Graham finds time to heal, hike

Graham finds time to heal, hike

Dr. Thomas P. Graham Jr.'s small second floor office in Medical Center North is organized much like his life.

There are framed degrees, multiple stacks of paperwork and a plastic model of the heart and its chambers. But smack dab in the center of his office is an oversized framed photograph of the smiling, curly-haired Graham, surrounded by his wife and children. Yellowstone National Park's snowcapped Avalanche Mountain looms in the background.

Graham – director of the division of Pediatric Cardiology and the Ann and Monroe Carell Jr. Family Professor of Pediatric Cardiology – and those who know him best will tell you that his family is the driving force in his life; his wife, Carol Ann, daughters Bethany and Brooke, son, Brent, and three grandchildren, Caroline, age two-and-a-half, Christopher, one, and David, four months.

"When I was an intern or a young faculty member, I didn't have as much time with my family as I wanted to, but I did make time as best I could," Graham said. "We always took vacations together and made time on weekends to do things as a family. I cherished the time together."

His family is the first love of his life. Pediatric Cardiology is the second. In fact, Graham is so well respected among his peers that this year he was voted one of the nation's best doctors by both Good Housekeeping and American Health magazines.

Graham's department recently honored him with a lecture, a golf tournament and a dinner and dance celebrating his 25th year on the faculty. The events were attended by both current and former Pediatric Cardiology faculty and fellows, other Vanderbilt faculty and friends, as well as Graham's family.

Vanderbilt's pediatric cardiology program is one of several in the country with multidisciplinary expertise in treating congenital heart problems in adults – adults who were born with congenital heart defects, some of whom are now having children of their own. Physicians and nurses from the divisions of Pediatric Cardiology and Adult Cardiology team up with the departments of Cardiac and Thoracic Surgery and Obstetrics and Gynecology to offer care to this group of patients.

Graham's leadership has made the division of Pediatric Cardiology one of the most respected in the country, said Dr. James A. Johns, assistant professor of Pediatrics and a colleague of Graham's for the past 12 years.

"Vanderbilt is very fortunate that Dr. Graham brought his vision here. He's wonderful to work with and is a great leader. He's made tremendous contributions to all of pediatric cardiology, across Tennessee, the nation and around the world."

"I think virtually all of us in Pediatric Cardiology came to Vanderbilt because of Dr. Graham, and it's been because of him that we've stayed. He's a wonderful division chief."

Graham, 59, said that combining pediatrics with cardiology was a "natural marriage" for him.

The Charlotte, N.C. native broke a family tradition when he enrolled in the pre-med program at Duke University in 1955. He was the only family member to pursue medicine and the only one to choose Duke over the University of North Carolina.

"I was a turncoat," he said.

He became interested in medicine in high school when as a freshman he broke a leg playing football and spent months recuperating.

At Duke, Graham received a 70 on his first chemistry test, but quickly buckled down in the competitive premed environment and ended up Phi Beta Kappa.

"It was not without some sweat and worry. I guess that first test was meant to scare everybody into really working hard."

He was accepted into Duke's medical school and during his freshman year saw Dr. Madison Spach show one of the early cineangiocardiograms, a motion picture of a heart abnormality. Graham was enthralled.

"I was fascinated with the thought of congenital heart disease and how there were evolving methods to treat these congenital defects," he said. "I was also incredibly impressed with Dr. Spach. He was very dynamic, young and enthusiastic."

Spach became Graham's role model, and after pursuing summer fellowships in adult cardiology, he settled into what would become his life's work.

"I was really torn between adult and pediatric cardiology, but it became clear that I loved dealing with children during my third year of medical school when I took pediatrics," he said.

"My only concern was whether there would be enough jobs in pediatric cardiology to support the growing number of people who were interested in this emerging specialty. Dr. Spach assured me there would always be room for people who worked hard and applied themselves.

"Fortunately, there are not that many children with heart problems, so you don't need a lot of pediatric cardiologists, in contrast to adult cardiology where there's so much heart disease."

Graham trained at Boston's Children's Hospital from 1963 to 1965, worked in cardiovascular research at the National Institutes of Health in 1966, then did a two-year cardiology research fellowship back at Duke in 1967. In 1969, he joined Duke's faculty.

It was during this time his first two children were born: Bethany in 1964 and Brent in 1967. Bethany attended Duke Medical School and is finishing her training as an adult hematologist/oncologist at Harvard. Brent is training to be a pediatric rheumatologist at Cincinnati Children's Hospital. He graduated from Vanderbilt University School of Medicine where he received his medical degree from his father.

Brooke, Graham's third child was born in 1971 at Vanderbilt University Hospital. She is the family's traveler and is in her first year of a two-year teaching stint in Botswana, Africa.

In 1971, Dr. David T. Karzon, who was then chairman of the Department of Pediatrics, wooed Graham away from Duke. It was his second try.

"I have been very fortunate to work under such supportive chairmen, Dr. Karzon and now Dr. Ian Burr," Graham said.

"When I made the move from Duke to Vanderbilt, I never realized I would be here for the next 25 years."

Many children with severe heart problems could not be treated when Graham was a medical student. Since the day when he chose pediatric cardiology as his subspecialty, there have been major changes in the field, he said.

"There was a large percentage of problems we could do very little for. Our ability to treat many conditions was very limited. I remember seeing children in the hospital who were blue and sick and short of breath and we could do nothing for them. Now there's almost no congenital condition we can't treat. The evolution of the medical and surgical treatment of these conditions is absolutely astounding."

The other change has been seeing adult patients who were born with congenital heart defects. In years past, many of these patients never survived into adulthood.

Now, some of the women patients are having babies of their own. The babies of some of these patients, 5 to 8 percent of the time, are born with congenital heart defects.

"This really makes it important for surveillance. We can now look at the fetus with echocardiograms and sometimes, but not always, we can know about a heart condition before the child is born and can be ready right after birth to offer treatment."

Graham said Vanderbilt's program to take care of adults with congenital heart defects is successful because of the collaboration between the adult and pediatric cardiology programs and the work of Drs. Benjamin F. Byrd III and Gottlieb C. Friesinger and others.

A monthly conference, that is well attended by residents and fellows, brings the two subspecialties together to discuss patients.

Graham keeps a heavy patient load despite his administrative duties.

"He's one of the few people in his position who spend as much time on patient care as he does," said Dr. Johns. "He comes in in the middle of the night like the rest of us. He's done more than his fair share," Johns said.

Graham also has an extremely gentle, caring bedside manner, Johns said.

"When a parent brings a child to a pediatric cardiologist, by nature they're very worried. "Dr. Graham puts people at ease, both the parent and the child," Johns said.

I've developed a lot of relationships with referring doctors and patients," Graham said. "It takes a long time to learn how to treat these patients and I feel like I do it pretty well now. I feel like I get more secondary gain out of dealing with patients than I do in solving administrative problems, and I am probably able to solve more patient problems than administrative problems.

"I do think it's important as your career gets on down the line to take the things you've learned and pass them along to newer faculty members. I'm beginning to do some of that."

Graham said he is enjoying his grandchildren in a way he never anticipated.

"I mentioned to Carol Ann that I thought the grandchildren are cuter than our children were, and she said 'no they're not. You just missed some of the times when our children were this cute.' "

Graham said he and his wife try to see his two grandchildren in Cincinnati about every month or two, and will try to see his new grandson in Boston as often as possible. On those weekends which aren't taken up with Vanderbilt travel and visiting his children, he will work his other two passions, golf and Vanderbilt sports, into the remainder of his limited free time.

His family vacations together nearly every year. They have hiked together in the western United States and last year in Tuscany, and will spend part of next summer in Maine. The trips must now be grandchild-friendly.

"Having grandchildren is like seeing your children growing up again. It's one of the most wonderful experiences we've had."