Dr. Robert Sanford can make a rather unique claim for those in the medical profession: He once graduated both first and last in his class. (He attended a two-room elementary school in Dumas, Arkansas, and was the only member of his sixth-grade class.) Now the chief of pediatric neurosurgery at St. Jude Children's Research Hospital, Sanford has been eyewitness to what he calls the "golden era" of pediatric neurosurgery. Children who would not have survived certain kinds of brain tumors as recently as 1990 are now walking away healthy, the kind of victories that make Sanford's field of choice eminently rewarding, even when mixed with the heartbreak of patients beyond cure.
Sanford attended Hendrix College in Conway, Arkansas, where he lettered in swimming and basketball while developing an interest in the academic side of medicine, specifically neurosurgery. "I went to medical school with the idea of getting into a neurological field," reflects Sanford, "but I didn't know it would be neurosurgery." When asked about tackling the imposing challenges of the human brain, Sanford chuckles. "When you're young, you don't know better. I became a mechanic more than a scientist."
While teaching was Sanford's initial interest, it merely opened the door to his true calling. "I found a love for taking care of children," he explains, "and that's when I became truly a dedicated physician. When you're teaching surgery, you're never far from the practice, and you're making progress in the diseases you treat. And if you make one change that changes the way doctors in the United States — or the world — do a procedure, you've impacted thousands. Some of the things I'm most proud of are the innovations we've made, especially in the brain-tumor field, where we've made significant improvement."
Sanford acknowledges the biggest challenge his field faces is a scarcity of physicians. Many talented young doctors are unwilling to enter a field where salaries are lower than that of neurosurgeons concentrating on adult patients, and where emotions can run to extremes over the tiny bodies that need healing.
"I'm a very spiritual person," says Sanford. "So it's not much of a problem for me. But it's a problem we have in recruiting." Sanford has seen doctors he's convinced are on their way to careers in pediatric neurosurgery turn away when one lost patient changes everything. Sanford emphasizes that his field is mission-driven, about a cause and a battle worth fighting.
"The victories are tremendous," he stresses. "We have quadrupled the cure rate in some of our most common tumors over the last 20 years. Not only have we improved the cure rate, but we've improved on the harmful effects of treatment as well. It's like being on the crest of a wave." - FM
As medical director of the West Clinic, Dr. Lee Schwartzberg emphasizes that patients — individuals — always come before the disease in his approach to treatment. It's a quaint notion, one you might see on the wall of a family practice. But in the fight against cancer?
"In my opinion, it's more important for cancer patients," says Schwartzberg. "They're facing the most difficult battle of their lives, and we need to face it together. My philosophy is to treat people like they're a member of my family, to show them respect and compassion. And be honest with them. Patients respond to that."
Having completed his fellowship at Mem-orial Sloan-Kettering Cancer Center in New York, Schwartzberg moved to Memphis to join the West Clinic in 1987. (He brought with him a master's degree in biochemistry, which was the foundation for his interest in hematology.) Over the last 21 years, Schwartzberg has seen remarkable progress in the research, diagnosis, and treatment of a disease once considered a veritable death sentence.
"Therapies have improved the lot of patients over the two decades that I've been practicing," says Schwartzberg. "I've seen really tangible changes. We've changed cancer from a death sentence to a chronic disease. People can live productive lives for years with cancers that can't be cured but can be controlled. We really now understand much of what makes a cancer cell a cancer cell; therefore companies can design medicines that target these kinds of abnormalities."
Schwartzberg notes that there are currently more than 400 cancer-fighting drugs in development, the most for any medical field. And antibodies — proteins naturally found in blood — are now playing major roles in fighting lymphoma and breast cancer.
Adds Schwartzberg, "We've also learned in just the last five years that the way a cancer cell looks under the microscope is only the beginning of the story. We can sort them by molecular techniques — and using their genes — into different subgroups. It's no longer a one-size-fits-all approach."
Referring again to his emphasis on the individual patient, Schwartzberg explains advances that have helped in not only attacking cancer, but in recovering once the attack has been completed. "We can now deliver chemotherapy with much less side effects than we did before. We have good anti-nausea medicines, we have medicines that protect the immune system from the effects — like anemia — of chemotherapy."
Schwartzberg is an avid tennis player, and balances the gravity of his profession with that rarest of avocations: a rock band. (He plays keyboard in a local band called Oasis.) Whatever impact his version of classic rock makes, though, is dwarfed by his vision for the future of oncology. "There's a growing sense of prevention and earlier treatment," he notes. "People [recovering from cancer] are also now eligible to receive preventive treatment, to keep their cancers from coming back. And getting more clinical trials to patients will benefit the next generation."- FM
OBSTETRICS & GYNECOLOGY
One day in the life of urogynecologist and pelvic reconstructive surgeon Veronica Mallett is unlike any other. And that's just the way she prefers it.
"I'm in surgery Fridays and Tuesdays, and I see patients on Monday morning," she says, summarizing her demanding schedule. "I also teach residents and medical students. I have them with me in surgery and in my office. Academic medicine is a complex career. But I was attracted to it for its complexity. I love seeing patients, I love being in the operating room, but I also have the challenge of being a mentor and a teacher, and a researcher."
The University of Tennessee-Memphis hired the multitasking Mallett to chair its department of obstetrics and gynecology in August 2005, so, she explains, "The remainder of my time is administrative."
In that capacity, Mallett has worked to rebuild the obstetrics and gynecology department after numerous faculty left the university with her predecessor. "I've hired seven people," she explains. "A lot of my time was spent recruiting. I recently brought Dr. Giancarlo Mari, an internationally renowned division head for maternal fetal medicine. He'll head that research institute and focus on reducing our problem with infant mortality and premature birth."
Mallett's no stranger to new situations. After completing her residency at Northwestern University, she entered the then-new specialty of urogynecology and pelvic reconstructive surgery. She explains that helping women attracted her to the field. "When a woman is losing urine involuntarily, she also loses a bit of her dignity. Being able to restore that is very rewarding."
Additionally, the prospect of participating in new research drew her to urogynecology. "There were lots of unanswered questions, with very limited treatment options," Mallett says.
Mallett has participated in trials to determine the "gold standard" surgery for urinary incontinence, as she describes it, and was among the first in her discipline to use new, minimally invasive surgery to correct the problem after participating in a National Institutes of Health research group. "The whole impetus for forming this research network was to take the science away from the people who are trying to sell to the market and put it into the hands of clinical experts who can independently provide the public with knowledge about these techniques. It's been very successful."
The ambition that's guided Mallett's career so far carries over into her outlook for the department she leads. "My vision for the department is to be internationally renowned for providing outstanding educational opportunities and research to reduce infant mortality and eliminate urinary incontinence," Mallett says, adding, "We're well on our way."- PL
OBSTETRICS & GYNECOLOGY
University of Tennessee-Memphis Geneticist Owen Phillips and her husband Reid, now an attorney with the Hardison Law Firm, moved to Memphis in 1989 from Pascagoula, Mississippi. They raised their two daughters here. "I was determined to do something more than private practice," Phillips explains. "The beauty of doing academic health care is that every day is a new challenge."
After completing the fellowship that first drew her to Memphis, Phillips stayed with the university. "I liked that I'd have a little more control over my time if I was teaching than if I was in private practice."
The best alternative for her family also turned out to be a good career move. Phillips recently became associate dean of student affairs at the medical school.
The job requires student mentoring in aspects of the medical profession beyond the lab. Phillips, from her days in private practice, knows what young doctors will face after completing their education and residencies. "Most of the educators in my profession have gone through a traditional academic line. What most residents do is go into private practice," Phillips says, "so that's where my interest in resident education took off, beyond what they might learn in a book. I can help with how to negotiate a position, where to look for jobs, common-sense things."
Academic medicine takes up about half of Phillips' time. The rest is spent as a practicing geneticist and obstetrician-gynecologist. "The patient population I focus on is pregnant women at risk for that pregnancy associated with genetic disease. Most of it is counseling, passing on information about risks," she explains.
"I feel like the luckiest person in the world," Phillips says. "I have the privilege of keeping up with some of the newest genetic research. And I have patients who come from all over the Mid-South for counseling, and I can share that knowledge with them, about sometimes very rare disorders. I still get to use my OB-GYN skills through working at The Med in labor delivery and in clinic. That's in concert with the teaching of the residents and medical students. I have a private population of patients, and then I also get to think through some higher-level diseases."
Memphis is fortunate to have Phillips caring for its expecting mothers, just as Phillips feels lucky to work here. "We've raised our family here in Memphis, and I've had plenty of opportunities to go elsewhere," Phillips says. "I've gotten job offers, but it would have been very hard to leave Memphis and UT. We've loved it here." —PL
Thoracic surgery is not a specialty to enter for the easily intimidated. Considering the number of ailments — not to mention cancers — that strike the abdominal cavity, a thoracic surgeon must have a versatility exceptional even among physicians. During his fellowship at the University of Pittsburgh Medical Center, Dr. Mathew Ninan recognized challenges in thoracic medicine that energize him to this day.
"It was in the early and mid-Nineties that minimally invasive thoracic surgery was coming into its own," explains Ninan, "because of the development of media technologies that allowed us to place cameras inside the chest and view video live. [Pittsburgh] was also a leader in the area of lung transplantation, which really first became a part of clinical practice in the mid-Nineties. Heart surgery was ruling the roost when it came to thoracic surgery, and there were only a few of us who had this interest in [lung transplants.] When you work with pioneers, their enthusiasm rubs off on you."
A native of India, Ninan spent seven years at Vanderbilt before moving to Memphis in February 2007, first joining the Cardiovascular Surgery Clinic and later UT Medical Group, where he is now an associate professor and chief of the Division of Surgical Oncology. Having performed more than 100 lung transplants — a procedure that can be more challenging for the recipient than heart or liver transplants due to the complexity of the organ — Ninan has reached a point in his career where he measures advancement less by technological growth than by improved communication among physicians of various backgrounds and specialties. Treatment, in Ninan's eyes, begins with dialogue.
Says Ninan, "Bringing patients together in one division [at UT], with breast surgeons, abdominal surgeons, and chest surgeons who deal with cancer was an innovative idea, and hasn't been done in many places around the country. Abdominal cancers are the biggest cancer killers by far. As time has moved on, treatment of these cancers has grown more and more complex. What kind of therapies do we provide? The question is no longer whether you do one type of treatment. The question is how do we bring together the treatments in the right order so that we give the patient the best outcome?"
Ninan has embraced Memphis, in part because he sees the Mid-South community as small enough for him to deliver real impact. "We can go to large institutions and work," he acknowledges, "but some people are better off in places that aren't as large because they can blaze their own trail. Memphis was considered small when it comes to thoracic surgery. No one really specialized in what I did. The people who trained me made what might have been called a difficult decision, but they stuck with it and came out on top. That's something I want to do in Memphis." — FM
"I like kids," James Wheless says, "so pediatrics was an easy choice." The rest of Wheless' professional life, though, is not so simple. He is the chief of pediatric neurology at University of Tennessee-Memphis, St. Jude Children's Research Hospital, and Le Bonheur Children's Medical Center, as well as a leading clinical researcher in the field. "Neurology was also an easy choice," he adds, "because the brain is where you live. The brain was always interesting to me."
Wheless, born in upstate New York, graduated from the University of Oklahoma medical school before completing neurology training at Northwestern University, and epilepsy training at the Medical College of Georgia. At least part of what brought Wheless to Memphis was the opportunity to simplify the process of becoming a pediatric neurologist for those following in his career path. He came to Memphis in 2005 after directing the epilepsy program at the University of Texas at Houston for the previous 16 years.
"When I looked at the position here," Wheless explains, "the three major players — Le Bonheur, St. Jude, and University of Tennessee — were basically all interested in enhancing the level of neuroscience care locally and regionally. That's unusual, and it's what got me here. I thought that if those three could keep their act together, we could create something special here."
Wheless is pleased with the progress. He has recruited new faculty to UT and organized a department of pediatric neurology there. "When I was recruited here," he explains, "there were two pediatric neurologists. There will be ten here this summer. We could still use a few more, but we've expanded the clinical and research faculty. We now have a nationally accredited training program to educate people who want to become pediatric neurologists." The first class of students in the department, learning the skills that Wheless developed at three different institutions, is one year into the program.
In addition to Wheless' advancements in education, he and his researchers — a team of nurses, doctors, and scientists at St. Jude and Le Bonheur — are developing new treatments for epilepsy, and new imaging technology to advance medical understanding of brain development.
"Our goal is to continue to build on what we've done, and provide outstanding clinical care," Wheless says. "We're internationally recognized for our work with epilepsy and brain tumors. We want to continue to train pediatric neurologists, and do research. We can't advance clinical care if we don't discover new stuff — from diagnostics to treatments." — PL