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#118 - The Giants of Neonatology Ep 5 - Dr. Mildred Stahlman

Mildred Stahlman Incubator Podcast

Hello Friends 👋

We are excited to announce a new episode in our series of Giants of Neonatology. Featuring our first female Giant: Dr. Mildred Stahlman. We are joined today by healthcare writer and editor Corey Reese and Dr. Elizabeth Perkett, a neonatologist who had the privilege of training and working with Dr. Stahlman. Stories shared on today's podcast will baffle you and make you appreciate the dedication of Dr. Stahlman to her patients and her trainees. We hope you enjoy this nice conversation. Happy Sunday !




The transcript of today's episode can be found below 👇

Ben 0:59

Hello, everybody. Welcome back to the incubator podcast. It is I've lost track of what day it is. It's been a whirlwind. Working on the podcast, setting up the conference, we're so excited. It's tomorrow.

Daphna 1:14

It's here. It's very exciting. We have been working so hard at this right for like the last year really. So I mean, if you if any, anybody listening has been a part of conference planning, you know, it's, it's so highly anticipated. And then there's so many things at the end just to get done, you know, that we're, we're really helping to provide a unique experience for

Ben 1:41

our GM to be the bomb, as they say, in high school. And now the reason I'm saying this is because, you know, we what was very interesting I was I was sort of reflecting with Rooney on this today was. We had a vision for this about a year and a half ago. And it's so amazing to see that with, I think that's probably as a group, one of our collective talent is that we're able to effectuate those visions pretty well. And so it's kind of nice to see everything coming together. So this is beyond excited.

Speaker 1 2:17

Hopefully, we'll be able to get some sleep, so we'll be ready big. Yeah,

Ben 2:21

yeah. Okay. So we're excited about the conference. I think we have like very few, like we have out of that thing, like 10 seats left. So if you have a spur of the moment, you could still count. And yeah, I mean, we're, we're, I think somebody saw, I think there's one person who reached out to me to ask if they could submit like a last minute poster slash idea. And I was like, yeah, like, why not? perish? Okay, so we have a very busy the one thing I wanted to say was that we have our conference Monday, Tuesday, Wednesday, and we will give the incubator team and audience break next Sunday. So do not so we haven't. So if you don't see an episode next week, we're taking a one Sunday break, so that we could come back.

Daphna 3:17

And it's worth noting that since we started the incubator nearly two years ago, we've not taken a single week.

Ben 3:24

No, I think what I'll do is we didn't eat this, but this one, I'll probably I'll probably post one of our favorite episodes as a replay if people missed it. But yeah, so there'll be an episode but we just won't have like a new episode next week. And we'll come right back the following week with board review and journal club. So that's exciting. Definitely, we have a we have an unusual episode format today. Can you can you tell us about that?

Daphna 3:53

That's right. We really want it as part of our giants in neonatology series. We really wanted to honor the legacy of Dr. Mildred Stallman, who, unfortunately is not really up up for an interview. So we've done something a little bit unique. And we have collected one of her former fellows and colleagues and our writer who is authoring Dr. Solomon's biography with us on today to help kind of describe her career and this legacy that she left. So I'll introduce them and then they will introduce Dr. Stallman to all of us. So we first have with us, Dr. are retired professor and neonatologist, Dr. Elizabeth perkett, who really is a giant of neonatology in her own right she had a distinguished career in neonatology and pediatric pulmonology at both Vanderbilt and New Mexico universities. She's one of the first pediatric subspecialties to be board certified in both of those fields. She trained in neonatology under Dr. Mildred Stallman at Vanderbilt and then later returned as a colleague of Dr. Stallman for 20 years and a lifelong friend. And Cory nacin. Reese is a writer and editor who specializes in healthcare and education. She's a graduate of the William Allen White school of journalism at the University of Kansas and is freelanced for 30 years writing articles for newspaper journals and professional organizations. She befriended Dr. Stallman 20 years ago as well and is tasked with collecting her life stories to rate her beyond biography. So we are so happy to have on Dr. Beth Perkins and Corey Neeson Reese with us today.

Ben 5:40

Dr. Beth Paquette Corey Reese, thank you so much for being on the show with us this morning.

Unknown Speaker 5:47

Glad you're here.

Daphna 5:49

Well, you know, we've started with your bios, but we'd love to hear a little bit more specifically from you guys about why you took on this mantle of kind of cataloging Dr. Solomon's life's work.

Speaker 3 6:06

Well, I'll start I saw Dr. Stone moons nursery in 1974 as a fellow and basically have interacted with her for the rest of my life. She is one of those remarkable people without even just addressing her neonatology, which is what we're addressing today. But it's just a powerful presence in my life and everyone's life. So I think it's a noteworthy person that should be recognized for who she is and what she's accomplished. And over the years, I met Cory, who, thankfully has the skills to be putting together a biography and trying to truly document what's going on with Dr. Mildred Stallman.

Speaker 4 6:58

Thanks, Beth. This is such nice words from you. I got into this because I'm a healthcare writer, but my husband is actually a neonatologist, Jeff Reese at Vanderbilt. And he went in at seven

Unknown Speaker 7:12

A star A star in his own right. Well,

Speaker 4 7:16

I like to think so. But anyway, he was in 1987, he came to Vanderbilt for pediatrics. And Dr. Stallman was at the end of her hands on world with a career with nursery. And she turned it over, you know, a few years later, but she was still doing rounds and once a week, and they were called Millie rounds. And they were daunting, your expect to know all your P's and Q's. And at that point, I met her but I was too junior of a writer to even like approach her. So through Jeff's career, we ended up back at then at Nashville at Vanderbilt in 2002. And then I was thrown into her circle and was escorted to a lot of things with Jeff was busy. And she's she for you may not know she never married and never had children. Her family is dispersed her she's got a couple of nephews that live close to her. So as my career went along, I had the chance to meet and interview some very senior neonatologists. And I thought, you know, holy cow, if I'm getting to meet them, we should approach Dr. Stallman about could I be your biographer and I noticed to be other people had had approached her. But by this point, she's getting to be her late 80s. And so I think she was more receptive because she never was before. And so we approached her and some of the things if you don't know Dr. Stallman, she's four foot like maybe five foot 11 Maybe five foot doll like 101 pound, Jesus little tiny lady, and, but she, as Beth will attest, has kind of a spicy language. She, she could speak with, let's just say I, anyway and spicy. And so we approached her and said, you know, Jeff and I sat down with her. It's like Cory would like to write your biography. And I'll modify but she goes, I don't know what the heck you're gonna write about. That began you know, if you've seen the, there's like a book called is it Mondays with Maury or something like that lunches with anyway, so we begin to sit down and have lunch and we roll the tape. And she's told me stories and and it began, for me just a wonderful career of, you know, hate to tell you that was like 2009. So the book I hope to write is, keeps getting interrupted. But along the way, it's been a real blessing to be able to interview some of the greats Paul Squire and Bill Oh, and Fred Metalia. I mean, there's been just neonatology as a young enough field that the greats are still around. So that's how that embarked. And hopefully now, we hope in the next I hope in the next year that I can actually write her bio.

Daphna 10:18

That's exciting. That's exciting. Well, you're gonna have to get your list of interviews then so we can make sure we tackle that because yes. And that's kind of what I've heard about Dr. Stallman, just from a personality perspective that she was, like, tough, but also quite kind in fair. And that's kind of a hard line sometimes to toe in medicine.

Speaker 4 10:43

Well, Beth can certainly address it because she lived it and but I, I interviewed a one of her fellows, Frederick Sardinian in Sweden. And he made the comment that he was a fellow over here and we'll get to that she, she trained many international fellows, but they would have like three o'clock Friday, and I don't know if Beth, if you ever did this, did you ever do journal club with her? Oh, definitely. And so she would be three o'clock and you would, you would I used to have you tilt. But the three o'clock the journal club would start and go till four and maybe she she challenged you a few times, Beth on the journal club. And then at four o'clock said, Oh, it's for let's go to the university club and have a beer.

Speaker 3 11:32

Yeah, no, she, you know, everything she did was with full passion. She didn't do anything halfway. So if you did journal club, you did it. It ended. And if then it was TGIF and going, the faculty club, you quit, you did it. And you switched in to the mode of, you know, congenial, you left, you definitely left work behind when you switch to the next piece so that she didn't tolerate you being wishy washy about anything. Which I think is just dumb mantra for all sorts of things were Christmas carols. You knew all the verses, she couldn't sing, she didn't have any voice. But she knew the word up every single verse in line so that, that everything was complete in terms of what she did. And I think that's part of where she influenced everybody that you really admired. That approach.

Ben 12:40

Yeah, it sounds like she had words sharpened like knives from from the, the, the articles that you've written and from the stories that you're telling us, but for the people who who may not be so familiar with it with her story, and, and, and with who Dr. Stallman was, can you? Can you give us a brief overview of, of where her career lies in the context of neonatology because I think her career really took place at a very crucial moment in our field where we're really things were getting off the ground. And obviously, she played an instrumental role in getting these advances off the ground. So I'm just curious if I had the I had the pleasure and you sent us your your most recent article that was published in the American Journal of Physiology, lung, Cellular and Molecular Physiology, which sounds so technical as a journal title, but the article is basically a short historical review of Dr. Solomon's life and we'll we'll post the link on our on our website for people who are interested. But for the people who haven't had the pleasure of reading this article, can you walk us through a little bit as to when her career started? And what are some of the challenges she faced and potentially the paths she could have taken away from neonatology along the way but somehow always made her way back to neonatology.

Speaker 4 14:02

So that just almonds from Nashville, Tennessee, and was born in 1922. And part of the story it her story that always amazes me is that this could come this woman, this development could come out of Nashville, Tennessee, right now, Nashville is a hip, it kind of city. But in those days, it was small and known for country music. So that in itself is is amazing. I think the fact that her father, and their family was a newspaper editor and at one point was president of the like the American newspaper publishing, I think helped put it on the the map but she eventually she went to Vanderbilt, her dad was on the board of trust. I think one of the things about Dr. Solomon's life Is it maybe everyone if I interviewed all of you, there's a big part that in either serendipity or Providence, depending on your perspective really played a part because she entered into Vanderbilt. Right when World War Two, she entered in 1940, when World War Two was just on the cost, and Vanderbilt condensed its program to six years for medical school and undergraduate and the men were a lot of them were leaving. So she was one of four in her medical school class. She finished it, they went year round, she finished it in three years. And then again, it's in her class is amazing. Who's she ended up with? She's an Apgar and a hallander, winner, award winner. And I think she had another one or two people in her class. So it was just quite a conversion of talent. And so then she, she, she wants to I think she at that point, she knows she wants to do pediatrics, but a lot of the schools were not accepting women. And so she ended up at Cleveland, I think it was called Western Reserve. And she did her rotating internship there. And then she goes to Boston. And although she didn't talk about it, Clement Smith, who was there, we all know, he's, you know, one of the fathers. But so she was at least under his tutelage. She didn't never mention him to me, nor did I find that she's written about him specifically in their interactions. But she might have been too Junior. So she comes back to Vanderbilt. And here's for Providence, serendipity comes in. A very famous pediatrician from Europe was invited to come his name was Arvind Walgren, and was one of most famous pediatricians in Europe at the time, and we're done with World War Two. And from my perspective, you would expect that to be Germany or France, but those two city countries had been decimated. So he comes in, he comes to Nashville, and has a visiting professorship for a couple of months. And in the near establish a between Karolinska, that's where it was in Stockholm, where he was from, and which is a famous Institute, and that and Vanderbilt and they establish a an exchange fellowship and add Dr. Stone was the first one chosen ad, you kind of shake your head, you know, why her? So she goes to Sweden in 1949, and 50. And studies under John land and Petter Carver, which are again, very famous early pioneers in this, in studying the fetal fields are in newborn physiology and pathophysiology and cardio pulmonary research, and she'd never really done research. She talks about that, that really, that sparked her interest. And as you know, we'll talk about later it changed her life as far as her academic career, her outlook on things because Swedish is was Sweden, has a lot of had a lot of health care delivery that was very regionalised. And not private, it was a you know, a government. And so she changed like from conservative to or liberal in her in her Outlook. So anyway, she comes back after a year of that

Unknown Speaker 18:30

does a does a six month

Speaker 4 18:33

cardiology and kind of a fellowship in Chicago. At Rabida Robina. I'm not quite sure how to pronounce it, and does cardiology and comes back to Vanderbilt and doesn't like it. I think I don't know if it was two terminals like oh my gosh, because they were interested in cardiology in Sweden. And I think here's one of her big her big forks in the road, because she said I didn't like it. And I thought I might go down to Destin, Florida where her family had a summer home and be a pediatrician. Because there weren't any at the time and you think wow, that would have changed the world. So anyway, at that point, Vanderbilt brings in a cardiologist who is a strong physiologist named Elliot Newman. And he invites her into his, she's unhappy with her practice and she invites her into her lab and she begins then her study of physiology, they get a small grant. And she's, she's she's got the cardio training, and she's interested in the in the pulmonary aspect. And so she studies that and gets her small grant, and then begins interacting sets up her sheep lab. And Beth can tell you more about that sets up for sheep lab where they're beginning to do catheterizations on sheep, and in the process she interacts with I think in Europe with Jeffrey Dawes And then Baron and Don Baron and Yale. And I find out she's going there and studying with him. And this is how the late 50s and she hasn't even done babies yet. She's doing sheep, and then goes up with Stan James and and in Virginia app guards nursery and begins to learn catheterization. So you can just see the snowball. And then Elliott Newman says to her, Well, why don't you apply for a bigger grant the the hardest? To get that right? The hardest dude, I think is gives her instead of an $11,000, Grant $125,000 Grant. And they set up a lab next to the newborn nursery. And that,

Daphna 20:45

which at that time was an extraordinary amount of money. Also, I mean, that's a big grant now. But grant,

Ben 20:52

I think in the, in the article, you mentioned that the in today's equivalent, that would have been about $1.2 million. So So yeah, so 125,000, at the time was was significant. But before before, before we bring back, Dr. Paquette I wanted to then so then, so then she really is the person who establishes one of the first NICUs in in the world. And, and in, in the article, you mentioned that she gets she gets really passionate about about the care of newborns. And I think her interest in pulmonology. And her background in cardiology really sets her up for trying to or wishing to understand and solve the problem of what we call to the respiratory distress syndrome, which at the time was called having membrane disease. And that grant really gives her the latitude from an institutional standpoint to to explore this this avenue, because, as you mentioned, and I quote from the article, it says that the carrot for the hospital administration was that every baby that I studied in that nursery, if it had hyaline membrane disease, and we studied that they be their hospital bill would be covered by this NIH grant that that they had received. And so it really was, it was a brilliant

Daphna 22:07

way actually, to get funding and revolutionary care really, for babies. It was remarkable, actually, the way she was able to speak.

Ben 22:19

And so and so then in the in the in the article, I think it's fascinating that in 19, you mentioned in 1961, there's this this first opportunity that presents itself to her where a baby that's born about two months prematurely, which I'm assuming would be around like 30 to 33 weeks with severe hyaline membrane disease, whose father was in training as a as a senior medical student at Vanderbilt, is given very poor prognostic survival statistics and, and within an in a shared decision making with the family, they agree that they would, they would let her try to apply some of the of the knowledge that she has to try to solve, to heal this baby. And at the time, what's interesting is that the ventilators that she's using are basically adapted from the polio epidemic with these iron lungs, basically, that are made sort of miniature so that they could fit a baby inside. And, and it's interesting how, even though positive pressure ventilation in the future sort of really becomes the mainstay of treatment, she still at the time is is of the opinion that negative pressure ventilation would be both beneficial from a pulmonary standpoint, and from a cardiac standpoint, in terms of improving diastolic filling, and so on. So at the time, and then she eventually turns the corner when it comes to the evidence, as the evidence comes out on positive pressure ventilation, she definitely adopt adopted, I don't want to I don't mean to say that she was reluctant, but at the time, that was the tool that they had available. And that in the in the paper, you mentioned how she basically is staying at the baby's bedside continuously for days on end. And eventually the baby does survive and ends up becoming the baby ends up going to college and so on. And I think that's that's a that's a great story. And she says, if their baby hadn't survived, I think I would have quit or done something else. So Can Can Is there any other any other stories or any other Inklings as to the challenges that are the pressure that she was under when when she first established this this special nursery?

Speaker 3 24:28

I think one of the differences perhaps in the NICU that Dr. Stallman started is she came from being a researcher from being a physiologist. And I think if we look at many people, they were physicians, they were caring, they were looking at better ways to under the physiology, but they went from the clinical to the research and then maybe back and forth. So when she set up her nursery, she wanted to have the same exact this she could have have in the research lab. And so that she physiology was hugely important as far as doing blood gases measuring pressures, understanding what was going on in this baby as a physiologist. And so I do think that broader in a different way and a different perspective. And, as you mentioned, the cleverness of getting the patient's care paid for was part of what who she was, she was a realist, you know that this is the way something should be done. But it wasn't going to happen in a private school like Vanderbilt without being paid for. And that's kind of how she implemented many things, including when they went to regionalization is such as that. She took her exacting knowledge as a researcher, but then had to put some realism in it to make it happen, you know, in the clinical setting. But that that makes her I think, a little bit different than some of the other researchers, clinicians and back and forth. I had the

Speaker 4 26:07

opportunity to talk recently to her fellow, one of our fellows who was there at the time. And I said, you know, this is huge. Was she afraid? Was she anxious? He's like, No, he just did it. Because I think she, you know, she doesn't have a partner to go home and say, What do you think I should do? And, you know, once they I think she was fearful that first that first week, and the weaning off was what she was really concerned about. But I think once it happened, and I talked to her speaking to her mother, the baby's mother. She said, they came in and talk to me, and then I never saw her again in the nursery. The dad can go on there, shake hands. He was a medical student, but I like oh, you got home. And Dr. Stallman was not is not good wasn't good. By the way. Dr. Stallman is 100. She lives about 10 minutes from me and Nashville. She lives in a restored log cabin that she put to log cabins together 1965 or 66. It's modernized, obviously has great home care. physically healthy, she does have dementia. So we were glad we gathered her memories when we could. But she was a I don't know where her fearlessness came from. But there was some real fearlessness, fearlessness there.

Ben 27:35

And you do need fearlessness. Because I think it's a very lonely endeavor, when you're trying something for the first time. That's not I mean, I think it's kind of comfortable for us today. We have practices that we can say are evidence based, and we put them in place and we're like, Okay, well, we have this paper that has documented that this works and so on. But when you're starting something innovative and new, and a baby's life is in the balance, it's it's I can only imagine how immensely stressful that must be and how immensely lonely you feel where it's really your reputation. And so I completely understand her reaction when she says, Well, if this baby hadn't made it, I would have I would have done something else. I think it's it's extremely, extremely tough. Now, Dr. procut? I mean, I wanted to ask you because you joined Dr. Stallman in 1974 If I'm correct when when you when when you went for your neonatal perinatal medicine fellowship, and you your your educational track up until that point, did not really revolve around Vanderbilt. I mean, you you had done your your college degree in Michigan and medical school in Michigan and and so what was the thought process that you had in in joining Dr. Stallman at Vanderbilt? Instead of maybe another institution? God knows there was there were great institutions all around just Yeah. What was the thought process there?

Speaker 3 28:56

She was certainly well known as one of the places to go. And it's a little bit of serendipity. She needed somebody and I don't remember who talked to whom, but I got a letter say do you want to come and I went, Yes. It's now it ended up you all think of fellowships as as structured, organized beings for Milly. Actually, at the time I was there was when boards were just starting. And one day Millie came in to us. An N one for her office. She had there was one big office, her desk was in the middle. Everybody else was in the room. We did not have separate offices you were so you've heard all her conversations. But one day she walked in and said, I have to write some board questions. But you all write them for me in short. And so we're sitting here

Unknown Speaker 29:54

right it's a different time. It was a different pin.

Speaker 3 29:58

But for her she had had some ambivalence about fellowships being so structured because she included cardiology people, physiology people, adult people. And she saw the development of a fellowship in some way of of limiting who you put in to have an input into your thought process. Not that he didn't ultimately need it. As such, so see, as a mentor wouldn't fit. What a lot of people define as a mentor, this person who takes you under their wing and gives you guidance listens to you through your ups and downs. But I think a lot of mentorship can just providing you the environment. So just in a way by sitting in the same office, as Dr. Mildred Stallman, you've heard all sorts of conversations with all these other giants in neonatology and what discussions were going on about different therapies and such so you know, it was the experience and it know you put together your mentorships I mean, everybody likes to talk about the perfect mentor, which is wonderful when you when you get that, but I think you can also get it by putting pieces together. And one of the things she provided was an incredibly experienced environment of not just exposure to her but of exposure to everything that was going on in neonatology

Ben 31:27

from being being French myself reading reading the short article and listening to you guys, it does remind me of a three star kitchen where there is it's I mean, I'm sorry, it's not demeaning. I mean, again, I'm French to us, the kitchen is probably the highest. But you know, it does feel like this three star Michelin chef that has extremely high expectations where everything is defined by the quality of the care that is being delivered. And I think where a lot of things that if you look from an outside perspective can seem very hard sometimes, but for the people inside it feels absolutely expected. Is that Is that Is that wrong to think like that? No, I

Speaker 3 32:11

actually, I like that, especially now that we have all these cooking shows with these demanding chefs, you know, I've never thought of thinking Emily as the chief chef who, you know, comes in and, you know, if you, she could pick up charts and slam them down, if that what they weren't complete and such, but actually that I like that picture. Because, in fact, you know, it's the perfection of the meal. And for her, it's the perfection of the care. And you might or might not achieve it. But you better be better next time. No, as far as whatever went on, but yeah, that's okay. And,

Ben 32:48

and she had the knowledge of all the steps, right, just like right, just like a chef or chef could could cook anything that needs to be cooked in the kitchen because they've gone through this formative period. And so I feel like she also could very much do any procedure at the bedside. And so I think, I think anyway, that's what so that's why I was thinking about that, but go ahead, and and I'm sorry, I didn't mean to interrupt. This episode is so proudly sponsored by Wreckit Mead Johnson recognized Johnson is dedicated to the research and development of nutrition products that help support baby development at every stage, including an extensive and familiar portfolio for premature and low birth weight infants learn more at HCP dot meet No, well, I

Daphna 33:30

think what you're describing as we talk about this on the podcast all the time is like medicine, especially as we progress is becoming more and more siloed. And more and more specialized. When neonatology really requires the integration of so many, you know, all of the body systems and all of the really subspecialties, you know, that we encounter in in pediatrics, and what I think is really interesting about Dr. Solomon's story and your career. Dr. perkett is really, neonatology is so young of a field that like her career encompassed all of neonatology and I think for those of us who were, you know, early career neonatology right now is is so different than it was, you know, when you started as as a fellow and so much has changed over that time, in terms of medicine in terms of the hierarchy in terms of technology, but to really see an entire field, developing before your eyes and talking about being innovators and being brave enough to try new things. I'm hopeful that you can talk to us about some of those experiences that you yourself had during those those early days. But again, seeing the evolution of of neonatology something that we really take for granted. it right? Good ventilation, surfactant and things that are part of our everyday arsenal that just were non existent when when this all started, I think at

Speaker 3 35:13

the beginning, you really had to solve a lot of your own problems. And so you refer to ventilation and using the negative pressure ventilators and then getting the positive pressure. So at the time I started, we had the baby birds, which were pressure time cycles. And then we had a board, which was a volume ventilator, which was pretty crude. And they none of those ventilation techniques were really good. And Milly understood the need for the gentleness of ventilation. But what could you do these were the tools you had. So what she did is she trained, they were called technicians. And the training program, I'm told was extraordinarily rigorous, most people failed. And I actually don't know what the requirements were to take it. These were not nurses. But these they were all women had incredibly gentle hands and insight into how to care for a baby. And as a fellow, if you didn't listen to the technician, you know, you were out. But when the ventilator wasn't working, these women could ventilate the babies by hand. And so they use an anesthesia bag. And they would ventilate a baby for hours. So that

Daphna 36:33

so they were the the early respiratory therapists that well there were

Speaker 3 36:36

more than respite, there were ventilators Yeah, there were the shaper, the better ventilator, you know, as far as them then the machine and machines. But I mean, I think that was an example of, you couldn't just say, hey, this ventilator isn't working very well call our T. Now, it was your problem to solve it. And so as a fellow, I knew how to put the ventilator together. I mean, you had to if something happened, you had to be able to put the ventilator together. You really had to solve all your problems. With her knowledge of physiology, you know, she worried about blood volumes. I mean, she measured cardiac output. Well, if you take five ml for blood gas, and for monitoring, she wanted frequent blood gases. So what's five amounts? So what sometimes happened is, we would be cross matched to a baby. So one of the things that you went to the blood bank that did all the screening, and then you were cross matched, you are the blood donor for that baby. Wow. And if you had to draw a lot of blood from a baby, then you do five mL from me and gave it right back to the baby. And it was actually really, you know, stable for the baby to not lose that. That's right, you really helped her baby didn't need an exchange transfusion because I was had to get a whole unit drawn from you. But I think, you know, the people in that age had to figure out how to solve problems. Eventually, the blood bank decided they couldn't do that anymore, because they were worried that it was that we weren't screened, but that we were putting the right amount of heparin in the blood we drew from us, you know, to give back to the baby and such and such but I think, you know, neonatology, in that era, you had to solve your own problems. And I think it addresses what you had to know all aspects of what was going on with the baby, you know, you weren't just focused on Oh, I'm a ventilator person or, you know, this person.

Ben 38:43

And I think this leads me to my next question, because I think in the article you do mention this that Dr. Stallman had this knack for being very curious. And I'm wondering how that curiosity. How do you think that curiosity manifested itself? And how did you think it helped her? continuously evolve? I guess, I think the example that we gave about her her transition from negative pressure ventilation to positive pressure ventilation is a product of that curiosity, but I'm just wondering if you can speak to that a little bit more.

Speaker 3 39:18

But in a way, I think, you know, everything was kind of fascinating tour, which is probably part of why she knew so many people in the field and why she was willing to go and it didn't feel compelled to just stay in her one area which kept her mind open and allowed her to have a lot of people influencer. And Beth talked about her.

Speaker 4 39:49

Her extra or I'm gonna say her non medical world was so broad and Beth involved. It was involved in a lot of those things that This kind of will also illustrate her curiosity. It wasn't just in me, she was a renaissance woman. So talk about some of those fun things that you all did with her. nonmedical world.

Speaker 3 40:15

But she one of her mentors, Dr. Mary Phillips Gray, who she ultimately they were collaborators. She walked in one day and said Dr. Gray has never been to the Grand Canyon. She wants to RAF the Grand Canyon. So meet us in Las Vegas, and we're going down the Grand Canyon. And so it ended up there was a neonatologist in Denver, who had retired to be in a setting up a rafting surface through the Grand Canyon. So we we get there, and we start down. And she had picked a tour that had an archaeologist talking but she had read all of Pauwels book, you know, she knew everything about rafting the Grand Canyon, no. So she just read continuously. And so as we're rafting through the Grand Canyon, she can tell you all the history of well, this is where his boat did this, this is what happened. That, you know, was kind of typical of anything you did when you arrived. We had meetings in Europe and such and when you arrived there, she knew the history she she just read continuously. She actually never was much of a TV person. And as she got older people tried to get her to get cable and she never would. So she just read books and things like Santa Fe Opera, she basically introduced me to the southwest because she had read so much about it. So here's this woman from Nashville who's always lived in Nashville, and knew more about the southwest and all sorts of people. So I think that's she just loved reading, and loved learning about everything in the world.

Speaker 4 41:58

She was also blessed with a tremendous memory. She could recite your burns poetry, your burns nights that you would have it you read poetry that

Speaker 3 42:11

Yeah, so we you know, January is kind of a blind mode. So she decided we would have a burned supper because we have a couple of postdocs from Scotland and so she could flip up in the book and read any of the Bobby Burns poetry as we sipped a little bit of singable.

Speaker 4 42:35

She had she here she came from a newspaper family and was introduced by her father. And the more I learned about a father, he was a rascal sometimes, but he had a great I think, exposure to the world and famous people. There's a mountain in Antarctica, named at by Admiral Byrd was a friend of their family named after Stallman. So her dinner table growing up her fair, her parents did split early, which was scandalous at the time. But her dad was very prominent in the people that came through, she was an avid equestrian. And her brother was taking her to pony shows when she was young. And then, you know, all these things that were happening in her life that she was exposed to is wonderful memory. She can I mean, in the 90s, she couldn't recite things to you she had memorized in high school. So I think between her she just so curious in this great memory, and then, you know, having we talked about her courage, but she was willing to Yes, I'll try that and, and I'll go to Sweden, and I'll go to Cleveland. And so I think that and then just having the she never, you know, she and her family had had somebody but she didn't have a lot of money. But she did travel. I think she actually went to England and met Geoffrey Dawes. And travel was a big part of her life and that exposure.

Unknown Speaker 44:07

So that I think that's

Speaker 3 44:10

the mount Stallman there is a of a mountain it Antarctica named mount Stallman and it's just a little piece of rock and a little box and I asked her about it and she said, Oh, you know what Admiral Byrd came I took him to school for show and tell

Daphna 44:30

why this story just is such a good reminder for those of us about how important our hobbies are extracurriculars are keeping our mind open to like new ideas and innovation and so many of us lose that once we enter medicine, but this is I mean, she dedicated her whole life to medicine, but her life was still so full outside of medicine. And I think that brings me you know, there's still other things she we talked a lot about her work in physiology. But it also I think, shows how much neonatology was changing over her career where she was a pioneer in regionalization of care, neonatal transport, and then really starting to get into the ethics of neonatal care. So I hope you guys will speak a little to that as well.

Speaker 4 45:23

Yeah, Beth may address the regionalization. Because she talks about in Sweden, she saw that kind of pattern, where you didn't have tertiary care in every hospital. And Beth was brought in to do it. She's the expert.

Speaker 3 45:37

Yeah, but though, the reason I got the job offers, they wanted the fellow to do transports. And I did something like two under transports my first year. So the she'd gotten the grant through the state. And it paid for the van, what's the van was a full intensive care unit. It had blood gas machines, we had ventilators, we had tanks, everything because she knew the rural hospitals in Tennessee had nothing. And what I was told as the year before we started that half of the babies arrived dead on arrival at Vanderbilt, they were just thrown in a ambulance mostly without a transport incubator. And so the regionalization was started. But also she knew it wasn't just about having a good ambulance and a crew to go pick up the baby is you needed the OB part, that mom was the best transport incubator. And so she started fighting to get the mothers transported while she didn't have the care of their care would be cared paid for, which did provide some challenges. And in terms of getting the moms there, but we also included an education program. So when we weren't transporting babies, we were visiting every hospital in Middle Tennessee, to give them an educational update of how to stabilize the baby what to do and when the call. So it was a massive switch, but from babies arrive and Doa and regular ambulances to this whole program that encourage maternal transport that did education and transfer the babies. And so I think it was kind of like anything she instituted, it was not done halfway, you know, you when you started it, you totally did it. And that's typical administratively. The grant paid for a driver and a nurse Monday through Friday, eight, five, I'm not quite sure what your experience is. As far as how many babies you've admitted between mothers but it five so so another fellow learned to drive the ban. And we would go into the nursery. And we would say, is there anybody any nurse that wants to volunteer to go to Livingston, Tennessee, and remarkably, there were a few that became regulars, they did not get paid? Who would volunteer to go on the van with us that night, because somehow, Monday through Friday, eight to five, but you know, that was an administrative thing that, you know, as we all know, that controls some of the decisions. So

Daphna 48:26

many, so many breakthroughs in in medicine and care really have relied on just the pure altruism and, you know, energy of people who are, you know, willing, willing to take a little bit of a risk.

Speaker 4 48:44

Right. And she talks a lot about as she gets into her developing this and in their ethics, the calling, she talks a lot about medicine, you know, it was a calling, and she becomes very concerned in the 80s that it becomes a profession to make money, and that was never her experience. So she would probably, you know, Beth talked about the environment. Some of those nurses had that calling to the end, she demonstrated that in her life. She might have been, she might have been a little tough, no more than a little tough. They always say she could make grown men cry around if they didn't know their p's and q's. But she was completely devoted to it. And so her experience in you know, her devotion might have been, I would say probably hit encourage the people that she worked with and a lot of speed for those who loved her and really enjoyed that. There's a lot of esprit de corps, I think.

Ben 49:53

Well, I we're getting close to the end of the hour. So I want to make sure I have two more questions I wanted to ask you number one Dr. Paquette, can you can you tell us a little bit the what was what's the mystique around the melee rounds? It seemed, it seemed like it was quite scary. But also something to be experienced was, can you walk us through what that looked like?

Speaker 3 50:21

Well, I'd say with Millie rounds, whatever was being said, you want it to be totally up to date and completely knowledgeable about your patient. And one anecdote, when I first arrived, I was standing in the hall, and I'd already scrubbed and we were gowns. And somebody came in with a baby in an incubator or transport incubator, and this baby wasn't very sick, you know, maybe, you know, I don't know, 36 weaker. So this person had just come in, and they saw I was all scrubbed, and ready to go in the nursery. And they said, Would you push the incubator into the nursery where the spot was so isolated? Sure. So I pushed the baby in. And Millie was making rounds. And so she said, Who is this? I didn't even know the baby's name. And she said, what's going on with this baby. And, you know, I knew nothing. And she said, You are a physician, who just accepted responsibility for a baby, and you know, nothing. And,

Unknown Speaker 51:27

and she was correct,

Speaker 3 51:28

you know, I really had, you know, one we'd looked and knew the baby wasn't that sick. But once I put that baby in my care, I was responsible. So that's sort of just a little example of when Milly rounds went on, it was obviously much more complex, because you were dealing with a very sick baby. But if you were going to talk about your baby, you better be totally responsible, totally up to date, fully knowledgeable. And you had no excuse of saying, well, so and so didn't tell me or this was, you know, if you needed information, you found it in so many rounds, where you had to be at your best and you had to be complete.

Speaker 4 52:10

And Beth Wasn't she she was really strong on you need to detach, and listen and observe that child, not rely on machines or data, but your hands and your eyes.

Speaker 3 52:24

Ya know that you totally knew your your patient, you know, you knew exactly what the exam was. And the other data was part of it. But you knew your baby, this was your how,

Ben 52:38

how do you think she would feel about the burden that's now placed on us for documentation, taking us away from the bedside to try to sign all these notes?

Unknown Speaker 52:47

She would agree with us.

Daphna 52:54

That's so funny. Well, I have I have one more question. I've been you said, you have one more question. You want to go where you want me to go?

Ben 53:01

Oh, you go, definitely. Go ahead. Okay.

Daphna 53:03

Well, I keep hearing about her. You know, her fierceness really, I think, is a good way to to describe her and I'm I'm cognizant of how difficult it must have been though it doesn't. It doesn't sound like she made it seem difficult to be a woman in medicine. And I'm sure you have had some of this experience yourself Doctor pocket. And I wonder how much of that personality was even potentially, you know, a factor of this environment? You know, it sounds like nobody ever said no to her, but I'm sure that she did encounter in you as well, a number of of obstacles just given our kind of society at the time?

Speaker 3 53:50

Well, no, I think you're right, there certainly were obstacles, I think she very much wanted to just be known as a good doctor, and would really not want to be characterized by her gender. But I do think one of the things I noticed is there were male doctors who were fierce, who had colorful language, and that did not get discussed about that. So to me, one of the big differences this people always address. I don't even want to call it the negatives, but that may be the more difficult parts of her personality in a male doctor with the same characteristics that probably would not be addressed it would or be just with different words, you know, in terms of was strong willed, you know, if you just think of words you describe a powerful male doctor and a powerful female are different. So to me, those were the two things that really became apparent that people would address that part of her first sometimes before her competence. Yeah,

Ben 55:00

Female would be would be labeled as bossy while a male would be called a great leader. Yes, it's the Yes.

Daphna 55:06

It's a struggle still today. But we're, we're so fortunate to have heads, you know, such strong some stronger role models for sure.

Ben 55:15

My last question is, is actually maybe a difficult one. But I'm always fascinated when somebody of the stature of merely Stallman, when when, when the time comes to step down, right. I mean, in the, in the article, you mentioned that Dr. Cotton was the one who succeeded her as the second as the second division director. I think in 1989, I think Dr. Puckett, you were there at the time. How did that transition happen? How did she take it? I think I am early in my career, but I have seen all sorts of transition some good, some less good. I'm just wondering, how did she take this transition? And, and and what was your impression of, of that transition as a physician there at the time?

Speaker 3 56:03

Well, Dr. Cotton had worked with her, basically, from the 70s, early on, and so that I think he was able to take over because he still allowed Millie in, I think, to have hired a totally new person into the nursery, she would have had the challenges that that we see of a lot of people are, you know, when you have your pet project that you've really worked on, but also if she had developed other interests, you know, she was getting more interested in the pathology and such, so she had other things to be doing that were keeping her going. So I think that certainly assisted with the transition, she didn't need to continue to do this. For her own intellectual pursuits, you know, she had other things to do. And one of the things she did when I was there, if a baby died, we usually got permission for a lung biopsy. And because this was before of a lot of care, these biopsies did not have all the interventions that we do now. And that led to her long term project with Jeff Whitsitt. Because she had this trove of tissue of the early stages of respiratory distress syndrome and such. So you didn't have all the drugs, not all the babies had been ventilated if they came in Doa and set. So that kind of provided her a new academic career, which not that many people switch to such a different field and just keep going. And that's what she did.

Ben 57:49

I think this is, to me, the, the highlight of who she was as a person, because for many, when that transition happens, and you're the division director, and you and you hand off to somebody else, it's usually to just fade in the background. And for her, it was the closing it seemed of one chapter and the continuation of other chapters. And I think this is true. This is tremendously inspirational for us as young physicians, because this idea of quote, unquote, the mountain is really not the right one, because you always want to be progressing and and and maybe keep, keep moving on to other initiatives keep keep building that curiosity. And yeah, and filling that and satisfying that curiosity, I think is very important. So I'm very happy to hear your answer. Dr. Prickett.

Speaker 4 58:40

And I do think in those, the end of her career as a derivative director and into the 90s, she has, I've recently been given one of the talks that she gave, and we mentioned she was very involved with ethics. And she was giving a lot of talks about in those years, national and international talks about where's it neonatology headed, and? And at what point do I mean, it's the same talks we hear today? About at what level is their viability? How much money should we be spending? Who makes that decision? How was the enough the physician is, are we supporting? We put tremendous money into the neonatal world, but how much do we put in as a society and the follow up? So I think her again, her curiosity and her passion, maybe because she trusted Dr. Cotton so implicitly, implicitly, she went on to what Beth mentioned, as far as her academic career, but then her career as far as intellectually addressing those larger social issues, I think really took place in the 80s and the 90s for her.

Ben 59:48

Yeah, and you mentioned in the article, a talk that she gave in 1996. During her acceptance speech for the APS John Holland award called who will save our children question mark. And I think this is something that is still a question today. And actually, through the podcast this year, we're going to try to have a series of podcasts on advocacy, because it is still an issue of not children not being not not having the attention that they deserve and seeing how resources are allocated to adults, sometimes over children. And that's something that still lingers. And I think she, as usual, as we've seen through this podcast, she had the ability to really see where the problems were and addressing them early on. So it's not really surprising. Corey, Beth, thank you. Thank you very much for for making the time to speak with us today. If people want to find out more about Dr. Stallman is there. As I said, we're going to link the article that you wrote on the website also found this other article that you reference in the paper called fellows come and fellows go. It's a great yeah, I really liked that article as well. Is there any other places where people can find out more about Dr. Stallman that you would recommend until the book comes out?

Speaker 4 1:01:15

Actually, it sounds kind of elementary, but her papers are very interesting that she's written and just a quick PubMed study because there hasn't been a search. There she's a member of you know, she's an Apgar award winner. She's a Howland Medal Award winner. But I guess you'll just have to wait for the book.

Daphna 1:01:47

All right, well, then you have to keep us updated so that we can we can revisit it and let everybody know when it's out. How about that?

Speaker 4 1:01:55

Yes. And and just why thanks also to I've interviewed Dr. Bearcat Paquette, too, and I think you can see the quality of people that Millie trained. And, you know, just from this discussion here, and the intellectual curiosity that her fellows and her faculty members add, I learned something new every time about her, like when I talked to Beth or some of these other people and it really wasn't, it continues to be but it was really an outstanding program and people who are passionate about the newborns and the the the neonates, so it's it's, it's thrilling to see and hear people like that speak.

Daphna 1:02:37

Absolutely. We're so grateful for both of your, your time and your experience and your storytelling. So, Cory Dr. Paquette, thank you so much for for joining us today.

Speaker 3 1:02:50

Thank you for doing this. Dr. Stone? Yes, they milled mother Mildred. She was also known.

Unknown Speaker 1:02:58

Yes, thank you for

Ben 1:03:01

that. Thank you for listening to the incubator podcast. If you liked this episode, please leave us a review on Apple podcast or the Apple podcast website. You can find other episodes of the show on Apple podcasts, Spotify, Google podcasts, or the podcast app of your choice. We would love to hear from you. So feel free to sentence questions, comments or suggestions to our email address NICU You can also message the show on Instagram or Twitter at NICU podcast or through our website at WWW dot d dash incubator that org This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns. Please see your primary care professional. Thank you

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