September 1, 2011

VUMC Reporter profile: Ware, Thompson navigate a balanced path in life

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Lorraine Ware, M.D., and Reid Thompson, M.D., take a stroll in their Richland-West End neighborhood. (photo by Joe Howell)

VUMC Reporter profile: Ware, Thompson navigate a balanced path in life

For their first date, Lorraine Ware, M.D., and Reid Thompson, M.D., went hiking in Virginia’s Shenandoah National Forest. On the return drive to Baltimore, Md., where they were both resident physicians at Johns Hopkins University, they had car trouble.

“It was this beautiful, star-filled night and we’re driving along this parkway that was completely dark and deserted, and my car got a flat tire,” Thompson recalls during a recent conversation in his Medical Center North office.

He got out of the car without admitting that he had never changed a tire.

“So I’m struggling to get this little thing hooked up,” he says.

“The jack, you couldn’t figure out how to work the jack,” Ware chimes in.

“Right, the jack, I didn’t know how to work it,” Thompson says. “So Lorraine is watching me … and at some point she says, ‘You need more torque,’ and I thought wow, this woman knows something about torque … she’s really something special.”

“Oh no,” Ware groans, “don’t put that in the article.”

“Come on, it’s a fun story,” Thompson objects. “And it’s true. In our house, when things break, Lorraine’s the one that fixes them. I always say that I operate on brains, and she’s the brains of the operation.”

“I’ve heard that a few times,” Ware says, grinning.

A conversation with Ware and Thompson — about their early years as a couple and about how they have forged two successful careers in academic medicine and nurtured an active family — offers a glimpse of their contrasting personas. Thompson is demonstrative and chatty; Ware is reserved and careful in her responses, but she’s quick to smile and laugh — and sometimes roll her eyes — at Thompson’s telling of the adventures they’ve shared.

“Lorraine and I are a little like the yin and the yang,” Thompson says. “We complement each other.”

At Vanderbilt, Ware and Thompson are exactly where they want to be. She is an associate professor of Medicine with an active research program in the Division of Allergy, Pulmonary and Critical Care Medicine. He is the chair of Neurological Surgery.

They have three spirited children — 11- and 5-year-old sons and an 8-year-old daughter — and a lively, “chaotic” household.

But their path to Vanderbilt was one that’s typical for couples in academic medicine: it took compromise and sacrifice.


Getting to Hopkins: Ware

Ware moved to Baltimore from the West Coast — she had just completed her undergraduate degree in Biology and Chemistry at Claremont McKenna College near Los Angeles. The daughter of two Ph.D.-level chemists, Ware spent her early years “all over the place” — California, Minnesota, Southwestern Ontario, Canada — as her father, a professor of Chemistry, held positions at various universities.

Lorraine Ware, M.D., and members of her research group share their progress at weekly lab meetings. Because projects include a spectrum ranging from basic science studies to clinical trials, group members “get a broad exposure to different kinds of research,” Ware says. (photo by Daniel Dubois)

Lorraine Ware, M.D., and members of her research group share their progress at weekly lab meetings. Because projects include a spectrum ranging from basic science studies to clinical trials, group members “get a broad exposure to different kinds of research,” Ware says. (photo by Daniel Dubois)

She grew up with dinnertime discussions of quantum mechanics (“I didn’t enter the discussion much,” Ware says) and was encouraged from an early age to become a physician.

Ware wanted to combine medicine and research, so she entered the M.D.-Ph.D. program at Hopkins. But after completing two years of medical school and joining a laboratory for her Ph.D. research, she decided the program wasn’t for her.

At the time, she says, “I had no idea what my clinical interests were; I was just getting started being a doctor.

“I decided it would be better for me to finish my M.D. and get research training as a postdoctoral fellow, which ultimately meant that my research training was very relevant to my clinical interests.”

After graduating from medical school, Ware opted to remain at Hopkins for an Internal Medicine residency, during which she found herself drawn to pulmonary and critical care medicine. Ware enjoyed working in the intensive care unit, and she found satisfaction in applying physiology at the bedside.

“All the things we had learned in medical school about lung physiology, gas exchange, oxygen delivery … you can actually see how they become dysregulated in patients and cause disease, and you can institute treatments that alter the physiology,” she says.


Getting to Hopkins: Thompson

Thompson’s father was also a university professor — in the area of plant genetics — and the family moved around, living in Illinois, India, Arizona and Indonesia (“It was an interesting experience being one of the only blond-haired, blue-eyed people in a town of 10 million or so,” Thompson says with a chuckle).

He went to high school at a boarding school in Massachusetts and then opted to stay close to his parents, who had recently moved from Indonesia to Maryland, and attend the University of Maryland, Baltimore County.

An honors program mentor recognized his interest in the brain and encouraged him to do research in a neuroscience laboratory at Johns Hopkins.

“I wasn’t always clear that I would go to medical school,” Thompson says. “I just became interested in it, and the right doors opened for me to go to Hopkins.”

There, the first-year neuroanatomy course was his “very favorite.” (Ware hated it when she took it three years later.)

That course and his longtime fascination with the brain convinced Thompson that he “needed to see the brain in a living patient” before he finished medical school. So as a third-year student — even though he had already told the dean that he was heading toward a career in pediatrics — he arranged a clinical rotation in neurosurgery.

Reid Thompson, M.D., and chief resident Lola Chambless, M.D., discuss a surgical case. Thompson says that educating residents — “tomorrow’s Neurosurgery leaders” — is one of the most important things the department does. (photo by Anne Rayner)

Reid Thompson, M.D., and chief resident Lola Chambless, M.D., discuss a surgical case. Thompson says that educating residents — “tomorrow’s Neurosurgery leaders” — is one of the most important things the department does. (photo by Anne Rayner)

On his first day, he found himself scrubbed in next to Benjamin Carson, M.D., director of the Division of Pediatric Neurosurgery at Johns Hopkins, who was operating on a 12-year-old boy with a brain tumor. Carson invited Thompson to touch the child’s brain.

“That in and of itself was just amazing,” Thompson says, “but what was really unbelievable was that half an hour after surgery, the kid was playing video games in the Pediatric ICU, and I’m thinking, ‘I just touched his brain.’

“I remember everything about that day; it’s seared into my brain,”

Thompson says. “I remember driving home and thinking, wow, something really magical has just happened to me. I need to re-think my career path.”

With encouragement from Carson, Thompson opted for a Neurosurgery residency at Johns Hopkins.


The early years

They met at the gym. A mutual friend was “scheming to set us up,” Ware recalls.

“I was a fourth-year neurosurgery resident, sleep-deprived, doing pediatric neurosurgery, and Lorraine was an intern, sleep-deprived, doing internal medicine,” Thompson says. “We met at a really intense time in our training and in our lives; we were working more than 120 hours a week, I think.”

They discovered that they had overlapping interests — a love of the mountains, of hiking and camping and traveling, and of “random things,” Ware says, like quilts and textiles, and taking pictures of flowers. Ware was learning to quilt at the time (one of her first quilts, entirely hand-stitched, hangs in her office at Vanderbilt), and Thompson told her that he came “from a long line of quilters.”

Ware and Thompson married in an outdoor ceremony in Aspen, Colo. in 1995, after she had finished her Internal Medicine residency.

Ware accepted a faculty position at Johns Hopkins for Thompson’s final year of residency, and she applied for Pulmonary/Critical Care fellowships that started the following year.

“It was always a struggle to get our careers lined up; that’s been a recurring theme,” Ware says.

It was a tough time for the young couple. Ware wanted to pursue fellowship opportunities elsewhere — the program she liked best was at the University of California in San Francisco. Thompson was finding his niche at Hopkins — he had written part of a research grant that was funded and enjoyed working with his colleagues in neurosurgery.

“My career was really moving,” Thompson recalls, “and I remember a conversation with Lorraine when she said, ‘the thought of staying in Baltimore makes me want to cry,’ and I said, ‘we’re leaving.’”

Thompson arranged to do a neurosurgical oncology fellowship at UCSF.

After Ware matched with the pulmonary program there though, the physician Thompson had planned to work with left, and Thompson’s plans fell through (because neurosurgery is a small field, fellowships often depend on a single faculty member).

“Reid said, ‘that’s okay, I really like pediatric neurosurgery, and there’s a great peds fellowship there too,’” Ware says. So Thompson arranged that, and a couple of months later that physician — and that fellowship — left too.

“So Reid said, ‘well, I’ve always liked vascular neurosurgery,’” Ware says with a laugh.

Thompson completed a one-year vascular fellowship at Stanford, about 40 miles from UCSF (they lived in between), and then tried to find a position.

“I was really struggling,” he says. “It turns out that time period — 1996-97 — was the nadir for job openings in academic neurosurgery.”


The two-career conundrum

Thompson ended up taking an opportunity to help build a neurosciences institute at Cedars-Sinai in Los Angeles. But Ware had only completed one year of her fellowship — “one of the most prestigious pulmonary fellowships in the country,” Thompson says.

So for two years, he lived in Los Angeles and she lived in San Francisco, and they spent weekends together.

“I think we only missed seeing each other three weekends in two years,” Thompson recalls.

Ware was fortunate to have a supportive mentor at UCSF, Michael Matthay, M.D., who didn’t mind her spending more time in Los Angeles when she was working on grants or publications. Matthay’s support became even more critical when Ware and Thompson’s first child, Conner, was born during her fourth year of fellowship.

Matthay made it possible for her to move to Los Angeles and continue her fellowship there. There was still some back-and-forth traveling to San Francisco, but “we made it work,” Ware recalls with a laugh.

When Ware completed her training, she and Thompson reached another crossroads.

“We always knew that one of us would have to kind of compromise, follow the other’s lead,” Thompson says. “Lorraine had interviewed other places, and UCLA wasn’t her top choice, but she graciously took a job on the faculty there.”

“It’s a big problem for two career academics,” Ware adds. “Not only is it hard to get your careers in sync, but to both find good positions is really challenging.”

Thompson and Ware with their children, from left, Conner, Claire and Cameron, enjoy active family outings such as zip-lining.

Thompson and Ware with their children, from left, Conner, Claire and Cameron, enjoy active family outings such as zip-lining.

A few months into Ware’s new position at UCLA, the couple attended a Johns Hopkins function and met George Allen, M.D., Ph.D., who was chair of Vanderbilt’s Department of Neurological Surgery.

Though Thompson didn’t know it at the time, a few months before the event, Allen had asked the neurosurgery chair at Hopkins to recommend someone to specialize in brain tumors at Vanderbilt — the chair recommended Thompson.

“I gave a talk, and George Allen came up to me afterwards and told me about building up the program at Vanderbilt, and I’m thinking, where’s Vanderbilt?” Thompson recalls. Allen invited him to visit.

Although Ware was skeptical, having just started her UCLA position, she encouraged Thompson to take a look at Vanderbilt.

“I really liked him,” Allen says. “He’s obviously very smart; I knew from my friends at Hopkins that he was a skilled neurosurgeon; and I thought he would fit in well in the department.”

During his first visit, Thompson saw the glass piece by Dale Chihuly — an artist that he and Ware liked (he has a Chihuly piece, a gift from Ware, in his office at Vanderbilt) — in the Eskind Biomedical Library entry. He took it as an omen that Vanderbilt was a place where they would both be able to build rewarding careers.

“Reid’s a big believer in omens,” Ware laughs.

Ware and Thompson were recruited in parallel and joined the Vanderbilt faculty in 2002.


Ware’s research links bench, bedside

Since their arrival, Ware has developed a thriving research program focused on acute lung injury, a clinical syndrome of respiratory failure — acute respiratory distress syndrome (ARDS) is a severe form.

Her research spans from the laboratory bench to the patient bedside — from basic science studies of how the lung epithelial cells that line the airways respond to injury by depositing the protein fibrin, to clinical trials that are searching for and validating biomarkers for diagnosis and prognosis in patients with acute lung injury.

Ware’s clinical biomarker laboratory is “a national resource that measures nearly all of the cytokines and inflammatory molecules in specimens retrieved from patients in ARDS Clinical Trials Network studies,” says Gordon Bernard, M.D., associate vice chancellor for Research.

Ware enjoys the challenge of her group’s broad spectrum of research.

“I think it keeps our research relevant because everything we do is directly tied in some way to what’s going on in our patients. We learn things in patients that give us ideas for experiments in cells or in mice, and we make observations in the lab that we then examine in our patients,” she says.

Acute lung injury after lung transplantation — and the donor and recipient factors that contribute to the injury — is another area of interest for Ware.

She is leading a randomized clinical trial in organ donors, working with an organ procurement organization in northern California, to test whether treating pulmonary edema (fluid in the lungs) improves oxygenation and utilization of donor lungs and lung function in transplant recipients.

Citing the influence of her own fellowship mentor to her success, Ware says she really enjoys mentoring the next generation of physician-scientists. And she’s good at it.

“Lorraine is an excellent mentor, and many young investigators have sought her out as a role model for development of a translational science career,” Bernard says.

One of her first trainees, Julie Bastarache, M.D., who is now a faculty member at Vanderbilt, says, “everyone should work with Lorraine. Her critical thinking and scientific skills are amazing, and she strikes the perfect balance of being involved and giving her fellows the freedom to try different approaches.

“She’s a phenomenal role model for a woman in academic medicine — she’s an internationally recognized scientist, a great clinician, an incredible mom, a gourmet cook…if I can accomplish half of what Lorraine has accomplished, I’ll be lucky.”


Patients, residents vital to Thompson

A couple of years after Thompson started at Vanderbilt, Allen recognized in him the makings of an excellent chair and asked him to become vice chair of the department.

“I gave him real responsibilities as vice chair — he was in charge of the neurosurgical ORs for a number of years — and he did a wonderful job,” Allen recalls. Thompson assumed the department helm in January 2010 when Allen stepped down after more than 25 years as chair.

“I couldn’t be happier about how Reid is moving the department forward,” Allen said.

Thompson, who says that he never imagined being a department chair, is enjoying the challenge.

Hiking is a favorite pastime for Thompson and Ware, and they often return to the mountains near Aspen, Colo., where they were married in 1995.

Hiking is a favorite pastime for Thompson and Ware, and they often return to the mountains near Aspen, Colo., where they were married in 1995.

“I think a lot about what it means to be an academic neurosurgeon,” he says. “To me it means having this opportunity to have an impact on people at different levels — taking care of patients one at a time, educating our residents to be tomorrow’s neurosurgery leaders, and asking research questions that could impact tens of thousands of people.”

Thompson operates on patients with brain tumors, patients who come to him at “arguably one of the more critical times in their lives,” he says.

“To be able to walk with patients and their families through the diagnosis — ‘here’s the problem, let’s spell this out very clearly’ — and the details of the operation, and then to get to do the operation…I love it. It’s tangible, it’s visual, it’s immediate…I come home at the end of the day and I know what I’ve done.”

Lola Chambless, M.D., chief resident in Neurological Surgery, who first rotated through the service as a third-year Vanderbilt medical student, credits Thompson with her decision to become a neurosurgeon.

“He was doing really complex, interesting operations, and had this sort of infectious enthusiasm about them,” Chambless says. “He clearly loved what he did and was very approachable and encouraging to me.

“He’s a real advocate for resident education,” she adds. “He will always go out of his way to make sure that the residents are getting what they need in terms of their education.”

He has also passed along “the Thompson method” for operating, she says.

“My own surgical immortality will be that in each resident’s brain, there will be a synapse that fires and they will hear my voice while they’re operating,” Thompson laughs. “I have those synapses from my mentors.”


Yin + yang = balance

With their yin and yang personas, Ware and Thompson have found a life of balance.

Ware’s “serene nature and inner peace” have been a calming force for Thompson’s fiery side, he says.

“Her sensitive, lovely approach to life, our family and our relationship has provided a degree of stability that has grounded me and helped me enormously,” Thompson says.

“Their number one priority is really their family and each other,” says Bastarache. “I think they’re able to achieve balance because they always put each other and their family first.”

Their family life is typical — children running in different directions and being toted to various sports activities, music lessons or friends’ houses. They enjoy having the assistance of a long-term nanny, Ana Diaz, who moved from Los Angeles to continue working for them. They also enjoy traveling and hiking, especially in the Colorado Rockies.

“Life is fairly simple really,” Thompson says.

Like the first-date drive that proved memorable, they share vivid recollections of another drive — this one along the Pacific Coast highway, at a time when neither was feeling too happy about their positions in Los Angeles.

“We said, ‘Oh, wouldn’t it be nice if we could both get great faculty positions at a great medical school,” Ware says, “in a nice city, a livable city, a city smaller than LA.”

“And here we are, 10 years later, and we have exactly what we hoped for,” Thompson says.