February 4, 2005

Intensive caring: Stahlman has always demanded excellence from herself, others

Featured Image

Mildred Stahlman, M.D., in her Medical Center North office.
photo by Anne Rayner

Intensive caring: Stahlman has always demanded excellence from herself, others

Mildred Stahlman, M.D., with her Arabian mare, Belle, at her Humphreys County farm.
photo by Daniel Dubois

Mildred Stahlman, M.D., with her Arabian mare, Belle, at her Humphreys County farm.
photo by Daniel Dubois

Stahlman and former fellow Doena Van der Vorm, M.D., perform a procedure on a lamb in the late 1970s. Through the study of lambs, Stahlman and her colleagues developed ways to diagnose and monitor respiratory distress in human newborns.
photo by Elizabeth Perkett, M.D.

Stahlman and former fellow Doena Van der Vorm, M.D., perform a procedure on a lamb in the late 1970s. Through the study of lambs, Stahlman and her colleagues developed ways to diagnose and monitor respiratory distress in human newborns.
photo by Elizabeth Perkett, M.D.

Stahlman shares a laugh with residents during rounds in the NICU, back when it was housed in Medical Center North.

Stahlman shares a laugh with residents during rounds in the NICU, back when it was housed in Medical Center North.

Half a century after she began studying lung disease in premature infants, Mildred T. Stahlman, M.D., continues her research aimed at saving society's youngest members.

The pioneering professor of Pediatrics and Pathology at Vanderbilt University Medical Center is credited with establishing the first newborn intensive care unit in the country to use monitored respiratory therapy on infants with damaged lungs.

Not content to sit on her laurels or to retire, she currently is collaborating with researchers at Cincinnati Children's Hospital Medical Center to identify the genetic underpinnings of respiratory distress syndrome, a leading killer of premature infants.

In recognition of her contributions, Stahlman, who earned her bachelor's and medical degrees from Vanderbilt, received the university's 2004 Distinguished Alumna Award last fall.

“Many people did much more than I did,” she insisted in a recent interview. “My idea of science is that everything is built on the backs of somebody else.”

Key discoveries that revolutionized treatment of premature infants were made elsewhere, but Stahlman, a past president of the American Pediatrics Society and a member of the prestigious Institute of Medicine, is internationally known for her broad vision and unflagging dedication to translate new knowledge into action.

“She has an ability to see the big picture, what needs to be done to help babies,” said her long-time Vanderbilt colleague, Hakan W. Sundell, M.D., professor of Pediatrics. “There are only a few people who have had that ability to have so much wisdom and insight, and to do something about it to accomplish change.”

Stahlman established Vanderbilt's Division of Neonatology, the subspecialty of pediatrics that deals with the care of infants immediately after birth. In the mid-1970s, she helped regionalize newborn intensive care services in Tennessee, and to date she has trained more than 80 physician-scientists from 20 countries. But her contributions don't stop at the nursery door.

“She's just as committed to developing … the poetry environment, and the arts and music, culture … as she is in understanding how a specific cell contributes to a baby's survival,” said Jeffrey A. Whitsett, M.D., chief of the Section of Neonatology, Perinatal and Pulmonary Biology at Cincinnati Children's Hospital Medical Center.

Several years ago, for example, Stahlman established a college scholarship program for high school students in rural Humphreys County, where she has a 700-acre farm. Whitsett likens her “to a hummingbird darting among the Indian paintbrushes at her farm, pollinating all aspects of modern civilization and culture.”

Stahlman's prowess as a teacher is legendary around the halls at Vanderbilt. So is her quick temper, which does not excuse sloppiness or irresponsibility. She insists that her students and colleagues assess and treat the fragile babies in their care in a precise and intellectually rigorous manner.

Until the late 1970s, Stahlman held Monday morning rounds in the nursery to go over patient charts prepared by resident physicians and interns.

“They had to have everything in order,” recalled Sundell, who came to Vanderbilt as a fellow under Stahlman in 1966. “If a chart wasn't right, she threw it to him across the room. And it was a metal bound chart!”

“She's going to pose the unexpected and perturbing, often challenging questions,” said Whitsett, who met Stahlman 15 years ago at a symposium at Vanderbilt. “She does that in a dialogue which, for many people confronted by a sharp mind like hers can be withering, but for other folks, they think, 'This is great!'”

“She never does anything without passion,” added Elizabeth A. Perkett, M.D., another former fellow who currently directs the Pediatric Pulmonary Center at the University of New Mexico. “When you are with Dr. Stahlman, you will never be bored. Your mind will always be challenged.”

No time for snobbery

A tiny woman with flashing blue eyes and graying hair usually pulled back in a bun, Stahlman is intensely serious about her work. But ask about her friendships that span half a century or the social gatherings she hosts, and her face floods with an easy smile.

For the past three decades, Stahlman has invited her fellows and their families to her log house in Brentwood during the Christmas break for a day of partying that includes shooting mistletoe out of her trees with her .410-gauge shotgun. “There's so much mistletoe, even the little kids hit some,” she chuckled.

Stahlman is no longer as driven as she was in the early days of her career, when she was chronically sleep deprived. “I was hard on everybody,” she admitted. By the end of the 1970s, “I was just burned out.”

She gave up some of her administrative responsibilities, but her commitment to research is as strong as ever. Being bored, she said in a 1986 interview, is her “definition of Hell.”

Medicine also is more than a profession to her. It's a calling, an acknowledgment of one's debt to society for being born into a life of privilege. “That's a debt you can't pay,” she said.

Born in Nashville, Stahlman was raised on Graybar Lane, about a block south of Woodmont Boulevard, which at the time was on the outskirts of town.

There was so much open land that she and her sister Ann, who is a year older, were surrounded by animals: dogs and cats and ponies, chickens, rabbits, exotic birds — Stahlman even had a baby groundhog for a time.

Their father, James G. Stahlman, president and publisher of Nashville's afternoon newspaper, the Nashville Banner, was known for his fiercely conservative political views. But he and his first wife, after whom their youngest daughter was named, encouraged their girls to be creative and independent.

When she was about 11, Stahlman was given a microscope. “I looked at flies' wings and bugs,” she recalls. “A cousin of mine had a chemistry set, which I envied greatly.” About this time, she decided she would be a doctor when she grew up.

Like most “bright and proper” young ladies of that generation, the Stahlman sisters attended Ward-Belmont, a Nashville finishing school whose alumni include Sarah Cannon (Minnie Pearl). Then it was on to Vanderbilt, in part because of their family's connections to the university — their father was a graduate and a member of the Board of Trust.

Ann Stahlman Hill would become a driving force in the development of Nashville Children's Theatre, the oldest and one of the best children's theater companies in the country.

Mildred Stahlman set her sights on Vanderbilt's medical school, and she was not going to let what she calls “snob society” get in the way of her goal. When she complained to her father that she was required to study in her sorority house, a noisy environment that made it impossible to concentrate, he advised her to “tell them to go to hell.” So she did, and found a quieter place to study.

Stahlman entered medical school in 1943. Although she was one of only four women in a class of 50, “medical school was a marvelous experience,” she recalled. “Every professor … knew you by your first name, knew who your parents were.

“I admired the people in my class … Some friendships have lasted 55 years.”

That doesn't mean it was easy in those days to become a doctor, however.

“She was trained, as I was, in an environment where your instructors were often very strong authority figures,” recalled Eric M. Chazen, M.D., a Nashville pediatrician and longtime colleague of Stahlman's who earned his medical degree from the University of Tennessee in 1955. “It was a male environment … There was no room for sentiment.”

A bed in the lab

Two early experiences helped determine the course of Stahlman's career. The first was a fellowship at the famed Karolinska Institute in Stockholm, Sweden, where she studied pediatric cardiology. It was there, she said, that she became “hooked” on the care of newborn infants — and developed a decidedly liberal bent to her political views.

Stahlman had not thought much about politics before, but in the breadth of services provided by the Swedish government, “I saw there was another way to look at the solutions to social problems.”

Taxes were high and Sweden had been neutral during World War II, but unlike the rest of war-ravaged Europe, there were no beggars and there was not a large gap between rich and poor. Academic achievement was prized. “To be a professor was one of the highest things you could achieve,” she said.

Stahlman has returned to Sweden many times and continues to have close ties with friends and colleagues there.

The second pivotal experience was her relationship with Elliott V. Newman, M.D., founder of Vanderbilt's General Clinical Research Center. Newman, whom Stahlman described as “my most important mentor,” persuaded her to do cardiopulmonary research in his division.

By 1951, Stahlman was working as an instructor in pediatrics at Vanderbilt — for $250 a month. “I paid my (lab) technician the same amount,” she recalled. “I lived in a $100-a-month garage apartment in the back yard of somebody's nice house in Belle Meade.”

In 1954, she received a small grant from the National Institutes of Health to study hyaline membrane disease, the failure of the alveoli, or small sacs in the lungs, to expand with air. When severe, the condition, also known as respiratory distress syndrome, was nearly always fatal.

For decades, sheep had been studied as a model for lung development and disease. With Newman's blessing, Stahlman kept four sheep in a now-filled-in courtyard in the 'D' wing of Medical Center North, and established a lab next to the nursery on the third floor.

Through the studies of fetal lambs, Stahlman and her colleagues developed ways to diagnose and monitor the course of hyaline membrane disease by measuring blood gases (oxygen and carbon dioxide content, and acidity) through miniaturized catheters placed in the umbilical vessel. They also began experimenting with infant “iron-lung” machines — originally developed for polio victims — to ventilate premature babies.

Vanderbilt had been given a prototype of an infant respirator in 1956, but it lay in a back storage room for years until the technology for monitoring blood gases in infants became available.

Then on Oct. 31, 1961, a baby girl was born at Vanderbilt hospital two months prematurely and gasping for breath. With the permission of her parents and the support of Eric Chazen, the baby's pediatrician, baby Martha was placed into the negative-pressure breathing machine.

The idea was to keep her alive until her lungs matured sufficiently for her to breathe on her own. Stahlman put up a folding bed in the next-door lab so she could help monitor the baby day and night. “I was there for four nights,” she said. “On the fifth day, we managed to get her weaned off.”

“A lot of it was handmade, homemade research,” recalled Martha's father, Hendersonville pathologist Jerry K. Humphreys, M.D., who at the time was a fourth-year medical student at Vanderbilt. “But it was well thought out, and it worked.”

Today Martha H. Lott is the mother of two with a bachelor's degree in biomedical and electrical engineering from Duke University. She currently is studying to be a nurse and working as a medical receptionist in the neonatal intensive care unit at Vanderbilt.

Stahlman, who became the child’s godmother, has remained a close family friend. “She could cut a medical student off at the knees, but she’s always had a soft spot for Martha,” said her mother, Lee Smith Penuel.

Pulling the woodchuck out

The treatment of respiratory distress has come a long way since those early days. Surfactant, the protein that helps alveoli expand and which is deficient in hyaline membrane disease, today is given routinely to babies born too early.

Prematurity remains a serious public health problem, however. Every day in the United States, 1,300 babies are born prematurely. Many of them will require ventilator assistance for weeks in the hospital, at a cost that can run into the hundreds of thousands of dollars. Those who survive are at increased risk of bleeding in the brain, blindness, hearing loss and cerebral palsy.

As the new field of neonatology developed, so did Stahlman's determination to prevent diseases of the newborn from occurring in the first place. That means, ultimately, working to alleviate poverty — an important risk factor for premature delivery.

“We cannot afford to ignore the cumulative results of lifetimes of poor medical and social care on pregnancy outcome much longer,” she wrote in the Journal of Pediatrics in 1996. “Band-Aid medicine will no longer suffice. We must prevent what we cannot cure.”

That same year, in an address to the American Society of Pediatrics, Stahlman lectured her peers “about what really makes babies sick in our communities, which is accidents, violence, social, economic issues,” Whitsett recalled. “As pediatricians, if we really want to take care of our children broadly, we need to look outside our intensive care unit.”

With Whitsett, who helped pioneer surfactant therapy, Stahlman is continuing to take the long view in her research as well. They and their colleagues are studying genetic mutations that may — through the production of misfolded proteins — contribute to respiratory disease in adults as well as newborns.

“We've got already three or four genes that we're identifying in our mice and in our babies that turn out to be genes critical to pulmonary fibrosis,” Whitsett said. “It's a whole new way of thinking about lung disease … And Millie's been involved in all that work …

“She has this wealth of clinical experience, as well as understanding the structure and the progress of lung disease in the baby,” he said. “I'm talking to her an average of two to three times a week,” he said, often to brainstorm a particularly vexing research problem.

“The two of us are both characterized by persistence, and some people would call that stubborn,” Whitsett said. “But you've got to get it right, and if you've got to get into the hole and pull the woodchuck out, that's what you do.”

On a wall in her ground-floor office in Medical Center North, amidst stacks of research papers, microscopes and five decades' worth of memorabilia, hangs a poster of Albert Einstein.

When asked about it, Stahlman described the 12-foot-tall statue at the National Academy of Sciences in Washington, D.C., which depicts the famous physicist “sprawled out, disheveled, extremely relaxed, not professorial — not even intelligent.”

Some people don't like the sculpture, Stahlman said, because it conflicts with their view of what the Nobel laureate should look like. “But it shows that he was human,” she said. “I like it.”

That remark is quintessential Stahlman — confounding stereotypes, opening her mind to the world, and always, always, challenging others to do the same.