Wright loves her patients and their mysteriesJul. 21, 2016, 10:24 AM
Everyone knew everyone in Patty Wright’s hometown of Scottsville, Kentucky, population 4,336.
During her junior and senior years in high school, Wright was a weekend disc jockey at the local country music station. She recalls having great ’80s hair in 1989, the year she became high school valedictorian.
“I am a product of family life and rural Kentucky. That’s my full background story,” said Wright, M.D., who joined the Vanderbilt faculty in 2002 and specializes in infectious diseases.
In Wright’s specialty, “For the most part, we’re always dealing with some sort of microorganism that is someplace that it shouldn’t be. It might be bacteria, it might be a virus, it might be a fungal infection, it might be a parasite. But it’s someplace it shouldn’t be.
“When we win, most of the time we win because we put the right antibiotic along with somebody’s immune system to fight the infection. Our medicines give the immune system the chance to clean up the mess.”
Wright used to watch “House,” a TV drama that ran for eight seasons on Fox, with stories centered around infectious diseases specialist Gregory House, M.D. Each episode presented a new and baffling medical mystery. And then came an episode where a junior doctor was shown receiving shots in his stomach after an exposure to rabies. In that moment, for Wright, the show lost its charm.
“That was the last episode of House I ever watched. We haven’t done that for decades. If you need rabies shots you get ’em in your arm like you would any other shot.”
Wright, while mostly amused by this recollection, is also apparently still a bit indignant over this TV depiction. “I was like — uh-uh, crossed the line Dr. House. People are scared enough about rabies without propagating this incorrect message.”
Wright, an associate professor of Medicine, also conducts clinical research, and in recent years she has become busy as an administrator, spending 18 months as interim director of the Division of Infectious Diseases, then taking roles as medical director of the sprawling Medicine Patient Care Center (more than 100 clinics and several hospital units), associate vice-chair for clinical affairs in the Department of Medicine, associate director for clinical affairs in the Division of Infectious Diseases and medical director of Vanderbilt’s Specialty Pharmacy.
Her job is currently around three-quarters administrative duties, 20 percent clinical work and teaching, and five percent research.
“No matter what other things that I do, administrative or research, the most important thing that gets me out of bed in the morning is to take care of patients,” she said.
Before entering first grade, Wright had set her sights on a medical career. She distinctly remembers being 5 years old when her great uncle, who had probably never encountered a female doctor, asked what she wanted to be when she grew up.
“I said, ‘I want to be a doctor.’ He corrected my response with, ‘You mean you want to be a nurse.’ I said, ‘No, I want to be a doctor.’ And my resolve has never wavered.”
Wright was always attracted to science, and by high school was fascinated both by the science behind medicine and by the roles doctors play in patients’ lives. After two years of medical school at the University of Alabama in Birmingham, she planned to specialize ultimately in obstetrics and gynecology. And then came her OB-GYN clinical rotation.
“I didn’t feel like there was enough mystery for me. If a pregnant woman comes in, the outcome is that one way or the other she’s going to have a baby.
“One of the things I love about infectious diseases is so many of my patients are a mystery, and I have to figure out what’s wrong with them and what kind of infection they have.”
The Division of Infectious Diseases currently includes 16 clinician educators (all physicians), four nurse practitioners, 14 physician scientists and four research scientists. In fiscal year 2015 they conducted 3,575 inpatient consults and 16,033 outpatient visits, and were the attending service for 656 inpatients. Wright was drawn early in her career to caring for patients with HIV/AIDS, and has since become focused on orthopedic infections. She follows adult patients in both hospital and clinic settings.
One of the most difficult things Wright and her colleagues encounter are patients who come in with fever and nothing else.
“If they have no other symptoms to go with their fever, the infection can be almost anywhere.”
And Wright does mean anywhere — joints, bones, heart, brain, what have you. It’s part of what she likes about her specialty.
“Infections happen everywhere. I’m not just a kidney doctor, I’m not just a liver doctor; I’m an everything doctor. We literally go everywhere in the hospital to see patients, because infections go everywhere.”
When a mysterious infection is associated with a recent history of foreign travel, it adds complexity to Wright’s work. She talks about being entertained by the challenge of helping patients who come in with uncommon, but ultimately treatable, infections.
One of Wright’s abiding concerns is overuse and misuse of antibiotics, which can lead to drug-resistant infections. The Vanderbilt Antimicrobial Stewardship Program was launched 10 years ago by Wright and one of her trainees at the time, Titus Daniels, M.D., MPH, now chief operating officer for Adult Clinical Operations. With communicable infections, “How I treat this person’s illness can influence how I can treat the person next door’s illness. If I mismanage you and you develop a resistant infection that you spread to your neighbor, how I’ve treated you is now influencing how I treat the neighboring person,” Wright said.
The stewardship program has instituted a routine review process to prevent inappropriate use of antibiotics across Vanderbilt clinical areas.
Asked to describe a patient who died, Wright recalls a burn patient who died in hospice care with a multidrug-resistant Acinetobacter infection.
“That’s a really awful conversation for us to have: to say, ‘I’ve got nothing to treat this infection with.’”
Asked to describe another patient, Wright recalls a patient diagnosed with a brain tumor.
“They were getting ready to irradiate his brain when the test came back and we found out he had a fungal infection in his brain. We saved him from undergoing radiation therapy and treated his fungal infection, and he got completely better.” (It’s not uncommon for infectious diseases specialists to see patients who are thought to have cancer but who instead turn out to have an infection of some sort.)
After treating life-threatening infections, how does Wright muster the enthusiasm required to treat a finger infection in the clinic?
“It’s actually very nice to see the finger infection. If all you have is intensity-intensity-really-really-sick, it’s hard on you as a person and a physician. It’s nice to be able to go into that next room and say, ‘Hey, we can fix you and make you better and you’re going to go back to being normal.’”
Wright, who puts in long hours through the week, says that on weekends she’s able to leave her work behind and concentrate on her family and home life. She enjoys cooking and travel. Her husband, Chris Wright, teaches physics at Martin Luther King Jr. Academic Magnet School. Their daughters, Natalie and Audrey, are 13 and 11.