August 30, 2002

Nurturing leader — Deborah German is dedicated to helping Vanderbilt’s medical students

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Dr. Deborah German talks with first-year medical student Bob Thiele during the curriculum fair last week. (photos by Dana Johnson)

Nurturing leader — Deborah German is dedicated to helping Vanderbilt’s medical students

German discusses the characteristics of a good doctor during the first-year medical school orientation. The "Good Doctor" talk is an annual event on the first day of medical school.

German discusses the characteristics of a good doctor during the first-year medical school orientation. The "Good Doctor" talk is an annual event on the first day of medical school.

German props her foot up while reviewing charts in a clinic conference room before seeing patients. She suffered a lisfranc fracture this year after a fall.

German props her foot up while reviewing charts in a clinic conference room before seeing patients. She suffered a lisfranc fracture this year after a fall.

Julie Neaderthal, a physical therapist with Rehabilitation Services, checks German's foot during a recent appointment. German is confident she will run again.

Julie Neaderthal, a physical therapist with Rehabilitation Services, checks German's foot during a recent appointment. German is confident she will run again.

German examines patient Debbie Douglas-Jones in the rheumatology clinic. Before accepting the administrative position at Vanderbilt, German made sure she could continue her medical practice.

German examines patient Debbie Douglas-Jones in the rheumatology clinic. Before accepting the administrative position at Vanderbilt, German made sure she could continue her medical practice.

In 1972 when Deborah Campano traveled from Providence, R.I., to Boston for a Harvard Medical School admissions interview, her Italian immigrant grandfather gave her some advice. “Be on your best behavior. Harvard is where all the smart people are, the really refined people,” he told her.

What she found was quite the opposite.

When she entered the office, her interviewer, the school’s dean of admissions, was sitting behind his desk. Her application, written in peacock blue ink (she couldn’t afford a typewriter), was open on his desk. The imposing Foster looked at her and asked, “Who are you and what makes you think you’re good enough to come here?” The stomachs of most hopeful medical students would have flipped. Not Deborah Campano’s.

“I looked at him and thought: ‘My goodness, this is where all the refined people are? My grandfather told me to be on my best behavior? How sad this man doesn’t know how to treat people, that he doesn’t seem to have any manners at all. He could learn a few things from my grandfather.”

What she said was, “Dr. Foster, I’m Debbie Campano. I’d like to answer your question. I think that’s my application on your desk. Can I make a suggestion? I’d like to suggest you take a few minutes and read through it, and then when you’re done, if you have any questions, I’d be happy to answer them.”

“I knew that he knew who I was,” she said. “He was looking at my application.”

Foster went from grim to stunned. Then he smiled. “Well, Miss Campano,” he said, “you’re everything they said you were and more.”

Campano, now Dr. Deborah C. German, is Vanderbilt University School of Medicine’s senior associate dean for Medical Education. She is well known for tackling complicated issues head-on and speaking her mind. She came to Vanderbilt in 1988 as associate dean of students, counseling and mentoring medical students at Vanderbilt and designing a number of electives that took medical students out of the classroom and into the community. She served in that capacity until 1999 when she assumed the new senior associate dean’s role. She is also a visible national figure in medical education, having leadership roles with the Association of American Medical Colleges and other national medical associations.

“Debbie is truly amazing,” said Dr. Steven G. Gabbe, dean of the Vanderbilt University School of Medicine. “She does everything so well, from counseling a student one-on-one to leading our curriculum revision process, to chairing the AAMC’s group on student affairs. She is an extremely creative and incredible role model for our students whether they be men or women, but she’s an especially important role model for women in academic medicine.”

Growing up with a can-do attitude

German grew up in Providence, R.I., the younger daughter of Mentana and Pasco Campano. Her high school-educated parents pursued additional training to support the family — cosmetology for her mother, mechanical engineering for her father. Early in German’s life, her family lived with her maternal, Italian-immigrant, Italian-speaking grandparents in a bustling home.

“When you grow up in that environment, you get kind of a can-do attitude about this country, the land of opportunity,” German said. “It was a large, noisy, busy family environment. Lots of ordinary people — aunts, uncles, cousins and a lot of hopefulness about the future.”

The decision to become a doctor didn’t happen early in life for German. “Throughout my childhood I knew I wanted to work with people. I didn’t know if I was going to be a teacher, doctor or a veterinarian,” she said.

Animals have always been an important part of German’s life. “There’s not a pet alive that I haven’t had — ducks, snakes, rabbits, chickens, anything that could conceivably be called a pet, I’ve had.

“In high school I wasn’t sure what I wanted to do with my life. I thought about medicine a lot. I thought about science a lot, the idea of curing cancer, winning the Nobel Prize, all those thoughts that children have,” she said.

When the petite German mentioned the idea of becoming a veterinarian to her high school guidance counselor, she was told she’d be too small to handle cows and horses and suggested she become a pediatrician instead.

German attended Boston University where she at first thought she’d pursue research as a career. She majored in chemistry and published her first paper, “The Generation of Radicals in the Charge Transfer Photochemistry of Coordination Complexes of Cobalt (III) in Aqueous Solution” in the Journal of Physical Chemistry as a college junior. With a partial scholarship, she worked her way through college as a dormitory resident assistant and a chemistry tutor for the football team. She graduated in 1972 at the top of her class.

Yale or Harvard or Penn or Johns Hopkins?

The decision to attend medical school wasn’t nearly as difficult as the decision where to attend medical school.

German received acceptance letters from every medical school to which she applied. She liked the University of Pennsylvania best — the people were friendly and she was impressed by the school’s long history and rich tradition. But she would have to attend on 50 percent scholarship and 50 percent loan — something she didn’t want to do since she had graduated from college debt free.

“When my letter came from Harvard, I called my parents to tell them and they were very excited,” German said. “I also told them I didn’t want to go there. My experience interviewing there led me to believe it would not be a friendly, supportive place to learn medicine.”

She sent a letter of regret to Harvard, turning down their offer. The next day, before her letter had time to reach Harvard, she received another letter from Harvard — this one offering a full scholarship (the Charles Smith Bequest) plus spending money. She called the admissions office, telling them she had already sent her regrets, and they asked her to reconsider and write a second letter if she was sticking by her original decision.

“My parents didn’t know what to say to me. They had no frame of reference, so they asked their family doctor, a Yale graduate, and his advice was for me to go to Harvard,” German said. “I took his advice. I decided that there are people out there who know more about this than I do.”

At Harvard German found that there were obstacles — she was in one of the first classes to have 10 percent to 20 percent women —- but the obstacles weren’t insurmountable. She felt that her Harvard education should have included more about the emotional and spiritual needs of patients, in addition to teaching students about the basic mechanisms of disease. The structure of her Harvard education was also hierarchical, which was a different way of learning from what she was used to.

“When you’re from an Italian family, there are lots of discussions, lots of questions, there’s always a free exchange going on. This wasn’t the case at Harvard,” she said.

“But overcoming the obstacles was good for me. One of the things I’ve learned is the bigger the obstacle, the bigger the lesson and the more you gain when you conquer something,” she said, adding that some of her concerns about her own medical education gave her a different way of looking at educating others.

“It’s given me a way of thinking about education that is different. I like to think that if we eliminate some of the obstacles for our students, like dealing with administration, orientation, the nuts and bolts pieces of being a medical student or a resident, they will have more energy to deal with the obstacles that are even greater today than they were when I was a medical student. We can help them use their energy for some of the important things.”

German, who had grown up in a frugal household, continued her modest spending in medical school, even with the scholarship’s spending money (she chose the minimum amount offered).

“In medical school I had some don’ts, including never use a vending machine. That’s still a habit,” she said. “There’s nothing in a vending machine that’s healthy and nothing in a vending machine that’s a bargain.”

A good cook, she rarely bought prepared food. Instead of pizza or burgers, she would buy whole chickens and fresh vegetables.

“I would buy the cheapest food in season, take it home, cook it, and make it last. I lived very cheaply. I ended up with more money in the bank at the end of medical school than in the beginning, because I didn’t even spend the minimum amount they gave me.”

She was also popular with male medical students who would buy food and have her over to cook for them.

At Harvard she was the first woman president of the Harvard Medical School Lecture Service and was named Aesculapian, an honor at graduation given to students who are leaders and embody the spirit of the good doctor. It was Harvard’s equivalent of Alpha Omega Alpha, the medical honor society, at the time. In her fourth year of medical school, she had a rotation at Robert Breck Brigham Hospital, a hospital for patients with rheumatic diseases. It was there that she learned that she loved rheumatic diseases.

“I noticed later in my fourth year that whenever a patient became very sick and nobody knew what was wrong with them, they always called a rheumatologist. That had a certain appeal to it. I loved studying the muscles and skeleton, and even thought about being an orthopaedic surgeon, but I wasn’t sure that that was the lifestyle I wanted.”

Beginning a career and family

Married to Lawrence German, a fellow college and medical student, between her first and second years of medical school, German headed to Strong Memorial Hospital in Rochester, N.Y., in 1976 for an internship and residency in internal medicine. The concept of treating the patient as a person, not as a disease, was well developed at the University of Rochester.

“In different phases of training, you look for different things,” she said. “In the residency phase of my training what I really wanted was to learn how to care for the patient,” she said. “I felt I wouldn’t learn that as well at Harvard, so Rochester was my first choice. I was very happy to go there, although I was advised by many people at Harvard that I was making a big mistake (leaving Harvard).”

The Germans wanted children, but planned the timing carefully, waiting until she was a senior resident to have her first child.

“I thought it was unethical for me to have a child during my internship year. I was on the steepest part of my learning curve, and I was under contract with the program to do a certain kind of work,” she said. “If I had a baby at that time, I wouldn’t fulfill my contract with the residency program in the way that was expected. That’s the way I saw it then, and if someone asks me today, I would say that since we can plan these things, you might as well plan them at a better time. When you look at your training, there are certain years that are just busier, fuller, and the internship year is one of those.”

At the end of her internship year, she applied for a fellowship in rheumatic diseases, three years away. She and her husband were already planning to have a baby just before her fellowship began. During the interviews she would ask for five minutes with each program director so she could be candid about her family planning.

“The only way I could see making all this work was being straight with people,” German said.

She particularly remembers her conversation with Duke’s Dr. Ralph Snyderman, who was the program director for the rheumatic diseases fellowship and is now Duke’s Chancellor of Health Affairs.

“There’s something you need to know about me,” she told Snyderman. “I plan to have a three-month-old child when I arrive here and here’s what I want: I won’t do any outreach. I won’t sleep in another town to see patients. I’ll sleep at home with my child. And I’m not going to start in July. If you take me, I’ll start in December. The reason is that I can’t move to a new city with a brand new baby and just dump him or her in day care. I’m going to need six months to make sure I’m comfortable about leaving my baby.

“I just wanted you to know this because I want to be the best mother I can be and I want to be the best resident I can be, and this is the only way I can do both things well. If you don’t like what I just said, please reject me because I don’t want either one of us to be disappointed.”

German got the Duke fellowship, and had her first daughter, Laura, in 1979 during her senior residency year at Rochester. She was the first person in her residency program to have a baby. There was no maternity leave, so she had Laura on Sunday, April 1, took a week of vacation, and was back at work the following Monday. After her senior residency the Germans and their infant daughter moved to Durham. Before she began her fellowship six months later, she grew vegetables and made organic baby food for Laura. She made a baby quilt and refinished furniture for their home.

“I went nuts. There weren’t enough things for me to do,” she said. “Taking care of Laura was wonderful, but babies sleep a lot.”

Guilt, Italian style

From 1981 to 1988 German advised subsequent fellows at Duke on career and family issues and led the Dean’s Committee on Women, establishing policy on family leave, child care, promotion and salary equity. After German’s second daughter, Julia, was born in 1981, she turned down an assistant professor faculty position. Instead, she accepted a prestigious, but less stressful, position as an associate investigator with the Howard Hughes Medical Institute. “I changed my career path because I had children,” she said.

German studied adenosine metabolism and presented her research nationally and internationally. “It was a nice life. Research life was hard, it was a lot of work, but it was flexible and allowed me to be a mom the way I wanted to be a mom.”

At 4 p.m. every day, when she was finished with her research work, Laura and Julia’s nanny would bring them to join her at Duke’s wellness facility, where she taught an aerobics class. The four- and five-year-old siblings would do the aerobics routine in the back of the room while their mom led the class. While doing everything she could to spend quality time with her daughters, German spent much of her time feeling guilty, wondering whether her daughters were getting enough of her attention.

“When you’re raised an Italian Catholic, you are raised to have guilt. And the guilt about your family has to be the biggest guilt you’ll ever have, especially if you’re raised by a stay-at-home Italian mom. There’s no way not to have that guilt.”

Then came “the epiphany.” One winter day in 1984, when German was director of the gout clinic at Duke, it snowed. There was no preschool for her daughters and the German’s nanny didn’t drive in the snow. The gout clinic started at 8 a.m., and there would be 30 patients waiting to see her, in addition to a group of residents, fellows and interns. Staying home wasn’t an option.

She got the girls ready and gathered their coloring books, crayons, lunches and snacks. About 7:30 a.m. she fastened them in their car seats and backed down the driveway.

“In the back of my mind, I was thinking ‘you’re an awful mother. When you were a child, you would have been out playing in the snow. Besides, in North Carolina it doesn’t even snow that often.’”

As they backed down the driveway, their next-door neighbor Sabrina, the wife of an anesthesiologist and mother of two young children, was in her robe and boots walking down the driveway to get her newspaper.

“Julia said ‘Mommy,’ and I cringed because I thought she was going to say ‘why can’t we stay home and play in the snow like Shawn and Ryan?’ I braced myself. Instead she said, ‘Mommy, I feel so sorry for Sabrina. She doesn’t have a fun job to go to.’ And suddenly it dawned on me that their life experience was not mine. What they saw that day was a mom happy to get out in the snow and go to work. I loved what I did.”

Her daughters have always come first, but sometimes it was hard sharing a mom with her career.

“I’ve tried to include them in my life as much as possible, and have spent so much time with them, but you don’t necessarily have to build your life around them. You build them into your life,” German said.

Julia German, who is now a senior at the University of Colorado, said as an adolescent it was sometimes hard to share her mom. But she learned some very important life lessons through her mother, including it’s hard to be successful at two things (parenting and a career) but entirely possible. Once German was a half hour late picking up Julia because she had been counseling a student whose family had been killed in a car accident.

“She was at Vanderbilt counseling this person who was going through the hardest thing she had ever experienced in her life, and I was just a stuck-up kid. I was fiery mad, so, so upset because I had a bad day and Mom was late picking me up,” Julia said. “But she was upset too because it affected her. It was a killer good lesson for me, knowing that I had been sitting there waiting, but this student was having it way worse than me. My mom has helped me learn more about being human and compassionate in ways I probably couldn’t have learned anywhere else. When you’re young, your family tends to be your own community, but the world’s bigger than that.”

In 1985 German became director of part of Duke’s Internal Medicine training program and an associate dean for medical education at Duke University Medical School. In 1988 her husband accepted a job in a private cardiology practice at St. Thomas Hospital and the family moved to Nashville. German decided to take some time off until a job came along. She didn’t have long to wait.

At Vanderbilt

Although German had envisioned herself as an academic physician with a research and patient care focus, she took a bit of a detour when she moved to Nashville and was offered the job of associate dean of students at Vanderbilt. She followed Phil Felts and was the first woman in the Dean’s office.

“I love education and one of the things I wanted to be as a child was a teacher,” German said. “I have this feeling about life. You have to give it thought and planning and you will find there’s a range of things you can do to be successful. Success isn’t worth anything if you’re not happy.”

At Vanderbilt she talked Dean John E. Chapman, who hired her, into letting her have a small private practice (one half day a week) in addition to her administrative duties. “I told Dean Chapman, ‘I can give up research, but I went to medical school to be a doctor, so I won’t give up patient care.’” Chapman agreed to let her practice medicine.

“She has a blend of energy and intellect, and more than anything else she’s innovative,” Chapman said. “She has an expressed interest in the welfare of the student, the welfare of the institution and the relationship between the two.”

As dean of students, she went above and beyond her job description, creating a number of new electives for students as well as a community scholars program. She created an action group for research, which became the medical school’s Introduction to Biomedical Research course, and spearheaded putting together a number of joint degree programs. She has been behind plans to redesign the curriculum and to integrate clinical care and the basic sciences in early and late medical school.

“As dean of students, students would often come in with problems and she would help them turn their situation around. They’d leave with a solution,” said Benita Stubbs, German’s administrative assistant since 1988. “She moves fast. She’s very demanding, but in a nice way, and she’s good to work for. We work well together.”

German has been recognized both locally and nationally for her achievements in medicine. She received the Alpha Omega Alpha Faculty Award and the Class of 1996 named a scholarship in her honor. She was a Harvard Macy Scholar at the Harvard Macy Institute Program for Physician Educators from January to May of 1997, and has assumed numerous leadership roles in the AAMC’s student affairs groups, the American Medical Association and the American Medical Women’s Association. She also received Nashville’s Athena Award in 2000, designed to honor a Middle Tennessee woman who embodies the qualities of the goddess Athena and personifies the highest level of excellence within family, vocation and community service.

In 1999 German and her husband divorced.

“Divorce is always difficult,” German said. “It wasn’t something I wanted, but having gone through it, it worked out well for both of us.”

Lawrence German, who is fighting pancreatic cancer, lives in Albuquerque, N.M., and is married to a nurse who worked for him in Nashville.

Although her spare time is scarce, German has no shortage of things to do. She reads all types of books, cooks, gardens, and always has an athletic goal.

She ran in the Honolulu Marathon last December and raised $10,000 for the Arthritis Foundation.

“I had never considered myself a runner, and originally thought I would walk in the marathon, but it was boring walking hours and hours in training,” she said.

So she took up running and finished in the top 8 percent of her age group, and in the top half of 20,000 runners.

Her current athletic goal is to re-learn how to walk.

In June she fell from her front steps and broke her foot and suffered a lisfranc fracture involving many bones in her foot. In orthopaedic surgery seven wires and two screws were placed in her foot. She spent two weeks at home and still can’t bear any weight on her foot for another 10-12 weeks. She’ll have another operation in three months to remove the screws and will start the healing process all over again.

“I expect to be back to normal in six months. I told my surgeon, a former student of mine, I wanted to be able to walk again, to wear high heels again and to run again. He said I would hopefully be able to do the first, but we’d have to see about the other two. But once I walk again, I’ll run again.”

But for the time being German will have to settle for being pushed. Before her fall, she volunteered to serve as captain of the Juvenile Diabetes Research Foundation International Diabetes Walk on Sept. 21. Not one to quit, she’s invited volunteers from the four classes of medical students to help her in the walk, which is being chaired by Dean Gabbe.

“It occurred to me that maybe I could still ‘walk’ in a wheelchair with a team of pushers. I am not sure I have built up enough upper arm strength to do it on crutches or alone in the chair,” German wrote to the students.

She ended her e-mail to students with a suggestion.

“Be good to your patients and NEVER take your legs and your ability to walk for granted."