Pioneers of Hope

At the Monroe Carell Jr. Children’s Hospital at Vanderbilt, our physicians’ work extends beyond patient exam rooms. They are also searching for discoveries to offer better treatments, and hopefully, find cures for their pediatric patients. The doctors profiled here represent only a sampling of the physicians working tirelessly to make Children’s Hospital a place of unwavering hope. In each issue, we also include a profile to highlight our long-standing partnership with our community pediatricians who help ensure all children receive the best care each and every day.

 

In his spare time, Christopher Wootten, M.D., builds musical instruments. His day job is a bit more complex—repairing human throats.

Wootten is the director of the Pediatric Otolaryngology Service, supervising the treatment of ear, nose and throat-related disorders in children. He directs a group of about eight clinicians, the second busiest operative service at Vanderbilt University Medical Center, with multiple specialties and subspecialties.

He and his team perform life-changing procedures such as surgeries that allow tracheostomy-dependent children to breathe without a tube. The operations usually involve dissecting rib cartilage tissue and carving it into certain shapes to expand the airway, eventually allowing for the plastic tube, or tracheostomy, to be removed.

It’s what Wootten is most passionate about.

“I think it’s a sense of restoration, and that’s a wonderful experience for a physician to take part in, restoring somebody to wholeness,” he said.

Wootten is the surgical director of the Complex Airway Digestive Evaluation Team (CADET), which takes a comprehensive approach to airway disorders, treating them from the nostrils to the lungs. He has also been the impetus to start an interest group in refractory obstructive sleep apnea, which is developing as a specialty clinic in combination with the Department of Pediatrics, he said.

As an assistant professor, his research includes looking at eosinophilic disease, an allergic inflammatory disorder of the esophagus and the airway.

Wootten took an unlikely path from being an only child to being a pediatrician with three children of his own.

“It actually took a little bit of a leap of faith to believe that I would be comfortable with children,” he said. “Now I love them. I’ve got kids at home. I’m completely comfortable with kids here and taking care of the kids at the nursery at church. But at the time, it was daunting.”

He majored in English as an undergrad at Birmingham Southern College in Alabama, “because I was so certain I was going to go into medicine,” he said. “I didn’t want to lose that last opportunity to study things that I also enjoyed at a high level.”

But Wootten also knew that he didn’t want to self-indulge in the humanities. “I knew I wanted to have more of a service to mankind and a mission to heal,” he said.

He entered medical school at the Baylor College of Medicine in Houston, Texas, where the most interesting lecture “hands-down” was about language coding among songbirds. The concept of how language is expressed fascinated him, and steered him toward otolaryngology.

Wootten became a resident at Vanderbilt in 2002. About midway through his residency, he gravitated toward pediatric otolaryngology, because it allowed him to treat a broader spectrum of ear, nose and throat disorders than in an adult practice. This includes hearing-related evaluation and treatment and speech interventions for children with cleft lip and cleft palate.

He left Vanderbilt only briefly, from 2007 to 2009, for fellowship training at Cincinnati Children’s Hospital Medical Center. He now lives in Nashville with his wife, Joanna, twin 3-year-olds, Thomas and Mercer, and their older brother, John Christopher, 5.

Pursuing his professional passions leaves Wootten with limited spare time, much of which he spends exploring the outdoors and woodworking. He has made a mandolin and mandola, and his next project is a violin.

“I’ve always been very broadly interested in things,” he said. “You end up in medicine hoping to become a master of what you do, but I think outside of medicine I probably apply the ‘Jack of all trades, master of none’ motif a little bit better.”

– by Matt Batcheldor

•••

Every day at Monroe Carell Jr. Children’s Hospital at Vanderbilt, young patients face life-threatening illness or injury. As an expert in both critical care and medical ethics, Jessica Turnbull, M.D., is bringing palliative care and shared decision-making to the forefront for these patients and their families.

A child’s palliative care or medical decision-making needs can vary widely—from a severe neurological injury to a chronic need for mechanical ventilation or feeding tube—but all cases share a need for communication, Turnbull said.

“The commonality is that the palliative care team helps us navigate shared decision-making with our families. We try to ascertain what the family’s goals are and if those goals are achievable. If not, we try to make new goals and then figure out a path forward to meet those goals,” Turnbull said.

“To do it well takes lots of time and trust and communication back and forth. Rightly so, no decision gets made quickly.”

Turnbull went to John Carroll University, a liberal arts school, and took just as many philosophy and religion courses as chemistry and biology in preparation for medical school.

“I knew that I enjoyed the more philosophical questions of life and death and what makes a good quality of life,” she said.

“The other thing I love about ethics is that everybody has an opinion and wants to be in the conversation. It makes me feel like delving into these dilemmas really matters.”

Turnbull has implemented a screening process with four criteria to encourage those conversations—neurologic injury; discussion of tracheostomy placement; discussion of ECMO (extracorporeal membrane oxygenation); and conflict of goals of care between the patient, family or medical care team. If a patient in the intensive care unit (ICU) meets any of those criteria, the bedside nurse discusses having a palliative care consult with the patient’s care team.

“This hasn’t caused a huge spike in palliative care consults, but it has brought the conversation up more often. These kids are complicated and at high risk of dying, and we need to be thoughtful about that in the daily work of the ICU, which is what I’m most proud of,” Turnbull said.

Pediatric palliative care is especially nuanced because it is hard to project a child’s outcome.

“Children are so resilient and we also don’t have a good understanding of disease trajectories now because the technology is changing so much. It’s less about doing curative versus end-of-life care, and more about doing what is best for the child and family unit.”

Turnbull has also performed interviews with pediatric intensivists and surgeons to research their decision-making process for supporting critically ill children on ECMO, a machine that does the work of the heart and lungs. Her next research project, part of the Katherine Dodd Faculty Scholars Program, is interviewing parents of children with multiple organ disease or other chronic health needs to learn how their ICU experience differs from acutely ill patients.

Growing up in Ohio, Turnbull knew she was good at science and thought she should become a doctor, especially after her mother developed cancer while she was in high school.

“I wanted to be just like her oncologist—so kind but also very definitive with a game plan.”

Turnbull earned her medical degree the University of Cincinnati and performed her residency at Akron Children’s Hospital. During a fellowship in pediatric critical care medicine at Seattle Children’s Hospital, Turnbull received her master’s degree in bioethics and performed a clinical bioethics fellowship. Turnbull joined the Vanderbilt faculty in 2013, which includes an appointment in the Center for Biomedical Ethics and Society.

She revels in a medical career that lets her operate at completely different ends of the spectrum, from rapid life and death decision making in the ICU, to very carefully considered discussions around palliative care.

“I live in the grey areas. I like to give the space to sit and think really hard and talk it out, and then come to a decision and go forward,” she said.

– by Leslie Hill

•••

Thirty years ago in Talladega, Alabama, a 10-year-old boy listened to the radio as Vanderbilt’s football team beat Alabama.

“And I asked my mother, ‘What is Vanderbilt?’” said Barron Patterson, M.D. “And she said, ‘It’s a great school. It’s the Harvard of the South.’ The trajectory of my entire life changed that day, because I became a Vanderbilt fan and I knew that’s where I wanted to go to college.”

Patterson completed his undergraduate education, medical school and residency at Vanderbilt, and in 2006, became a general pediatrician in the primary care clinic, “where we teach residents and students how to be excellent general pediatricians.”

That’s just one of his roles. He’s also the vice chair for Ambulatory Services for the Department of Pediatrics and medical director for Outpatient Quality and Patient Safety, working to improve processes and systems for better patient care.

“I’m an old engineer,” said Patterson, who studied biomedical engineering as an undergrad, “and so I love thinking about the details. I love thinking about numbers and measuring and proving that we provide really good care, and that if we fall short, we work really hard to do better. And I like to say that doing better is my motto and the emphasis is both on ‘doing’ and ‘better.’”

He’s getting results. Four years ago, his clinic gave about 4,600 doses of flu vaccine to clinic patients. Last year, that number had more than doubled—to 9,500 doses. The vaccine is consistently offered about 94 percent of the time, and he works to ensure that there are no racial or ethnic disparities in who’s offered a dose.

Getting to that point required three things—people, process and technology, Patterson said. Part of it was ensuring that vaccine was available and putting the supply lines in place. Implementing technology that included color-coded reminders to give flu shots was another. Ultimately, its success was due to training and engaging everyone on the team of providers and staff to make flu shots part of the culture.

“We just have the best team, the most dedicated staff and providers throughout outpatient areas who want nothing more than to provide the right care for the right patient every single time,” he said.

Other improvements Patterson has implemented include same-day checkups for children who are overdue for an appointment and advances in screening labs for anemia. He’s passionate about prevention, intervening early on to change outcomes in a child’s life.

He said he knew he wanted to be a pediatrician early on in his medical training when his pediatrics clerkship took him to Monroe Carell Jr. Children’s Hospital at Vanderbilt.

“I like to laugh a lot, and I guess the deal was sealed for me when I was in medical school on my pediatrics rotation and I realized that, despite being in a hospital, there was laughter in a children’s hospital that I didn’t hear in other areas,” he said. “That spoke to me about the people who worked at Children’s, that as they were helping children, they were also helping them with laughter and with kindness. That meant a lot to me, and that was a real big draw for me.”

When Patterson is not working, he’s enjoying Vanderbilt football from the same season ticket seats that he had as a resident. Or he’s spending time in his vacation house in Monteagle, Tennessee—his favorite place in the world—with his partner, Burton Jablin.

“I really do feel fortunate that I have the best job at Vanderbilt,” he said. “I get to take care of these kids, and I get to help think about doing better by those kids and providing the level of care that they deserve.”

– by Matt Batcheldor

•••

With his signature bow tie, round glasses and hearty laugh, Eric Chazen, M.D., cared for thousands of Nashville children during his 40-year career as a pediatrician and founder of Green Hills Pediatric Associates. He was a witness to, and often influencer of, the evolution of children’s health care at Vanderbilt and in the community.

A native of Knoxville, Chazen graduated from Vanderbilt University in 1952 and then attended medical school at the University of Tennessee. A cousin found him a spot in a pathology residency in New York, a year he remembers very fondly.

“My Fair Lady had just opened on Broadway. I was footloose and fancy free, with a reasonable allowance, unencumbered by anything,” he recalled.

After realizing he wanted to follow the example of his uncle and become a pediatrician, Chazen found a position at Harvard under Sidney Farber, M.D., who would eventually be known as the father of chemotherapy.

He did his residency at Vanderbilt and Harvard, and then was recruited back to Vanderbilt to run the outpatient pediatrics department. After a year, he wanted to start his own private practice, but didn’t know just how unprepared he was.

“They don’t teach you the business side in medical school. For three years I really struggled. I think one month I saw 26 patients. I made house calls all over Nashville until the handle on my bag broke. I took that as a sign from God that I could quit making house calls.”

Seven years after striking out on his own, Chazen was so busy he had to find a partner. Joseph Lentz, M.D., was just finishing his chief residency at Vanderbilt and Green Hills Pediatric Associates was born. They were partners until Chazen retired in 2002. Lentz died in 2009.

“I just love children. They’re forgiving. They heal fast. They can be desperately ill one minute and happy as can be and jumping around the next,” Chazen said. “I love getting stopped in restaurants and having children come up and put their arms around me and say they remember me. That is a great reward.”

When David Karzon, M.D., became chairman of the Department of Pediatrics, he consulted with Chazen on ways to make Vanderbilt more welcoming to community pediatricians.

“He reached out wonderfully to the town doctors and made it evident to them that if they wanted to admit a patient to Vanderbilt where the best care could possibly be given to their patients, they were welcomed with no strings attached,” Chazen said.

In the 1970s, Karzon also developed Vanderbilt’s “children’s hospital within a hospital” concept, which Chazen wholeheartedly supported.

“I thought forming the Children’s Hospital was brilliant. There was a group of pediatricians in Nashville who were beginning to petition for an independent children’s hospital, but I with my big mouth was really vocal against that idea. Without question, I thought Vanderbilt should run Nashville’s children’s hospital.”

Chazen was also a career-long instructor of medical students and residents. For more than 25 years, he welcomed four to six medical students to his clinic every Wednesday afternoon to learn child development.

In 1961, one of his patients, a baby born two months premature, was the first to be placed in a negative-pressure breathing machine under the pioneering care of Mildred Stahlman, M.D., professor of Pediatrics at Vanderbilt and former director of the Division of Neonatology..

“In all truthfulness, at that time, you let nature take its course, and nature would not give them much chance to live. But Dr. Stahlman controlled that nursery like General Patton in control of the Third Army. If she said, ‘we’re going to put the baby in this machine,’ that’s what you did. She has had wonderful outcomes and greatly advanced neonatal care.”

Over his long career, through many changes, Chazen said Vanderbilt has always been a beacon of good pediatric care for Nashville.

“Because of Vanderbilt I’m a better doctor. I have experts at my fingertips, and it is a huge comfort to know it is in our community.”

– by Leslie Hill