VUMC Reporter Profile — Sell’s pioneering career defined by humility, strength

VUMC Reporter Profile — Sell’s pioneering career defined by humility, strength

When Sarah Sell, M.D., was a young pediatrician at Vanderbilt, some of her sickest patients suffered from meningitis caused by Haemophilus influenzae type b (Hib).

Most of the patients were under 5 , and many would suffer long-lasting effects — blindness, deafness, mental retardation, learning disabilities or even death — no matter how quickly they were diagnosed and treated.

“By the time we got them, they'd be burned already,” Sell recalls, also affectionately known as ‘Sally.’ “I like to compare them to young trees growing in a forest, and a forest fire goes through and you put out the fire but you still have all that charred stuff left on those young trees. And that's what we had left, what the fire had left behind.”

So Sell, professor of Pediatrics, Emerita, “set about trying to work on that,” and was one of the key players in the development of the childhood vaccine to protect against Hib. The premise — that it was easier to prevent a disease than cure it.

One of her early research projects followed 100 children with bacterial meningitis who had been cared for on the Vanderbilt pediatric wards. They were matched up with an equal number of public school children in the third and fourth grade, and both groups of children underwent psychological testing at Peabody.

“We found that in the children with meningitis, their intelligence as a group was limited,” Sell said. Forty percent had problems.

“This showed us without a doubt that no matter how fast you treat them, how early you diagnose them, all these tricks we were trying to do to be better doctors, wasn't enough.”

Her initiatives led to the licensure of several conjugated Hib vaccines in the late 1980s and early 1990s. These vaccines have been so effective that they have virtually eliminated this devastating disease in young children in the United States.

Helping hands

In 1972, Sell, who graduated from Vanderbilt University School of Medicine in 1948 and joined the faculty in 1954, organized a gathering of 38 investigators on the cutting edge of Hib research, in order to gain a better understanding of the Hib bacteria.

The three-day meeting, held at Vanderbilt, was the stimulus for the development of the vaccines and was paid for by a $10,000 donation from Sell's former roommate from her graduate school days.

“I wrote to her excited about the possibility,” Sell said. “I mentioned that we hoped Eli Lily would give us enough money to work on the vaccine because we were convinced the only way to cure is to prevent, and she wrote back, 'Darling Sally, Would this $10,000 check help? You don't have to work with the drug company. I'll help you.'

“However, we did receive some funds from Atlanta, from the CDC,” Sell said.

Sell recalls that it was important for the 38 clinicians and scientists gathered at Vanderbilt to set aside their egos before the meeting began.

“A lot of these people were pretty egocentric, and I said, 'we're all here together for a purpose, to find a way to prevent this meningitis. I beg you while you're here, put your egos aside, and instead of trying to outdo each other, let's really try to find a way to prevent this thing.' And it started the snowball rolling,” she said.

In a 1986 study, Hib was found to be the most common cause of meningitis, responsible for 45 percent of meningitis cases. Before the widespread use of Hib vaccine — which children currently receive four times between 2 months and 15 months of age — about 20,000 children under 5 in the U.S. got severe Hib disease each year, and nearly 1,000 died.

Sell, who is also known for her work with the bacteria associated with otitis media (middle ear infections), recalls sleepless nights when the Hib vaccine was being developed. “I just lived with it. It's great having something larger than you to think about.”

Dirty work

Humility was in her genes. So was determination.

Sell started thinking about becoming a doctor at the age of 10. That year, she was sick all summer with jaundice and spent a lot of time in her beloved pediatrician's office. When she was 12, she invited him to her grammar school graduation banquet. He declined because of a busy schedule, but told her he'd come to her medical school graduation.

Her mother told her becoming a doctor was possible, but there were very few women doctors. Then she told Sarah about a story she had read, about a woman physician from Chicago who started a home for incorrigible girls and helped them get their lives in order.

“My mother just made a point of finding out about women who had been there, done that, so I knew there were women out there who were doctors, and I wouldn't be doing anything unusual.”

But before she enrolled in medical school, the same family physician who told her he would come to her graduation from medical school, questioned her determination.

“He said 'I think you could marry an M.D., and that would be a whole lot easier.'”

But when he saw that she was serious about becoming a doctor, he had some advice. “In addition to being the lady your mother has trained you to be, you must also be a gentleman. You have to do your part of the dirty work. Everyone who is there has more than they can possibly do; and the men don't want to be waitin' and totin' and fetchin' for somebody else. So you do your part, and hold your head high, and you'll be all right. And I tried to do that,” she said.

So, a decade after receiving her undergraduate degree from Berea College and six years after getting her master's degree in microbiology from Vanderbilt, she enrolled in Vanderbilt Medical School. She was one of two women. The other left at the end of the first year.

“When I went to sign up, I felt a little uneasy. I was a little older than the rest of them. They were barely 18. I had been out of school for several years.” And did she feel equal to her male classmates? “Oh, I never doubted I was equal,” she recalls with a laugh. “I was about eight years older than them! They were just 18-year-old kids. I never tried to be one of them. They had a lounge where they played poker; I never went in that lounge. But they treated me with kindness and respect.”

Sell recalls one of her first experiences in the anatomy lab.

“Old Man Bill,” a staff member who helped the students in the anatomy lab, told the students, “Now gentlemen and ladies, you are now entering Vanderbilt Medical School. It has a long history of being an honorable school. Dr. Sam Clark is your professor. He's one of the Lord's finest gentlemen, but if he ever hears you say anything untoward in front of those ladies, gentlemen, Sam Clark will be a lion. That made me feel pretty special,” she recalls.

But she remembered her pediatrician's lecture about doing her own dirty work, and she never asked for any special treatment. After medical school, she did an internship at Vanderbilt, then two years of residency at Cincinnati Children's Hospital, and three years of fellowship at Louisiana State University before returning to Vanderbilt for most of her career.

Achievements

Sell will be honored tonight (Oct. 20) by the Vanderbilt Medical Alumni Association with its Achievement Award, one of many she has received in her career. Last year, she was presented with a lifetime achievement award by Vanderbilt's Department of Pediatrics.

The awards are nice, she says, but she doesn't understand why she's been chosen. “Why? I haven't done anything except what I wanted to do,” she said. “I never felt like a pioneer. I was just doing what there was to be done. Everybody would do something like this if they had the opportunity. I never felt that special.”

But there are many who would argue that point.

Kathryn Edwards, M.D., professor of Pediatrics and director of the Pediatric Clinical Research Office, has worked with Sell since she came to Vanderbilt 26 years ago. She says Sell has an ability to see good in everyone, to see the positive aspects of all people.

“I found through the years that her counsel was enormously important, as well as her insight and her untiring optimism.”

This summer, Edwards attended a meeting that gave annual data about the various infectious diseases in the United States. There were only 32 cases of meningitis from Hib in the United States last year, compared to the 20,000 before the Hib vaccine.

“I used to teach medical students about the bad effects of Haemophilus influenza b, but it's virtually gone,” Edwards said. “That's in large measure due to Sally's work, her ability to bring people together and to collaborate in a selfless way that made everyone a winner. And certainly children were the greatest winners of all.”

After retirement from the full-time Vanderbilt faculty in 1978, Sell took her work with the Hib vaccine one step further — working as a consultant for the Tennessee Department of Health and Environment, seeing that children actually received the vaccine.

Edwards describes Sell as unflappable, respectful and kind to everyone. “She never has a bad word to say about others. She's a wonderful human being.

“When I started out, I said I wanted to be like Dr. Sell, wanted to have many of her best qualities, but I'm not sure I've achieved them as she has,” Edwards said. “She has been such as good mentor and role model — the positive, 'I can do' attitude; the bringing together of people of various strengths.”

Edwards said that Sell was very nurturing to young faculty. Edwards, her husband and four children would often go to her home in the summer to swim in her pool and eat watermelon on her patio. “Her door was always open. She invited others in to share her warmth and love.”

Grace notes

Although retired, Sell still visits Vanderbilt often. She lives close by, and stays active at home, swimming laps in her home pool in the early summer mornings.

Her husband, C. Gordon Sell, M.D., one of the nation's leading pediatric cardiologists, died in 1999. Formerly chief of pediatric cardiology at Vanderbilt, he helped establish VUMC's clinical cardiac catheterization laboratory as well as laboratories at Saint Thomas Hospital and the former Hubbard Hospital, now part of Meharry Medical College. One of Sell's sons, Charles, lives in Nashville; the other, Clive, a 1980 graduate of VUSM, in Phoenix.

Edwards says that Sell showed her that it was possible have both a family and a successful and meaningful career.

“She integrated her professional and private life in a way that's a model for all of us. She was never out crusading for women, but she always did important things and showed people how you could integrate it all with great grace.”

Accolades and awards aside, Sell says her “Ma” degree is her best. “My boys are my best thing. My family.”

And just like a life without children, Sell says she couldn't imagine a career that didn't center around them. But like any pediatrician, she first had to learn how to relate to them.

“Katie (Dodd) was one of the greatest teachers I ever had,” said Sell, who worked with Dodd at both Vanderbilt and Cincinnati Children’s Hospital. “She could go right up to a little fellow and calm him right down.”

Sell learned quickly that when dealing with children you had to be both honest and calm.

“One of my old professors said, 'pediatricians have to be like ducks. They float along the top as though they had nothing important to do, but they're paddling like hell underneath.”