Finding meaning in medicine

Allan Doctor, M.D., always expected to work on the water. He loves the ocean so much that he began undergraduate study intent on becoming an oceanographer. But after a lot of thought, the coastal Virginia native determined he would find the most meaning in medicine, knowing he would get some ribbing because of his last name.

Doctor directs the Division of Pediatric Critical Care Medicine and treats patients in two intensive-care units at St. Louis Children’s Hospital: the Pediatric Intensive Care Unit and Pediatric Cardiac Intensive Care Unit. He says he decided long ago not to be bothered by questions about his last name.

“It gives people a way to remember me,” he says with a laugh.

However, in medical school, it wasn’t so easy for him to shrug it off.

“We didn’t have photo ID badges then, just pin-on name tags like you see at Shoney’s,” he says. “Mine just said ‘A. Doctor,’ so people would just look at it and say, ‘What’s your name?’ It was awful,” he says chuckling.

Doctor arrived at the pediatric intensive-care specialty indirectly after his initial residency training in emergency medicine at the University of Pittsburgh.

“I had a difficult time choosing which specialty I wanted to pursue,” Doctor says. “I really liked taking care of children, but I also enjoyed the challenge of adult critical-care medicine. While I was in school at the University of Virginia, pediatric critical-care medicine had not yet fully developed.”

During a rotation at the Children’s Hospital of Pittsburgh, Doctor followed patients from the emergency room to the intensive-care unit. “The clouds parted, and I knew this is what I wanted to do,” he says.

Because there wasn’t a clear path from emergency medicine to pediatric critical care, Doctor worked with Harvard University and Children’s Hospital Boston to create a custom program that entailed six years of training in general pediatrics, pediatric emergency medicine and pediatric critical care as well as a research fellowship.

“This was the kind of medicine I enjoy,” he says. “There is so much potential in a child, and it is tragic when that potential is cut short by a serious illness. Striving to restore that potential in very ill children is particularly fulfilling, and I knew that’s what I wanted to do.”

Doctor’s patients range from newborns to 18-year-olds who are in the unit after organ transplants or failure, accidents, severe infections, cancer or any condition that requires close monitoring.

“It is very fulfilling to see these children do well, which they do most of the time, thought it is very saddening when they don’t,” he says. “At the same time, involvement in these challenging cases can be very meaningful when you see that the care they receive is making things better than they would be otherwise. If we can’t cure the problem, we can at least ease suffering or help the family cope with a devastating outcome, which can be just as important.”

Seeking the root of a disorder

Doctor’s research explores the control of blood-flow distribution in the body.

“There is a very important efficiency in our circulatory system in that blood flow routes to areas in the body where there is specific demand and away from areas where there is not,” he says. “Loss of control in this routing and disordered distribution of regional blood flow are signatures of early shock and organ failure. We’re basically helpless in trying to deal with this, and I was seeing patients slip through our fingers because of this problem.”

During his training in Boston, Doctor began studying abnormal regional blood flow in the lungs of children with severe infections and worked on a technique called liquid breathing, a form of artificial respiration in which a patient “breathes” an oxygen-rich liquid rather than air.

After completing his training, he joined the faculty at the University of Virginia (UVa) as a pediatric intensivist and to work in a laboratory studying how blood vessels get injured in the lung in early sepsis. While there, he went to hear a lecture by a visiting scientist about how signaling by red blood cells governs the redistribution in regional blood flow that occurs during exercise.

As it turned out, the visiting scientist had a trainee at UVa, Benjamin M. Gaston, M.D., who was studying the impact of inflammation upon nitric oxide metabolism in the airway of asthma patients and the effect on airway smooth muscle. Doctor proposed that the same biochemical phenomenon may disrupt the control of vascular smooth muscle during systemic inflammation. He joined this lab and discovered that red blood cells are injured in severe infections and that these abnormal red blood cells then interfere with normal vascular control and signaling in the lung microcirculation.

Gaston, now professor of pediatrics at UVa, says the most remarkable thing about Doctor is his boundless energy to do both clinical work and research.

“What stands out the most about Allan is that he is the kind of person who will be up all night in the ICU taking care of patients and up all the next day doing research,” Gaston says. “He is certainly someone who thinks and lives outside the box, which is partly a function of his overall energy level. It’s hard to contain his enthusiasm for just about anything he does.”

A skeptical move

“I was very happy at the University of Virginia and was making progress in the lab, but I missed working in a dedicated children’s hospital and was looking for a platform to develop some new clinical programs,” Doctor says. “About this time I met Alan (L.) Schwartz (Ph.D., M.D., the Harriet B. Spoehrer Professor and chair of Pediatrics at the School of Medicine) at a retreat. I was talking with him one night after the meeting and later realized I was being interviewed for the division director position here.”

Doctor says he accepted Schwartz’s invitation to visit the School of Medicine out of respect but was skeptical about the Midwest.

“A lot of people I’d trained with in Boston were here, and I came out to see why,” he says. “It was immediately obvious. I was completely blown away by the environment at the medical school, St. Louis Children’s Hospital and the health system overall. I found a very open and collaborative environment and world-class resources for the research I wanted to do.”

Schwartz says Doctor is a “terrific addition” to the WUSTL community.

“Allan Doctor is one of that rare breed of individuals who is a passionate and outstanding clinician and educator and as well a creative and insightful investigator,” Schwartz says. “On a personal note, he has boundless energy and real desire to make an impact in the field — on behalf of children.”

Doctor says he is grateful to have sufficient resources to both pursue bench science and develop new programs for pediatric critical care in clinical medicine.

“There are very few places where the hospital runs smoothly enough that a practicing intensivist can also pursue an investigative career, and that’s another reason I wanted to come here,” he says.

Doctor had to do a bit more convincing with his family, particularly his wife, Dahven White, and their children, who were very happy in Charlottesville. Doctor says St. Louis has exceeded his family’s expectations.

“We’re thrilled to be here,” Doctor says. “I miss living in the mountains and being near the coast, but it’s more than balanced by easy access to fantastic parks, the ease of getting around the city, the welcoming community and great culture.”

Dahven, an architect by trade and an essayist, is renovating the family’s Central West End home and writing. It was her writing that brought the two of them together.

While Doctor was doing his residency in Boston, he read a column the Seattle-based Dahven had written that intrigued him so much he sent her a fan letter. The two corresponded for about six months before they met. They have been married 11 years.