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Lessons from the School of Life
Posted By Vanderbilt Magazine On August 5, 2009 @ 2:51 pm In In Class, Summer 2009 | No Comments
When Dr. Judy Aschner was busy completing her third year of fellowship in neonatology at the University of Rochester School of Medicine, a personal experience did more to shape the way she practiced medicine than all her previous years of training.
It was August of 1987, and Aschner was 21 weeks pregnant with her third child. Unexpectedly, her membranes ruptured, which meant her son likely would be born soon—and most certainly would not survive.
Against medical advice, she left the hospital five days later, determined to continue the pregnancy yet knowing the likelihood of carrying the baby to viability was extremely low. She remained at home on complete bed rest for 10 weeks before delivering her son, Nadav, nine weeks early, on Halloween.
“I was terrified. He did not cry at birth—there was not a sound,” she remembers.
Nadav was critically ill, suffering from sepsis (a serious bloodstream infection), respiratory distress and low blood pressure. He remained in the neonatal intensive care unit (NICU) until December, when he was discharged home on oxygen.
“We were unbelievably lucky that he survived,” Aschner says. “The statistics were not in our favor.”
What she found most difficult was “being on the other side of the bed,” she remembers. In the mid-’80s it was common practice not to include families on medical rounds.
“We were asked to leave the NICU when the team discussed our child,” Aschner recalls. “In 1987 nurseries were one great big room. Hospitals did not allow families to attend rounds due to privacy concerns for the other patients and families. It wasn’t until I was ‘that’ family that I realized this was not the right way to do it. It was a lesson learned in a very personal way.”
Aschner is the first holder of the Julia Carell Stadler Chair in Pediatrics and director of the Mildred Stahlman Division of Neonatology at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. She came to Vanderbilt nearly five years ago after previously serving as professor of pediatrics and director of the neonatal–perinatal medicine training program at Wake Forest University.
She feels strongly that parents should be included in all decisions being made about their child, and encourages the family to be present for rounds and participate as much as possible in the care of their infant.
Although Nadav has grown into a healthy young adult—he is about to start his senior year at Vanderbilt, majoring in political science—the memory of that experience still lingers. Judy’s husband, Michael Aschner, the Gray E.B. Stahlman Professor of Neuroscience and a professor of pediatrics and pharmacology, still finds it difficult to enter the Neonatal Intensive Care Unit.
“My experiences as an NICU mom changed the way I practice medicine in a very fundamental way,” Judy Aschner says. “Every neonatologist understands how stressful it is for a family whose baby is critically ill, but once the baby is stable, the team’s focus is on the next critical patient. What I learned from my experience is that the stress for the family remains until discharge and beyond. Things happen for a reason, and I guess it taught me a lot about the true meaning of family-centered care.”
Under her leadership the division has grown from 12 faculty to 30, with marked expansion of both the clinical and research programs in neonatology. “The beautiful NICU at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, with its single-patient rooms, facilitates family involvement,” she says.
For years Aschner has juggled patient care with research. She has a special interest in pulmonary hypertension (high blood pressure in the lungs), a particularly dangerous form of lung disease that can affect newborn babies—and a condition that affected her son, Nadav. She has published numerous articles examining the causes of pulmonary hypertension and exploring better ways to treat this life-threatening condition in newborn babies.
“She is passionate, brilliant, articulate, and devoted to the academic principles of scholarship in her chosen field,” says Dr. Jonathan Gitlin, chair of the Department of Pediatrics at Children’s Hospital.
Born in Troy, N.Y., the blue-collar hometown of “Uncle Sam” situated along the Hudson River, Judy Aschner was among the first in her family to attend college. She fantasized about becoming a physician but never knew another woman who had been one. She had to be talked into applying to medical school by her mentor, William Roth, professor and chair of biology at Union College in New York.
Roth asked why she did not attend a “pre-med” meeting at the end of her sophomore year of college. Because she wasn’t a pre-med major, she responded. “Why the hell not?” he demanded.
She enrolled at the University of Rochester School of Medicine in the midst of a long-distance, six-year courtship with Michael. The two had met when Judy was an 18-year-old on a visit to the Red Sea. Michael, an Israeli, moved to America to begin training as a research scientist while Judy completed medical school.
Two days after receiving her diploma, she gave birth to their first child, Yael, who is now a second-year resident in internal medicine at Vanderbilt. Besides Yael and Nadav, the Aschners have two other children: Eitan, who is now working in China after graduating from Vanderbilt’s School of Engineering in 2008, and Amir, a rising sophomore at Vanderbilt.
“All our children are or will be Vanderbilt alumni,” Aschner says. “It is hard to describe what a bonus it is to have them close by and getting their education here—or how proud I am of all my children.”
Today, Aschner is extremely busy leading one of the top-rated neonatology programs in the country while expanding her involvement with a litany of professional and scientific organizations. She admits she has a difficult time telling people “no,” which is reflected in the traveling and lecturing she does all over the world. She even writes the questions that will be asked of neonatologists when they take the American Board of Pediatrics certification exam in neonatal–perinatal medicine.
“I wear a lot of hats,” says Aschner, who this spring was recognized as one of “10 Women to Watch” by Nashville Medical News. She recently was elected to a six-year term as secretary–treasurer of the American Pediatric Society (APS), with responsibilities that include service on the planning committee of the organization’s annual meeting and appointment as the APS liaison to the Federation of Pediatric Organizations. She also serves on the strategic planning committee for the perinatal section of the American Academy of Pediatrics and spent four years as chair of the Organization of Neonatology Training Program Directors.
At Vanderbilt she serves on several departmental committees and is actively engaged in the education of neonatal–perinatal fellows. “Teaching residents and fellows at the bedside and in small lecture settings is something I really enjoy, but I’m doing less of it now than I have done in the past,” Aschner says. “Now my education and training activities are done more at a national and international level.”
Aschner also is vice chair and executive board member for the International Postgraduate Organization for Knowledgetransfer Research and Teaching Excellent Students, an international postgraduate teaching organization that particularly focuses on transferring evidence-based medical knowledge to developing nations. But she makes sure outside activities don’t detract from her primary mission of improving the lives of sick infants and the processes of care in the NICU.
“We’ve got wonderful, dedicated faculty in neonatology and outstanding NICU nurses and nurse practitioners at Vanderbilt,” she says. “The next step is to reach outside the walls of Vanderbilt.”
Two years ago she founded the Tennessee Initiative for Perinatal Quality Care (TIPQC), which seeks to improve health outcomes for mothers and infants through a statewide collaborative of neonatal and perinatal health-care providers. Tennessee’s infant mortality rate currently ranks a dismal 45th in the nation.
“No matter how great a job we do here at Vanderbilt, it won’t move the statistics a lot. We need to share what we do with others, and we need to learn from each other,” says Aschner. “We also need to partner with our obstetrical colleagues to really make a difference in the rates of preterm birth in Tennessee. The enthusiasm across the state for TIPQC is amazing, even to me. I really believe TIPQC will make a difference in Tennessee’s birth outcomes.”
The goal is for all 27 NICUs in Tennessee, as well as obstetrical practices, to join TIPQC and participate in evidence-based changes in practice to improve prenatal care, reduce infant mortality, and reduce complications of preterm birth. All NICUs are asked to join an existing national quality improvement network and to share data about NICU practices and outcomes. TIPQC will teach teams how to implement and monitor changes in their practice and establish a statewide database to analyze the impact of those changes on infant outcomes.
On a recent morning, Aschner and her husband realized their demanding travel schedules would place them on different continents for the better part of the next month, so they quickly rearranged appointments so they could retreat for a few minutes together to have a cup of coffee.
“In the past we intentionally never traveled at the same time so someone would always be home with the children. Now that everyone is out of the house, this old habit is pretty dysfunctional,” she says. “We need to try to coordinate our travel schedules or, better yet, do some traveling together. However, we both travel so much for work that it is easier said than done.”
Even on her most hectic days, though, Aschner says, “I am completely sure I was put here on this earth to be a neonatologist. There is nothing else I want to do. I think I have the best job there is.”
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