Portal de Periódicos da CAPES

Our New President—Gail A. Hecht, MD, MS

2009; Elsevier BV; Volume: 136; Issue: 5 Linguagem: Inglês

10.1053/j.gastro.2009.03.008

1528-0012

Diane Martinez, Jerry S. Trier, James Madara, Thomas J. Layden,

Diversity and Career in Medicine

Gail Alane Lawson's 2:00 am entrance into the world on Thursday, February 17, 1953, at McCune Brooks Hospital in Carthage, Missouri, long preceded the arrival of the obstetrician. Lillis Lawson, Gail's mother, says, “She came in like a gale and hasn't stopped.” Gail and her mother were fetched home a few days later by her father, Roy Lawson; her paternal grandparents, Noema and John Lawson; and her older sister, Diane. Home was La Russell, population 128. The business district of this southwest Missouri town consisted of Gail's grandparents' general store, the post office, 2 feed stores, a gas station, and 3 churches. These establishments lined Main Street, an unpaved road bisected by a community pump (Figure 1).Figure 1Gail's hometown of La Russell, Missouri, population 128, consisted of the general store, 2 feed stores, a post office, and 3 churches. A community water pump bisected Main Street.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Gail's parents worked at the family's general store. Lillis stocked shelves and did the books; Roy “ran the route” (delivering groceries, picking up fresh eggs and coops of chickens to transport to market) and repaired appliances and televisions. The hours were grueling, and the low wages made them more indentured servants than employees. Gail feels that the work ethic of her parents and grandparents shaped her own value system. “My mom always worked inside and outside the home,” Gail said. “She was a self-taught bookkeeper and did accounting for a series of businesses until her retirement—at age 76!” As children, Gail and her sister learned to entertain themselves under the watchful eyes of extended family: parents, grandparents, Great-grandmother Laura, Aunt Marlene. “The town was my playground,” Gail says. “Everybody knew everybody. I was free to roam. Everywhere was safe.” Although limited in many ways, the small town environment offered endless possibilities for imaginative expression. Gail used that freedom to explore her numerous aptitudes and interests. To Papa's great frustration, she dabbled in preschool crime, becoming a recalcitrant snitcher of dried macaroni and the small colored Band-Aids from the shelves of the general store. She gained early administrative experience as treasurer of the Flower Club, until her sister Diane disbanded the group by executive order at the suggestion that someone else might have a turn at being president. In 1958, John Kerry, Gail's younger brother, was born, providing her the opportunity to precociously try out her maternal instincts (Figure 2). Gail and Diane, likely put off by the celebration surrounding the birth of the first male Lawson, enjoyed dressing John as a girl and pulling him around in their Red Rider wagon to introduce the town to their “new little sister.” Gail's nurturing tendencies were less ambivalently directed toward a series of cats, including Sugar Plum (a feral cat Gail tamed), Fluff (also known as LoMoKits), and Henry. Portending perhaps her future public prominence, Gail generated significant local fame in her preschool years as a child singer with an impromptu performance of more than 30 popular tunes of that time (Elvis Presley, Brenda Lee, Andy Williams, Perry Como) at a PTA meeting, with follow-up performances on live radio shows at stations in Carthage and Springfield. More to the point for this tribute, Gail describes 2 childhood experiences that presage her interest in science. “There was a slaughterhouse behind my grandparents' home. I'd watch the workers kill the animals, put hooks in the back legs of the animals, and hoist them up. They would cut the jugular veins and split their abdomens open to let the blood run out before removing the intestines, liver, and spleen. I watched the process over and over. It never seemed gross to me.” Also, Gail collected frog eggs from a nearby pond in a jar of water, which she would place in the window so as to watch the eggs hatch into tadpoles. “The process was amazing to me,” she says. In 1959, Gail began her formal education by enrolling in first grade at La Russell Elementary; the town had no kindergarten. The school had just been expanded from a 1-room institution to 2 rooms: grades 1 through 4 were taught by Miss Baker, while the upper grades were assigned to the sterner Mr. Henry. Although the school did not acquire indoor plumbing until Gail was in fifth grade, gender-specific outhouses were provided. In the absence of drinking fountains, the students developed the skill of fashioning notebook paper into a cup to be filled at the outdoor pump. Gail remembers being bored during much of the largely unstructured school day. The teacher could only attend to one grade at a time. Gail lived for recess activities: softball in warm weather, snow sledding in the cold months. Her favorite class was reading, for which students would be summoned to a communal table in the back of the room. For motivation, every child was given a plastic tree on which he or she could stick a gumdrop for each error-free performance. When the last branch was filled, the owner was allowed to remove the candy to take home. Also in 1959, Papa Lawson, in what in retrospect was a midlife crisis, traded the general store for an ill-fated motel-diner combination in the Ozark region of northern Arkansas. The financial disaster this ultimately brought on the Lawson family turned out to have a silver lining in that Roy Lawson was forced to go to work as a sales representative for an agricultural supply company. That job required the Lawson family to move about 100 miles north to El Dorado Springs, Missouri, population 3500. The consolidated school system there, with approximately 100 students per class, offered much more academically. Gail was elected cheerleader in high school and as a sophomore lost the title of basketball homecoming queen to the senior candidate, her sister Diane. In 1968, Gail's father received a promotion and the Lawson family again relocated, this time to Blue Springs, Missouri, a suburb of Kansas City. Gail finished high school there, serving as secretary for her senior class and again as cheerleader. As an undergraduate student at the University of Missouri in Columbia, Gail did not aspire to be an academic physician-scientist. Indeed, aside from the psychology courses required for a bachelor of arts degree in psychology conferred on her at graduation, Gail completed only 2 “hard” science courses—introductory biology and astronomy. Her apparent lack of ambition and focus was such that during her junior year, Lillis and Roy sent older sister Diane to intervene. At that time, Gail was working part time as a nursing assistant at the Harry S. Truman Veterans Administration (VA) Hospital to meet her financial needs. Diane recalls Gail making a vehement argument for the virtue of a life well lived as a nursing assistant. In due time, however, Gail began to resent that subservient role. Encouraged by colleagues at the VA Hospital and by friends, she applied for admission to the 2-year nursing program at St Louis University. In one of the more fortunate turn of events of her life, Gail was denied admission. It would be amusing to watch those responsible for that decision review Gail's current curriculum vitae and bibliography. Rather than discourage Gail, this rejection served to markedly alter her career trajectory to the benefit of the digestive diseases community. As an alternative to nursing school, she enrolled as a nondegree program graduate student at the University of Missouri in Columbia and began taking science courses while continuing to work at the VA Hospital. One of these courses was medical microbiology, which provided Gail her first exposure to the field that would ultimately become the focus of her career. Gail excelled in this course, and her enthusiasm did not go unnoticed. She was recruited to work in the laboratory of a young microbiology faculty member, Thomas Brauner. This allowed her to leave her VA job and stimulated her to join the graduate degree microbiology program. She initially lacked the necessary prerequisites for her advanced degree study but solved that problem by completing the requirements (general chemistry, organic chemistry, physics) while taking graduate-level courses. Her advisor encouraged her to include a graduate-level immunology course, one of the most difficult courses offered, in her first-semester schedule, telling her if she did not do well on the first test she could drop the class. To her surprise, and that of her professors, she earned the highest grade. For her master's thesis project, Gail studied potential pharmacologic agents for the treatment of genital herpes. This research required her to master a variety of basic cell culture, microbiological, and biochemical techniques. Nearing completion of the master's degree curriculum, Gail was faced with the difficult decision of whether to pursue a doctorate in microbiology or apply to medical school. Gail describes reaching her decision to become a physician as a result of 3 converging influences. First, she found herself fascinated by the complexity of the human body while attending the autopsy of a critically ill patient she had cared for in her job as a nurse's aide. Second, Gail discovered that she not only enjoyed science courses, but that she was confident her ability to master the content equaled or exceeded that of her fellow classmates, most of whom were medical students. Third, Gail was strongly influenced by Diane, her older sister, who was in medical school at that time, and by her friendship with fellow graduate student David Hecht (the man who would become her husband), who planned to become a physician. “David and I first became good friends,” Gail says. “And it was important that we both liked to dance.” Gail applied to 2 medical schools: the University of Missouri at Columbia and Loyola University Chicago Stritch School of Medicine. She was accepted by both. The choice of which school to attend was simplified when David was offered and accepted an early decision slot at Loyola. At Loyola, 2 superb academic clinician-educators, Rolf Gunnar, a cardiologist, and Ketty Badrinath, an oncologist, influenced Gail to seek residency training in internal medicine with an eye toward an academic career. Initially, she found herself drawn to the subspecialty fields of nephrology and rheumatology. However, inspired by her first attending physician at the University of Minnesota Medicine Residency Program, Craig McClain, and subsequently by Robert Knodell, Gail developed a strong interest in gastroenterology. Attracted by the diverse research opportunities, available protected time for research, and emphasis on mentoring, Gail chose to join the gastroenterology training program at Harvard's Brigham and Women's Hospital upon completion of her residency training. Simultaneously, her husband David entered training in the prestigious infectious diseases program at Tufts University Medical School under Sherwood Gorbach, MD, long-time American Gastroenterological Association (AGA) member and division head. As a first-year clinical fellow, Gail earned a reputation as an astutely intuitive, compassionate clinician with an encyclopedic knowledge base who could dissect out and plan approaches to the core issues in patients with complex medical problems. Her attending physicians more than once used the word “awesome” to describe her clinical performance. For the research component of her fellowship training, Gail decided to combine her interest in epithelial cell function and her past experience in cell culture. She chose to work with James Madara's group. As Chief of Gastrointestinal and Liver Pathology at Brigham and Women's Hospital, Jim directed an extremely productive epithelial biology laboratory and had close ties to the Gastroenterology Division, having spent time in the division as a research fellow himself. Jim became Gail's research mentor. After completing her clinical fellowship in gastroenterology at Brigham and Women's Hospital, Gail spent 2 productive research training years in Jim Madara's laboratory at that same institution. Gail had great success in her early research career, which served as a launching pad for many of her accomplishments. Often what one accomplishes in a research career is put in narrow terms of “what was discovered.” Underlying the “discovery” piece—and equally important—are the personal characteristics that facilitated success in discovery (and in life). These are interesting and abundant in Gail's case. Having had master's degree–level training in medical microbiology, she was drawn to an intersection of microbiology in the context of the polarized columnar epithelial layer that lines the majority of the alimentary tract. Work at this interface was first expressed in examination of the physiological effects of Clostridium difficile toxin A on intestinal epithelia, work done collaboratively with Tom LaMont and Harry Pothoulakis from Boston University. This work resulted in the first publication in an extraordinarily productive career (J Clin Invest 1988;82:1516–1524) as well as a reinforced sense that the intersection of microbiology and intestinal epithelial biology would be an intellectual site favorable for mining over the ensuing years. Gail's work was part of an emerging paradigm shift at the time: that the internal protein skeleton (cytoskeleton) of intestinal epithelia was not simply a static support that maintained the shape and position of intestinal surface cells, but rather the components of the cytoskeleton were both adaptable and highly regulated in health and in disease. Moreover, the cytoskeleton was itself a regulator of basic parameters of epithelial surface functions such as permeability and ion transport. Given this core orientation of thought, Gail's focus for subsequent work as she established her own laboratory at University of Illinois at Chicago is, in retrospect, not surprising. She established clear relationships between specific activities of cytoskeletal components (catalytic domain of myosin light chain kinase, for example, Am J Physiol 1996;271:C1678–C1684) and epithelial permeability; in addition, she established a model in which several of the molecular determinants of enteropathogenic Escherichia coli interaction with epithelia could be dissected and resolved (J Clin Invest 2001;107:621–629). This early research and its subsequent connection to the development of a highly meaningful research program also reveal some of Gail's characteristics that serve her well. In the first instance, Gail developed a philosophical approach. Jim Madara described this in the following way: “Gail would sit with me in my office, typically late in the day when time felt more open. We would converse not simply around the question being asked, but rather drill into why, in a larger sense, this question was important, how the question related to larger topics or integrated parallel lines of thought, and what the approach to the question said about higher-order philosophies of scientific approaches.” For example, the connection of 2 fields, microbiology and epithelial permeability, which up to that time had not been generally or well connected as a field unto itself, touches on a scientific philosophy. Namely, the unknown space between the edges of 2 known fields could yield high rates of vertical discovery relative to the simple expansion of the shell of knowledge in one isolated well-defined field. A second characteristic that Gail exudes is a potent mix of charisma, passion, and optimism. Isolated, these elements have considerable strength; combined, they are irresistible and ablate the activation barriers to professional engagement, stable collaboration, and a productive environment. The bias toward success in her early research career stemmed, in part, from these personal assets. This passion and optimism also sidestepped what can be a pitfall in early career development: the unexpected experimental result. For Gail, an outcome that did not conform to the current thinking was a gift—providing real insight if one could only understand it—rather than a troublesome wrench thrown into the day. A third ingredient to her early success was intelligence coupled with practical knowledge of the need for a cumulative daily product. Considering what is possible is useful only to the extent that one can imagine a sequential order that, if pursued in a disciplined way, would answer a question. These defining characteristics of her early research success capture the platform on which many of her successes were built in domains reaching from research to leadership. Tom Layden, then Cheif of Gastroenterology at the University of Illinois at Chicago, says that when he first met Gail, he was impressed by her unquestionable enthusiasm for research and her authentic midwestern family values. At the time of her recruitment to the University of Illinois at Chicago, Gail was pregnant with her first child, Aaron. Tom was advised by his superior that given her state, it might be wise to accept the alternative male faculty candidate under consideration. Whether out of wisdom, inherent stubbornness, or because he had a daughter, Tom selected Gail to join the faculty of the Gastroenterology Division. In 1990, Gail welcomed Cameron (“Cam”), her second son, into the world while struggling to balance a 2-career marriage with David (also now a physician-scientist who had returned to Loyola as a faculty member in infectious disease) as well as making great efforts to get her own research funded. Even with these abundant family obligations, Gail received the first of her 4 continuous VA Merit Review Awards and a National Institutes of Health (NIH) Clinical Investigator Award focused on the regulation of intestinal epithelial barrier function. Her K08 grant application was submitted the same night she delivered Cameron. Because the Hechts live only a few blocks from Tom, he and Gail would often carpool. Tom describes listening with amazement, and often exhaustion, to the intricacies of the research activities of his younger colleague's day, the details of her children's lives, and her interactions with the predoctoral and postdoctoral students and fellows in gastroenterology working in her laboratory. Many of these conversations would become soul searching, with Gail challenging the wisdom of the struggle of maintaining her precarious life balance and wondering if it might be more satisfying to be devoted full time to raising her sons. In the end, she managed to maintain enthusiasm for both mothering and a career in academic research and education. This success was in no small part due to her husband David's extraordinary organizational and household skills and the reliable presence of Mary Ann Dahlquist, who served as caregiver for the Hecht family for more than 16 years. In 1996, Gail and David further complicated their lives by deciding to buy a second home situated on the northeastern shores of Lake Michigan. Originally this summer home was purchased against Gail's will, with her contesting that so many do not own even one home, but it soon proved to allow the Hechts a much-deserved family escape. This retreat provided the setting for many happy memories for Gail's family and friends, as well as quiet time to imagine the next new experiment, article, or grant. Early in Gail's career, she received VA RAG and Career Development awards. These mentoring grants paved the way to a series of R01s (1996–2011) that focused on the mechanism of interaction of enteropathogenic and enterohemorrhagic E coli on intestinal function and ion transport. When Gail obtained her first R01 grant in 1996, her research and enthusiasm for her studies on host-microbe interactions became recognized nationally and internationally. This recognition was propelled when in 1998 and 2000, James Kaper, PhD, Professor and Chairman of Microbiology at the University of Maryland, invited Gail to present her research at the premier Gordon Research Conference on microbial pathogenesis. This exposure allowed her to become part of the microbiology scientific community and to forge connections with other investigators and collaborators in the field. Around this time, she was invited to serve on an NIH study section but declined membership to devote more time to developing her research. A few years later Gail agreed to become a member, and in 2004 she was appointed Chair of the Gastrointestinal Mucosal Pathobiology Study Section. In 2002, Gail assumed the role as Chief of the Section of Digestive Disease and Nutrition at the University of Illinois at Chicago. Under her leadership, the section flourished with the continuation of a T32 training grant in molecular training in gastroenterology and hepatology along with the support of her close friend and academic conscience and advisor, Richard Benya, MD. With Gail serving as principal investigator, the Section of Digestive Disease also obtained an NIH-sponsored Program Project Grant entitled “Regulation of Intestinal Transport.” Pradeep Dudeja, PhD, Krishnamurthy Ramaswamy, PhD, Richard Benya, MD, Mrinalini Rao, PhD, at the University of Illinois, Chicago, and Jerry Turner, MD, PhD, at the University of Chicago played vital roles in securing this important award. In the course of her career, Gail has successfully mentored a number of new faculty, predoctoral and postdoctoral students, and medical students through the process of obtaining funding from the NIH, VA, and other peer review grant agencies. Gail insists that her research work would have never been as well directed and funded were it not for the critical eyes and pen of Krishnamurthy Ramaswamy, PhD, affectionately known as Ram. Ram is the master of the statement “Why should I care about this research? It's not coming across to me.” No grant application, even to this day, escapes the University of Illinois at Chicago Section of Digestive Diseases and Nutrition without Ram's red-ink comments and blessing. Gail's involvement with AGA research was initiated by then–AGA President James Freston, MD, who encouraged Tadataka Yamada, MD, AGA President-Elect, to assign her to an AGA committee; she was offered membership on the Research Committee, which she gladly accepted. From then on she became increasingly involved with the AGA and later served on the Education Committee, organized and chaired several AGA research symposia, and reviewed abstracts for the annual meeting. This involvement provided the opportunity to rekindle her connections with her prior mentors at Harvard, Jerry Trier, Jim Madara, and Tom LaMont. In addition, Gail was advised and mentored by Dan Podolsky on her road toward AGA leadership, and in 2005 she was elected Basic Research Councilor to the AGA Governing Board. Gail's election as president of the American Gastroenterological Association is an amazing honor for her, her family, and the University of Illinois at Chicago Department of Medicine. Tom Layden notes that despite her astounding professional career, Gail holds the same values as the young, pregnant faculty applicant he met 20 years ago. These values are obvious in the excitement she shows when she talks about her family (Figure 3), in particular when she announces that David and she will celebrate their 30th wedding anniversary this year. Gail is extremely proud of David's career achievement. In the years since their return to Chicago, David rose through the faculty at Loyola University Chicago Stritch School of Medicine to the rank of professor and then to chief of the Infectious Disease Section. He was named head of the Department of Medicine at Loyola in December 2008 and will complete his master of business administration degree in health administration this spring. Meanwhile, their sons have begun to shape their own successful lives. Aaron, an undergraduate student at Washington University, plans to follow in his parents' footsteps by applying for MD/PhD programs this year. He will present an abstract of the research he performed at the University of Chicago under Jerry Turner, MD, PhD, at the 2009 Digestive Disease Week in Chicago entitled “Cytoskeletal Regulation and Tight Junction Reorganization During Epithelial Wound Closure In Vivo.” It will be with extraordinary pleasure that Gail will serve as moderator of that session. Their younger son, Cameron, is a freshman at the University of Vermont, where he is majoring in environmental science and perfecting his guitar and singing skills. The rest of the family consists of 2 mixed-breed dogs, Vinny and Stewart, and cat Missy. Although Gail did not pursue the promise of her early singing career, she continues to love music, especially alternative rock and opera. She enjoys antiquing, gardening, reading, and the restoration of their 100-year-old Victorian home in LaGrange Park. Gail has the love and admiration of her parents Lillis and Roy Lawson, her sister Diane Martinez, and her brother John Lawson and his wife Melissa, and she is the idealized, “fun” aunt to Alejandro and Pilar (Diane's children) and to Kerrie Ann, Kelsey, and Matthew (John's children). It is particularly befitting that Gail will be announced as president of the American Gastroenterological Association, only the second woman to hold this position, at the organization's national meeting this year in Chicago, the city where she received her medical degree, where she forged an incredible career as an academic scientist and physician, and where she and David raised their wonderful family.