Pioneers of Hope

At the Monroe Carell Jr. Children’s Hospital at Vanderbilt, our physicians’ work extends beyond patient exam rooms. They are also scientists – searching for discoveries to offer better treatments, and hopefully, find cures for their pediatric patients. The four doctors profiled here represent only a sampling of the physician-scientists working tirelessly to make Children’s Hospital a place of unwavering hope.

 

Suanne Daves, M.D. Cardiac Anesthesiology. Photo by John Russell.

Suanne Daves, M.D., always roots for the underdog.

As a Pediatric Cardiac Anesthesiologist, she cares for children who have complex heart defects and are among the sickest patients at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

“I’m always drawn to the person least likely to win, and children and their families are especially vulnerable and need our stewardship and protection,” said Daves, associate professor of Pediatrics and Anesthesiology and chief of the Division of Pediatric Cardiac Anesthesiology.

Daves believes in the power of teams to care for these vulnerable children and provide the best outcomes.

She gathered her team to examine patients who did well in the crucial first 24 hours after surgery and patients who need mechanical support, chest compressions or their chest re-opened due to bleeding or heart failure. From those comparisons, the team developed a set of criteria to meet before the patient would be allowed to leave the operating room.

“In the OR, you still have a full team gathered around this one patient – a nurse anesthetist, the surgeon, three nurses, and a perfusion team. If a patient doesn’t meet the criteria for transfer to the ICU, we can collaborate and discuss how to make the patient more stable. We can pull in other providers to bring a new set of eyes to the problem.  We can develop a plan and implement it immediately.  We’ve found that this level of collaboration allows us to deliver a much more stable and safer patient to the ICU,” Daves said.

“It was a culture shift because we were asking people who had been on their feet for eight to 12 hours to stay another couple of hours. But when we said that these kids could do better, everybody signed on immediately.”

Daves has looked at the outcomes of 200 patients with this new system in place and says the data shows an improvement. She will continue to follow the data to ensure the good results sustain.

A native of Oklahoma, Daves’s path in medicine was consistently driven by the suggestions of others, first with her college biology teacher recommending she pursue a medical degree.

“I didn’t even think of being a doctor. I didn’t know any women doctors in my small hometown,” she said.

She attended medical school at the University of Oklahoma and trained in Anesthesiology and Critical Care Medicine at the University of California, Irvine, and University of Chicago.

In Chicago, mentors suggested the jack-of-all-trades anesthesiologist start caring for patients in the ICU and then specialize in pediatric cardiac anesthesiology.

“My perfect practice is following a beautifully complex cardiac patient from being their anesthesiologist in the operating room to caring for them in the ICU. It’s powerful because I’ve seen what happened in the OR and can picture the heart in three dimensions and know what could go wrong. It’s all about getting them on the fastest trajectory to go home.”

– by Leslie Hill

•••

Fernando Polack, M.D. Infectious Diseases. Photo by Anne Rayner.
For Fernando Polack, M.D., success has required two things: curiosity and an open mind. The Cesar Milstein
Professor of Pediatric Infectious Diseases at Monroe Carell Jr. Children’s Hospital at Vanderbilt straddles two hemispheres, taking advantage of the year-round opportunity to investigate seasonal respiratory illnesses in children from bases in Buenos Aires, Argentina, and in Nashville.

As director of the INFANT Foundation for Children’s Infectious Disease Research, a research and clinical program based in Buenos Aires, Polack works to describe the burden of serious respiratory illness that hospitalize and even kill the youngest and most vulnerable children and infants. He also seeks to describe how some common childhood illnesses behave differently depending on the environments where children live. He hopes that somewhere within the evidence he will find simple solutions to save children.

“Sometimes we find from very complex questions that there are simple answers hiding very close to us. It is exciting to learn that things we take for granted may have deep biological impact,” Polack said.

With a grant from the Bill and Melinda Gates Foundation, Polack continues to build evidence on respiratory syncytial virus (RSV), one of the longest standing health threats to infants.

Polack says despite having a well-documented list of risk factors for the past 20 or 30 years, RSV continues to take its toll.

“While it is rarely fatal in the developed nations, even in Atlanta, or Nashville, the rates of hospitalization are as bad as ever, and are certainly not improving. This tells us we have not been effective in decreasing severe RSV anywhere. It is a significant burden everywhere,” Polack said.

Pulling from his experiences in the lab, Polack says he uses well-planned work, careful thought and vigilant observation to see things that may have been hiding in plain sight.

“The key to certain problems may hide in the amount of dirt in a room, or dietary preferences in pregnant women. When we ask complex questions and perform the hard work, it’s gratifying to learn the answers don’t need to be sophisticated,” he said.

Polack received his medical degree at the University of Buenos Aires and completed residencies in both Argentina and the United States. He went on to a fellowship and faculty position at Johns Hopkins University. In 2003, Polack became the director of INFANT. In 2009, he won the Young Investigator Award from the Society for Pediatric Research, the same year he joined Vanderbilt’s faculty.

His work is documented in a number of top medical publications, including Nature Medicine and The New England Journal of Medicine. His projects are wide-ranging. He has created a motorcycle brigade to distribute breast milk door-to-door in order to examine potential benefits of donor human milk for premature infants. Also, he has provided insightful laboratory evidence that an errant immune response caused the lungs of hundreds of previously healthy adults to fill up with inflammation during the H1N1 epidemic. Polack says he feels his research has wandered far from its original path, in a most pleasing way.

“When I began I hoped to bridge between basic science and implementation, where I saw a gap. I wanted to translate back and forth between lab work and relevance in a population. But by allowing one thing to lead to another, it’s going in a way I never imagined it would,” Polack said.

– by Carole Bartoo

•••

Chris Lehmann, M.D. Neonatology, Biomedical Informatics. Photo by Daniel Dubois.

When Chris Lehmann, M.D., joined the faculty at Monroe Carell Jr. Children’s Hospital at Vanderbilt in August, it felt “a bit like coming home.”

For more than a decade, the board-certified neonatologist and biomedical informatics specialist, has earned the recognition of his peers through his work in applied clinical informatics with a focus on the use of health information technology to improve patient care, safety and outcomes.

“Truly, one of the most exciting things for me when I came to Vanderbilt, was the quality of the colleagues that I would be working with,” said Lehmann, professor of Clinical Pediatrics and Biomedical Informatics. “This is an amazing place for pediatrics and arguably the No. 1 place for informatics in the country.

“This was a little bit like coming home because I have known many of these people through my work in informatics,” he said. “They are all good friends. I have come to a place where I have an instant family.”

Lehmann comes to Vanderbilt from Johns Hopkins University where he was an associate professor in the Division of Neonatology and the Division of Health Sciences, Informatics. He also served as the director of Clinical Information Technology at John Hopkins Children’s Center.

His list of achievements includes computer-based applications that have proven to reduce provider errors, reduce costs, decrease unnecessary medication usage and improve safety.

How did a neonatologist become so entrenched in informatics?

“It started when I was standing in the NICU and watched a resident make a mistake in overdosing a child,” recalled Lehmann. “When I saw this I said to myself that I had made the same mistake when I was a resident.

“I knew these were incredibly smart people, but that dosing medications based on the weight for teeny tiny babies was hard. Something needed to be done.”

A graduate of Westfälische Wilhelms Universität in Münster, Germany, Lehmann had very limited knowledge about medical schools in the United States. He traveled to America in pursuit of his pediatric residency, landing at
Marshall University School of Medicine – choosing it because “it had the nicest reply letter.”

It is there that he began dabbling in computers. After completing his residency, he ventured to Johns Hopkins
University for a fellowship in neonatology, followed by an additional fellowship in medical informatics.

“While I know that no computer can substitute for a caring nurse or physician, computers can make their work easier, make it safer, and make it better for patients,” he said.

Lehmann is dedicated to his work in Biomedical Informatics. He serves on the board of directors of the American Medical Informatics Association, and he is the first director of the Child Health Informatics Center of the American Academy of Pediatrics. He was also recently elected fellow of the American College of Informatics as well as vice president for Services of the International Medical Informatics Association. In addition, he is the creator and editor of the journal Applied Medical Informatics and co-author of “Pediatric Informatics” – one of the first textbooks on the subject.

Lehmann is married with three children and is looking forward to exploring Nashville for excellent live music and great food.

– by Jessica Pasley

•••

Douglass Clayton, M.D. Urologic Surgery. Photo by Daniel Dubois.

We’re prone to reduce the urinary system to mere “plumbing” and take its mechanisms for granted, but it is actually a complex system that has a huge impact on daily life, says Douglass  Clayton, M.D., assistant professor of Urologic Surgery.

For children with spina bifida, a congenital disorder caused by the incomplete closure of vertebrae around the spinal cord before birth, the urinary system is a chronic concern.

“They all have some element of bladder dysfunction,” Clayton said, “Urinary tract issues are one of the most common reasons they get admitted to the hospital as children and as adults, and if they don’t manage their bladder properly, they could develop kidney damage and end up on dialysis.”

But these patients have a champion in Clayton, who treats them at the multi-disciplinary spina bifida clinic and uses that experience to inform his research in the lab.

“From a basic science perspective, we don’t really know why patients with spina bifida have these bad bladders, and the whole idea behind our research is to figure out how to repair a bladder that doesn’t work so well, either through therapy or a specific type of surgery,” Clayton said.

One hypothesis Clayton is working on is about blood flow to the bladder, which fluctuates frequently in spina bifida. The fluctuation also releases free radicals, a molecule that can further damage the organ.

Although research in this area is always challenging, Clayton says his enthusiasm is renewed every time he interacts with his patients in the spina bifida clinic.

“I go to clinic and see the 16-year-old girl who just wants to be dry and not be on dialysis. That brings it all back to why it’s important to do this research. All of these kids just want to be as normal as possible.”

Clayton also uses the da Vinci Surgical System to perform complex operations. Children with spina bifida often undergo surgery to expand their bladder using a piece of bowel or undergo creation of a catheterizable bladder channel in their abdomen. The da Vinci’s robotic arms allow Clayton to do much more precise and minimally invasive surgery.

“We do a lot of robotic kidney surgery and reconstruction of the urinary tract, but this is an area where we want to advance as much as we can. We want to push the envelope, because doing surgery in a less invasive way makes surgery a lot less stressful for the patient.”

Clayton grew up in Jackson, Tenn., and worked as an orderly at Jackson-Madison County General Hospital throughout high school and college.

“Seeing things come in and out through the ER and seeing the way surgeons managed patients really attracted me. There’s a lot of instant gratification with surgery,” he said.

He attended medical school at the University of Tennessee Health Science Center in Memphis. After residency at the University of Alabama – Birmingham, he came to the Monroe Carell Jr. Children’s Hospital at Vanderbilt for a fellowship in pediatric urology.

“I originally planned to go back to Jackson and be in private practice, and that would have been great, but I felt like I wanted to do more. Being able to be integrally involved in clinical care and advance technology, while at the same time trying to find answers to some basic research questions, is a nice fit for me and is really gratifying work.”

– by Leslie Hill

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