August 26, 2005

VUMC Reporter Profile: Intense caring fuels Guy’s fire

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Jeff Guy, M.D., associate professor of Surgery and director of Vanderbilt’s Regional Burn Center.
photo by Dana Johnson

VUMC Reporter Profile: Intense caring fuels Guy’s fire

Jeff Guy, M.D., medical director of VUMC's Regional Burn Unit, visits with patient Joe Lee and his wife Lora during rounds in the burn unit. Guy commended Lora for doing wound care herself in preparation for her husband’s release.
photo by Dana Johnson

Jeff Guy, M.D., medical director of VUMC's Regional Burn Unit, visits with patient Joe Lee and his wife Lora during rounds in the burn unit. Guy commended Lora for doing wound care herself in preparation for her husband’s release.
photo by Dana Johnson

Guy conducts rounds in the burn unit with Ravi Tandon, M.D.,Thor Milland, M.D., Anne Conquest, M.D., and Laura Eichhorn, M.D., all resident physicians. 
photo by Dana Johnson

Guy conducts rounds in the burn unit with Ravi Tandon, M.D.,Thor Milland, M.D., Anne Conquest, M.D., and Laura Eichhorn, M.D., all resident physicians.
photo by Dana Johnson

The Guy family of six makes family time a priority. From left, Spencer, 2, Danielle, 11, Christian, 9, mom Deanna Aftab Guy and Madeline, 5, help Jeff Guy bathe their three golden retrievers on a hot Sunday afternoon.
photo by Dana Johnson

The Guy family of six makes family time a priority. From left, Spencer, 2, Danielle, 11, Christian, 9, mom Deanna Aftab Guy and Madeline, 5, help Jeff Guy bathe their three golden retrievers on a hot Sunday afternoon.
photo by Dana Johnson

Guy ran in his first marathon, the Music City Marathon, in April.
photo by Dana Johnson

Guy ran in his first marathon, the Music City Marathon, in April.
photo by Dana Johnson

It definitely wasn't funny when it happened back in 1991, but Deanna Aftab Guy finds it quite amusing now when she talks about the day Jeff Guy left her high and dry during a haircut.

The couple, newly married house staff in Akron, Ohio, were at a salon. Deanna was in the chair first, when a serious automobile accident occurred outside the hair salon. Her paramedic-trained husband bolted out the door, helped stabilize one of the patients, and then hopped in the ambulance, holding the victim's airway open on the ride to Akron General, the hospital where he was a general surgery intern.

Great for the patient; not for Deanna. “Jeff drove a stick shift. I couldn't drive his car. I was stuck, and I was so mad. I understood it, but I was mad. I asked him later, 'what are you, a scout for Akron General or something?,'” she recalls, laughing as she tells the story, and laughing a little harder when she told how after a couple of hours, the fire truck returned, bringing Guy back to the hair salon.

The example pretty much sums up Jeff Guy, say those who know him well.

“If Jeff hears lights and sirens, he's running,” says his wife of 14 years, a pediatric endocrinologist at Vanderbilt University Medical Center. “He wants to be with the helicopters, in the patient's throat, intubating. That's why he's very good at what he does. He gets an adrenaline rush and never burns out.”

An ironic choice of words to describe the 38-year-old physician who has directed Vanderbilt's Regional Burn Center since 1999.

Guy, associate professor of Surgery at VUMC, is described by those he works with as a highly driven, but uniquely compassionate individual. He came to Vanderbilt in 1999 from the University of North Carolina at Chapel Hill, where he was an instructor in the Department of Surgery.

A rotation in the burn unit when he was a resident in Akron sparked an interest, and Guy chose to pursue additional fellowships to be fully trained to care for burn patients. When he finished training at Chapel Hill, he was looking for a place that fit with his expertise — treating both trauma and burn patients — in a city that would be ideal for raising a family. He settled on Vanderbilt, because of the hospital's reputation and the “livable” city of Nashville.

“I wrote John Morris (the director of Vanderbilt's Division of Trauma and Surgical Critical Care), and he answered my call. He and Dr. (Jim) O'Neill (former chairman of the Section of Surgical Sciences) made my dream come true,” Guy said.

At Vanderbilt, about 90 percent of his patients are burn patients, a complicated group with complex physiological and emotional needs, but he also sees trauma patients, although not as many as he would like.

“Trauma surgery is a game of immediate gratification. It's a different kind of rush,” Guy said. “Treating burn patients is like running a marathon. You think about making it to the next tree, the next corner. Burn patients have months or years to get better. You take it in pieces. They are very difficult patients to take care of, because you lose a lot of people, but you also make a difference. Everybody who works in our burn unit — doctors, nurses, technicians — are all there because they want to be there. And we're like a family. It's a great commitment, but it is very rewarding. You hear many thank you's in this specialty.”

Guy said the burn patient's family often has more to worry about than just getting their loved one well. “If a family loses a patient to cancer, it's horrible, but they can go home and look at their memories and put their lives back together,” he said.

“A burn patient's family member goes home and the wedding pictures may be gone, and all of their memories. You just can't treat the patient. You have to treat the whole unit.”

Family plan

Nobody knows the truth of that statement more than Denise Harper, the sister of Fran Harper of Hartsville, Tenn., who was burned deeply over 35 percent of her body in a grease fire on March 3. Fran Harper, with her sister by her side most days, has spent more than 100 days at Vanderbilt.

Denise Harper says that Guy was brutally honest from the beginning, telling the Harper family that Fran's chances for survival were slim.

“But he told me at that very first meeting, 'I'll treat her like I would treat my sister,'” she recalls. “He told us it wasn't going to be pretty, but he helped relieve a lot of fears.”

Since March, Guy has not only taken care of Fran, but has helped the family with financial pitfalls, including helping locate a rehabilitation center that will help her sister heal more fully. Harper family members have been out of work, taking turns sitting with Fran, and a family funeral recently drained what little they had.

“One rehab center was going to charge us $13,000, and I was about to sign the agreement,” Denise says. “I would have signed my name in blood to get her what she needed. When I saw Dr. Guy one day at the Hospitality House, he said, 'hey honey,' and said he heard I was having a rough day. I told him I was kind of scared,” she said.

“When he found out what was going on, he wasn't real pleased. He told me not to worry about it, that we had gotten her this far, he wasn't going to let her fall.” Guy found a rehabilitation center where Fran could go at no out-of-pocket cost to the family.

“I've been a nurse for 14 years, and I have never seen a doctor go to bat for a family like that,” Denise said. “We have nothing, and he stood up for us. He knows my whole family by name. It's like he's family. He's like the guy next door that you grew up next to, who cares for your family as much as you do.”

Guy said Fran Harper is one patient who clearly beat the odds. “This is a woman I was convinced was going to die, and her family never wavered, never gave up hope. Sometimes we quote the statistics too much. People do survive.”

Naji Abumrad, M.D., professor and chair of General Surgery, says that Guy is driven. “He cares about these patients. These are incredibly tough patients and he knows every aspect of their lifestyle, every aspect of their economics, their social life, their ills, their pain, their passions. It's not unusual for a doctor to have these qualities, but not with the intensity he does. I don't know what it is, but you know what, I want my son to be just like him.”

Formative years

The desire to help families through rough financial times may have come natural to Guy since he's quite familiar with poverty. “I grew up knowing poverty in capital letters,” he said.

Guy was born and raised in Champion, Ohio, and his parents were divorced when he was young. His mother worked two jobs — as a bank teller and at a grocery store — to support Guy and his sister. Mrs. Guy died the day her son, the first in his family to go to college, passed his surgery boards. His father, who left the day before Christmas when Guy was 12, didn't see his son again until his mother's funeral. “We were not the Cleavers,” he said.

He received a full scholarship and started a six-year B.S./M.D. program at Kent State one week after delivering the valedictory address from his high school. After his internship in Akron, he did a fellowship in trauma surgery research at Case Western Reserve University in Cleveland, and surgical critical care and trauma surgery and burn surgery fellowships at UNC-Chapel Hill.

In 1998, he received the Charles Fox Traveling Burn Fellowship from the American Burn Association and studied at five institutions, including Massachusetts General and the Shriner's Burn Institute in Boston.

He had known since his grandmother died of a heart attack that he wanted to be a doctor. As a child he carried around a fishing tackle box with tape and Band-Aids pretending it was a medic's drug box.

In college, he received paramedic training, and to this day, misses the thrill of being on the scene of an emergency. He has compensated by directing the paramedic training program at Columbia State Community College for the past five years.

Guy is also the associate medical director and editor of Prehospital Trauma Life Support (PHTLS), the largest prehospital trauma training program in the world. The organization has trained people in more than 35 countries, and Guy recently trained providers in Spain following the terrorist bombings in Madrid.

“The hospital is a very sterile environment. If you need a unit of blood or a mocha latte with soy, it appears in your hand,” Guy said. “When you're a paramedic, you carry all the supplies you need on your back. You might be doing CPR in front of the patient's family in their living room. It's really a more challenging environment than the hospital, and you get to see where your patients live.”

When he was a 20-year-old college student, working as a paramedic, he was inside a wrecked vehicle caring for a trapped patient when it exploded. He and his partner got out, but had to stand and watch the trapped man burn to death.

“I thought I had seen a lot of emergency crises, but I wasn't prepared for that,” he said. “Even though a crew was there, we couldn't do anything. It was overwhelming and leaves a stain on you.” But it set in motion the path of his career.

When Guy talks about some of his former patients, he gets emotional, especially about the children he has cared for. He remembers the Christmas of 1998 when he was a fellow, and a 6-year-old boy was burned over 70 percent of his body and suffered inhalation injuries when a space heater blew up in his garage. His father was also burned, but not as badly.

The child's name, ironically, considering the time of the year, was Emmanuel, and he was very close to death on Christmas day.

“We worked all day on Christmas day, trying to keep him alive. The next morning, he died, and the machines were off and everything was so quiet, and his father heard the quietness when he came down the hall, and he just knew,” Guy said.

“You could hear him sobbing, and I had to tell him that his son died, and this dad, he thanked me for doing everything I could,” Guy said, his eyes filling with tears and his voice choked with emotion. “I got a Christmas card a year later from Emmanuel's father, thanking me again. Sometimes you just can't put the pieces back together again,”

But he sure does try.

“I've rarely seen this in doctors, and I'm not just saying this because I'm married to him,” says Deanna. “He will never stop working. He will never give up until he has to. You'd think somebody like that would go way overboard and not know when to stop, but not Jeff. On the other hand, he'll sit with a family, hold the patient's hand, and let them die with dignity. I don't know how he knows the difference, but he does, and he does both so well,” she said.

Guy says being a burn doctor is a never-ending process of peaks and valleys. “The losses make the wins much sweeter. And there is such a thing as giving a patient a good death. If you can't save a life, you can give the patient a dignified death.”

As many as a third of Vanderbilt's burn patients at any given time have been burned in methamphetamine explosions.

The patients are challenging to care for, and Guy is concerned about the financial burden the patients bring to Vanderbilt's Burn Center.

Guy said he doesn't judge those patients who are burned in methamphetamine explosions. “These may be bad people by anyone's standards, but I'm just a doctor. I'm not a judge or an executioner. Some of these people have just made a mistake.”

But Guy told Newsweek in an August cover story on the methamphetamine crisis that if Vanderbilt continues to take on the large burden of $5 million to $10 million per year in uncompensated care, "I don't know if we will have a burn unit five or 10 years from now.”

Guy is frequently in the news, both locally and nationally, and has been quite vocal on a variety of topics including the methamphetamine crisis and the need for legislation to require sprinklers in nursing homes.

The home front

Long days at work don't leave much time for anything else, but Guy makes certain that he reserves quality time with his family.

Guy and his wife have four children, Danielle, 11; Christian, 9; Madeline, 5; and Spencer, 2. Guy, Deanna (brown belts) and Danielle and Christian (black belt candidates) take karate together. “A family that kicks together, sticks together,” he says. Guy says his children know he's not spending time away from them frivolously. “Sometimes it's tough when you miss a recital, but they understand that somebody's hurt and Daddy's going to help.”

Deanna says her husband is extremely appreciative of all he has, not just because he has a good marriage and great kids, but because of a brush with death in 2003.

After complaining of occasional stomach pain for several years, Guy was on his way back into Nashville from an out-of-town meeting when the pain became intense. He made it home, and after calling his wife at work, called an ambulance to his home in Brentwood. He asked them not to come with lights and sirens so his children wouldn't be scared, and the paramedics who arrived were ones he had helped train through the Columbia State program.

Guy had a sigmoid volvulus, or an intestinal obstruction, and had surgery to cut out some of the bowel. He recovered nicely, but a week later, the day he was discharged from VUH, the bowel perforated, and he was rushed to the hospital, critically ill, this time to stay in the trauma unit for two weeks.

Deanna would work during the day at Vanderbilt, rush over to visit when she could, and go home at night to take care of their children.

“I can do anything. Trust me, I'm a very strong woman, but at night I would break down, thinking 'oh my God, I can't do this,'” Deanna says. “Jeff works his butt off at work, but he's really good with certain things at home — one on one with the kids, Boy Scouts, outside the home stuff. When I had this thought of losing my husband, it really hit me that I couldn't do it without him.”

Once Guy healed, he took stock of his life, picked up karate and decided to train for a marathon, getting up at 4:30 each morning to run. He ran his first this year, the Music City Marathon, and finished with a time of 4:04:32. “I'm so type A that I figured I wouldn't do well if I couldn't win,” he said. “But just being in it was intoxicating. I've never felt more alive.”

And grateful.

Guy and his wife are discussing the possibility of adopting one or two children from China once their youngest is a little older.

But for now he's making sure the time with his children is well spent. He reads to them at night, likes to cook with 5-year-old Madeline, and Sunday nights are family movie nights.

Guy says working with burn patients day in and day out has made him more aware of the fragility of life and more appreciative of his own good fortune.

“If you get stuck in traffic, well, it's just hard to have a bad day,” he said. “Life has more value when you see lives crumbling around you,” he said.