortality by 40 percent. which gives students the chance to “The recommendations can now be re-examined in light of these new findings,” engage in scholarly research during said John Oates, M.D., senior author of the study published in the September/October their first two years of medical school. 2008 issue of the Journal of the American Society of Hypertension . Here are a few of the students’ Thiazide diuretics successfully reduce blood pressure for many patients, but stories: they are also known to deplete potassium, said Oates, a professor of Medicine and • Matt Kynes and his wife, Ansley, hypertension specialist. This potassium “wasting” has sparked concern over the traveled to Nimule, Sudan, a town on years with studies suggesting a link between potassium loss and sudden cardiac the border of southern Sudan and death. The new findings — that combining a potassium-sparing drug (ENaC inhibitor) Uganda that has seen a rapid and with a thiazide diuretic reduces sudden death — beg the question of whether thi - alarming increase in HIV. azide diuretics given alone actually increase the risk of sudden death in patients with Kynes’ Emphasis project involved high blood pressure. It’s possible, Oates said. interviewing more than 20 religious lead - “There’s biologic plausibility for an adverse effect of the thiazides,” he said. “If ers about their opinions and attitudes it’s true, it’s probably the largest adverse effect in the history of modern pharmacol - toward HIV/AIDS and the current preven - ogy. The number of individuals affected over the last 50 years would be staggering.” tion, counseling and support programs The Joint National Committee, under the direction of the National Heart, Lung, their congregations were offering. and Blood Institute, publishes clinical practice guidelines for hypertension — new • Chris Estopinal worked for two guidelines are expected in 2009. VM months at Macha Mission Hospital, a - LEIGH MACMILLAN Y

208-bed facility in Zambia that provides M R U

free HIV care and treatment to more N A S U

than 3,000 patients, many of whom S must travel hours or even days to reach the hospital. Estopinal evaluated the hospital’s home-based HIV care program by com - paring outcomes such as death and drug adherence between those patients who live in communities with home- based care and those who do not. • David Silvestri also traveled to Zambia, where he partnered with a short-term mobile clinic comprised of Zambian and American medical providers, including Jeff McKinzie, M.D., a Vanderbilt professor of Emergency Medicine. VM - BRENT MCNEW

John Oates, M.D., is studying a hypertension therapy that may reduce coronary mortality rates.

4 WINTER 2009 around the medical center :: Sullivan Pardee is being treated for congenital glaucoma at the Vanderbilt Eye Institute. L L E W O H E O J National spotlight shines bright on Medical Center In addition to being named to U.S. News & World Report’s “honor roll” of the nation’s best hospitals, Vanderbilt Medical Center’s ongoing efforts to improve quality of care and patient safety were featured in the magazine’s annual “America’s Best Hospitals” issue, published in July 2008. The 12-page article, told in a time- stamp format, is titled “America’s Best Hospitals — Vanderbilt’s special mix of Sights set on easing congenital glaucoma skill, passion, and Southern comfort hits all the right notes in Nashville,” Parents of newborns often are told that their baby has big, beautiful eyes. and kicks off with a two-page photo of It’s a common compliment, but it’s one that a Vanderbilt ophthalmologist cautions LifeFlight offloading a patient. could be a warning sign for congenital glaucoma. What follows is an account of some “When the pressure in the eye is high, the eyes enlarge,” said Karen Joos, M.D., of the events that happened the week of Ph.D., associate professor of Ophthalmology at the Vanderbilt Eye Institute. “A child June 9-14, 2008, as witnessed by U.S. may also show signs of light sensitivity and a cloudiness of the cornea. Sometimes News staff writers Sarah Baldauf and these are subtle changes that can easily be missed.” Lindsay Lyon and photographer Jim Lo Congenital glaucoma is a rare condition affecting one in 10,000 births. Sullivan Scalzo during their six-day visit. Pardee, 8 months, is one of those cases. Thankfully his mother, Tracy, noticed a The article’s content was shaped in change in his eyes when he was about 3 months old. part from a lengthy menu of sugges - According to Joos, the best prognosis is found in patients whose symptoms devel - tions that were received and compiled op between the age of 3 and 12 months, while those occurring earlier than 3 months in response to an e-mail sent by Harry typically experience more severe signs of the disease and a tougher outcome. Jacobson, M.D., vice chancellor for Sullivan was quickly scheduled to see Joos, but before making that appointment Health Affairs, prior to the U.S. News he was whisked to the emergency room at Monroe Carell Jr. Children’s Hospital team’s pending visit. More than 200 at Vanderbilt. suggestions from people at all levels “We woke up the next morning and my husband, Tyson, looked at Sullivan,” said throughout the organization who want - Pardee. “His eye was totally clouded over. It looked like someone had spilled milk in it. ed to show their work were received The pressure in his eye had built up so high, it burst the membrane that covers and and then carefully reviewed. protects the iris.” In part from these suggestions, a Within three days, Sullivan underwent a goniotomy in both eyes to remove the 14-page list of story suggestions was fluid buildup caused by the improper development of the eye’s drainage channels. created and used by News and Public Because the channels were defective, fluid was continually produced with no way to Affairs personnel as they showed the exit. This caused high pressure inside the eye. reporters numerous programs, initia - A second surgery was performed a few weeks later because the pressure in tives and protocols. Sullivan’s eye did not decrease as much as Joos hoped. “One of the more gratifying “Sullivan has clear, clear eyes,” said Pardee. aspects of this project with U.S. News Nearly 75 percent of congenital glaucoma cases occur in both eyes and is most was receiving these e-mail suggestions often seen in boys (65 percent). The success rate for congenital glaucoma is about 90 from people throughout the Medical percent for up to five years. VM Center,” Jacobson said. -JESSICA PASLEY “From these e-mails it is readily apparent our workforce is proud of what we do, and they really understand how their role within the organization serves a common goal. I want to thank everyone who offered their input and assistance with this project.” VM -JOHN HOWSER

WINTER 2009 5 :: around the medical center

Carlos Arteaga, M.D., directs VICC’s Breast Cancer Research Program, which received renewed funding from the National Institutes of Health. L L

Trauma Center celebrates a E W O decade of saving lives H E O In August 2008, the Vanderbilt J Trauma Center celebrated its 10-year anniversary. The acute care unit, located on 10 North in Vanderbilt University Hospital, opened on Aug. 13, 1998, with then Nashville Mayor Phil Bredesen on hand to help cut the ribbon. Since its opening, the Trauma Center has treated a broadly diverse patient population from all walks of life, and has also cared for highly visible patients such as country music super - stars, pro football players and elected officials on several occasions. As the region’s only provider of Level 1 trauma care, the Vanderbilt Trauma Center’s staff of 16 physicians, 108 nurses and 42 staff has treated Breast cancer research gets $12 more than 33,000 acutely ill patients since the unit’s opening. million boost from NCI Since 1998 the Trauma Center’s Vanderbilt-Ingram Cancer Center’s Specialized Programs of Research Excellence number of annual admissions has risen (SPORE) in Breast Cancer has received a new round of grant funding from the National from 2,000 to nearly 4,000 per year. Cancer Institute (NCI). During this same period, more than The NCI will provide $12 million over the next five years to support and expand 16,000 motor vehicle accident victims, Vanderbilt-Ingram’s translational research efforts in breast cancer. 3,100 gunshot victims and 5,000 unin - “We are grateful that the NCI has recognized the high quality of our research pro - sured Middle Tennesseans have been gram and rewarded our team for the novel and promising avenues of research we are treated by Trauma Center staff. VM pursuing,” said Carlos L. Arteaga, M.D., director of the Vanderbilt-Ingram Breast -JOHN HOWSER Cancer Research Program. The NCI initiated organ-specific SPORE grants in 1992 to encourage translational

E research, which is designed to speed discoveries from the laboratory into treatment K A R

B options in the clinic. This patient-centered research platform encompasses work by L I E N basic scientists, epidemiologists and clinicians and encourages collaboration. Vanderbilt-Ingram received its first SPORE grant in Breast Cancer in 2002. The grant brings together 15 co-investigators from seven departments in the School of Medicine, spanning a breadth of basic science and clinical disciplines. “Working as a team we want to make an impact on breast cancer research, treat - ment, detection and prevention worldwide,” said Jennifer Pietenpol, Ph.D., director of Vanderbilt-Ingram and a Breast Cancer SPORE researcher. “The SPORE grants are critical to our mission of making a difference in the lives of cancer patients.” All three of Vanderbilt-Ingram’s SPORE grants — in breast, lung and gastroin - testinal cancer — have now been renewed by the NCI, which is a remarkable accomplishment among cancer centers. VM -DAGNY STUART

6 WINTER 2009 a new dean ::

School of Medicine alum chosen as new dean BY LYNNE HUTCHISON

Jeff Balser, M.D., Ph.D., “As an alumnus of our Medical is the new dean of Vanderbilt Scientist Training Program, I University School of Medicine. am deeply committed to the Balser served as interim lives and careers of our faculty R E N dean before his appointment in and staff, and our growing Y A R E

October 2008, and is a newly number of students and trainees N N elected member of the Institute in the sciences and health care.” A of Medicine and an alumnus of Balser was born in established new paradigms for “The School has enjoyed the school. He becomes the Indianapolis, Ind., in 1962 and how the chambers of the heart remarkable progress over the 11th dean of VUSM since its received his M.D. and Ph.D. in contract and relax, and are past decade, increasing in its founding in 1875. Pharmacology from Vanderbilt yielding new targets for local, national and international In addition to his respon - in 1990. He trained as a resident arrhythmia control. stature,” Balser said. “While sibilities as dean, Balser is asso - and fellow in anesthesiology Balser and his wife, nurturing our atmosphere of ciate vice chancellor for Health and critical care medicine at Melinda, are the parents of cooperation and collegiality, Affairs with continued over - Johns Hopkins, where he joined three children: James, 18, we are now called to leadership sight of the Medical Center’s the faculty in 1995. He Jillian, 16, and Madeline, 12. in shaping the future of bio - research enterprise. returned to Vanderbilt in 1998 Balser succeeds Steven medical science and academic “Dr. Balser has earned the as associate dean for Physician Gabbe, M.D., who left medicine. This will be an respect of his colleagues in the Scientists. In 2001 he was Vanderbilt in June to become exciting period in the history of School of Medicine, and appointed the James Tayloe senior vice president for Health the Medical Center. I’m thrilled throughout Vanderbilt, for his Gwathmey Professor and Chair Sciences and chief executive to have the opportunity to keen intellect, sound judgment of Anesthesiology. officer at Ohio State University work with so many friends and high ethical standards,” said In 2004 Balser became Medical Center. and colleagues in advancing Chancellor Nicholas Zeppos. “I associate vice chancellor for Daniel Beauchamp, M.D., our goals in health care, educa - have great confidence that Jeff Research, heading a period of director of the Section of tion and research. will continue to advance the significant expansion that Surgical Sciences, headed “I recall sitting in Light School of Medicine to new moved Vanderbilt into 10th the selection committee, Hall as a student in 1984, lis - heights of excellence, both place among U.S. medical which chose Balser from a tening to Dean Chapman give a nationally and internationally.” schools in funding from the group of nationally prominent talk about the contemporary “Jeff has proven himself as National Institutes of Health. candidates. challenges in academic medi - the chair of Anesthesiology, the Balser also is a member of “While each applicant had cine,” Balser added. associate vice chancellor for the American Society for an impressive academic record “I remember thinking at Research and as the interim Clinical Investigation, the of leadership and accomplish - that time how exciting it must dean,” said Harry Jacobson, Association of American ment, Dr. Balser was the be to be dean of the School of M.D., Vanderbilt’s vice chan - Physicians, the AAMC Advisory applicant who most impressed Medicine at Vanderbilt. I still cellor for Health Affairs. “He is Panel on Research, and has the committee with his energy feel exactly the same way, and I a leader, a clinician, a researcher recently chaired the NIH and enthusiasm, his breadth of am extraordinarily grateful for and a mentor with the energy Director’s Pioneer Award knowledge and interests span - this opportunity.” VM and insight to lead the School Committee. ning basic sciences to clinical of Medicine to an even greater His studies in the journals practice, his diplomacy and his level of achievement in the years Nature, Proceeding of the vision for the future of the to come. National Academies of Science School of Medicine and “I’m proud to be entrusted and Nature Structural and Vanderbilt University in its with this honor,” Balser said. Molecular Biology have entirety,” Beauchamp said.

WINTER 2009 7 :: alumni profile CFiulrl cle Levi Watkins Jr., M.D., is well known for a host of firsts. He was the first African-American student ever enrolled at Vanderbilt University School of Medicine. When he graduated four years later, he was still the only one. He was the first African-American to serve as chief resident in cardiac surgery, as professor of cardiac surgery, and as associate dean of the School of Medicine at Johns Hopkins. He defined the role of the renin-angiotensin system in congestive heart failure, which led to the use of angiotensin blockers. In 1980 he performed the world’s first implantation of the automatic implantable defibrillator. He even graduated first in his high school class. In October 2008, Watkins, MD’70, associate dean of the Johns Hopkins University School of Medicine and professor of cardiac surgery, was awarded Vanderbilt University’s Distinguished Alumnus Award, which recognizes a graduate whose contri - butions have had a broad, positive impact on humankind — and who has chosen to do something of even greater benefit to the universal community. “Dr. Watkins’ career has been an inspiration to legions of physicians and scientists in this country and around the world,” says Jeff Balser, M.D., Ph.D., Vanderbilt’s asso - ciate vice chancellor for Health Affairs and dean of the School of Medicine. “His courage in overcoming adversity and racial prejudice is inspirational.” “I’m deeply honored by this,” Watkins said. “It reminds me of something my grandfather said at my Vanderbilt graduation. He’d never been to Vanderbilt — he thought it was just for whites — but he came, saw the people, the stage, the robes. Then he said ‘Boy, this is really something.’ “ Watkins’ warm, rich voice pauses, then drops deeper. “I feel the same way — this is really something. It’s full circle.”

WRITTEN BY LYNNE HUTCHISON PHOTOGRAPH BY JOE HOWELL

8 WINTER 2009 alumni profile ::

LEVI WATKINS JR., M.D.

WINTER 2009 9 :: alumni profile

LEARNING BY EXAMPLE Watkins was born in 1945 in Parsons, These days, the cardiac surgeon’s heart lies with Kan., then moved with his family to improving postdoctoral training and diversity in Montgomery, Ala., when he was still a medical education. baby. His father was a business administra - tor and later was named president of Alabama State University. Montgomery was ground zero for the some negativity,” Watkins says of his the clinical knowledge. Research is impor - early Civil Rights movement and Watkins Vanderbilt years. “The beauty was meeting tant because that’s the way people push was involved from childhood. people like John Tarpley (a classmate), and the cutting edge of understanding disease, “Growing up in a segregated society faculty who were great teachers, who genes, devices, drugs.” was tough,” he recalls. “Movie theaters, embraced me in a way you’d never forget. In 1978 Watkins joined the Hopkins stores, neighborhood, buses, train It was academically challenging. I barely faculty as an assistant professor of Surgery. stations — they were all segregated. But passed my first biochemistry exam. Within months he embarked on the black families and churches and communi - “There was also negativity,” Watkins groundbreaking work that launched his ties were strong and spirited. That helped adds. “I remember the use of the ‘N’ word career and has saved the lives of thousands balance the negativity of segregation. by occasional patients and occasional stu - of patients who suffer from cardiac “Daddy and Dr. Martin Luther King dents. Also by occasional faculty.” arrhythmia. Jr. were good friends,” Watkins continues. Worse, Watkins had water and feces “So we joined the Dexter Avenue Baptist thrown on him from the fourth floor of LIFE’S WORK Church, where Dr. King was the preacher. Curry Hall, where he kept a picture of On Feb. 4, 1980, Watkins performed He used to bring us boys to his home to Martin Luther King Jr. on his dorm room the world’s first surgical implantation of keep us from being violent during those door. His saddest memory of that time was an Automatic Implantable Defibrillator tough days. He was a wonderful man and returning to Curry Hall the day Dr. King (AID) in a 54-year-old California woman greatly influenced my life.” was assassinated. who would otherwise have died from Even more influential was Watkins’ “Not all the students in Curry Hall cardiac arrest. father — a kind man who led by example, were as disappointed and devastated as The AID automatically detects irregu - demonstrating the virtues of hard work I,” Watkins says. “I could tell by what lar rhythms and shocks the heart back to and love of people. “Folks said I looked they wrote on the door — ‘We finally life. Its inventor, Israeli cardiologist Michel and smiled like him. But he didn’t have got the coon.’” Mirowski, brought the device to Johns any special children — we all got the same By the time he had earned his M.D., Hopkins for research and testing. whippin’,” Watkins says with a chuckle. however, Watkins had made many friends. Although Watkins was a junior faculty After graduating from high school in He considered staying at Vanderbilt for member at the time, his mentor recom - 1962, Watkins took his father’s advice and residency, but the chief of surgery provided mended that he work with Mirowski on headed to Tennessee State University in him with a strong recommendation to the project. Nashville. Although he had intended to Johns Hopkins. Watkins arrived there in “I did the early animal work,” Watkins follow in his father’s footsteps and become the fall of 1970. says. “Then in 1980 the FDA approved the a college professor, Watkins soon had a Three years later Watkins interrupted implantation of the device in a human. change of heart. his training at Johns Hopkins to do cardiac That first operation sure was something.” “I had an adviser and mentor — Dr. research at Harvard Medical School. Watkins explains that after implanti - John Mallette — who was a biologist,” There, after months of investigation, he ng the AID, he had to stop the patient’s Watkins explains. “He saw talent in me defined the role of the renin-angiotensin heart to see if the device would work. that I did not see. He suggested the possi - system in congestive heart failure. His “We’re taught to restart the heart, but bility of me being a doctor.” research ultimately led to the use of here we had to stop it. It took what Watkins took the challenge and in angiotensin blockers in the treatment of seemed a long time. The device was sup - May 1966 became the first African- heart failure. posed to fire in 20 seconds, but it took 30 American ever to be admitted to VUSM. Watkins credits VUSM with his love to 35 seconds. We almost used external He learned of his acceptance from a front- for research. defibrillation, but finally it fired and start - page headline in the Nashville Tennessean . “Vanderbilt had a lot of research fac - ed. People almost cheered.” “It was a complex experience with ulty,” Watkins explains. “I liked their Watkins notes that there have been incredible beauty, but also challenges and quest for new knowledge in addition to problems over the years with AID leads

10 WINTER 2009 alumni profile ::

Left: Levi Watkins, M.D., in his 1966 class composite; Right: Watkins, left, greets NFL quarterback Bart Starr in 1998. Looking on are Harry Jacobson, M.D., (second from left) and former VUSM dean John Chapman, M.D.

and infection, and that fellow cardiologists “He represents the leadership necessary to had a great friendship. Rosa Parks, we were once criticized the procedure, thinking it make progress,” Hill says. “You have to be friends. I oversaw their health once I would kill patients. “But we overcame all prepared to work hard, sometimes against became a doctor. Andrew Young and that,” he says. “The AID is implanted in all odds to be successful. He is willing to Belafonte — they’re all equal — but several million people and its success is take a stand on what he believes.” brought different spices to my pie.” well known. I’ve gone full circle in that As a member of the Board of Trust, Watkins lives in Baltimore, where he area, too.” Watkins was proud that the VUSM Class was named “Best Citizen” by the city’s Balser, now VUSM’s dean, trained as of 2012 was the most diverse ever admit - mayor. He has been awarded four hon - a cardiac anesthesiologist under Watkins ted, with 20 of the 105 students belonging orary doctorates and numerous other and counts himself among those fortunate to minorities underrepresented in medicine accolades, and in 1993, PBS showcased individuals to benefit from Watkins’ men - and 12 hailing from 10 foreign countries. his life and work in a New Explorers series toring and friendship. “His willingness to But Watkins feels the nation still has a episode called “A Dream Fulfilled.” take the extra time to truly know and ele - long way to go in improving diversity. A life full of honors, hard work and vate those of us who cross his path is very “I’m very happy with Vanderbilt,” travel has left Watkins little time for one of special,” says Balser. “He is always there he says. “It took leadership and commit - his loves: the water. “I had a boat until my when you need him … sometimes before ment, and I hope other schools will life got so busy I had to sell it,” Watkins you even realize he is watching.” emulate Vanderbilt in this. When I saw says. “The boat’s name was Amandala. I those admission numbers I felt back once got the name when I went to South Africa COMMITMENT TO DIVERSITY again — full circle.” and met Desmond Tutu. It means ‘power These days, the cardiac surgeon’s Watkins’s commitment to racial to the people.’ Most people thought it was heart lies with improving postdoctoral equality prompted him to initiate an a girlfriend’s name,” he adds a laugh. training and diversity in medical educa - annual birthday tribute to Martin Luther Music also is important to Watkins. tion. He travels the country every year in King Jr. at Johns Hopkins. The program, He played alto sax in his medical school an intensive drive to locate and recruit the which honors King and focuses on global days, then sold the instrument to buy a best men and women from backgrounds humanitarian issues, has featured such microscope. under-represented in medicine. leaders as Desmond Tutu, Coretta Scott But his greatest love is people, includ - “I do recruiting at all levels — stu - King, Rosa Parks, former Atlanta Mayor ing numerous friends around the world and dents, postdocs and faculty — every chance Andrew Young, and singer Harry “a whole herd of non-genetic children” that I get,” Watkins says. “While African- Belafonte. Not surprisingly, Watkins he mentors. “My family is a larger family,” Americans have felt the brunt of segrega - counts them all among his close friends. he explains. “Traveling, friendships, music, tion, we recruit African-Americans, Native The surgeon chuckles when asked non-genetic children — all occupy a space American, Latinos — a host of minorities.” which of his famous friends has impressed in my life.” According to VUSM’s Associate Dean him the most. “They all impress me Watkins says he’ll retire when he can. for Diversity, George Hill, Ph.D., Watkins equally,” he says with admirable diplomacy. But even then, he says, “I’ll continue to has made a tremendous difference in med - “Bishop Tutu impressed me when I met serve. I’ll try to have fun, and to talk and ical education by stressing the national him in Africa. We got to be great friends. touch and change people’s lives.” importance of a diverse physician pool. Coretta Scott King, I knew all my life. We May the circle be unbroken. VM

WINTER 2009 11 :: feature

teaching death .:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.

Emily Maston had been a Vanderbilt medical student for only a month when she visited with a hospice patient hours away from death. Dying was not something she was familiar with. At that point in her education she hadn’t even learned much about the disease process. .:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.

WRITTEN BY NANCY HUMPHREY PHOTOGRAPH BY SUSAN URMY

12 WINTER 2009 f e a t u re ::

W I N T E R 2 0 0 9 13 :: feature

Maston, 28, was participating in Vanderbilt University School of Medicine’s Patient, Profession and Society course, and was on a rotation at Alive Hospice Residence Nashville with Melinda Henderson, M.D., one of the nonprofit agency’s medical directors.

The patient, in his late 40s, had long Death — specifically how physicians medical student) was taken aback by what gaps between each breath and was show - should break bad news, process the infor - we just saw. I was getting ready to go on ing many of the impending signs of mation themselves, and relate to dying with the medical details, but I saw his death. Despite the labored breathing and patients — is not a particular class at face, and we stopped and talked about it the immediacy of death, the room was VUSM, but is instead woven throughout and how we do this work. I told him if peaceful, Maston recalls. She observed as the curriculum and into teaching rounds we measure ourselves as physicians as Henderson spoke with the man’s mother by faculty members who believe that stu - death being failure, we’d always be about his last days — that he had been dents should learn early that death and unhappy and never measure up, because lucid, able to enjoy his family, and do the loss are an everyday part of the physician mortality is 100 percent. Death is not a last things he wanted to do, pain free. experience. Lessons learned early on can failure because it’s the ultimate end for all The doctor talked easily with the man’s help the physicians-in-training be better of us.” mother about her son’s life that was being at both breaking bad news to patients and Henderson, who says she wasn’t cut short. their families and caring for a dying exposed to death in a medical setting until “To me, in that environment, death patient. The lessons can also help them her geriatrics fellowship at Vanderbilt didn’t seem frightening, it seemed learn how losing a patient will affect under James Powers, M.D., tells students human,” Maston said. “It was at the same them, and what they can do to emotion - it is OK to be emotional. “Just like the time heartbreaking and hopeful, a cele - ally protect themselves. science we learn, this will be a learned bration of life just as much as it was a “We in the hospice profession have process, too. How much emotion depends mourning of death. The totality of life accepted death as a natural extension of on the physician, the circumstance, the was acknowledged: the beginning, the life,” Henderson said. “Just like birth, it’s day,” she says. “I can’t think of an emo - end, the good, the bad, and that’s some - commonplace. We grieve, of course, but tion that isn’t acceptable. All of my physi - thing we all know. We’re all human,” the in some cases we rejoice because suffering cian partners have cried with families. We Southern California native said. has ended,” Henderson said. have some long-term patients who have “I left feeling honored to have been When she explains what she does to become part of our family here. You may there, and incredibly grateful for my life. others, they often ask if it’s depressing, connect to someone because of their age It just put things into perspective,” she she said. “I tell them it’s not. It’s very or because of similar life experiences. And said, adding that her experience prompted rewarding,” she said, recalling a conversa - sometimes you don’t even know why it an extemporaneous visit to see her parents tion with a Vanderbilt third-year student touches you, but if it does, it’s better to let that weekend. “I was surprised at how who had witnessed a dying patient at that emotion show. Families are having deeply the experience affected me. I don’t Alive Hospice. “We left the room to dis - those emotions too and they appreciate think I’ll ever forget it actually.” cuss the patient’s case. I could tell he (the knowing that grieving is OK.”

14 WINTER 2009 feature :: L

Frank Boehm, M.D., rounds with residents L E W at Vanderbilt Hospital (top); Melinda O H E

Henderson, M.D., speaks with Alive O Hospice patient Betty Butin, 77, as first- J year medical student Emily Maston observes. L L E W O H E O J

Breaking bad news Frank Boehm, M.D., admits he’s emotional. He has felt things intensely since he was a child, he says. In his book, “Doctors Cry Too,” he recalls an experi - ence as a 26-year-old intern in obstetrics that has stayed with him throughout his career. During an emergency Caesarean section, both the mother and child died. As Boehm accompanied the woman’s attending physician down the hall to deliv - er the bad news to the woman’s husband and mother, he felt a lump forming in his throat. He no longer remembers what the physician said to the family, but he clearly “It occurred to me that physicians important at this time than the dis - remembers the “stunned expressions and show their grief in different ways, but I cussion you are about to have.” chaotic disbelief” in their eyes as the dry- believe patients and their families really • Watch your body language. Boehm eyed attending delivered the bad news. care how we feel about what happens to suggests breaking bad news sitting on Although he tried not to, Boehm them,” he said. the edge of the bed and looking the began to cry, and the woman’s mother Boehm frequently has a “teaching patient in the eye, or sitting down, put her arm around him and thanked moment” with residents by offering tips facing a family, leaning forward mak - him for caring, reassuring him that the on how to break bad news to patients and ing eye contact. medical team had done all they could. their families. It’s not a formal talk or lec - • Once the bad news has been broken, “She had just lost her daughter and ture, but instead a note card he keeps in don’t try to comfort with words. grandchild, and she was comforting me,” his pocket. “I’m not sure you can teach “You won’t be able to do it,” Boehm Boehm recalls. He left the waiting room compassion, but at least you can teach said. “The only thing that really and retreated to the doctor’s lounge showing compassion.” works is ‘I’m so very sorry.’ Saying where he was surprised to hear muffled The tips: things like ‘I know how you feel’ sobbing — the attending physician had • Prepare. Before you deliver bad news, doesn’t work, because you don’t been able to hold back his tears around select a private area. Turn your beep - know how they feel even if you’ve the family, but freely let go when alone. er and phone off. “Nothing is more had a loss.”

WINTER 2009 15 :: feature

“I’m not sure you can teach compassion, but at least you can teach showing compassion.” .:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.

• It’s OK to touch patients, to give patients and their families. Working with Miller said she has been asked by them a hug, to put your arm around standardized “actor” patients, the students first-year students how they can protect them. “They want to know that you practice discussions about complicated themselves from the emotional havoc that care what is happening to them.” end-of-life issues, and then evaluate their losing patients can cause. “They’ve said • Use “speak back.” Ask the patient, own performances. that they’re afraid of getting so involved “What did you hear me say?” not There are also small group discus - with patients that they get hurt over and “Do you have questions?” Frequently sions every six weeks in the third-year over again, and they ask how they can patients stop listening after they hear curriculum where students can meet to avoid that without going too far to the statements like “You have cancer of talk about difficult cases. “This allows other extreme, which is feeling nothing,” the ovary. It’s spread to the lungs.” students to process care episodes that are Miller said. “I tell them I’m far more con - • Finally, try to leave patients and their difficult to deal with,” Miller said. cerned about them feeling nothing.” families with hope. Not hope for a “Sometimes they don’t understand why cure, necessarily, but with the reas - certain decisions were made. Sometimes surance “I’ll be there for you.” patients make decisions that go against Looking inward the student’s own personal values. We Students in the second-year neuro - hope these discussions allow our students science course start the year in an unusual Weaving loss throughout the to gain an understanding of these situa - fashion for a course designed to address curriculum tions and also give them the opportunity the cellular and anatomic description of Students at VUSM begin thinking to examine their own coping mechanisms the brain — on the first day they are about the end of life in the first-year when they are distressed by such asked to look inward. “Patient, Profession and Society” course episodes. Ultimately, these end-of-life Jeanette Norden, Ph.D., professor of and through small group discussions fol - decisions are the patients to make and we Cell and Developmental Biology and a lowing this course, said Bonnie Miller, must learn to be supportive even when Master Science Teacher at VUSM, gives M.D., associate dean for Undergraduate we might disagree.” the students three index cards and asks Medical Education. Electives in palliative care are offered, and students also spend

some time discussing death and dying L L E W

during the first two weeks of medical O H E

school in the Foundations of the O J Profession course. Second-year students will learn to address quality of life issues in their Patient, Profession and Society course and more content is being added. Third-year students have intersessions in pain man - agement and palliative care. And with the help of Vanderbilt’s Notecards with questions like these new standardized patient program, third- play a role in Jeanette Norden’s sec - year students learn how to counsel ond-year neuroscience course.

16 WINTER 2009 feature :: L L E W

Jeanette Norden, Ph.D. O H E O J them to write the name of a person they taken away from them, a talent is taken think, ‘how would I feel if I were given love on the first card, a talent they have away, or dreams are changed in a pro - this diagnosis,’ and that gives them at on the second, and on the third, a dream found way. Sometimes, people lose all least a little insight.” they have for their life. three at the same time.” The second part of the exercise is that Norden tells them to put the cards Norden tells the students to think they are asked to call, e-mail or write the face down on their desks, and to shuffle about assumptions they have for their loved one they named on their index card. the cards, then to draw one. “I want them own lives — that they will become a doc - “One of the more surprising things is the to imagine that whatever is on that card is tor, that they will marry and have chil - name they put on the card is often some - gone and gone forever. I tell them that dren, that they will live long lives. “And one they are estranged from — a sibling, a every day people walk into Vanderbilt they need to appreciate that other people parent or a friend. When they imagine that Hospital and are either diagnosed with a have assumptions like that, too, and that they might not ever have the opportunity terminal disease or they are accompanying they have responses to grief and loss to see the person again, to say they’re a loved one who is. Either someone is which are very profound. They need to sorry, it has a real impact on them.”

WINTER 2009 17 81 :: R E T N I W p Nor respon to wit th st hum d bod respct bei Nor f lov tor neu ber wif wh wit bei bei ailm li ty li La br d m br m be.’ you beh or a e f rom ke ke at oc isea ory an emor e in ea t t lok a s ng ng ng ed o e ien h h s eral o ” tor in rolg r go y den den g kin fr Mu ent y hav bad T No “ As In “ an wh w se), lost th Alz ch deat s s s t me d. Stu I — u t om VM in ones t kin he o /patien. h d s, coming f f y s e g d S s fr n oice ose acing acing being oft at o rd e ltipe imply other heimr’s said. said. with indvua cleros ic or meory eur t of medic den w they om children bad on speakr ds a h. er includ he tirels stroke, en 90 0 2 us ’ al nd en her lives Alz the ilnes os Som to of wha t por, dis doctrs r wh s as new Scleros d los “T “T kin th com em w cien hum is sa heim eath; be learn los al in fam s It ther eas il ed e pos en s y his hes ly have (AL t e s inds dnes.” an , . d profes s ba . s, an brings eith to ls they tel ing to forev peol but It e. isea th an cared tw “ or e, spoken ily d s e er’ ran bec d Thes d or S ible we’r is, tha brain e h In the an a is o othe s ben er th th bein c th in, ap se say re or s he me a god aring thei ou gi ome Amyotrph s sion d a t th di e e ey ets meory a N it s for for multip ng e Lou ing we’r slow tel sa mbe nurse tu d s ght s sea ens rs e be god gs.” al tuden tuden tumor aren’t ord r d ie to, expri afec ys s of , p dents, ling l from du own s si h fami se. for the pa ast mo ‘we ufe , sud h to er to rs x Geh en par fo de the uman rin s, a rt te l y m l le e h th re dyi r th do,” ev c bad,” ear de l l s, r en le f s ne tr s to you d en y usba of g di li re em or ft th h ri h ‘ e ei fr wh e c both ie i t it ne an nl u c m by ng u e c t g’ r s. s ha tu ts on em om r v he th a e s y de abi th man man ory y, i is s d e re , d e - wi s re to n nd m e e n i em r - a l s to l i - -

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O :: S N H O J A N A D

prepare for the inevitable, I was mentally preparing myself to earnest demeanor that their loved one had arrested minutes talk with his family. “Remember the four rules,” I thought. I after my previous conversation with them. Despite our efforts found a large, smiling group including his parents, two sisters, to revive him, we could not save him. He was dead. and brother eagerly awaiting my arrival. I introduced myself and To no surprise, the patient’s sisters fell to the ground, cry - settled into a quiet spot in the waiting room, telling them point ing loudly in anguish, holding each other. The reaction of his blank that our patient had taken an unexpected turn for the parents surprised me. Using his cane, the patient’s father worse and would surely die barring a miraculous turnaround. pulled himself up, walked over to me, and held out his hand. After processing the shocking news, his mother simply asked, “Thank you for everything you did,” he said, shaking my hand. “Can we see him while he is still alive?” “Of course,” I replied, “You fought hard for our son. This must be very hard for you, promising to summon them in 15 minutes, just as soon as his too, and we appreciate your honesty.” I was shocked and room was tidied up by the nursing staff. impressed by this man’s strength. After hearing such tragic To my dismay, the patient lost a pulse and flat-lined the news about his son, he was thanking me? My overwhelming moment I returned to the ICU. In some futile clinical situations feelings of guilt and powerlessness were overcome by a it would have been appropriate to let the patient pass peacefully, sense of relief. At that point, everything and nothing made but since he was relatively young and previously healthy, he perfect sense. deserved every possible chance of survival. Moreover, I could I would be lying if I said I have not dealt with tragedy since not let his family down. We performed several cycles of CPR for that fateful day in the VA MICU — after all, it is a part of the 30 minutes, but he never regained a pulse. He expired less than job. Regardless of the scenario, I continue to have meaningful two hours after his arrival in the ICU. His family would never be experiences when approaching these situations with compas - able to say their goodbyes. sion, strength, and, most importantly, honesty. Incidentally, I have had to break bad news several times, but never to the after I complete my residency I will specialize in pulmonary same people twice in a thirty minute time span. My head was and critical care medicine, a field where morbidity and mortal - swimming, but I once again retreated to my four rules. I took a ity is the norm. While I look forward to using my training to deep breath and walked toward the waiting room. There his save lives, I feel comfortable being the bearer of bad news in parents stood, composed, eagerly awaiting my permission to times where families are seeking compassion the most. To see their son. Instead of taking the family to the chaos of the my amazement, I find that the most gracious patients and ICU, I took them to the nearest conference room, my hands families are those dealing with bad news and loss. In the end, shaking on the doorknob, thankful that it was unlocked. The it is not the type of news that is delivered, but how it is deliv - family knew something was wrong, but I fought to maintain my ered and by whom. As long as I stick to the four rules, the composure. After sitting them down I told them in my most result is always a positive one. VM

WINTER 2009 19 :: f e a t u re

20 W I N T E R 2 0 0 9 feature :: The caged bird sings with a fearful trill of things unknown but longed for still and his tune is heard on the distant hill for the caged bird sings of freedom.

- Maya Angelou Death Done

WWRITTEN BY KAeTHY WlHITNl EY ILLUSTRATION BY CHRIS M cALLISTER

Life can change in the blink of an eye. For Debbie Atkinson, that moment came Sept. 2, 2006. An accomplished equestrian, Atkinson, 49, was participating in the Kentucky Classic horse trials at Kentucky Horse Park in Lexington. She was competing in the open intermediate division, galloping on the cross-country course, achieving that adrenaline rush she loved. As she approached a jump, her horse, Melancholy Blues, caught his legs at the welding wall and somersaulted. Atkinson fell from the horse and landed on the ground. She lay motionless and unconscious. Emergency Medical Technicians immediately tended to her, starting intravenous fluids on the course while waiting for a medical transport helicopter to arrive. Physicians at the University of Kentucky Medical Center in Lexington recognized the severity of her condition shortly after she arrived — a high C-2 spinal cord injury. They placed Atkinson on a mechanical ventilator to keep her alive, and they waited for the swelling in her spine and neck to go down. Within a few days, her prognosis became clear. Atkinson, beloved riding instructor and coach, renowned competitor, proprietor of her own boarding and training stable, was now a quadriplegic. She had no feeling in or the ability to move anything below her neck. She could not breathe on her own. Her life had changed in an instant.

WINTER 2009 21 :: feature

“As her brother, I was not surprised at the decision. As a bioethicist it was important for me to understand her rea - soning and to make sure that she was not making an impulsive decision and that she had thought about what she might possi - bly do to make her life seem worth liv - ing,” he said. “I was fully satisfied that she was making the right decision for her, given her circumstances. It was also important for me as a brother and bioethi - cist to do what I could to help her develop and implement a reasonable plan.” In August, Frank Miller, Atkinson and Wright contacted their local hospice In Ocon atntiboiotics anbd fluids.eHe strayed up and relayed Atkinson’s wishes to have the with her all day and into the night. They ventilator removed so she could die. both fell asleep around midnight. Wright “If I was able to get better or there awoke to find Atkinson in a coma. was some miracle, I would go on and try. “Someone in her condition is so frag - But there isn’t, and it’s more frustrating Atk2inson lef0t Lexingto0n for Shep6herd ile. You always have to worry about UTI; every day not to be able to do what I Spinal Center in Atlanta where she you always have to worry about respiratory want to do,” Atkinson said. endured months of rehabilitation. She infections; you always have to worry about After several discussions with hos - was discharged from Shepherd in January bedsores. You have to be super diligent 24 pice, which ultimately was unable to 2007 and headed home to Columbia, hours a day,” Wright said. “You can never fulfill Atkinson’s request, Frank Miller Ky., and a life full of new challenges. fold your hands and rest and say, ‘I’ve done placed a call to Vanderbilt. For two years Atkinson and her a good job.’ When something starts, it’s a Atkinson’s brother remembered devoted live-in companion of 17 years, cascade of events, like an avalanche.” Robert Miller, M.D., from when he took Mike Wright, tried to enjoy the life they Atkinson developed sepsis, a life- care of his sister in the MICU. He called had. They lived on a large farm, enjoying threatening illness, and was transferred to Miller at his office in Medical Center East the peace and serenity of their surround - Vanderbilt University Medical Center and asked if Vanderbilt would consider ings, along with their dogs and sheep. where she was admitted to the Medical taking his sister’s case. Would Vanderbilt They placed Debbie’s horses with other Intensive Care Unit (MICU) on 7 South allow his sister to die when she wanted, trainers. They kept up with friends as best and given a 50/50 chance of surviving the the way she wanted? as they could. first 24 hours. Robert Miller, M.D., assis - “I encouraged them to come to Atkinson said at first she was hopeful tant professor of Clinical Medicine, was Vanderbilt because I knew that we could and willing to try this new life of hers. on call that week and was responsible for make sure this process was done right,” “But it became pretty miserable,” her care. Atkinson survived, and she left said Robert Miller. “I felt that if any she said. the MICU 10 days later and returned institution could do it well, it would Confined to a wheelchair, with home to Kentucky. That would not be be here.” around-the-clock care, she and Wright had her last visit to 7 South. So began the exchange of e-mails, no privacy. Someone was in the house phone calls and meetings among physi - with them at all times. Hired help tended cians, ethicists, lawyers and members of to her most basic needs, whether it was to The right decision for her the Palliative Care Team at Vanderbilt. make sure her ventilator breathing tube Atkinson said she considered going No one could recall a specific case of didn’t pop out, which it did once, or to off life support an option “from day one.” admitting a patient to the hospital for the brush her teeth for her. Aides would come After her brush with death, in late summ er, sole purpose of removing a ventilator to and go, some more reliable than others. she began to consider it more seriously. allow that patient to die. In the spring of 2008 Atkinson She and Wright had long discussions “This was the first time I had ever WdeRvIeTlToEpNedBaY fPeAvUerLaGnOdVaERuNrinary tract about it. They consulted her brother, been involved in a case like this,” said PinHfOecTtOioGnRA(UPHTYI)B.Y WDrEiAgNhtDimIXmON ediately Frank Miller, Ph.D., a bioethicist at the Mohana Karlekar, M.D., assistant profes - took her to the doctor, who started her National Institutes of Health. sor of Medicine and medical director of

22 WINTER 2009 feature :: O I D

VUMC’s Palliative Care Team, a multidis - U T S ciplinary approach to pain and symptom E S R O management as well as quality of life H T R O improvement for patients at the end of life. P S From a legal standpoint, Vanderbilt was in the clear. “The right to refuse treatment, even if it means that you die as a consequence, is such a well-established principle in law and in ethics that people don’t think an awful lot about it,” said Larry Churchill, Ph.D., Stahlman Professor of Medical Ethics. “Most of the issues come up because a family is conflicted about it or divided or (Left) Debbie Atkinson on her horse, Melancholy Blues. Atkinson suffered a spinal cord injury someone on the staff has a problem about in an equestrian accident. (Right) Atkinson and her husband Mike Wright at their home in Columbia, Ky. it. It’s not ethically new ground.” On Sept. 24 and 25, Miller, Karlekar and Churchill met with the nurses and residents on the MICU to tell them that Atkinson would be coming to the unit. patient’s life could go horribly awry if the Sept. 26, four days before her life was to “We were going to do this up front,” family does not have consensus or if the end, and after 17 years together, Wright Miller said. “We were not going to lie medical team is not properly prepared. and Atkinson were married. about her admission or her reason. She The team would leave nothing to chance. “We’ve probably been more married was coming in to the hospital, and we got for a much longer time than most couples the ICU bed reserved.” who have the certificate are. This lady is There were very few questions from The final weeks my soul mate. My hero. My everything the staff, but a nurse raised her hand and Atkinson, on her last full day of life, all in one,” Wright said. asked the one that was on the back of reflected on what life has been like since everyone’s mind: how is this different she made her decision. from physician-assisted suicide? “Actually, a lot better. Because I sort Making sure “If you go on life support, you have of became confident about what I decid - On Monday, Sept. 29, Wright and the right to come off,” Miller said. “This ed, that it was right for me,” she said. Atkinson made the two-hour drive from is not suicide. You use life support for a “We used to have around-the-clock care, Columbia to Nashville. They stopped at a defined purpose. It’s either to save a life and I didn’t really like it. I knew I had to favorite restaurant to enjoy a last meal or to preserve the quality of life that you have it. We cut down on that.” together. They arrived on 7 South in the expect. If it doesn’t meet that need, With limited time left, she let most early afternoon. They got settled in room you’re not obligated to stay on it. That of her aides go. For two months, Wright 11 on the MICU. doesn’t mean it’s easy for you or for your was Atkinson’s primary caregiver from 5 Residents and the attending physi - family or for your physician to take you in the afternoon until 7 in the morning cian performed a medical evaluation. off it, but that’s part of our obligation.” and on the weekends. Amanda Wilson, M.D., assistant director Karlekar further clarified the difference. “We’ve had a lot to talk about and of the Consultation Psychiatry Service, “What is unique about Debbie’s case discuss. That aspect of it (the past two met with Atkinson to assess her capacity is she was in her steady state of good months) has been good,” Wright said. to make the decision to discontinue venti - health given her injury, and she chose to Family members, including lator support. take back control. The horseback riding Atkinson’s brother, Frank, visited in early “This assessment was as a vital part accident was her fatal injury, and she September. Two close friends came to the of providing her care as it was crucial to would have died two years ago if we farm to say goodbye. determine whether or not her decision [health care] hadn’t intervened.” “It was good and it was hard at the making ability was being impaired by In their meeting with the staff, same time,” Atkinson said. outside forces, psychiatric disease, or Robert Miller and Karlekar laid out a There was just one more thing other psychosocial stressors,” Wilson plan. Having worked in the MICU for Wright wanted to do. He asked Atkinson said. “One very important thing Dr. years, Miller knew that the final days of a for a favor. She complied. On Friday, Karlekar and I wanted to exclude was

WINTER 2009 23 :: feature

whether depression was influencing her On Tuesday morning, Karlekar and When do we stop? decision making.” the MICU team met with Atkinson and VUMC is a leader in palliative care, a If Wilson concluded Atkinson lacked Wright again and discussed with her how specialty still in its infancy that focuses on capacity, for whatever reason, to make the morning would progress. patients who are facing life-threatening this decision, then the medical team At 11:30 a.m., Chris Webb, R.N., illness or injury, at any stage in the con - would not have been able to move for - administered the first doses of morphine tinuum of disease. ward with the plan of discontinuing and Versed, a sedative. Wright stroked his American hospitals are historically ventilator support. wife’s hair and held her hand. Within a about rescue medicine — saving people. “I found Debbie to be a fiercely inde - few minutes, Atkinson was asleep. As early as the 1950s, doctors working pendent woman who felt that her quality Confident that she was comfortable, in with ventilators were asking if it was of life was extremely limited,” Wilson no pain, third-year internal medicine resi - morally permissible to stop using life sup - said. “She did not meet criteria for any dent, Joshua Fessel, M.D., Ph.D., pressed port. In the 1960s, as intensive care unit major psychiatric disease and was not the button on the ventilator, and turned technology evolved, the question of depressed. Her intentions were clear — it off. He gently disconnected Atkinson “when do we stop?” became an important she no longer wished to live with the assis - from the ventilator. Wright sat down in one to both health care providers and, to tance of a ventilator and appreciated that the chair by the bed and waited. Atkinson a lesser extent, policymakers. without it, she would not live.” died peacefully at 11:55 a.m. “Lawyers got pulled in to the discus - Wright and Atkinson spent the “It was seamless, it was peaceful,” sion because of the question of whether it evening alone in room 11 on 7 South. Karlekar said, still emotional two days was legal to stop treatment if stopping it She lay in the hospital bed, and he on the later. “I know that day we freed her of the meant someone was going to die. Is it pull-out bed beside her. It was quiet save body that stopped working for her. We legal not to use treatment you have avail - for the whoosh-whoosh of the ventilator. set her free the right way.” able to keep someone from dying?” said Elizabeth Heitman, Ph.D., associate pro - fessor of Medicine in the Center for Biomedical Ethics and Society and co- chair of the VUMC Ethics Committee. Y

M “This push to use available technology R U N

A became known as the technological imper - S U S ative: if the machine is there, we need to use it. Ventilators are a prime example.” A mechanical ventilator can save your life, perhaps prolonging it for a week, a year, or 20 years. “It will save your life” became the mantra of end-of- life care in many ways, she said. “The technological imperative in the hospital said you can never stop until you’ve run out of options. At the same time, there were an increasing number of options, so there was always one more thing that could be done for a dying patient.” Health care providers are trained to save lives. Hospitals advertise their low mortality rates and compare them to other hospitals. The fewer people who die in the hospital, the better, goes tradi - tional thinking. “Saying that life support saves lives is Robert Miller, M.D., Larry Churchill, Ph.D., and Mohana Karlekar, M.D., consulted on the med - false advertising with regards to end of life ical and ethical issues of disconnecting Debbie Atkinson’s ventilator. care. Ultimately, the life you save is going

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to end and planning for that end is part TOO YOUNG TO DECIDE of good medicine for people who have serious chronic illnesses,” Heitman said. Medical ethics, as it relates to the end of life, takes on a differ - Many of the technological questions ent meaning when it comes to pediatric patients. that health care providers were raising Legally, children don’t have the autonomy to make decisions became patient-based in the 1970s when about their care until they reach the age of 18. As is usually the families began to watch loved ones die in case where ethics are concerned, there is a grey area. Once a the intensive care units, unable to get off child understands what death means and has an adult perception life support. Patients and families increas - of death, which usually happens around 8 or 9 years of age, health ingly challenged medical decisions to care providers begin to listen to them as they express their con - treat terminal illness indefinitely. The cerns about continuing treatment. introduction of advance directives created “We want a child who is going through treatment after treat - legal documentation of patients’ refusal ment to have a say about his needs,” said Mary Jo Gilmer, Ph.D., of life support. Today, many Vanderbilt M.B.A. “We involve parents in that discussion. We talk to parents patients have directives that help ensure about the most loving thing they can do for their child. Is it pro - they get the kind of end-of-life care they longing his life even though it is a difficult and tortuous life, or is it want when they are too sick to express providing one special thing the child wants to do before he dies? their wishes. “In talking with parents and other family members, hopefully, In the 1980 Florida case of Satz vs. we can help the family come to a consensus about what is the Perlmutter, a terminally ill, ventilator- most loving thing to do.” dependent patient sued to have his venti - Gilmer was a co-leader in development of the Pediatric lator disconnected. The patient suffered Advanced Comfort Team (PACT) at the Monroe Carell Jr. from amyotrophic lateral sclerosis (ALS) Children’s Hospital at Vanderbilt and a professor at Vanderbilt and was unable to remove the ventilator School of Nursing. She is currently director of the Clinical himself, so he asked a physician to do it Management Program. for him. The Florida Supreme Court She helps guide families as they decide whether to continue ruled in favor of the patient. with treatment when a child’s prognosis is poor. It is a difficult The court decided that this was not process, at best. suicide because the cause of death was ALS, Kimberly and Dave Barboza faced a lot of stress when deciding not the actions of the patient and doctor. on their infant son Joshua’s treatment options. Joshua was diag - “This is something every health care nosed in utero with hypoplastic left heart syndrome, a condition institution ought to be willing to do if it that is not compatible with life without three complex, invasive has the skill to do it,” Churchill said. heart surgeries. Each surgery carries a 50/50 chance of survival. “Every case has to be considered on its “We wanted advice from nurses, the palliative care team and own merits. Every person’s situation is family members, but in the end, it was our decision whether to very different. The fact that this pursue treatment or not for our son,” Kimberly said. (Atkinson’s death) was so carefully done, They opted for treatment. Joshua passed away in the Neonatal so professionally done, makes me feel Intensive Care Unit at the age of 3 months, following his first really good about working at Vanderbilt.” heart surgery, but Kimberly and Dave are satisfied with the deci - Has Vanderbilt found itself on a slip - sion they made and appreciate the support they received from pery slope? It’s irrelevant, according to Gilmer and PACT. Karlekar. “When health care can fix something, everyone is happy. But “As physicians it would be wrong to there are a number of things we just can’t fix, and then we feel like say, ‘we could help you, but we we’re not failures as health care providers,” Gilmer said. “In a great chil - going to.’ We have to be willing to do dren’s hospital like Vanderbilt’s, there still are times when we these really difficult things,” Karlekar can’t fix something. That’s when we need to walk with families said. “We didn’t just say we’d do it and down that path on their difficult journey.” then write the orders and let it go. We - KATHY WHITNEY really spent the time to look at every variable to make sure this was the best transition for Debbie.” VM

WINTER 2009 25 :: feature

“ Tomorrow, and tomorrow, and tomorrow, Creeps in this petty pace from day to day To the last syllable of recorded time, And all our yesterdays have lighted fools The way to dusty death. Out, out, brief candle!”

– William Shakespeare

TombyoErin Brardy Worrsham ow I have procrastinated all my life. There always seemed to be plenty of tomorrows to get things done. Like in high school, when I put off writing my senior term paper until the week before it was due. Or in college, when I hopscotched between majors before settling on Theater and German just months before graduation. But in 1994, when a doctor told me I was going to die, I couldn’t put it off. I had run out of tomorrows. I was diagnosed with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) and given maybe three years to live. I was 36. Ironically, I had really started to get my life together. I was going to art school and felt I had found my real calling as an artist, like my mother. With a dear priest friend I was doing some much-needed housecleaning of ancient emo - tional baggage. I had accepted the possibility that I wasn’t meant to be a mother, since my husband, Curry, and I had tried for six years to have a baby without suc - cess. I was nearing a place of peace in my life. My newfound peace flew out the window on Sept. 7, 1994. I looked at my life and saw an endless series of wasted yesterdays. It was too late to change that. I went home to die. That was 14 years ago and I’m still here. The ALS has ravaged my body. I’m paralyzed below the neck and have only minimal movement above. I eat with a feeding tube. I breathe with a ventilator. I drool. But my spirit is strong. I believe the reason for my longevity is threefold; I love my God, I love my husband, and I love and cherish our son, Daniel Curry Worsham, who was born exactly nine months after my diagnosis. It was never my intention to use a ventilator until I learned I was pregnant. Then I was like any other mother. I wanted to be a part of my child’s life and I was willing to make concessions to do it. Daniel was 2 when I stopped breathing on Thanksgiving Day in 1997. Choosing to live with the ventilator did not ensure that my family and I lived happily ever after. Our lives have been full of challenges, which come with the territory when concessions are made. Living life on your own terms is not free. While the ALS has affected me physically, it has impacted Curry and Daniel equally in different ways. Some have been painful for me to see, knowing that I

26 WINTER 2009 L L

E feature :: W O H E O J

Erin Brady Worsham with her husband, Curry, and son, Daniel. am the cause. I have had ALS friends who Sometimes he gets an alumni newslet - into the hall and let him talk to them. He chose not to go on the ventilator, because ter from his high school. Many of his told them I was like them and they should they didn’t want to be a burden on their classmates went on to become prominent ask him if they had any questions. families. I am not that noble. people in their different fields. I know he Daniel is 13 now. He doesn’t cut me Curry has not had a full night’s sleep thinks about what he could have done had any slack or treat me any differently than in 14 years. I have seen it take its toll on our lives been different. But in the great anyone else. Growing up with a mother his body. At the end of the day he is scheme of things, in those things that really with a disability has made him a more physically and mentally exhausted. matter with God, Curry Worsham is the accepting person. I will never regret that. When Daniel was small, Curry could most successful person I know. What has been more difficult to deal not work because he was taking care of It was bittersweet for me to watch with is the loss of friends. I have often both of us. Our growing debt weighed Daniel grow in the realization that his said that ALS won’t kill you, the loneliness heavily on him, but he never considered Mom was not like other mothers. When will. When your death seems imminent, putting me in a nursing home. he was very young, we would pick up people flock to offer support, but when When I went on the ventilator in some Whitt’s Bar-B-Q on Whitt-nesday you keep on living, they drift away. It’s 1997, we fought for and eventually won and take Daniel to the park. not mean-spirited. It’s just human nature. nursing through the state. It wasn’t full- One day Daniel played with his two I thank God for the Internet, which time, but it allowed Curry to leave the newfound pals until it was time for us to has enabled me to be a freelance artist and house and work. He could sleep without go. I heard him say, “Don’t you want to writer. I’ve made some good friends worrying about not hearing my ventilator meet my Mom?” They took one look at through e-mail, as well as on SkiSpace and alarm, which could be fatal. me sitting in my wheelchair with the tra - MySpace. They have enriched my life. It’s hard enough making the transi - chea tube coming out of my neck and ran Strangely enough, I have been able to tion from boyfriend-girlfriend to husband- the other way. “She’s a nice girl,” Daniel come to terms with this greedy disease wife. It’s even harder to transition from called after them. My heart broke, but I after it hit me with everything it had. husband-wife to caregiver-patient. I have was filled with love for my son. There are no more unknowns. And, at had to accept that Curry needs time away In kindergarten some of the boys least metaphorically, I am still standing. from me. This was difficult because he’s were laughing about me in front of Standing and eager to face whatever my best friend. Daniel. The teacher wisely took them out tomorrows lie ahead. VM

WINTER 2009 27 :: f e a t u re

28 W I N T E R 2 0 0 9 feature ::

WEIGHING end-of-life care

For the chronically ill, health care can become an unending maze of expensive interventions with certain risks and uncertain benefits

Health care researchers are questioning health care professionals need to take more whether more is better and suggesting that time to talk with seriously ill patients standardizing care for the chronically ill in about all their options, he says, including the last two years of life will reduce expen - pain management and end-of-life comfort ditures without sacrificing patient out - care — instead of more tests and treat - comes or satisfaction. So as the health care ments — when they feel the time is right. system faces decades of growth in the num - “We find that palliative care for hos - ber of aged patients, Americans might be pitalized patients definitely saves money, asked to respond to this sobering question: and the patient satisfaction is frequently How do we want to live, and how do we higher than on other units of the hospital,” want to die? Elam explains. Studies that show only “I think it’s very important that we marginal cost savings from hospice care leave cost out of the equation in consider - usually fail to compare appropriate time ing how we care for people at the end of periods, he contends. Hospice care is most life,” says Roy Elam, M.D. The health common in the last days of life, and com - care community must never support parisons that reflect that, show it costs less choices that appear to hasten death in than other interventions and is embraced order to save money, he says. by patients and their families at the same Instead, Elam believes runaway time, he explains. expenditures might be tamed by this “Better care costs less — that’s impor - undervalued health care intervention: a tant,” observes Elam, an associate professor sincere conversation. Physicians and other of Medicine.

WRITTEN BY ELIZABETH OLDER ILLUSTRATION BY DAVE CUTLER

WINTER 2009 29 :: feature R E N Y A R E N N A

Too much of a good thing? That assertion — that better care costs less — is the seemingly counterintu - itive research outcome of the Dartmouth Atlas Project. The 2008 study found that for chronically ill Medicare patients more health care interventions — doctors’ visits, hospital stays and the like — increased spending but did not produce better patient outcomes or satisfaction. W. Kip Viscusi, Ph.D. Two-thirds of patients in the study were diagnosed with one or more of these dis - eases — cancer, congestive heart failure and chronic lung disease. “The extent of variation in Medicare spending, and the evidence that more care does not result in better outcomes, should “We need to benchmark the best sys - to a record high of 78.1 years. By 2030, lead us to ask if some chronically ill tems and use policy to drive providers the number of Americans age 65 and Americans are getting more care than they toward the benchmark by holding them older is expected to double to 71 million, or their families actually want or need,” accountable for the volume of services which will account for 20 percent of the said Risa Lavizzo-Mourey, M.D., M.B.A. they deliver,” asserted study co-author U.S. population. Lavizzo-Mourey is president and chief Elliott S. Fisher, M.D., M.P.H., and Government policymakers already executive officer of the Robert Wood director of the Center for Health Policy balance the cost of saving lives against the Johnson Foundation, which provided Research in the Dartmouth Institute. The benefit gained based on economic models principal funding for the research project study suggests academic medical centers that weigh identified amounts of risk done by the Institute for Health Policy and federal agencies need to lead the way against people’s willingness to pay to con - and Clinical Practice at Dartmouth by conducting research on when chroni - tain it. Vanderbilt economist W. Kip Medical School. cally ill people should be hospitalized, Viscusi, Ph.D., has done a lot of these The Dartmouth Atlas Project found referred to specialists and recommended analyses, which rely on input from people huge variations in dollars spent on chroni - for other tests, treatments and services. who will be affected to quantify the trade - cally ill Medicare patients in the last two off between money and small risks of years of life, from a high of $59,379 per death. He understands that might make patient in New Jersey to a low of $32,523 some people uncomfortable. per patient in North Dakota. In The health care “When people hear that economists Tennessee, expenditures hit $42,478; the cost-benefit conundrum are putting a dollar value on human life, U.S. average was $46,412. The number As the outsized baby boom genera - they imagine how we are conceptualizing of services patients received was driven by tion moves through the health care that number,” observes Viscusi, the co- the number of health care providers and system in the next few decades, some director of Vanderbilt’s new Ph.D. facilities in the area. One-third of annual observers suggest that studies like the Program in Law and Economics and the Medicare dollars are expended on chroni - Dartmouth Atlas Project could be used to first University Distinguished Professor. cally ill patients who are in the last two promote health care allocation in “All the numbers I use are based on years of their lives, the study says. America. People develop more chronic the preferences of people who actually face Spending on Medicare and health care health problems and use more health care risk,” explains Viscusi, one of the world’s overall is predicted to skyrocket in the dollars as they age; life expectancy has leading experts on cost-benefit analysis next decade as the baby boomers age. continued to climb in the United States whose estimates of the value of risks to life

30 WINTER 2009 feature ::

and health have been used extensively by thinks this methodology is misguided and And Viscusi points out that health the Environmental Protection Agency, the without theoretical basis. Research shows care studies that look backward two years Federal Aviation Administration and other that neither patients with a chronic illness from when patients die — as the government regulators. “What matters is nor older individuals are willing to take big Dartmouth Atlas Project does — don’t people’s preferences, what they say, their risks with their personal safety, an indica - account for any positive results of expendi - willingness to pay for risk reduction. You tion, Viscusi says, that they continue to tures or for how physicians would even ask the people who are affected.” place a high value on their lives regardless know their patients had only 24 months to While health care economic models of physical limitations or aging. live when care decisions were being made. often use “quality-of-life” adjustments that “There’s a danger that people would “For decades economists have cited reduce the value of saving the lives of older get shortchanged if you do the raw calcula - expenditures in the last two years of life as people because they have more health tion based on remaining life expectancy,” a sign of wasteful medical expenditures,” problems and less time to live, Viscusi he says. Viscusi observes. “Raising this issue has

In 1994, the year the aging-related illnesses, some No longer a Comprehensive Care Center of which are caused and exac - death sentence opened, Raffanti says he lost erbated by treatments, 350 patients. Raffanti explains. “It was really just a It is imperative to help When Ken Lucero was lost vision in his left eye, one chronically progressive ill - patients “chart that very dan - diagnosed with human immun - clue that informed a diagnosis ness,” he recalls, and about gerous course through the odeficiency virus (HIV) in 1988, of infection at the base of the the best doctors could do was final stages of an illness,” he prepared to die. Two brain and a related partial to get to know their patients preferably by collaborating decades later, his story shows blockage of the carotid artery. and understand their wishes and not simply through crisis how treatment advances have After a delicate surgery for deathbed care. intervention. Some patients changed what once were ter - Lucero improved, but other “We got very good at diag - will choose hospice care, to minal diseases into chronic ill - health hurdles — including a nosing the complications of “die in control,” he says. nesses that people live with for PICC line infection — brought AIDS,” he says, many of which When he’s talking and lis - years, often until they die from him to Vanderbilt again early were relatively rare until then. tening to patients, Raffanti says other causes. this year. “We got much better at treat - some days he is keenly aware “Back then HIV or AIDS “Nobody knew if I was ing them.” the waiting line is getter longer was a death sentence,” recalls going to live or die,” he says. Then, in 1996 new drug on the other side of the door. Lucero. “I had friends drop - “I couldn’t feed myself, I treatments aimed at control - “It’s extremely time-con - ping like flies.” couldn’t dress myself, I ling the underlying virus suming and energy-consum - In 2007, after struggling couldn’t bathe myself.” became available; unexpect - ing to do it right,” he says. But for several years with health That’s when Raffanti edly, patients’ immune sys - doing it right is what the problems and consulting with asked him if he wanted to go tems grew stronger with this patients want. “Some doctors 12 specialists, Lucero’s prog - home, and if he wanted to intervention. Mortality rates are recognizing that patients nosis turned grim: six months continue liquid nutrition. His plummeted. Today, with have knowledge, that they are to live. He moved from Dallas answers were “yes” to going proper medication, HIV/AIDS comfortable making choices,” back to Lawrenceburg to be home, and “no” to liquid patients can expect to survive Lucero says. “Why not allow near family and within three nutrition. for decades. them that?” weeks was treated at Back in Lawrenceburg, “The bottom line is most -ELIZABETH OLDER Vanderbilt University Medical Tenn., Lucero continued on of our patients will not die of Center by Comprehensive antibiotics and regained HIV disorders,” says Raffanti. Care Center Medical Director strength as he was cared Patients still must come to Stephen Raffanti, M.D., asso - for by his mother and two terms with a chronic illness ciate professor of Medicine. nurses — one his sister. By that requires lifetime medica - “He said, ‘I think there’s his April appointment at the tion and limits lifestyle choices , something else going on with Center, everyone was amazed while doctors have to refocus you,’” Lucero recalls. He had at his condition. on treating these patients’

WINTER 2009 31 :: feature N O X I D N A

E This is really D the “big talk” As the debate looms about who should get what share of America’s limit - ed health care resources, Roy Elam has a proposal that would put the people most likely to be affected in the middle of the conversation: require every 65-year-old American signing up for Medicare to discuss their preferences about medical interventions and end-of-life care. “Death is not an event. Death is a process,” Elam explains. “We should begin the discussion about death at the age of 65 for everybody and every five years have the discussion again...If we begin talking about this as a culture, we can know what people really want.” People diagnosed with a life-threaten - R. Lawrence Van Horn, Ph.D. ing illness at any age could be assigned a nurse, a social worker or another trained professional — a coach, as Elam sees it — to help them deal with evolving medical the benefit of forcing people to think Van Horn says it difficult to imagine issues, but also to listen to concerns and about the efficacy of the expenditures, but how policymakers would be able to justify talk about sensitive topics like when to the fact that the expenditures are made in health care decisions that keep treatments stop treatment. Other changes would be the last two years of life doesn’t necessarily that carry even a small chance of success needed to support this societal discussion, imply that they are wasteful.” from seriously ill patients. he adds, like instituting a reimbursement While medical treatment for the “How do you take that away from system that rewards doctors for time spent chronically ill could be calculated using them? I think that’s very difficult to do,” counseling seriously ill patients and find - some kind of cost-benefit approach, he observes. “I think we need to recog - ing new ways to talk about palliative and Viscusi thinks that would present unique nize there is a limited amount of hospice care so patients don’t hear “as far challenges. resources. As resources are committed as we’re concerned, you are going to die.” “I just think it’s a much harder area, here, they’re not committed there.” Elam has forged a personal connec - a much more sensitive area, because Because of this reality, Van Horn tion with that dilemma as a longtime stu - you’re dealing with much larger probabil - says physicians and other medical profes - dent of medical ethics, board chairman of ities of death, and because they are sionals need to be out in front of the Alive Hospice and a husband who was identified lives, as opposed to anonymous discussion of what he calls a “societal, caregiver for his dying wife. But he is lives,” he explains. cultural resource problem.” optimistic that medicine today is shifting Health care management and econom - “Clinicians should be the people more toward caring for the whole person, ics expert R. Lawrence Van Horn, Ph.D., involved in making that decision, not rather than focusing on fixing body parts. M.P.H., M.B.A., echoes that observation. economists,” says Van Horn, an associate And he believes helping patients and fami - “You can put a value on life, and pol - professor of Management. lies make peace with declining health and icymakers do this all the time in terms of “Despite our insatiable demand demise is part of that. evaluating interventions,” says Van Horn, for technology, we are not in the position “We want them to know that who is faculty director of the Health Care to commit unlimited resources to every - doctors have heard the story of their ill - MBA Program in the Owen Graduate body in the last years of life,” he adds. nesses and the larger story of their lives,” School of Management. “But here’s the “I don’t want economists to be the guid - Elam explains. “We want them to know key...everything is different when you look ing force in what care is provided at we genuinely care about their pain and at it from a societal perspective as opposed that point.” suffering.” VM to an individual perspective.”

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Another important role is also one of the most difficult: dealing Specialized service with families, many of whom are agonizing over how to care for their aging loved ones. provides caring touch A 92-year-old patient with Alzheimer’s lived at home with his 87-year-old sister until he suffered a fall recently. for elderly “He really needed more supervision,” Solberg said. “He needed to be in a structured environment. His sister and her children were adamant that he not be placed in a nursing home.” Despite community services and social work intervention at Senior patients require a particularly deft and caring touch home, the patient kept returning to the hospital. from their medical team. “We finally approached them with a real team approach, with Vanderbilt University Medical Center’s new Geriatrics Consult therapists and social workers,” Solberg said. “We said, ‘We just Service offers just that type of expertise and specialized treatment really can’t let him go home again. It’s not in his best interest.’’’ for the elderly and their families, too. The team discussed with the family their fears of nursing “We can make a difference in these patients’ lives, even if it’s homes, and set up tours of three facilities to help them choose. for just one day,” said Laurence M. Solberg, M.D., chief of the “We were able to talk to the family about end-of-life issues service. “We can give them a better quality of life near the end of and about getting the best care for him, even though it wasn’t their lives.” them caring for him,” Solberg said. “It was better for their Doctors from any hospital department can request a consult for mother to see her brother well-cared for and not worry about patients age 65 and older. About 65 percent of those patients have him all of the time. three or more geriatric syndromes, which include conditions such “That’s a success story from the geriatrics team, because it as dementia, incontinence, malnutrition, frailty and delirium. made his quality of life better. And it helped his sister, too, Since its inception earlier this year, the service has seen an because now she doesn’t have to worry about him.’’ average of four new patients per week. An added benefit comes from teaching young physicians about The multidisciplinary approach includes physical and mental the needs of older patients. All internal medicine residents at health assessments; details of the patient’s social and economic VUMC now undergo a geriatric rotation. status, such as family support and home safety issues; a review of “The best thing we get to do is show the younger doctors in medications; and development of a care plan. training that this is a part of elderly care that they never saw The experiences of two recent patients reveal the need for the before and didn’t understand,” Solberg said. “Now they get to see specialized service. it as a real extension of care. They help keep people functional. An 86-year-old woman who lives a few hours away came to “But also, if we can’t keep them functional, we teach them how Nashville after fainting in church. to deal with family members as they come face-to-face with the When seen by the Geriatrics Consult Service, the patient was on reality that their loved one is at the end of their life.” 14 medications and “feeling very weak,” Solberg said. It turned - LAURIE E. HOLLOWAY out she’d recently seen a new cardiologist, and he’d put her on six additional medications. Like many seniors, she was worried about the cost of those Senior citizens participate in a tai chi class at Vanderbilt’s Dayani Center.

medications. R E N Y

“Many doctors in the community just don’t think about the fixed A R E income that seniors are on,” he said. “They forget about it, or N N think it’s going to be covered.” A The cardiologist “put her on all of the latest, greatest medica - tions, and they all cost a ton of money,” Solberg said. “None of them were cheap. To me, that’s always a concern. There may be a generic that will do the job very well and not force the patient to choose between medicine and food.” The patient left Vanderbilt on four generic medications, which cost a total of $16 per month. “Here was a woman who was doing fine,” Solberg said. “She didn’t need all of these new medications. There was no thought to how her lifestyle would be affected by this.”

WINTER 2009 33 :: department

THE ULTIMATE A look inside EXAMINATION the autopsy suite

44 WINTER 2009 feature ::

Leonardo da Vinci’s Vetruvian Man is perhaps the most iconic anatomical drawing, capturing the ideal human proportions. But da Vinci is also notorious for how he gained his knowledge of anatomy — by digging up bodies to dissect them. In the 15th cen - tury, that was the only way to see what is under the skin, to exam - ine the bones, muscles and ligaments, supplying da Vinci the knowledge of human anatomy necessary for masterpieces like the

Mona Lisa and Last Supper. Fast forward five centuries, and post mortem examination is still the gold standard for discovering what is happening under the skin. Marcia Wills, M.D., director of the autopsy service at Vanderbilt University Medical Center, calls autopsy the “ultimate examination.” It’s a chance for pathologists to explore the body in ways not possible during life, to examine every organ inside and out and to see things that may not be dis -

WRITTEN BY LESLIE HAST covered on an X-ray or in lab results. PHOTOGRAPHY BY DEAN DIXON

WINTER 2009 35 :: feature

opular imagination would put the process is diagnosed and put into context for the family, they can seek genetic autopsy suite in a dark dungeon counseling.” After a patient dies, the clinician with stainless steel walls and dim discusses the autopsy option with their lights. It is in fact located on the family. Decedent Affairs ensures that con - sent is properly completed, and contacts fourth floor of The Vanderbilt Clinic; its pale blue the first-year pathology resident about the Pwalls actually give it an airy, well-lit feeling. new case. The resident then picks up the patient records, reconfirms proper consent and contacts the clinician about clinical treatment questions to investigate, depending on the patient’s health history and cause of death. The answers help physicians understand what went wrong and how to prevent it in the future. The 64-year-old male had a history But it is also cluttered with reminders year. But just a few decades ago, there were of right ventricle dysfunction and died dur - of what goes on inside. Plastic tubs with more than 500 autopsies per year. Wills, ing open heart surgery. The pathologists unidentifiable tissues swimming inside are however, says there is no magic number. have been asked to investigate the cause of stacked around the room. Countertops are “We should do enough to serve the the dysfunction and why the patient had filled with scalpels and clamps, and an purpose of the community and hopefully such difficulty with a defibrillator. electric saw rests on the floor. move knowledge forward,” she said. “An Before the procedure, the staff And in the middle of the room, on a older pathologist would say ‘absolutely do involved in this case is gathered around a steel table, is the body of a 64-year-old more autopsies,’ but it’s different in these desk in the corner littered with papers male with a history of cardiovascular financial times. We need a purpose to and files and boxes of supplies. Jessie problems. perform a test.” Britton and Leavy McCoy, the technician s “The beginning of an autopsy fea - An autopsy is offered as a service to involved in every autopsy, are ensuring tures sadness, reverence and a respect for the families of Vanderbilt patients at no that all the necessary tools are ready and each person’s dignity,” Wills said. “The cost. Because a hospital must recover the everyone has the proper gear. family has very generously given us the cost of this test, the number of autopsies, During the autopsy, the first-year opportunity to figure out what we couldn’ t both at smaller hospitals and hospitals resident is assisted by a second-year during life. It’s sad to know that the indi - like Vanderbilt, has declined. Another charge while an attending physician looks vidual was once living and breathing, and reason for the decline is the fact that there on. But perhaps the most important know many people cared about this per - aren’t as many unanswered questions teachers are Britton and McCoy. son. You have to realize this person has because of modern diagnostic technology. “They have about a combined been through a great deal and they deserve Wills said that future patients benefit 70 years of experience,” Wills said. the highest level of respect with the inva - from the accrued knowledge of autopsies, “They’ve seen everything, and they sive procedure we are about to perform. and even the patient’s family members know everything.” Then the pathologist uses the techniques can be helped if medical problems are Britton has assisted with VUMC we were trained in to find answers.” illuminated that could help them as well. autopsies for more than 40 years, and “We hope that reading and discussing McCoy for 28. Declining numbers the autopsy report with the clinician will McCoy said that medical students Wills estimates that approximately 200 help them understand the disease process have the book knowledge, but he and autopsies are performed at VUMC each of their loved one. Once the disease Britton teach the practical knowledge.

36 WINTER 2009 feature ::

Marcia Wills, M.D.

“I know anatomy as well as the profes - and Tedesco’s job is to oversee James’ paper gowns covered with plastic aprons, sors,” he said. “I don’t know all the termi - work and help teach the procedure. shoe covers, hair nets, face masks and a nology, but I have practical knowledge as “Teaching is challenging,” Tedesco plastic face shield. Those wielding the good as anyone. I can do it in my sleep.” says. “You have to have patience. A lot of scalpels wear a pair of Kevlar gloves sand - McCoy has a degree in mortuary sci - first year residents haven’t done too many wiched between two pairs of rubber gloves. ence and has also worked at the Medical autopsies before and need time and To remove the breast plate, McCoy Examiner’s office. After 28 years, McCoy opportunity to learn.” and James position themselves on each said facing death is just another facet of After a final verification of toe tag side of the body, grip it with both hands going to work. and hospital wrist tag, the first incision is and make three quick coordinated tugs “Either you can do this or you made, a Y-shape, with branches from the down toward the abdomen. can’t,” he said. “You have to like it, and shoulders meeting at the abdomen and “An autopsy is very physical,” Wills I think it’s interesting to get to solve a continuing down around the navel in a said. “I’m a small person, and I have to problem for a family and discover single line. stand on a stool to get the right angle.” unknown diseases. Every case presents Next, the breast plate is removed. The next important step is to tie the something new.” McCoy picks up the striker saw, which carotid artery with a piece of string to has an oscillating blade that will cut bone prevent it from retracting during the The process and soft tissue but not the person operat - autopsy, giving the funeral home easy To begin the gross dissection, first- ing it. He does the left side of the rib access for injecting embalming fluid. year resident Sam James, M.D., presents cage, then hands the saw to James and Wills said the needs of the family the patient history to Wills while the sec - advises him on how to do the right side. and funeral home are always top priority ond-year charge, Jason Tedesco, M.D., Every autopsy is treated as a contami - during autopsy. They will accommodate looks on. This is James’ fourth autopsy, nated environment, so the staff wears all cultural and religious requests, like the

WINTER 2009 37 :: feature

Threefold mission Jewish practice of burying the body the same incisions their forbearers did before sundown, or the Native American centuries ago. In the 21st century, the purpose of practice of returning the organs to the The part that is changing, Wills said, an autopsy is vast, but can be bro - body for burial. is what can be done with the tissues once ken down into three general cate - “He will look perfectly normal after they are dissected. Pathologists now have gories: embalming,” Wills said. “We never access to genetic testing, microbiology, cul - touched the face, and we take out what tures and toxicology screening that can find 1. Better understanding of the we need while preserving the integrity of answers not possible even five years ago. disease process for the the body. We do autopsies in a very sensi - Once the organs have been fully family — depending on the tive way. We do take great care, and we examined, they are placed into plastic findings of the autopsy, genetic specialize each case in an attempt to tubs filled with formalin, a clear liquid counseling and further testing answer the questions being asked.” that fixes cells in static positions, thus may be necessary for the famil y Once the organs are exposed, cultures “stopping the organ at that moment in members of the deceased. can be taken. In a scene that could be out time,” Wills explained. of the 19th century, a scalpel rests on an Although the evisceration only takes 2. Continued education of the open flame from a small glass kerosene about an hour, it can take another two to medical community about the burner. McCoy presses the hot scalpel to four hours to examine the organs. patient and the concepts of the the lung, and with a hiss and a puff of “The body can already be at the general disease — medical smoke, the area is sterile and James can funeral home while they’re still dissecting education can be enhanced for get a germ-free lung tissue sample. He also organs,” McCoy said medical students, residents, uses a needle to collect urine from the McCoy sprinkles the inside of the pathologists and various teams bladder and blood from the aorta. body cavity with drying powder and then of physicians. Next, the organs are separated from sews it up with a baseball stitch. the surrounding tissue. McCoy, Tedesco “The funeral home will pack the 3. Research is also strengthened and James each hold a flap of fat in one inside with newspaper or cotton so it by access to tissue for ongoing hand, while making quick sweeping doesn’t cave in,” McCoy explained. projects. The tissue of the strokes with the other, slowly peeling it He washes the body with soapy deceased can help answer back to reveal the smooth shiny organs water, then puts it in a plastic biohazard questions being asked by the underneath. bag to prevent any leaks in transport to medical community at The atmosphere is relaxed but the morgue. Then it is put in a zippered Vanderbilt, nationally and inter - focused. There’s no rock music playing or body bag, placed on a gurney and covered nationally. talk of weekend plans, but there’s also no in a shroud to disguise what it is. McCoy pressure or anxiety. The smell is simulta - has a key that will lock the elevator and neously dirty and clean, like a very stinky prevent anyone else from getting on. bathroom being scrubbed with very strong cleaner. The findings Vanderbilt uses the Rokitansky tech - Within 48 hours of completing the nique, which dissects organs in place to dissection, the resident is required to better examine their relationships. Once complete the Preliminary Anatomical the organs are cut free, they are removed Diagnosis, which communicates to the from the body in two blocks — a heart family and clinician what was found in and lung block and an abdominal block — gross autopsy. to a parallel table for dissection. James Then there are 30-60 days to do the gathers each block into his arms like a microscopic examination and create the baby and rushes over to the other table final report, combining findings from before the slippery organs can slip out of gross autopsy with what is discovered in his hands. conferences with attendings and from his - Although there have been amazing tology and other ancillary studies. technological advances in medicine, The resident meets with the attending autopsy technique has remained remark - in what Wills calls “a time to teach and ably static with pathologists still making collaborate and think about hypothe ses.”

38 WINTER 2009 feature ::

The residents repeat their findings in front of other attendings and develop the ability to present efficiently. “Our job is to make it all make sense,” Wills said. “I don’t know all the answers and can’t figure out all the cases, but the interaction is so valuable.” Medical students are also involved in autopsy. From August to December, they are required to see one autopsy, write up the report and formally present it. As director of the autopsy service, Wills’ role is, in her words, “to make sure each autopsy is to the benefit and safety of its users.” That includes ensuring the safety of the pathologists, especially dur - ing infectious cases, and overseeing any research that is conducted. She also man - ages the report to the patient’s family. “They have very generously given the opportunity to figure out what we could - n’t during life,” Wills said. “I ensure the residents write the discussion in language accessible to the patient’s family.” But pathology isn’t just autopsy. The doctors are also involved in procedures for living patients, and Wills acknowl - edged she is often torn between serving the living or dead. “I’m absolutely conflicted,” she said. “I cover cytology, pediatric pathology, among other things, and it’s a constant juggle of time and effort, as any clinician knows. Yes, the patient is dead, but the thrust of the autopsy is for the family and clinician. Being dead doesn’t make them any less important.” Leavy McCoy Wills admits that autopsy was not the primary reason she chose pathology, but “We all have stories about what we’ve Of the 100 deaths VUMC averages says it is a necessary part of the field and seen, from massive hemorrhage to balloons each month, Williams estimates that 50- she enjoys solving the puzzles it brings. of drugs in the stomach. That one went 60 go straight to the funeral home, at “Autopsy is the opportunity that right to the Medical Examiner,” she said. least 30 go to the ME and 10-12 are families have given us to do the ultimate The Medical Examiner actually per - autopsied. examination on their loved one,” Wills forms the majority of autopsies from deaths Wills said there will always be a need said. “We can try to do all the appropri - at VMC. In Tennessee, the ME receives all for autopsy. ate detective work to find the answers to trauma deaths, homicides, suicides, drug “We will always serve a purpose,” clinical questions while educating and overdoses and unwitnessed deaths, pretty she said. “Autopsy is the only way to participating in research.” much anyone who expired on 10 north or answer certain questions. It is the most Wills said there’s also an element of in the emergency room,” said Marie complete exam that can be performed surprise in autopsy, and one can never Williams, program coordinator for on a person.” VM anticipate what will be discovered. Decedent Affairs.

WINTER 2009 39 :: feature

The Science  {and Art } of Dying

WRITTEN BY JESSICA PASLEY ILLUSTRATION BY LEON ZERNITSKY



In 1798 Benjamin Franklin had it right when he penned a letter stating: “in this world nothing can be said to be certain, except death and taxes.” The problem is — Americans want nothing to do with either. “Americans are not used to nor are they com - fortable with th¶e process of death,” said Roy Elam, M.D., asso - ciate professor of Medicine and medical director of the Center for Integrative Health. Elam said that many cultures approach death as part of the n¶atural cycle of life, while in the United States there is a tendency to tuck it away on a shelf. “We try to assume that death doesn’t exist. We deny that it can¶happen to us. Of course it happens to every one of us.”

40 WINTER 2009 f e a t u re ::

W I N T E R 2 0 0 9 41 L

:: feature L E W O H E O J

The art of dying has been around for centuries. Finding what is right for each person requires one thing — listening. Mohana Karlekar, M.D. 

The science These are indicators that a person will die follow this natural progression, about 10 in the next hour. percent to 15 percent experience terminal For something as certain as death “As a person physically gets closer to delirium, an agitation that occurs at the there is no way to pinpoint when some - the end of life the body begins to shut end of life. Medications are provided to one is going to die, but there are indica - down,” said Mohana Karlekar, M.D., calm the patients, allowing them to sleep. tors or stages of death — dying, active director of Palliative Care at Vanderbilt. “There is a real science to managing and imminent. “You eat less, drink less and eventually someone’s pain, fatigue and insomnia,” • Dying patients are those who have you stop eating and drinking all together. added Elam. “We are learning more and a limited life expectancy or who recently By this time, you’re not making as much more about the anxiety people experience learned of their illness. urine or having as many bowel move - and how best to help them. There is • Actively dying patients will exhibit ments. You get sleepier and sleepier. And much more science developing around physiological changes. Sleeping and eating at some point what will happen is that stress management and the molecular patterns increase, while activity regimes the amount of time spent asleep is more biology of stress.” decrease. These patients have days to than the time awake. Another area of scientific interest is weeks to live. “Eventually, you sleep and you sleep the wasting away process often seen in • Imminently dying patients show and your breathing patterns change… cancer, end-stage organ failure and burn clear signs of end of life. A patient has You breathe and breathe and pause. That patients. Cachexia causes severe weight cold and clammy hands, their legs are pause stretches out and stretches out and and muscle loss due to severe protein and bluish, red in color or mottled from the eventually there isn’t a next breath. That calorie malnutrition. lack of blood flow and their breathing is the natural progression of death.” “Fatigue, loss of energy, decreased patterns are slow and shallow (agonal). Although the majority of deaths muscle and strength make up cachexia,”

42 WINTER 2009 feature ::

 { Grief Resources } said Karlekar. “One predictor for survival Alive Hospice of Nashville offers a Loss of a Same-Sex Partner is functional outcome or performance sta - number of support groups to the offered as community needs arise tus. So if your cancer is really bad, but community. Groups provide par - you have great functional status — you ticipants the opportunity to In addition, Alive Hospice recom - can eat, drink, bathe, walk 100 feet — receive grief support with others mends the following printed you are going to do better with your can - who may be experiencing similar resources to those experiencing cer and someone is more apt to treat you. thoughts and feelings. The groups the loss of a loved one. This list “But let’s say that your cancer is not are offered several times a year. was compiled from an extensive as aggressive and you can’t get out of bed All groups are free of charge. bibliography provided by Alive and your functional status is poor, some - Hospice. one is less apt to treat you. Spouses Group: for those who “If you can find something to treat have experienced the death of a I Clemons, H., “Saying Goodbye to cachexia … you might be able to make spouse Your Grief. Macon,” GA. Smyth & some really big changes and people will Helwys, 1994. feel better. If you can offer a treatment General Grief Group: for adults early on in the disease where it can make grieving the death of a family I Grollman, E., “Living When a an impact — whether that is on a member or friend Loved One Has Died,” 3rd ed. patient’s quality of life, treatment or Boston, MA: Beacon, 1995. nutritional status — if it makes the Bereaved Parents Group: for any patient stronger, then it’s probably worth parent who has experienced the I Heegaard, M., “Grief: A Natural doing,” she said. (See sidebar on cachexia death of a child, regardless of the Reaction to Loss” on page 44) child’s age I Hickman, M., “Healing after Children’s Group (ages 8-10) and Loss: Daily Meditations for The art Pre-Teen Group (ages 11-13): for Working through Grief.” young people who have experi - The art of dying has been around enced the death of a family mem - I Johnson, J. & M., “Grief: What it for centuries, said Karlekar. Finding ber or friend is and what you can do.” what is right for each person requires one thing — listening. Grief in the Schools: an onsite I Ferguson, D., “When Winter “If you listen to what patients and support group at schools for high Follows Spring: Surviving the families are saying about their values and school students who are grieving Death of an Adult Child.” beliefs, then you can formulate a plan that the loss of a loved one is consistent, that makes medical sense, I Goodman, S., “Love Never Dies: and is not going to over treat someone,” Camp Evergreen and Camp A Mother’s Journey from Loss.” she said. “But you have to listen and that Forget-Me-Not: two-day summer takes time. And in this day and time, it is camps for children who have I Johnson, J. & M., “Children Die, a lot easier to order a test and do some - experienced the death of a family Too.” thing than to have that conversa tion. member or friend “For most patients, it actually allows I Kifer, C., “Left Behind: A you to live better,” she said. “Imagine being Holiday seminars: support ses - Mother’s Grief.” so worried about what is going to happen sions offering helpful strategies at the end of your life that it consumes you. for coping with the intensified I Klass, D., “The Spiritual Lives of Then you figure it out and you can actually sense of loss during the holiday Bereaved Parents.” Taylor and focus on what you want — those things season Francis Philadelphia, PA 1999. that give you the most meaning.” Dana Allen, of Nashville, knows Additional support groups: addi - what it’s like for someone to live their last tional support groups such as days with meaning. She knew when she

WINTER 2009 43 :: feature

left Tennessee for a trip to Maine last year of withdrawal grew. He would sit for hours “I told him that his girl was going to with her husband, John, that it was the watching TV with his eyes closed. He ate be OK,” she said. “He didn’t want to die last time they’d vacation together. His less and less. He grew more fatigued. without knowing I was going to be all battle with cancer was coming to an end. “I had read all the books. Right right. I would never lie to him. I made “It was a vacation from the chemo,” before we left the hospice doctor said to a promise.” said Allen. “But we both knew that there me — ‘You understand that he won’t be Within minutes, John Allen, 67, died. was not going to be any more chemo. We coming back with you.’” According to Karlekar, that is a very never talked about it. Deep down we both John died that week. common scenario. knew (it was the end). It was unspoken. Soon after praying with a minister at “You won’t find this information in “When he came out to sit with me his bedside, Allen told her husband that medical literature,” said Karlekar. “But if that last full day of our vacation, I knew,” she loved him. He mumbled he loved her you look at it clinically, people need per - Allen said. “There was nothing medical or too. Although they were his last words, he mission to die, just as they need the will scientific. It was just a feeling I had.” lingered. to live. Your will plays a very strong role Throughout their five-day stay, the Then Allen spoke one last time to in when you die. signs of death were increasing. His episodes her husband of eight and one-half years. “There are those who wait for either  {Wasting Away }

One of the biggest challenges when treating life-threatening reduce the estrogen deficiency side effects of androgen depriva - diseases is a syndrome called cachexia, the wasting away tion therapy for prostate cancer. process. This extreme form of malnutrition leads to profound Steiner earned his BS in molecular biology from Vanderbilt in fatigue and muscle loss and is oftentimes seen in patients with 1982 and his MD from the University of Tennessee. He completed diseases like cancer and AIDS. his surgery and urologic training at Johns Hopkins Hospital. He For years physicians have tried treatment after treatment to later returned to Vanderbilt University Medical Center as an improve a patient’s nutrition in hopes of increasing muscle mass. assistant professor of Urology, Cell Biology and Pathology during GTx, Inc., founded by Mitch S. Steiner, M.D., recently completed a a fellowship under Hal Moses, M.D., and Jay Smith, M.D., in 1993. Phase II trial of a drug called Ostarine, a selective androgen He then joined the University of Tennessee at Memphis as the receptor modulator or SARM, designed to increase muscle mass. endowed chair of Urologic Oncology in 1995 and served as the Results show that patients treated with Ostarine built muscle chair and professor of Urology. mass and climbed stairs faster with more power than patients GTx, formed in 1997, is a biopharmaceutical company dedicated taking the placebo. to the discovery, development and commercialization of small “If we can create a drug that builds muscle and can impact the molecules that selectively target hormone pathways to treat can - quality of life or a person’s ability to respond to chemotherapy, for cer, osteoporosis and bone loss, muscle wasting and other seri - example, that would be wonderful,” said Steiner, a Vanderbilt ous medical conditions. University graduate and former fellow. “When a patient is suffer - Aimed at treating cachexia in cancer patients, the Ostarine study ing from severe cachexia and does not have enough protein enrolled 159 patients with non-small cell lung, colorectal, non- stores that increase in muscle mass may improve quality of life Hodgkin’s lymphoma, chronic lymphocytic lymphoma and breast and survival. cancer. Thirty-five sites in the United States and Argentina partici - “We’re not certain where we would fit into the treatment pated in the randomized, double-blind, placebo, controlled study. process to make the most impact. It could be anywhere in the “Literature has suggested that lean body mass correlates with entire spectrum. If a patient feels better and comes to the dinner survival,” Steiner said. “This is not a curative therapy. If we can table because he has an appetite, then from a social and well- minimize many of the side effects of cancer treatments — fatigue, being standpoint he is part of the family. But when a patient has nausea (loss of appetite) — then quality of life is impacted. no appetite, lies in bed most of the time and begins to waste “When you think of terminal diseases, it doesn’t mean you don’t away, it completely affects the family dynamics.” want to live. It just means you need to think about how you want Steiner’s foray into the world of drug discovery came after suc - to live.” cessfully re-tooling a breast cancer drug, toremifene citrate, to - JESSICA PASLEY

44 WINTER 2009 N

O :: S feature N H O J A N A D

We try to assume that death doesn’t exist. We deny that it can happen to us. Of course it happens to every one of us. Roy Elam, M.D. 

a specific family member to arrive or to “Preparing for death doesn’t mean “It is that emotional acceptance of tell them it’s OK (to die). Or they wait you can’t keep living,” she said. “The ini - what you are going through, where you for news that certain things are in order,” tial process is not that you are going to die, are going, having the courage to talk she said. “Then there is a whole group of rather it is that you are no longer healthy.” about it, and having people around you people who wait for that one moment in At the time of diagnosis a patient who are willing to engage in the conversa - time where they get a break from family begins to grieve, she explained. For tion… the truth is, if you are dying you members. It has a lot to do with their instance, patients might lose the ability to want to talk about it because then you emotional preparation. It’s different ways work, drive, be active or even take care of can sort things out and move on to what to control when they die. The human themselves. These are all issues of loss that matters in life.” spirit plays a strong role whether you are a patient needs to talk about and share Elam and a growing number of awake and alert or lethargic.” with their family, friends or medical physicians agree that the more readily a team. But concerns about family, person accepts the fact that they are finances, work and other daily tasks can dying, and begins to focus on their life’s Acceptance impede the process. meaning and purpose, the better death “Emotionally everybody has things they will experience. In her nearly 10 years of practicing they want to figure out,” Karlekar said. “For many of our patients today, medicine, Karlekar has observed dying “As people begin to hone in on what they hope lies in the search for the cure,” Elam patients looking for ways to accept what can do to make peace in their lives, they said. “When there is no more chemother - is happening and make peace so that they get to a place where they begin to accept apy or no further treatment options, a can live. what is going on. person feels like it’s all over. But what

WINTER 2009 45 L

:: L

feature E W O H E O J

All of us will die. Some know when and why and some of us will never know. Dana Allen 

they don’t realize is that there is much either a life-threatening or terminal can get you to an emotionally better place more to hope for before they die. illness. A relatively new specialty in with what you are going through, perhaps “Curing and healing are very different medicine at Vanderbilt, palliative care you will do better with treatments or you things,” he said. “Curing is taking the dis - focuses on patients who are facing life- will be more inclined to prepare for what ease away. Healing is really about caring threatening illness or injury, at any stage might be down the road.” for the whole person. Our relationships in the continuum of disease. It is not Early studies have shown that pallia - provide healing even as one is dying.” just for the patient who is about to die. tive care patients are the most satisfied Vanderbilt’s program has been around patients in a hospital, Elam added. since 2006. “The outcome might be death, but the Palliative Care “We want to enhance the care that is patient satisfaction is higher than it is for given as well as provide all the informa - some other areas in the hospital,” he said. According to Elam and Karlekar, tion and resources a patient needs (when What experts have found is that palliative care has played a big role in dealing with life-threatening issues),” said patients facing a life-threatening or termi - educating both patients and medical Karlekar. “Death is a part of life and at nal illness need guides to help coach them professionals about living in the face of some point we are all going to face it. If I along the journey.

46 WINTER 2009 feature ::

 { Planned Giving }

“They need someone to walk with Many people create a personal or family legacy by partnering with a charitable them who not only helps them think organization such as Vanderbilt University Medical Center. Some donors make about dying, but helps them celebrate liv - an outright gift or multi-year pledge, but there are also “Planned Giving” ing, which can improve their quality of options. life,” said Elam. “That alone can help them hang onto hope. Hope doesn’t have Planned gifts include: to be that they are going to live forever. • Bequests under wills The hope might be that they get their • IRA beneficiary designations, and pain under control. It might be that their • Life income gifts (charitable gift annuities and charitable trusts where the donor nausea subsides or that their daughter is or family members receive income in exchange for a gift, usually for life). going to arrive the next day. “It helps to have a relationship with Benefits of planned giving: someone who is able to help a patient • It provides peace of mind. For example, an individual who does not feel relieve their fears which can allow them comfortable giving away $25,000 or more during life, may be open to the to let go at an appropriate time and die a idea of leaving such an amount as a bequest. more peaceful death,” Elam said. • It makes gifts possible. Consider a donor who feels that she cannot afford to give away $10,000 to charity. She may be able to make a gift if it will mean that she receives 6 percent of $10,000 paid to her quarterly for her lifetime, See you later, mosquito guaranteed.

For Dana Allen, a year has passed Other options: since her husband died. The man she wait - • Bequest under a will: There is no cost to the donor during his lifetime, yet the ed her entire life to find. The man who still gift is valuable to the charitable program and can be for a fairly high amount. brings a wave of giggles to his wife as she The donor retains control of his assets and has access to principal in emer - recounts their quaint greetings of “hello gency situations. mosquito” based on an old commercial. • Designating a charity as beneficiary of your IRA: This is easy to do — the “We really had fun together,” she said. donor can add the charity’s name online or by calling the IRA manager (TIAA- “We acted goofy and he was a wonderful, CREF, Fidelity, Vanguard or other). Depending on the donor’s situation, the wonderful man.” IRA to charity can simplify the estate administration and benefit survivors As Allen reflected on his death, she (Idea: Leave taxable IRAs to charity, non-taxable property to family.) discovered something about herself. • Charitable Gift Annuities: A donor (at least age 65) makes a gift (minimum “When he sat down that day with me $10,000) and receives income for life. A tax deduction is available immediately on the patio, I told him how pissed off I and the payments are partially tax-free. Payout rates are based on age: Age was that this was happening to him,” Allen 65 — 5.7 percent; age 70 — 6.1 percent; age 80 — 7.6 percent, and so on. said. “When John died, it was like having my own arm cut off. Gifts of Stock and Securities “But now I have put it all in perspec - When making an outright gift to charity, remember to think about appreciated tive. All of us will die. Some know when stock you may have in your accounts. If you have held the stock for more than and why and some of us will never know. I one year and it is worth more than you paid for it, use that stock for your chari - am not afraid to die now, because I will be table giving. Stock gifts can provide valuable tax advantages. with him again. It used to be something I was terrified of. No matter what road my Memorial Gift life takes, I will be with him again. A gift made in memory of an individual is a special way to remember a friend “I couldn’t say goodbye — just see or loved one and express sympathy to their family. A public obituary request you later, mosquito.” VM may advise friends and families how to honor a cherished life.

:: To learn more and see a video of Dana Allen For more information about these and other giving options, please contact Timothy A. Kaltenbach at talking about her experiences, please visit (615) 343-3113, (888) 758-1999, or by e-mail, [email protected]. For more information, www.mc.vanderbilt.edu/vanderbiltmedicine and click “The Science and Art of Dying.” visit VUMC’s Planned Giving Web site, www.vanderbilt.edu/alumni/plannedgiving.

WINTER 2009 47 :: feature

 { Gilda’s Gang }

When Gail Addlestone, M.D., (MD’97) was 18, she lost her With a new brain cancer diagnosis, “not just the patients them - mother to ovarian cancer. Years later, as a newly established selves, but family members, as well, may find themselves strug - Nashville pediatrician, Addlestone became a long-term volun - gling quite suddenly with something they never thought they teer at Gilda’s Club Nashville, a place where patients and those would have to deal with. Beyond coping with the medical com - near to them find free support for living with cancer. plexities, people may be facing other difficulties — spiritual, In her early 30s and pregnant, Addlestone was diagnosed emotional, interpersonal, vocational and so on. Gilda’s goes a with breast cancer at a time when she had continued to lead a long way toward addressing those needs. It’s an unbelievably Gilda’s Club bereavement group for children and adolescents. positive place,” he said. Under the care of neonatologists, her cherished daughter, “They’ve been a great partner to work with,” said Vanderbilt Eleanor, was delivered early and safely. pediatric hematologist Jim Whitlock, M.D., Craig-Weaver When illness and side effects of treatment eventually left Professor of Pediatrics. Whitlock said emotional support figures her unable to maintain her pediatric prac - greatly into treatment of childhood cancer. tice, Addlestone instead joined the staff at “It’s huge. It’s hard enough to be a kid these Gilda’s Club. There she conceived and Gail Addlestone, M.D., left, with her days, but add to that losing your hair, bearing launched Gilda’s Gang, an annual program friend and fellow Gilda’s Gang par - scars from surgery, walking around with a ticipant, Danielle Gilbert. marrying volunteer fundraising with a 16- central line hanging out of your chest: to week course of fitness training, including have a place where people understand what regular sessions with personal trainers, that’s about and freely provide informed sup - weekly group workouts and complimentary port is so essential.” gym access, culminating in group partici - The Gilda’s Club calendar is replete with pation in the Country Music Half Marathon. sessions devoted to yoga, pilates, tai chi, art In 2007, its second year, Gilda’s Gang drew activities, writing workshops and cooking 60 volunteers who together raised classes. Support groups for patients and for $150,000. Of that total, Addlestone herself family and friends each meet weekly. More raised about $50,000. specialized support groups meet monthly, Addlestone died from cancer in July including groups for teenagers, young adults 2007, three months after completing the and diagnosis-specific groups. Support groups Country Music Half Marathon with other are facilitated by on-staff social workers. Gilda’s Gang participants. “For our support groups, our philosophy In a non-residential, homelike setting is that the wisdom is in the room. The near Music Row at 1707 Division St., the experts are the folks who are living it,” said organization Addlestone helped nurture Felice Apolinsky, L.C.S.W., a cancer survivor continues to serve men, women, teenagers and children with all and staff member at Gilda’s Club. types of cancer, as well as their family members and friends, Jule West, M.D. (MD’97), assistant professor of Medicine, offering a varied program of support groups, workshops, recre - met Gail Addlestone during their first year of medical school at ational opportunities, information and referrals. Vanderbilt. The two became close friends. With Vanderbilt providing more uncompensated care than “Gail was really a magnanimous soul. She had this amazing all other Nashville hospitals combined, the Medical Center is gift — she was the type of person who lit up the entire room, and generally too busy raising money for its own programs to con - she was fully engaged whenever she was with you. And she was sider giving funds to other organizations. Gilda’s Club remains very selfless, thoughtful and brave,” West said. an important exception. The program counts Vanderbilt “From the time of her diagnosis onward, it was clear that she University Medical Center as a major corporate benefactor. was not going to be a person with breast cancer. She was going to Faculty and staff at Vanderbilt-Ingram Cancer Center have be a person — period. There’s nothing more amazing than watch - found a close partner in Gilda’s Club. Neurosurgical oncologist ing someone who’s dying from an illness live, and live fully. Reid Thompson, M.D., vice chair and associate professor of “I know Gail’s connection with Gilda’s Club empowered her Neurological Surgery, began referring more patients and fami - tremendously.” lies to Gilda’s Club after visiting the facility some years back. Gilda’s Club Nashville is one of 22 affiliates of Gilda’s Club “I suddenly came to realize it’s a very important resource, Worldwide. All programs are free of charge. For more informa - one that’s much broader than I had realized,” Thompson said. tion, visit www.gildasclubnashville.org. - PAUL GOVERN

48 WINTER 2009 canby robinson society :: C•R•S facing pediatrics with Jonathan Gitlin, Medical Center publications and to stay President’s Corner M.D., chair of Pediatrics, and Kevin informed on CRS activities. Churchwell, M.D., CEO and executive We are grateful for your continued he Canby Robinson Society is as director of Children’s Hospital. This pro - support and encourage you to let us know strong as ever and poised for gram was followed by a tour of the if there is anything we can do to better T another successful year in 2009. NICU. We also provided several opportu - serve you and your families. There are currently more than 2,500 nities to attend organ recitals with the members who were responsible for medical students in the Pathology Lab. $23,439,702 in giving to the Medical In September the CRS co-hosted a Center in FY 08 compared with regional dinner in Atlanta with Medical $17,038,817 in FY 07. The dollars raised Alumni Affairs, and we have other din - support chairs, scholarships, research, ners planned in Birmingham and facilities and departmental programs at Chattanooga in early 2009. The CRS the Medical Center. Board met in October and toured the We have been very busy this fall wel - new Anatomy Lab as part of the meet - Missy Eason coming our new Canby Robinson Society ing’s agenda. Executive Director Scholars (see article on page 50) and begin - In November we launched an excit - ning the selection process for next year’s ing new initiative, the Coalition for the scholars. We hosted two outreach tours: Canby Robinson Society, which will be a For more information about the Canby the LifeFlight/Trauma Program with wonderful vehicle for recruiting new Robinson Society, contact Missy Eason, John Morris Jr., M.D., director of members and increasing support to all Director of Donor Relations, Vanderbilt Trauma and Surgical Care, and a pro - University Medical Center, D-8223, Medical areas of the Medical Center (see article on Center North, Nashville, Tenn., 37232-2106, gram that updated us on expansion plans page 51). (615) 343-8676 or 8677, fax (615) 343-0809, for the Monroe Carell Jr. Children’s Please visit our Web site at e-mail: [email protected]; Hospital at Vanderbilt and the challenges www.mc.vanderbilt.edu/crs/ to access all www.mc.vanderbilt.edu/crs/

Class of 1978 halfway to goal of fully By reaching out to the class mem - attract students of the highest caliber endowed scholarship bers, Humphrey and Nygaard had a goal regardless of their ability to pay. The Vanderbilt University Medical of raising $100,000 by this year’s 30th “A lot us financially struggled to go School Class of 1978 is working to fund reunion. The class responded to the to medical school,” Nygaard said. “It was an endowed scholarship in honor of their request and has committed more than not easy on us. We want young people to 30th reunion, held in October 2008, and $320,000 thus far with almost half of the be able to attend medical school and we the class is well under way to reaching class pledging contributions for the want to attract the best students possi - its goal. scholarship. ble to Vanderbilt. The more students Classmates Stinson Humphrey, M.D., “The response of our classmates to who come to Vanderbilt and succeed, the and Thomas Nygaard, M.D., co-chaired date has been truly remarkable,” better it is for them and for Vanderbilt.” the campaign to raise the necessary Humphrey said. “We have an unusual Humphrey agrees and is proud of $600,000 for an endowed scholarship. class that was close when we were stu - his class’s mission to fund a scholar - dents, and many have stayed involved ship. “The cost of medical education and Members of the Class of 1978 at their through contributions to the School of obtaining a medical degree is expensive 30th reunion. Medicine throughout the years since and costs continually rise,” he said. graduation. The high level of participa - “I believe that an endowed scholar - tion is due to the support we received as ship that will cover the tuition for one students from faculty, administration student per year is a very significant con - and staff.” tribution for a single class to provide.” Scholarships fulfill a critical need After graduation Humphrey and have a powerful impact on the lives remained at Vanderbilt as a house offi - of many students in the School of cer, first as a general surgery first-year Medicine. By providing endowed scholar - resident and then as a resident in Oral ships, such as the Class of 1978 Endowed and Maxillofacial Surgery. Following Scholarship, Vanderbilt can continue to (continued on page 50)

WINTER 2009 49 :: canby robinson society

CRS scholarships where she conducted neuroscience research and completed an undergraduate honors expand education, thesis studying the role of the insulin path - careers of deserving way in C. elegans olfactory learning. The Ottawa, Canada, native chose to students attend Vanderbilt for several reasons. “The CRS scholarship was the final ive new Canby Robinson Society deciding point in my decision to attend scholars are among the 105-mem - Vanderbilt because of the flexibility it will ber Vanderbilt University School of allow me in choosing a specialty and in F Canby Robinson Society scholars, left to right, Medicine Class of 2012. deciding whether to practice in the U.S. or are: (front row) Rajshri Mainthia and Sarah back in Canada,” she said. “The CRS Bourne; (back row) Obi Umunakwe, Peter Rajshri Mainthia graduated from scholarship allowed me to make the deci - Knowlton and Ravi Parikh. Virginia Commonwealth University/ sion to attend an American rather than Medical College of Virginia, participating Canadian medical school without having to all allow me to further explore my interest in an eight-year Honors Medical Program take financial considerations into account.” in international health care management and majoring in chemistry. She also stud - She was impressed by how invested and economic development,” he said. ied abroad at Oxford University in Great faculty is in medical education and their “The CRS scholarship will allow me Britain before choosing VUSM. genuine concern for student well being. to follow an unconventional career path of “I ultimately decided to attend “I also liked that the emphasis program pursuing an M.D./M.B.A. to work in Vanderbilt based on its unique collegial builds the opportunity for students to do international health and health care devel - environment, faculty support network, research into the curriculum,” she said. opment without the burden of debt hin - and rising focus on translational and inter - She is considering careers in neuro - dering my career goals,” he said. national research,” Mainthia said. surgery, neurology, or psychiatry after Receiving the CRS scholarship will graduating from Vanderbilt. Peter Knowlton graduated from help Mainthia pursue her goals of becom - Duke University with a B.S. in biology ing a surgeon and collaborating closely Ravi Parikh majored in anthropolo - before deciding to attend VUSM. with financial consultants, scientists, gy, focusing on medical and cultural “As a hopeful physician-scientist, I lawyers, and community workers to anthropology, at City University of New was strongly attracted to Vanderbilt by the improve health care in low-income areas. York Brooklyn College in Brooklyn. access to terrific medical training and “In the future, I’d love to form a multi - He chose Vanderbilt due to its trans - world-class research,” he said. “Apart from disciplinary team that works synergistically formative educational experience and stu - that, I was deeply struck on my visits to to create sustainable surgical care models for dent-focused component. “The emphasis Vanderbilt by how happy and grounded poor, underserved populations,” she said. program (a two-year research program that its students seemed, as they appeared far is part of the curriculum), the stellar global more focused on actually learning quality Sarah Bourne attended Harvard health institute, as well as a business school medicine than on memorizing every fact University, majoring in neurobiology, with a health care management component within a textbook.”

(continued from page 49) residency he entered private practice in internal medicine at Johns Hopkins Cardiology for the Heart Center and Los Gatos, Calif., and practiced until Hospital, and later completed his fellow - chairman of the Heart Board. He is pres - retiring in 1997. He is spending his ship in cardiovascular disease at the ident of the Centra Cardiovascular Group retirement on such projects as the University of Virginia. He stayed on the and vice chairman of the board of scholarship campaign and an endow - faculty at the University of Virginia as an Centra, Inc., a regional health system ment he created and helps administer to interventional cardiologist and director with approximately 5,000 employees. help medical and theological education of the coronary care unit. In 1986 he and - JON COOMER in Nigeria, West Africa. his family relocated to Lynchburg, Va., Nygaard is board certified in cardio - where he served as director of the car - vascular disease and interventional car - diac cath labs at Stroobants Heart diology. After graduating from VUSM, he Center Lynchburg General Hospital until served his internship and residency in 2001. He now serves as director of

50 WINTER 2009 canby robinson society ::

“The recent completion of such facili - Medical Center. On Nov. 10, a new calling,” Randolph said. ties as CELA (Center for Experiential group, the Coalition for the Canby “The Coalition will be a wonderful Learning and Assessment) and the new Robinson Society, launched with the goal vehicle for increasing support to all areas anatomy lab ensured me that Vanderbilt not of continuing the success of CRS. of the Medical Center and to further only was a technologically advanced institu - The Coalition is made up of 26 engage donors about what matters most tion, but also one that would go the extra alumni and community members with a to them. The Canby Robinson Society mile to provide for the needs of its students.” wide range of associations to the medical reflects giving to all areas of the Medical Knowlton believes the CRS scholar - center. The Coalition will be charged Center from scholarships to chairs to ship will have a tremendous impact on his with recruiting new members to CRS and facilities, research and departmental pro - career. “Forming bonds with other CRS broadening the scale of support for the grams,” said Missy Eason, director of the scholars, donors, and faculty will hopefully Medical Center. Canby Robinson Society. provide me with an opportunity to net - The Coalition is led by Robert - LESLIE HAST work with some of the past, present and Collins, M.D., professor of Pathology, future medical leaders of America,” he said. Robert McNeilly Jr., and Judson Randolph, M.D. The troika began to Giving back Obi Umunakwe knew that meet 10 years ago to build a scholarship Vanderbilt would provide him with a program for Vanderbilt medical students, lenn and Barbara Merz have medical education that few other schools and their commitment led to the develop - shared many triumphs and tears could match. ment of the Coalition. G at Vanderbilt. The couple met at The M.D./Ph.D. candidate graduat - All three attended Vanderbilt as Vanderbilt as their late spouses were bat - ed from Howard University in 2008 with undergraduates. Randolph and Collins tling lung diseases after receiving trans - a B.S. in chemistry. He looked at current were medical students together, and plants. Barbara helped establish a fami - Vanderbilt research and determined it was Randolph and McNeilly are past presi - ly/spouse support group where she and in line with his interests. “What really dents of CRS. Glenn became close friends throughout sealed the deal for me was the people, “The Canby Robinson Society has a the recovery process. both faculty and students, who I met from great reputation and has grown mostly on Barbara’s first husband, Vernon Vanderbilt during the application its own through that reputation. This is a Rosser, was diagnosed in 1997 with process,” he said. “They really gave me the push to increase that. It will bring more Idiopathic Pulmonary Fibrosis (IPF), a feeling that Vanderbilt was very focused intentional recruitment of additional lung disorder with no known cause and on the well-being of the students and that members,” McNeilly said. no cure, and was placed on a national they would use whatever resources they Once the idea was proposed, similar waiting list for a transplant, along with could for student support. I felt as though models from other universities and med - 3,000 other hopeful patients. I would be happier at Vanderbilt than any ical centers were studied. In June 1997, a lung became avail - other school I was considering.” The leaders are especially passionate able for Vernon. The complicated surgery Receiving the CRS scholarship will about reducing the debt of medical school at Vanderbilt was a success, even though expand Umunakwe’s academic circles. students. Vernon faced many challenges during the “The Canby Robinson Society will pro - “Our working with the CRS through long recovery and spent nine weeks in vide me with an extra layer of support, the Coalition is a natural extension of our intensive care. Vernon recovered and he should I ever need it,” he said. “It will also interest in scholarship,” Collins said. and Barbara enjoyed five years before he be an avenue to interact with some of the “Students generally borrow inordi - died in December 2002. people who keep Vanderbilt Medical nate amounts of money to complete their Glenn’s first wife, Joyce, also suffered Center running.” schooling, and we want to reduce that from IPF and received a transplant in - JON COOMER debt burden,” McNeilly said. “As a result, 1998. According to the Pulmonary their choice of specialty would be much Fibrosis Foundation, there are 5 million freer, and it would attract to Vanderbilt people worldwide who are affected by this The Canby even more first-class candidates. And ulti - disease. In the United States there are mately, many will return to Nashville to more than 200,000 patients with Coalition practice, which builds up the community Pulmonary Fibrosis, with about 50,000 and maintains the tremendous accom - new cases diagnosed each year. As a con - or 30 years, the Canby Robinson plishments of the Medical Center.” sequence of misdiagnosis the actual num - Society has encouraged and hon - “I still think of medicine as a calling, bers may be significantly higher. ored those who support Vanderbilt and I refuse to think of it as an enterprise. (continued on page 52) F I want them to be able to follow their

WINTER 2009 51 :: canby robinson society

(continued from page 51) WHERE ARE THEY NOW? KENT K. ISHIHARA, M.D. Vernon and Joyce became very close friends during the transplant. Joyce died Kent K. Ishihara, M.D., and fami - demics, where he can use the skills and in February 2003, only nine weeks after ly are moving west. experiences of his Vanderbilt education Vernon. In June, Ishihara will join the fac - to provide care for patients with both “Joyce had been very ill prior to this ulty at the University of California, simple and complex endocrine disor - and I think once Vernon was gone, Davis in the Division of ders, while helping to train the next though his passing was totally unexpect - Endocrinology, Clinical Nutrition, and generation of doctors. ed, she was ready also,” Barbara said. “We Vascular Medicine. He and his wife, Abigail (VUSN both said they had something to do with Ishihara remained at Vanderbilt for 2005), married in 2005 in Nashville, us getting together.” internship and residency in internal and their first baby, MaryJane Ruth, Glenn and Barbara maintained their medicine after graduating from VUSM was born in 2008 in Kansas City. The friendship after the deaths of their spous - in 2001, then relocated to Washington couple both joined the Vanderbilt es, and eventually began dating. They University in St. Louis for an Medical Campus Outreach on a med - married in January 2004. endocrinology fellowship. After finish - ical mission trip to the Philippines in As a way of giving back to the insti - ing his fellowship training in 2007, he 2006, and he again joined the team on tution that means so much to them, that joined a small endocrinology private a trip to Ghana in 2008. helped care for their spouses and brought practice, Hellman and Rosen Endocrine - JON COOMER them together, they have established the Associates, in Kansas City, Mo. Glenn and Barbara R. Merz Scholarship Kent and Abigail Ishihara with The former CRS scholar is grate - MaryJane Ruth. for Medical Education and the Barbara ful for the opportunity that the scholar - and Vernon Rosser Endowed Fund in ship allowed him personally and profes - Lung Transplant Medicine. sionally. “The CRS scholarship was, The Merz Scholarship for Medical and continues to be, an amazing bless - Education will fully endow a medical ing,” he said. “The scholarship helped school scholarship fund, and the Rosser me choose a path in medicine without Endowed Fund will endow an unrestrict - the influence of a large burden of debt. ed fund in the Department of Medicine Therefore, I was able to choose a less supporting transplant medicine. lucrative career in Endocrinology, “Vanderbilt has impacted my life sev - where the needs are great because so eral times,” Barbara said. “I was born few choose to spend the extra years in there and developed a very serious disease training for what amounts to essentially myself. They used an experimental drug no financial reward.” that helped save my life. It is known as The scholarship also allowed him penicillin.” to consider returning to a career in aca - Barbara recalls the care and compas - sion she and her husband received while being treated at Vanderbilt. “When CRS members participated in a recent LifeFlight Vernon was a transplant patient he did outreach tour.

N not do well the first few days and was put O S

W into a drug-induced coma,” she added. A L Y

M “During those long nine weeks, doctors, M O save T nurses and even people I did not know came by his room in ICU to encourage and talk to me. I was not a spouse but a this member of the Vanderbilt family.” date - JON COOMER CRS Dinner May 16, 2009

52 WINTER 2009 alumni journal ::

ANN H. PRICE, M.D. Executive Director for Medical Alumni Affairs

CONTACT Vanderbilt Medical Alumni Association Vanderbilt University Medical Center Phone: (615) 343-6337 Fax: (615) 936-8475 [email protected] www.mc.vanderbilt.edu/medschool/alumni

Vanderbilt Medical Alumni Reunion 2008 Alumni Achievement Award, an award that recognizes outstand - For those of you who attended Reunion 2008 on October 23- ing personal achievement and/or professional accomplishments by 25, I hope you enjoyed your time on the Vanderbilt campus. A a VUSM alumnus or alumna. Mrs. Annette Eskind was the wor - big thanks to our class chairpersons, class gift chairs and class party thy recipient of the VMAA Distinguished Service Award, an hosts for making this a truly wonderful event. If you were not able award that recognizes an individual of exceptional merit whose to make it to Reunion 2008, please refer to the back two pages of dedicated and distinguished volunteer service has furthered the this issue for photographs from various Reunion festivities. aims and goals of VUMC.

VMAA Board of Directors VMAA/ProQuest Health and Medicine Dr. Warren F. McPherson (HS ‘66-’72), VMAA President Due to positive feedback from our recent yearlong Vanderbilt 2006-2008, presided over the VMAA Board Meeting, introducing Medical Alumni Association (VMAA) ProQuest Database trial, Dr. Wyatt E. Rousseau (MD ‘69) as the next president of the the VMAA is now opening enrollment to our VMAA/ProQuest VMAA to serve a term from Reunion 2008 to Reunion 2010, in Health and Medicine Complete users group. ProQuest Health tandem with the newly elected VMAA President-Elect, Dr. David and Medicine Complete is a 24/7 online resource offered through W. Patterson (MD ‘85). the VMAA at no charge for our medical alumni. ProQuest In addition, Dr. McPherson welcomed to the VMAA Board Health and Medicine Complete’s online database provides access Dr. Brock L. Schweitzer, the current Post-Doctoral Organization to almost 1,500 publications, including medical journals for most representative, and installed the following medical alumni to serve disciplines as well as consumer and health administration titles. as Specialty Society representatives from Reunion 2008 to User Group slots are currently limited by contractual agreement Reunion 2012: Dr. Sam S. Chang (MD ‘92, HS ‘92-’94), with ProQuest. We will enroll alumni on a first come/first serve Urology Society representative, Dr. James W. Felch (MD ‘77, HS basis until our group is filled. If you are interested in joining our ‘77-’81), Savage Society representative, Dr. Benjamin P. Folk III VMAA/ProQuest Health and Medicine Complete users group, e- (HS ‘81-84, FE ‘86-’87) Friesinger Society representative, Dr. mail [email protected] to check availability and learn Alan H. Fruin (MD ‘67, HS ‘67-’73) Meacham Society represen - more about this resource. tative, Dr. Thomas T. Dovan, Orthopaedics Society Representative (HS ‘97-’00), and Dr. Richard F. Treadway (MD Worthy of Note News ‘64, HS ‘64-’65) Luton Society representative. Please take a moment to submit new submissions for our alumni news section in Vanderbilt Medicine . Please send Reunion 2008 VMAA Alumni Awards announcements and digital photographs to During the Reunion 2008 festivities, the VMAA Award win - [email protected]; fax to (615) 936-8475; or mail to ners were honored at the Grand Evening Dinner held at the VUMC Medical Alumni Office, 21st Ave South and Medical Loews Vanderbilt Hotel Symphony Ballroom. The 2008 VMAA Center Drive, MCN D-8212, Nashville, TN 37232-2106. Distinguished Alumni Award, VUSM’s highest alumni honor, was bestowed upon Dr. Richard B. Johnston Jr. (MD 61, HS ‘61- ’63) and Dr. Harold L. Moses (MD ‘62, HO ‘62-’65, FAC ‘68- ’73, ‘85-present), the 30th and 31st recipients of this prestigious award. Dr. Clifton K. Meador (MD ‘55, HS ‘59, FE ‘60, FAC ‘73-’80, ‘82-Present) and Dr. Robert Sanders (MD ‘55, HO ‘55- ’58, awarded posthumously) were honored with the VMAA

WINTER 2009 53 :: alumni news Read Vanderbilt Medicine online, and send in your alumni news at www.mc.vanderbilt.edu/vanderbiltmedicine. Digital photos (200-300 dpi and at least 4 by 6 inches) are always welcome and will be included as space permits.

KEY idency program. He and his wife book focus MD - Medical School Graduate have two daughters, a son and three HS - House staff grandchildren — all live close by. FE - Fellow John H.K. Vogel, M.D., HS’57-’60, is practicing FA - Faculty *Paul H. Barnett, M.D., MD’58, cardiology in Santa Barbara, Calif., and co- CF - Clinical Faculty and his wife, Paula, have recently edited “Integrative Cardiology-Complementary returned from a trip to Israel, and and Alternative Medicine for the Heart.” The have added both a bearded collie text contains contributions of more than 40 * Indicates CRS member puppy and an eighth grandchild to authors. It can be obtained from their list of accomplishments. www.amazon.com. Grandson Phillip Daniel Lashinsky 40 s was born in August. G. B. Hodge, M.D., MD’42, who the American Society for Plastic Joseph F. Lentz, M.D., MD’63, helped found what is now USC *Newton Bramblett Griffin, M.D., Surgeons. His wife, Sharon, holds HS’63’-64, ‘67-’68, retired two Upstate, has chronicled the histo - MD’57, HS’57-’58, ‘60-’63, retired a law degree from the University years ago after practicing pedi - ry of the campus and its leader - in September 1997, but still con - of San Francisco Law School, and atrics in Nashville for 38 years. “A ship in his memoir, “Reflections tinues to earn enough CME cred - is a prosecuting attorney in the great time had by all,” he reports. on Building an Institution: The its to qualify for the AMA office of the San Francisco District He and his wife, Betty, are staying University of South Carolina- Physicians Recognition Award, Attorney. busy, spending time with their Spartanburg.” A Spartanburg which he has earned since 1969. four sons, their spouses, and 10 native and retired surgeon, Hodge He and his wife still travel in the Gerald E. Stone, M.D., MD’57, grandsons, age 2 to 15. helped establish the campus in United States and abroad. HS’57-’58, has been married to 1967, when Spartanburg needed a Lois Stone since 1956. They have Rebekah Naylor, M.D., MD’68, nursing program to train students Paul Huchton Jr., M.D., MD’58, 14 grandchildren, the oldest of was the first woman to graduate to work in a hospital setting. HS’58-’59, presented a course on whom, David Clay, is a pre-med from the surgical residency pro - “China Today” at the University of senior at Vanderbilt. gram at the University of Texas John C. McGill, M.D., MD’46, Texas at El Paso. The course Southwestern Medical Center in retired from family practice after includes dynasties, other history, 1973. She then spent 30 years in 44 years and sends his regards to modern politics, current problems 60 s India at the Bangalore Baptist his classmates. and events, the economic situa - *John H. Dixon, M.D., MD’67, Hospital serving as a doctor and tion, and other pertinent facts HS’67-’70, reports that his son, hospital administrator. Naylor’s David G. Stroup, M.D., MD’48, about China. John Trent, married Anne classmate from Baylor University, HS’48-’49, practiced obstetrics Benedetto in May 2008. Camille Lee Hornbeck, is the and gynecology in Atlanta from John Owsley Jr., M.D., MD’53, author of “Rebekah Ann Naylor, 1952-1992, and served as past was chosen as one of the Gordon Nelson Gill, M.D., MD’63, M.D.: Missionary Surgeon in president of the Atlanta Distinguished Professor Emeriti to HS’63-’64, emeritus professor of Changing Times,” which describes Obstetrics and Gynecology be honored at a special Medicine and Cellular and Naylor’s experience improving and Society and as chief of staff at Department of Surgery Grand Molecular Medicine, has been developing the hospital. This past South Fulton Hospital. He and his Rounds at the University of appointed Dean for Scientific June, Naylor received the 2008 wife, Betty, have three children: California San Francisco, in Affairs-Health Sciences at the Distinguished Alumnus award David Jr., Susan and Betty Anne. August. He continues in an active University of California, San from the Parkland Surgical plastic surgery practice in San Diego. Prior to that, he was Dean Society in Dallas. Francisco, and is director of the for Translational Medicine. He 50 s Aesthetic Surgery Fellowship of and his wife, Patricia, vacationed Michael B. Seagle, M.D., MD’67, Burton R. Bancroft, M.D., MD’58, the Aesthetic Surgery Institute at with their family of 17, including HS’71-’72, is chief of the Division of retired from practicing surgery in California Pacific Medical Center. four children, their spouses and Plastic Surgery at the University of St. Cloud, Minn., and is providing In 2005, he was awarded a special seven grandchildren on Lake Florida College of Medicine. medical care at free clinics spon - citation for excellence in education Martin in Alabama in 2008. sored by St. Cloud Hospital and res - by the Educational Foundation of *James A. Settle Jr., M.D., MD’68, retired in 2006 as head of Atlanta Pulmonary Associates worthy of note and medical director of Select Specialty Hospital in Atlanta. He Irv Heimburger, M.D., MD’57, HS’57-’58, (left), won the top award is now practicing primary care at in the annual American Philatelic Society’s 2008 Champion of the Eglin V.A. Outpatient Clinic Champions Competition in Hartford, Conn. His exhibit, titled “The and lives in Niceville, Fla. U.S. Pictorial Issue of 1869 and its Usage,” was judged the best of over 30 Grand Award exhibits from APS-certified national-level *Robert A. Sewell, M.D., MD’68, stamp shows from the preceding year. The American Philatelic HS’68-’70, HS’72-’76, reports that Society is the largest organization for stamp collectors in the his son, Nathan, and wife, Leigh, world, with nearly 50,000 members in 110 countries. live in Richmond, Va., where

54 WINTER 2009 alumni news ::

Nathan practices plastic surgery. Association for lifetime contribu - A son, Malcom, a veterinarian, tions to sports medicine. He was and his wife, Frances, live in featured in Forbes Magazine’s Nashville with their son, Sewell’s annual baseball edition as a “cata - first grandchild, Charlie. lyst for change” in baseball.

K. Shannon Tilley, M.D., MD’64, John H. Nading, M.D., MD’77, HS’64-’68, retired after practicing reports that his daughter, Mary ophthalmology for 26 years, Alice Nading, M.D., graduated including more than two years in from VUSM in May 2008. the U.S. Army in Hawaii. He also performed disability evaluations Kenneth Nix, M.D., HS ‘77-’80, is for 10 years. His wife, Gwen, retired Internal Medicine Program Aubrey Hough, M.D., MD’70, HS’70-’75, (seated), received the as department chair for Business Director, associate dean of the Drs. Mae and Anderson Nettleship chair in Oncologic Pathology Technologies at Nashville State Mayo School of Graduate Medical at the University of Arkansas for Medical Sciences. Hough, a Technical Community College. Education, and vice-chair of the distinguished professor in the UAMS Department of Pathology, Department of Medicine at Mayo chaired the department for more than 21 years, served two Clinic in Jacksonville, Fla. He was terms as UAMS Medical Center chief of staff, and chaired the 70 s named a Mayo Distinguished internal advisory committee of the Winthrop P. Rockefeller Ralph I. Barr, M.D., MD’72, Educator in 2001. His son, David, is Cancer Institute. He is associate dean for translational research HS’73-’76 has practiced psychiatry a Fulbright fellow at Tohoku and special projects in the College of Medicine and has been in Columbia, Tenn., since 1980, University in Sendai, Japan, study - named the College of Medicine Distinguished Faculty Scholar, and currently serves as the ing the origins and trajectory of the highest honor a faculty member at the UAMS College of regional medical director for contemporary Japanese sustain - Medicine can receive. Centerstone in the Columbia able architecture. Daughter, region, continuing to pursue his Elizabeth, is a veterinarian in last March, to an orphanage of has worked for three years with interest in early music playing Atlanta. more than 600 children. They their organization, Medical recorders. His wife, Donna, con - held a series of clinics and pre - Mission South Haiti, and has tinues volunteer work for Maury Don Schweiger, M.D., MD’72, HS scribed treatment including completed his ninth trip. He and County Library; son, Evan, is the ‘72-’74, recently completed his reading glasses and medications his wife, June, have adopted principal percussionist with the fourth year as chairman of the from their pharmacy. They have Jacob Baptiste, a student, who Arkansas Symphony Orchestra in Board of Low Country Medical seen both quotidian and grave asked Blood to be his best man Little Rock; and daughter, Rachel Associates, a primary care organi - diseases such as pufferfish at his wedding. Blood and Chandler, is a school librarian in zation of internists, family practi - sting, malaria and HIV. Blood O’Sheal thank their classmates Williamson County, Tenn. tioners and pediatricians. He has been in private practice for 31 *Janis Jones, M.D., MD’78, has years and currently resides in been practicing general pediatrics John’s Island, S.C., with his wife of in West Palm Beach, Fla., since 25 years, Susan. completing her residency at the University of Miami. She has a Frederick Turton, M.D., HS’77-’80, practice that encompasses private is chair-elect of the American practice, public health pediatrics College of Physicians (ACP) Board and hospitalist services. In July of Regents. He has served on the 2008, she became chief of staff of board since 2003 and has held St. Mary’s Medical Center and the the position of chair of the ACP Children’s Hospital at St. Mary’s. Ethics, Professionalism and Her husband, Amos Talley, is Human Rights Committee since retired from the Veteran’s 2006. He is also vice chair of the Administration and is now a real ACP Services Political Action estate investor. Their daughter, committee as well as the vice Janine, is the business manager chair of the ACP Finance, for her mother’s medical practice, Strategic Planning, and Health Children’s Healthcare Associates. and Public Policy committees. John Boldt Jr., M.D., MD’82, HS’82-’85, and his wife, Carla, worked in *Ben Kibler, M.D., MD’72, HS ‘73- Quito, Ecuador, from 1992 — 2004, training national Ecuadorian physi - ’77, FE’73-’74, is the medical direc - 80 s cians how to teach and take care of their own people. They have four tor of the Shoulder Center of Mike Blood, M.D., MD’81, and children and are currently residing in Chattanooga, Tenn., where he is Kentucky. He received the Jack *Steven O’Sheal, M.D., MD’81, an assistant professor of Medicine at the University of Tennessee Hughston Award from the led a group of 19 Americans to Medical Program at Erlanger Medical Center. He teaches residents, American Physical Therapy Pwoje Espaw in southern Haiti who hail from 14 different countries, in the critical care service.

WINTER 2009 55 :: alumni news

for the generous donations, Iraq in June 2008. He served as *Bryan Becker, M.D., FE’92-’95, which help provide not only med - the Deputy Commander for has been appointed president of ical aid but also sports equip - Clinical Services for the 325th the National Kidney Foundation. ment, shoes and other necessi - Combat Support Hospital located Becker, professor of Medicine at ties to the orphanage. They in Tikrit, Iraq. He was awarded the the University of Wisconsin encourage and welcome alumni Bronze Star Medal for service. School of Medicine and Public to participate in this project and Health, serves as vice-chair of the have a Web site undergoing con - Paul Pearigen, M.D., MD’87, is a Department of Medicine, struction, mmshaiti.org. captain in the U.S. Navy Medical Physician-in-Chief and head of Corps. He has served as pro - the section of Nephrology. A vol - John D. Gazewood, M.D., MD’87, gram director and chairman of unteer with the NKF for a decade, was appointed Residency Emergency Medicine and as Becker hopes to increase aware - *Sarah Samaan, M.D., MD’88, is Program Director at the group surgeon for two deploy - ness of kidney disease and the a partner with Legacy Heart University of Virginia ments in support of OEF/OIF. need for early detection through Center, a 15-member cardiology Department of Family Medicine After completing a tour in the expansion of the NKF’s Early practice in Plano, Texas. Her and has been named to the Washington, D.C., as the execu - Evaluation Program that provides book, “The Smart Woman’s “Best Doctors in America.” tive assistant to the Surgeon nationwide free screening for Guide to Heart Health,” will be General of the Navy, he began those at risk. published by Brown Books in Alan List, M.D. FE’84-’87, has his current post as Deputy January. She and her horse, been appointed executive vice Commander, Naval Medical Thomas Boeve, M.D., MD’93, will Helio, were ranked third president, physician-in-chief of Center, San Diego. He is serving complete 11 years of nationally for their dressage Moffitt Cancer Center in Tampa, as chief operating officer of this Otolaryngology private practice division in 2007. She and her Fla. Before joining Moffitt in 2003, large, teaching and referral mili - in Bristol, Tenn., this year. He husband, Gary Cooper, have two he served as the head for the tary treatment facility with more and his wife, Jolene, have been dogs, one cat and four horses. Leukemia and BMT Programs than 6,200 staff and expendi - married for 20 years and have and the associate center director tures of more than $500 million. four children. They are relocat - for clinical research at the ing to Kenya, East Africa, for Arizona Cancer Center. Eric Senn, M.D., MD’88, is the full-time medical missions. chief of staff at Grand Stand Anthony Martin, M.D., FE ‘87 - Regional Medical Center. He is Elizabeth Cato, M.D., MD’92, ‘89, completed his second tour in also the secretary of the board of clinical instructor in Nursing, directors for the Carolinas Center has been appointed associate for Medical Excellence and secre - medical director of AmeriChoice Dirk Hamp, M.D., MD’91, HS’91-’94 and his wife, Paige Holland Hamp, tary of his corporation, Carolina by UnitedHealthcare. Cato, an have a new addition to their family of six. They recently traveled to Health Specialists, the largest, internist by training, has exten - Uganda, East Africa, to adopt 9-year-old Jane, and to help create private multi-specialty group in sive experience as a practicing “Embrace Uganda.” In June 2008, they revisited Uganda to help finish South Carolina. He and Angelika physician in Nashville and as a a Vocational School building, engage in orphan outreach, conduct med - have a 4-year-old son, Aleks. health plan executive. ical clinics and help create library resources. AmeriChoice serves more than *Ghodrat Siami, M.D., FE ‘81-’83 180,000 TennCare beneficiaries is president of the International in Middle Tennessee and man - Society for Apheresis and cele - ages TennCare services for an brated 50 years of service from additional 83,000 members in the American Medical East Tennessee. Association and the Nashville Academy of Medicine in 2005. Anderson Collier III, M.D., His grandson is in medical MD’98, returned to Vanderbilt school and will be the fourth after seven years of training in generation physician in the fami - pediatric hematology-oncology ly. His great grandson was born at the University of Texas July 16, 2008. Southwestern Medical Center. He has been an assistant pro - fessor of Pediatrics for three years. He and his wife of four 90 s years, Rachel, celebrated the Felice Adler Shohet, M.D., birth of their first child, MD’93, HS’93-’96, specializes in Harrison, in June. pediatric infectious diseases at Children’s Hospital in Orange Brendan J. Collins, M.D., MD’99, County, Calif. has joined the Plastic and Reconstructive Surgery Center

56 WINTER 2009 alumni news ::

at Mercy Medical Center in Robert Lowe III, M.D., MD’98, Baltimore. lives in Nashville, where he prac - tices orthopaedic spine surgery. Sara Dann, M.D., MD’92, is in He has been married for six private practice in Miami, treat - years and has four sons under 5. ing children, adolescents and adults for psychiatry medical Susan Massick, M.D., MD’97, management and psychothera - lives in Columbus, Ohio, with her py. She recently remarried and husband, Doug, 7-year-old son lives with her husband, Bob, and and 4-year-old daughter. She is their six children. a dermatologist at Ohio State University. Sarah Gladstone, M.D., MD’98, welcomed daughter Charlotte David Myers, M.D., MD’97, is fin - on Dec. 6, 2007. She joins big ishing up his pediatric nephrology sister, Ellen. fellowship at Seattle Children’s Hospital with a Master’s of Bassam Helou, M.D., MD’98, Epidemiology degree with an Ron Wells, M.D., MD’00, and his wife, Elizabeth, welcomed works with the Surgical Clinic in emphasis in clinical trials. Catherine Victoria Wells on June 29, 2008. She joins older sister Nashville. He is married to Kris, Caroline, 2. They live in Germany where Ron is a pediatric cardi - and they have two children, George Robinson II, M.D., ologist at Landstuhl Regional Medical Center. Matthew, 5, and Gracie, 2. MD’93, is enjoying a satisfying career as a general James N. Johnson, M.D., MD’93, orthopaedist. He and his wife, was named chief operations Sara, have two daughters and officer for Nashville Orthopedic spend their time attending their Specialists, P.C. He and his soccer, basketball, t-ball and wife, Catherine, have a son, volleyball games. James, 2.

Adam Kremer, M.D., MD’97, HS’97-’01, joined a private prac - 2000 - tice in Holland, Mich., at the Ryan Bayley, M.D., MD’08, and Brain-and-Spine Center. India Landrigan, M.D., MD’08, Mark DeJong, M.D., MD’01, HS ‘04, (right) and Jeffrey Smithers, were married on May 17. They met M.D., MD ‘03, practice together in St. Louis, Mo., at Southern Illinois Laura Lawson, M.D., MD’98, at and graduated from Harvard Sports Medicine. They are taking care of primary care sports medi - HS’98-’03, FE’03, recently start - University. cine and non-surgical orthopaedic issues for adults and children. ed a new practice, Tennessee DeJong completed his internal medicine residency at Vanderbilt in Breast Specialists, in Nashville John Matthew Conoyer, M.D., 2004 and his primary care sports medicine fellowship at Duke. and is serving as a co-director of MD’03, HS ‘03–’08, has joined Smithers completed his internal medicine/pediatrics residency in the Saint Thomas Health Midwest ENT Centre PC in St. Phoenix, Ariz., and his primary care sports medicine fellowship at Services Breast Program. She Peters, Mo., where he is working Arizona State University. has two sons – Wade, 4, and alongside his father, *Michael Luke, 2. Conoyer, M.D., MD’75, John Conoyer has also joined in the Kenneth Leone, M.D., MD’92, medical staff at Barnes-Jewish completed his neurology resi - St. Peters Hospital. He and his dency training and fellowship wife, Ellen, are expecting their in EMG/Neuromuscular disease third child in May. They have two at the University of Virginia in sons – Michael, 3, and James, 1. 1997. He was in private practice for 10 years in Savannah, Ga., Kara Danner, M.D., MD’02, has before recently joining the been employed by the Center for faculty in the Department of Women’s Health and Specialty Neurology at UVA as a clinical Services since January 2007 and associate professor. He is enjoy - was voted Gerald Champion ing his new role as director of Regional Medical Center’s 2007 The VMAA hosted a dinner in San Francisco in conjunction with the neurological outpatient services Physician of the Year. She and Scott Society’s annual meeting in October 2008. Pictured here are and becoming reacquainted with her husband, Mark, have two chil - VUMC’s current Chief Residents of Surgery (left to right) Eric Castaldo, the area. dren – Aleah, 2, and Weston, born M.D., M.P.H., Joseph A. Greco, M.D., Truman M. Earl, M.D., MSCI, June 8, 2008. Aaron W. Eckhauser, M.D., MSCI, and Clinton A. Marlar, M.D., MD’04.

WINTER 2009 57 :: alumni news

Matthew Harris, M.D., MD’02, curriculum. She and her hus - Emily Stoneman Shuman, M.D., Elizabeth Atkinson Zow, M.D., will be leaving the U.S. Navy and band, Brent, have an 18-month- MD’03, married Andrew Shuman MD’02, and her husband, Mark, starting a radiology residency at old son, Whit. in December 2007. She is a fellow welcomed their second son, the University of Florida, in the in infectious diseases at the Lucas, on Sept.19, 2008. He joins summer of 2009. Milton Ochieng’, M.D., MD’08, University of Michigan. his two-year-old brother, Adam. and his younger brother, Fred Jon Heavey , M.D., MD’03, is Ochieng’, a third-year VUSM stu - cur rently on active duty in dent, have established a clinic in Kadamiyah, Baghdad, at a for - their home village of Lwala in ward trauma station. He and his Kenya. The clinic sees 100 colleagues set up a small 501(c)3 patients a day since opening in worthy of note non-profit foundation there and April 2007. Benefiting from a have been evacuating children to U.S.-based nonprofit, the Lwala the United States for surgery. He Community Alliance, the clinic is has finalized agreements with trying to expand with a maternity Amazon.com, Lowe’s and Gap ward and HIV/AIDS wing. The U.S. brands to help raise money to dollar stretches far there. An transport these children to aca - emergency surgery for an ectopic demic medical centers. For more pregnancy would cost at least information, visit www.hope.md. $10,000 in the U.S. but was $250 at their clinic, Ochieng says. Susannah Quisling Longmuir, Donations and awareness are M.D., MD’03, is an assistant pro - being raised as they continue to fessor of Pediatric Ophthalmology receive more patients. at the University of Iowa Department of Ophthalmology. Lynn Bunch O’Neill, M.D., MD’02, She and her husband welcomed is an assistant professor of their first child, Charlotte, on Geriatrics at Mount Sinai School Feb. 29. of Medicine and co-director of the Integrated Palliative Medicine Morgan McDonald, M.D., MD’03, Fellowship at the Hertzberg Dear Dr. Price, moved back to Nashville and Institute of Palliative Care. She accepted a faculty position with and James O’Neill Jr., were mar - On behalf of our 3rd Grade Class at Gilbert Elementary at the Med-Peds program at VUMC ried July 12 in New York City. Harlandale ISD - San Antonio, TX, we want to thank you for allowing to establish a community health us the opportunity to represent Vanderbilt University School of Medicine this year! We have had an amazing year that offered many wonderful challenges. Our 3rd grade students have been extremely motivated and hard - working individuals. This year has been exceptional. We are an Exemplary Campus, the only one in our district! As third graders, they must pass their TAKS tests in order to be promoted to the next grade. I am proud to inform you that our Commodores came out with 100% passing in Reading and Math! This is quite an accomplishment! As we finish this school year, and prepare ourselves for next year, let me just say that representing Vanderbilt has been a truly wonderful experience. Representing Vanderbilt has given us the opportunity to do a little research on our school, mascot, and colors. I am proud to say that our class is representing the only medical school on our campus! I would like to take this opportunity to thank you Dr. Price for the t-shirts that you’ve sent our students. They wear them proudly on our College Bound Pep Rally Days.

Raquel M. Zepeda Science Teacher-3rd-5th grade E.H. Gilbert Elementary, Harlandale ISD - San Antonio, TX TEA Exemplary Campus

Esther Maksymovitch Penn, M.D., MD’98, and Dan Penn, M.D., MD ‘98, had a baby girl, Misha Elle, on Oct. 6, 2008.

58 WINTER 2009 faculty news ::

Colleen Brophy, M.D., joined Vanderbilt the first comprehensive study of its kind ever Healthcare Executives, the nation’s leading Medical Center’s Department of Surgery conducted in pediatric anesthesiology. professional society for health care leaders. in July 2008. She is Vanderbilt’s only To obtain fellow status, health care execu - female physician professor of Surgery and Roland “Ron” Eavey, M.D., of Harvard tives must fulfill requirements including the only female surgeon in the Division of University, will become the new chair of passing a comprehensive exam, meeting aca - Vascular Surgery. She is also the first Vanderbilt’s Department of Otolaryngology demic and experiential criteria, earning con - female chair of the Bioengineering, and director of the Bill Wilkerson Center for tinuing education credits and demonstrating Technology and Surgical Sciences Study Otolaryngology and Hearing and Speech professional and community involvement. Section at the National Institutes of Health, Sciences, effective February. Eavey, director Fellows commit to ongoing professional a two-year term she recently accepted. of ENT Pediatric Services at Massachusetts development and are recertified every three Brophy comes to Vanderbilt from Arizona Eye and Ear Infirmary at Harvard since 1981, years. The American College of Healthcare State University where she was a research succeeds founding chair *Robert Ossoff, Executives is an international professional professor of Kinesiology at the Center for M.D., who announced last year that he would society of more than 30,000 members dedi - Metabolic Biology and an adjunct professor transition into a new role at Vanderbilt in cated to improving health care delivery. of Bioengineering and Cellular and December. The nationwide search also yield - Molecular Biology. She was also chief of ed a strong addition to the Monroe Carell Jr. Brent Graham, M.D., has been named direc - Vascular Surgery at the Carl T. Hayden Children’s Hospital at Vanderbilt, as Eavey’s tor of the Division of Pediatric Rheumatology VA Medical Center in Phoenix and a clinical wife, Sheila Desmond, M.D., also a faculty at the Monroe Carell Jr. Children’s Hospital professor of Surgery at the University member and pediatrician at Harvard, will at Vanderbilt. Graham previously served as of Arizona. join the Vanderbilt faculty. Desmond is cur - clinical director of the Division of Pediatric rently Unit Chief of Adolescent and Pediatric Rheumatology at Cincinnati Children’s Roger Chalkley, Ph.D., has been elected by Medicine at the MGH Chelsea HealthCare Hospital Medical Center. He joined the facul - the National Academies of Science as chair Center in Boston. ty there in 1998 after serving a three-year of the Committee to Study the National fellowship. Graham, who grew up in Needs for Biomedical, Behavioral, and Kathryn Edwards, M.D., and *Jeff Balser, Nashville and graduated from Vanderbilt’s Clinical Research Personnel. Over the course M.D., Ph.D., dean of VUSM and associate vice School of Medicine, is the son of *Thomas of two years, this task force will conduct a chancellor for Health Affairs, have been Graham, M.D., professor of Pediatrics, review and prepare a report to the National elected to the Institute of Medicine (IOM) of Emeritus. Graham’s research interests Institutes of Health (NIH) and the Agency for the National Academies. Edwards and Balser include musculoskeletal imaging and juve - Quality Research (AHRQ) on issues regarding join 17 other Vanderbilt faculty members nile fibromyalgia. research personnel needs. The focus of the elected to the IOM in previous years. committee will be gathering and analyzing Edwards holds the Sarah H. Sell Chair in *Frank Harrell Jr., Ph.D., chair of the information regarding the employment and Pediatrics and serves as vice chair for Department of Biostatistics, delivered the education trends of research scientists in the Clinical Research for the Department of keynote speech last summer at the biomedical, behavioral and clinical sciences, Pediatrics. Statistical Science Awards Ceremony, as well as oral health, nursing and health Centers for Disease Control and Agency for services research. Chalkley, who came to Peter Giammalvo, Ph.D., chief learning offi - Toxic Substances and Disease Registry in Vanderbilt in 1986, was also named presi - cer at Van derbilt Medical Center, was named Atlanta. In May 2008, he spoke at the annual dent-elect of the American Association of a fellow of the American College of meeting of statisticians of the Cleveland Medical Colleges group on Graduate Research Education and Training.

*Kevin Churchwell, M.D., CEO of the Monroe *Jason Morrow, M.D., chief of the Division of Clinical Carell Jr. Children’s Hospital at Vanderbilt Pharmacology in Vanderbilt Medical Center’s Department of was recently named one of Nashville Medicine, died on July 8, 2008. He was 51. Business Journal’s 2008 Health Care Heroes. Dr. Morrow received his bachelor’s degree from Vanderbilt The publication said Churchwell was select - University and his M.D. from Washington University in St. ed because of his ability to balance personal Louis, his hometown. He served his medical internship and relationships with the business demands of residency at Vanderbilt, and was chief medical resident from running Children’s Hospital. The list honors 1987 to 1988, when he joined the Division of Clinical the innovators, strategists and pioneers Pharmacology as a research fellow. whose work is helping to grow the region’s In 1990, he and Jackson Roberts, M.D., discovered a series of health care industry. compounds called isoprostanes that help researchers reliably detect and monitor free radical damage. Also called “oxidative *Jayant Deshpande, M.D., anesthesiologist- stress,” this damage has been implicated in the development of in-chief at Children’s Hospital, is serving as atherosclerosis, age-related macular degeneration and neu - president of the Society of Pediatric rodegenerative diseases. Anesthesia (SPA), a national organization Dr. Morrow joined the Vanderbilt faculty in 1994, and later was named the F. Tremaine dedicated to improved pediatric perioperative Billings Professor of Medicine and professor of Pharmacology. In 2005, he became the fourth care. In this role, Deshpande is overseeing chief of the Division of Clinical Pharmacology, which currently has 190 employees and a $33 “Wake Up Safe,” a quality improvement ini - million annual budget. tiative to collect and probe causes of negative He is survived by his wife, Lisa, and their children, Jeremy and Stephanie. events during anesthesia in children. This is

WINTER 2009 59 :: afalucumlntyi news

Clinic, Case Western Reserve University, and *Pat Levitt, Ph.D., director of the Vanderbilt age of 40 who show outstanding commitment Ohio State University and was also the invit - Kennedy Center, is stepping down after six to their community. McDonald is a founding ed keynote speaker for the Biostatistics years at Vanderbilt to pursue other opportu - member of the Blade and Light Society, Annual Talk at the Medical College of nities. Levitt, the Annette Schaffer Eskind which provides volunteer surgical care to Wisconsin. Harrell also recently was named Chair, has accepted a position at the Keck underserved communities around the globe. the 2008 Mitchell Lecturer for the School of Medicine, University of Southern She has been appointed to the Governor’s Department of Statistics by Glasgow California. He will be director of the Zilkha Council on Physical Fitness and Health and University, Scotland. Neurogenetic Institute, chair of the currently sits on the boards of Fifty Forward Department of Cell and Neurobiology, and and Friends of Nashville Ballet. In dermatol - *Billy Hudson, Ph.D., project leader and Provost Professor of Neuroscience, ogy, McDonald has special expertise in Mohs director of the Center for Matrix Biology, Psychiatry and Pharmacy. Associate Director micrographic surgery. heads a group of researchers at VUMC who *Elisabeth Dykens, Ph.D., will serve as VKC have been awarded a Program Project Grant interim director while a nationwide search is John McPherson, M.D., assistant professor of (PPG) to study the kidney’s filtration mecha - conducted for Levitt’s successor. Medicine, medical cardiology director, and nism. The grant, funded by the National John Selby, M.D., professor of Clinical Institute of Diabetes and Digestive and Kidney *Lawrence Marnett, Ph.D., professor of Anesthesiology and Clinical Surgery, accept - Diseases, awards $6 million over five years. Biochemistry, Chemistry and Pharmacology, ed the surgical director post in July – team - has received the first Founders’ Award from ing up to care for Vanderbilt Heart’s sickest Tina Iverson, Ph.D., assistant professor of the American Chemical Society’s Division of patients on the Cardiovascular Intensive Care Pharmacology, received a Young Investigator Chemical Toxicology. The award recognizes Unit (CVICU). This unique approach to dual Award from the National Alliance for Research Marnett’s contributions to the field of chemi - leadership reflects the overall vision of on Schizophrenia and Depression (NARSAD), cal toxicology. Marnett received the award Vanderbilt Heart and Vascular Institute the world’s leading mental health research during the fall ACS meeting. Marnett is the (VHVI), which is collaboration between cardi - charity. The two-year, $60,000 awards are founding and current editor of the ACS jour - ologists and cardiac surgeons, two groups given to early-career scientists who study psy - nal Chemical Research in Toxicology, which historically separated by professional differ - chiatric disorders. Iverson will study the sens - just celebrated its 20th year. He was also ences of opinion. ing of the neurotransmitter dopamine. one of the founders of the ACS Division of Chemical Toxicology. He is the director of the *Bonnie Miller, M.D., associate dean for *James Johns, M.D., professor of Pediatric Vanderbilt Institute for Chemical Biology and Undergraduate Medical Education, is heading Cardiology at Monroe Carell Jr. Children’s the Mary Geddes Stahlman Professor of a research project that received a $199,000 Hospital at Vanderbilt, has been appointed to Cancer Research. grant from the Arthur Vining Davis the TennCare Pharmacy Advisory Committee Foundation to study the effects of moral dis - by Tennessee Gov. Phil Bredesen. Johns will *Michel McDonald, M.D., M.B.A., director of tress on medical students. serve as the pediatric representative on the Cosmetic Dermatological Surgery, has won advisory committee, which meets quarterly the Nashville Emerging Leader Award for *Harold (Hal) Moses, M.D., professor of to make evidence-based recommendations to medical and health care services. These Cancer Biology and Director Emeritus of the TennCare Bureau regarding medications awards, sponsored by the Nashville Area Vanderbilt-Ingram Cancer Center, has been to be included on the Preferred Drug List. Chamber of Commerce and the 20/20 designated a National Associate, an honorary The appointment runs through July 31, 2011. Leadership Alliance, cover 13 categories and title given in recognition of extraordinary are given to young professionals under the service to the National Research Council in its role as adviser to the nation in matters of science, engineering and health, by the authority of the Council of the National Brent Polk, M.D., chief of the Academy of Sciences and the Institute of Division of Pediatric Medicine. Membership in this group is Gastroenterology, was recently offered as a lifetime appointment. Moses is honored as the division was re- the Founding Director of Vanderbilt-Ingram named in his honor – the Brent and current director of the Frances Williams Polk Division of Pediatric Preston Laboratories. He is well known for Gastroenterology, Hepatology his work on the transforming growth factor- and Nutrition. Since becoming beta family of growth regulatory peptides. chief, Polk has built the divi - sion from just three full-time *Jeanette Norden, Ph.D., professor of Cell faculty to 12. The division is and Developmental Biology and a Master now one of the largest of its Science Teacher at Vanderbilt University kind and is among the top School of Medicine, recently received a three in grant awards from the Compassionate Friends Professional Award National Institutes of Health. from The Compassionate Friends (TCF), a Polk has also taken leadership national support group for families who have of the Digestive Diseases Research Center. Along with associate director Richard Peek, lost a child. The awards are given to a pro - M.D., director of the adult Division of Gastroenterology, Hepatology and Nutrition, Polk is fessional psychologist, counselor or other guiding the center through unprecedented growth. practicing professional who has contributed in the area of supporting, assisting and edu -

60 WINTER 2009 faculty news ::

cating others about dealing with loss. Award from the National Alliance for Norden, a neuroscientist, incorporates first- Research on Schizophrenia and Depression *Karen Summar, person accounts of dealing with brain-relat - (NARSAD), the world’s leading mental health M.D., has been ed illnesses into the neuroscience course for research charity. The two-year, $60,000 named medical medical students. awards are given to early-career scientists director of the who study psychiatric disorders. Rogers will Down Syndrome Thomas Oeltmann, Ph.D., associate profes - use functional magnetic resonance imaging Clinic at the sor of Medicine and Biochemistry, has been (fMRI) to determine how different parts of Monroe Carell elected president-elect of the Society for the hippocampus interact with cognitive net - Jr. Children’s Glycobiology, an international association works in other parts of the brain. Studying Hospital at that brings together scientists studying “gly - these subdivisions may help contribute to Vanderbilt. The cans” — sugars and sugar-containing mole - understanding the functional roles of the clinic provides cules. He will serve as president in 2009. hippocampus and how it breaks down in psy - comprehensive Oeltmann served on the board of directors chiatric disorders. medical evaluations for individuals who and as secretary of the Society for have Down syndrome. Glycobiology from 1993-2006 and was also *Mace Rothenberg, M.D., HS ‘82-’85, chaired on the editorial board of the society’s jour - the 2008 GI Cancer Conference at the nal, Glycobiology, for 10 years. As president- Opryland Hotel in Nashville in October. elect of the Society for Glycobiology, received a coveted MERIT (Method to Extend Oeltmann will chair the committee responsi - Uchechukwu Sampson, M.D., assistant pro - Research in Time) award from the National ble for awarding up to $50,000 in travel fessor of Cardiovascular Medicine, has Institutes of Health for his research on grants to graduate students to attend the received a grant from the Robert Wood metabolism. Less than 5 percent of NIH- annual meeting. In 2009, as president, Johnson Foundation. He was selected for the funded investigators are selected to receive Oeltmann will have responsibility for all Harold Amos Medical Faculty Development MERIT awards, which reward consistently organizational aspects — scientific program, Program, a four-year postdoctoral research high grant performance with up to 10 years social program, location and logistics — for award. The Harold Amos Medical Faculty of continuous funding without competitive the society’s 2009 annual meeting. Development Program was created to review. The extended grant duration will increase the number of faculty from histori - “make it possible to conduct high-risk Christopher Olsen, Ph.D., research instructor cally disadvantaged backgrounds who can research with a high scientific impact,” said in Molecular Physiology and Biophysics, achieve senior rank in academic medicine. Wasserman. With the funding, his group will received a Young Investigator Award from Sampson, who is based at Meharry Medical investigate the mechanisms that control car - the National Alliance for Research on College and VMC, will perform studies of bohydrate and fat metabolism in the liver Schizophrenia and Depression (NARSAD), inflammation in abdominal aneurysms. and the conditions that cause the liver to the world’s leading mental health research accumulate fat, an early sign of type 2 dia - charity. The two-year, $60,000 awards Kim Smith, M.D., clinical fellow in betes and metabolic syndrome. are given to early-career scientists who Nephrology, has received a grant from the study psychiatric disorders. Olsen will Robert Wood Johnson Foundation, being Elizabeth Yang, M.D., Ph.D., has received a investigate physiological changes in a rarely named to the Clinical Scholars Program, $50,000 grant for her genetic research. studied population of neurons (dopamine which provides postdoctoral training for Yang’s research project will study how SHP2 neurons within the A10dc region) following young physicians interested in research and (a cancer-causing gene found in childhood repeated stress. leadership careers in health policy and aca - leukemias) causes B cell leukemia. demic medicine. Beth Price, M.B.A., has been named to the newly created position of chief executive Luc Van Kaer, Ph.D., professor of officer of the Vanderbilt-Ingram Cancer Microbiology and Immunology, was recently Center. Price has served as oncology opera - named deputy editor of the Journal of tions strategist for Vanderbilt-Ingram and Immunology. He will serve a five-year term Vanderbilt Medical Group since June 2007, as one of 10 deputy editors for the journal. where she assisted in the development and He previously served as an associate editor implementation of the regional market for the journal from 2002 to 2006 and as a oncology strategy and served as interim section editor since 2006. As a deputy editor, business officer for the Cancer Center. As Van Kaer will make editorial decisions about CEO Price will be responsible for expanding approximately 400 papers per year, handle quality cancer services in the Middle rebuttals from authors, nominate manu - Tennessee market and the Southeast, scripts for the “In This Issue” section of the enhancing Vanderbilt-Ingram’s status as a journal, and suggest topics and authors for top 15 National Cancer Institute-designated the “Brief Reviews” and articles for the Comprehensive Cancer Center and providing “Pillars of Immunology” sections of the administrative and business leadership. journal.

Baxter Rogers, Ph.D., research assistant David Wasserman, Ph.D., the Ron Santo professor of Radiology and Radiological Chair in Diabetes Research and professor of Sciences, received a Young Investigator Molecular Physiology and Biophysics, has

WINTER 2009 61 :: in memoriam

Amy Mayes Becker, M.D., MD more than 39 years. Dr. Brown 35 years practicing medicine in Arthur, Maggie, Peggy and John; ‘44, HS ‘44-’46, died Oct. 23, 2008. gave more than 50 years of serv - Asheville, N.C. In 1982, he began a and seven grandchildren. She was 90. Dr. Becker graduat - ice to the American Psychiatric solo practice of foot and ankle ed summa cum laude from Association and was one of the surgeries, which he continued •John D. Franklin, M.D., HS’67- Carson Newman College and was founding members of the until his retirement in 1995. He is ’77, died Sept. 16, 2008, from one of two women to graduate Louisiana Psychoanalytic survived by his wife, Patricia injuries sustained in an automo - from VUSM in 1945. She lived in Association. He is survived by his Callison; three children, Anne bile accident. He was 65. A Knoxville, Tenn., and was a pedia - wife, Carol Brown; sons Dr. Stokely, William and Frank; and Chattanooga plastic and recon - trician. She is survived by her Thomas Brown III and Dr. James seven grandchildren. structive surgeon for 26 years, he second husband, Felix G. Line, Brown; and 11 grandchildren. was chairman of the Department M.D.; three children Amy, Chris Henry Coppolillo, M.D., FA’71-’76, of Plastic Surgery, Chattanooga and Stephen; and 12 grandchil - Catherine Bell Brummett, M.D., died Aug. 26, 2008. He was 82. He Unit, University of Tennessee dren. MD’38, died July 17, 2008. She was born in Calabria, Italy, and College of Medicine , and presi - was 94. She practiced as a pedia - his family settled in Chicago. He dent and aesthetic and plastic Janet Kay Boyles M.D., MD’95, trician in Middlesboro, Ky., and held medical school posts at the surgeon with Specialists in died Dec. 22, 2006. She was 59. In Aberdeen, Miss., and later held University of Michigan and Plastic Surgery, Chattanooga. Dr. 1995 Dr. Boyles was a postdoctor - well-baby clinics for the Vanderbilt. In 1976 he became the Franklin was instrumental in the al Fellow and research associate Tennessee Public Health chair of the new training and clin - development of the microsurgical in cell biology for Yale University Department in Nashville and the ical programs in child psychiatry free deltoid flap in 1981. He is sur - school of Medicine. She worked Alabama Public Health at the Colorado University vived by two sons, Joe David and as a staff physician in occupation - Department in Birmingham. She Medical Center. Dr. Coppolillo Timothy Lee, and four grandchil - al medicine for Barnes Jewish lived in Mountain Brook, Ala., for then resumed private practice, dren. Hospital in St. Louis from 1998- 48 years. Dr. Brummett was acted as consultant to several 2001. She is survived by her active in volunteer medical mis - area hospitals and psychiatric John Alexander Galloway II, brother Bradley Boyles; sister, sions to India, Nigeria and Israel. societies, and continued to write M.D., MD’62, died at his home in Julie Fuller; and Kenneth Boyles. She is survived by five children, for assorted psychiatric and med - East Cornwall on Aug. 21, 2008. Jane, Betty, Chester Jr., ical journals. He is survived by his He was 71. A surgeon, he was James Henry Brown M.D., Catherine and Grant; six grand - daughter, Catherine; two sons, associated with many different HS’49-’52, died May 3, 2008. He children; and eight great-grand - Pete and Rob; and two grandchil - hospitals including Charlotte was 84. After serving as clinical children. dren. Hungerford Hospital where he instructor and associate profes - was a pioneering director and sor at Tulane University School of William J. Callison M.D., MD’53, Paul Fatum, M.D., MD ‘58, died founder of the Cardio-Pulmonary Medicine, from 1956-1965, he HS’57-’60, died May 11, 2008. He August 7, 2008. He was 78. Fatum Lab and chief of the Department formed his own practice in psy - was 79. Dr. Callison was an served the West Michigan com - of Surgery. Dr. Galloway spent choanalysis in New Orleans for orthopaedic surgeon who spent munity for 44 years as a kind and the last six years working as a compassionate anesthesiologist locum tenens in surgery at at Butterworth Hospital. He Johnstown Memorial Hospital in served as chief of the Department Johnstown, Pa., and Jackson of Anesthesiology for 14 years and Memorial Hospital in Jackson, Allan F. Moore, M.D., MD’03, the Young as a member of the Butterworth Tenn. He is survived by his wife, Alumnus Representative on the Hospital Board of Trustees for Laurel; children, Laura, Ellen, Vanderbilt Medical Alumni Association eight years. Dr. Fatum is survived Julia, Alexandra, Kyle and Board of Directors, died in July 2008 in by his wife of 50 years, Shirley; Christopher; and eight grandchil - Philadelphia from injuries sustained in his children, Mary Ann, Mark, dren. a motor vehicle accident. He was 31. Teresa and Monica; and 10 grand - Dr. Moore, a fellow in endocrinolo - children. Leo Gibson M.D. MD’61, died June gy at Massachusetts General Hospital, 15, 2008. He was 72. Dr. Gibson was researching the prevention and Maurice Fox, M.D., MD ‘57, HS served as an Ob/Gyn for 36 years complications of diabetes there and at ‘57, FE ‘60, died July 31, 2008. He in Picayune, Miss., before retiring the University of Pennsylvania School was 76. From 1964 until his five years ago. He is survived by of Medicine and was also was working retirement in 1990, he practiced his wife, Lisa Gibson; his daugh - toward a master’s degree in medical internal medicine and endocrinol - ters, Laura Anne, Karen Leigh science at Harvard Medical School. ogy at the Palo Alto Medical and Kristy; two grandchildren; His wife, Rebekah Gee, M.D., who was also seriously injured in the Foundation and was a clinical stepchildren, Jodi, Rachel, Angie accident, is an obstetrician-gynecologist and a Robert Wood Johnson professor of Medicine at the and Matthew; and nine step - clinical scholar at the University of Pennsylvania Medical School. Stanford University School of grandchildren. She is the daughter of former VU chancellor Gordon Gee. Medicine. He was one of the first A native of Danville, Va., Dr. Moore was a member of Alpha Omega endocrinologists to practice in the *Alvin F. Goldfarb, M.D., MD’47, Alpha and a Canby Robinson Society Scholar while a student at area and was a leader and inno - of Center City, Pa., a professor of Vanderbilt and received the Albert Weinstein Prize in Medicine from vator in the treatment of diabetes. obstetrics and gynecology at Vanderbilt, given to a student who has demonstrated high scholastic Dr. Fox is survived by his wife, Thomas Jefferson University and attainment and qualities. Ellen; their children Susan, a pioneer fertility researcher, died

62 WINTER 2009 in memoriam ::

on Nov. 1, 2008. He was 85. Dr. he was named chairman of the was 96. Salyer performed what is Anna; sons, Lucian III, Alex and Goldfarb joined the faculty at Board of Trustees and president believed to be the first open-heart Coleman; and eight grandchil - Jefferson in 1959, where he of the Tennessee Medical surgery in Orange County in 1961 dren. taught generations of doctors in Association. He also served as an when he repaired a hole in the reproductive endocrinology until officer of the Tennessee Public heart of a 5-year-old boy. He also William Wehunt, M.D., MD ‘72, 2006. He founded the North Health Council of the Tennessee performed Orange County’s first died June 10, 2008. He is survived American Society for Pediatric Public Health Department and as cardiac pacemaker implant in by his wife, Sandra; sons, Wesley and Adolescent Gynecology and President and chairman of the 1963. Dr. Salyer served 20 years and Tad; and daughter Wendy. the Adolescent Wellness Through board of the Middle Tennessee in the U.S. Army, attaining rank of Access to Resources to Education Heart Association. He is survived colonel, before establishing his *Pearl Zink, M.D., MD ‘37, HO (AWARE) Foundation in 1998, by his son, Rodney, and two practice in Santa Ana in 1959. He ‘37-’39, died July 21, 2008. She which provides confidential online grandsons. is survived by his wife, Jill; was 95. She was the first female interactive help at daughter, Barbara Yagi; son John to serve on the house staff at (www.awarefoundation.org). Dr. Archie Louis Lester, M.D., M. Salyer Jr.; two grandchildren; Vanderbilt University Hospital. In Goldfarb is survived by sons MD’50, HS’50-’51, died Sept. 8, three great-grandchildren; two 1939 Zink opened her practice in Michael, Robert and Daniel; a 2008. He was 86. He practiced stepchildren; and two stepgrand - the treatment of allergic diseases daughter, Lisa; and five grand - internal medicine in Lake children. in San Antonio. She was a pioneer children. Charles, La., from 1956 until 1987. in the field of allergy and was a Dr. Lester is survived by his wife, Joseph Steranka, M.D., MD’60, recognized authority throughout *Noel C. Hunt III M.D. MD’61, Mary Edith; four daughters, HS’60-’63, died Sept. 5, 2008, at the Southwest and Mexico. After HS’61-’66, died May 15, 2008. Dr. Shevawn, Dedrah, Mariet and his home in Dickson, Tenn. He retiring, she wrote an autobiogra - Hunt was a U.S. Air Force veteran Kerry; and nine grandchildren. was 87. He practiced pediatric phy, “Maybe if I Hurry,” and a and a founding member of the medicine in Nashville for 15 years, compilation on the changes that Chattanooga Heart Institute. He is *Charles H. Marks, M.D., MD’51, then in Dickson from 1977 until occurred during her lifetime, “On survived by his wife, Trisha Hung; died June 30, 2008. He was 80. his retirement in 1992. Dr. Borrowed Time.” She is survived three children, Noel, Peter and He and his family moved to Steranka is survived by his wife of by two nephews; adopted family Claire; stepdaughters Wendi and Ocala, Fla., where he was 68 years, Irene; sons, Joseph Jr., Sue McCrory, Maudine Brown and Aimee; and 10 grandchildren. Ocala’s first board certified sur - and Larry; five grandchildren; and Olivia Quiroga; and many wonder - geon in 1957. Dr. Marks practiced five stepgrandchildren ful friends. *E. Palmer Jones, M.D., MD’43, as a surgeon for 33 years until died Oct. 5, 2008, in Nashville. He retiring and volunteering at the *Joseph Garland Stroup, M.D., was 88. Among the first class at Marion County Public Health MD’54, HS’54-’57, died Sept. 12, Vanderbilt to graduate in uniform Department Surgical clinic for 14 2008, at his home in Napa, Calif., during World War II, he began his years. He is survived by his wife, He was 78. Establishing a prac - medical career at Saint Thomas Kay Marks, five children, and 12 tice in 1962, Dr. Stroup was the Hospital in 1951, and was one of grandchildren. first board-certified pediatric the first anesthesiologists to set allergist in the Sacramento, Calif., up practice in Nashville. From *Myron Morris M.D. MD’58, died His practice eventually expanded 1951-1967, Dr. Jones served as June 28, 2008. He was 83. A vol - to include offices in Carmichael, director of the Saint Thomas unteer for the Tucson Interfaith Yuba City, Auburn, Grass Valley, Department of Anesthesiology. An HIV/AIDS Network (TIHAN) for 12 Elk Grove and Lodi. He had a love avid Vanderbilt sports fan, his years, Dr. Morris established the of travel, food and music. He pre - family reports that he watched auction, “Treasures for TIHAN,” ferred France and Italy, but took the Commodores football team which has raised more than $1.4 family and friends with him on improve their record to an unde - million for the network. trips to every continent. He is feated 5-0 the night before his survived by his wife, Kathy; chil - death. Following his retirement in John T. Rawlings, M.D., MD’53, dren, Jane, Joe, Ruth, Lee and 1991, he archived the history of his died May 12, 2008, at his home in Elizabeth; and six grandchildren. life and catalogued his memora - Frankfort, Ky. He was a general bilia into 50 books. He is survived surgeon practicing in Frankfort Lucian L. Tatum, Jr. M.D. MD’61, by his wife of 65 years, Dorothy; for 25 years before retiring in HS’61-’62 died April 27, 2008. He four children, Pamela, Elizabeth, 1994. He also served for many was 72. A member of the E. Palmer Jones Jr., and years as a medical consultant at American Urological Association, Marjorie; six grandchildren; and Disability Determination Services the Southeastern Section of five great grandchildren. for the Commonwealth of Urology, the American College of Kentucky. He is survived by his Surgeons, and the American Otto Morse Kochtitzky, M.D., wife, Carol; a son, John Thomas Medical Association, he spent 42 MD’50, died June 26, 2008. He Jr.; daughter, Cynthia; and four years practicing medicine and was 87. Dr. Kochtitzky was chair - grandchildren. served as Chief of Staff and on man of Nashville’s Park View the Board of Spalding Regional Hospital and Chief of Medicine at *John Salyer, M.D., MD’38, HS Medical Center. Dr. Tatum is sur - Baptist Hospital. In the mid-’70s, ‘38-’39, died July 25, 2008. He vived by his wife, Nora; daughter,

WINTER 2009 63 :: photo gallery T O

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Reunion 2008 Photo Gallery L A W S O

Pictured here: N

1. Judson G. Randolph, M.D., (MD’53); Kitty Murfree (CRS President), and George W. Holcomb Jr., M.D., (MD’46, HS’46-’49), gather at the Loews Hotel Symphony Ballroom for Medical Alumni Reunion 2008’s Grand Evening Dinner.

2. Members of the Class of 2003 gather for a Reunion photo.

3. John Thomas West, M.D., (MD’51) and his wife, Ruth, enjoyed the live music and dance floor post presentations at the Grand Evening Dinner at Loews Vanderbilt Hotel ballroom. A 4. Newly inducted Quinq Medical Society members from the Class of 1958 2 N N E R A Y

5. Newly inducted Quinq Medical Society members from the Class of 1959 N E R 6. Distinguished Alumnus winner Hal Moses, M.D., presents a lecture during Reunion.

7. VMAA Distinguished Alumni Award 1986 winner Henry C. McGill Jr., M.D., (MD’46, HS ‘46-’47), left, congratulates Harold L. Moses, M.D., (MD’62, HS’62-’65, F’68-’73, ‘85-present), one of this year’s Distinguished Alumni Award winners, at the annual Quinq Society Luncheon.

8. Marvin H. Schwartz, M.D., (MD'55), and his wife, Ellen, enjoy the open - ing celebration at the Country Music Hall of Fame. T

3 4 O M M Y L A W S O N T O

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7 O 6 M M Y L A W S O N S 8 U S A N U R M Y J O E H O W E L L Board of Directors Vanderbilt Medical Alumni Association Board of Directors

Officers Anne-Marie Oelschlager, M.D. (‘97) James W. Felch, M.D. Affairs -Nashville, TN PictPurreesidehnet re: Seattle, WA Savage Society rep--Nashville, TN Wyatt E. Rousseau, M.D. (‘69) Alan S. Rosenthal, M.D. (‘64) (HS ‘64- Alan H. Fruin, M.D. VUSM Representative Richardson, TX ‘66) (FE ‘66-’79) Meacham Society rep -Nashville, TN Michael N. Young President-elect La Jolla, CA Benjamin P. Folk, III, M.D. Nashville, TN David W. Patterson, M.D. (‘85) Chloe E. Rowe, M.D. (MD ‘03) Friesinger Society rep.-Leland, MS Washington, DC New York, NY Lonnie S. Burnett, M.D. Post-doctoral Organization President Robert T. Snowden, M.D. (‘69) CRS Past President – Nashville, TN Brock L. Schweitzer, Ph.D. Regional Directors Pensacola, FL Allen B. Kaiser, M.D. Nashville, TN William J. Anderson, M.D. (‘69) Mitchell S. Steiner, M.D. (FE ‘93-’95, FA Brittingham Society rep. - Nashville, TN ‘93-’95) Nashville, TN Staff Members (non-voting) Clifton R. Cleaveland, M.D. (HS ‘64-’68) Memphis,TN H. Newton Lovvorn, Jr., M.D. G. Roger Chalkley, D. Phil (FE ‘70-’71) W. Bedford Waters, M.D. (‘74) Burnett Society rep.-Nashville, TN Sr. Assoc. Dean for Biomedical Chattanooga, TN Knoxville, TN Richard F. Treadway, M.D. Research John T. Cobb, M.D. (‘78) Luton Society rep. – Nashville, TN Missy Eason Atlanta, GA Graduate Student Representative Executive Director, CRS Robert E.L. Gotcher, M.D. (‘49) Julie Field House Staff Representative Donald Brady, M.D. Hillsborough, CA Nashville, TN Christopher Kuzniewski, M.D. Assoc. Dean GME Kenneth Bruce Jones, M.D. (‘78) Nashville, TN Joel G. Lee Jonesboro, AR Specialty Society Representatives Assoc. V.C. of VUMC Communications Catherine C. Lastavica, M.D. (HS ‘58-’60) Sam S. Chang, M.D. Ex-Officio Members Scott M. Rodgers, M.D. (Fellow ‘60-’61) Urology Society - Nashville, TN Harry R. Jacobson, M.D. Associate Dean for Students Manchester, MA Eric M. Chazen, M.D. Vice Chancellor for Health Doug Twells Susan Niermeyer, M.D. (‘79) Christie Society Rep. - Nashville, TN Affairs -Nashville, TN Associate Vice-Chancellor, Medical Denver, CO Steven J. Eskind, M.D. Jeffrey R. Balser, M.D., Ph.D. Center Development Thomas W. Nygaard, M.D. (‘78) Scott Society rep., -Nashville, TN Dean, School of Medicine - Lynchburg, VA Thomas T. Dovan, M.D. Nashville, TN Steven F. O’Sheal, M.D. (‘81) Orthopaedics Society rep.- Ann H. Price, M.D. (MD Birmingham, AL Nashville, TN Executive Director, Medical Alumni V A N D E R B I L

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