THE HUMAN TOUCH
Enduring
grueling hours and a non-stop schedule, Duke transplant surgeon Betsy Tuttle-Newhall, HS'96-'97, still makes the
time to connect with her patients
by Marty Fisher
At 22, Betsy Tuttle, HS'97, concealed her contempt at the question the paunchy surgeon leaned across his desk
and asked her, earnestly, through a thick cloud of cigarette smoke: "Do you think you have the
stamina?"
The year was 1988. Tuttle, a graduate of the Bowman Gray School of Medicine at Wake
Forest University and an intern at N.C. Baptist Hospital in Winston-Salem, was trying to
break into the male-dominated world of surgery. She was also an athlete—a national
junior women's 1500-meter champion—who routinely ran 80 miles a week. She resisted
the urge to deploy her trademark humor in a sarcastic remark. "I was terrified,"
she laughs. "I think I just said, ‘Yes sir, I think I have the stamina.'"
Tuttle was the first woman at the Bowman Gray School of Medicine to pursue a career in
surgery. Even at Duke, where women were accepted in medical school as early as 1930, the
first woman surgical resident wasn't admitted until early 1980. "People thought,
because of the all-nighters and the unpredictable hours, that women couldn't be as
committed as men," says Tuttle's older sister, Amy. "It was an uphill struggle
for Betsy. They kept trying to talk her into something less stressful, like being a
pediatrician."
Tuttle's break finally came when she was accepted for a surgical residency at New
England Deaconess Hospital at Harvard Medical School. "I might as well have been in a
different country," she says of her time in New England. "In the South, I had to
try, and try, and try to be taken seriously. In New England, you just did your job, it was
no big deal."
Tuttle spent six years at Harvard, including two research fellowships—one in
pediatric critical care and one in nutrition and metabolism. In 1995, she returned to the
South for a fellowship in surgical critical care at the University of North Carolina at
Chapel Hill. The next year she came to Duke for a fellowship in transplant surgery, and
she joined the Duke faculty in 1998.
Today Tuttle-Newhall, her married name, is one of only two women on the Duke surgical
faculty and one of only 20 female transplant surgeons in the country. At 37, she performs
a third of her division's liver, kidney, and pancreas transplants, takes call in the
surgical intensive care unit, oversees Duke's large kidney transplant program, directs the
transplant surgery fellowship program, and teaches surgery to medical students.
Her schedule is grueling—unlike most other surgeries, transplants are
"scheduled" when organs become available, often in the middle of the night with
only a couple of hours notice. Sometimes, a windfall of donated organs will push her to
the point of exhaustion, other times she watches helplessly as her patients die waiting.
More than stamina, Tuttle-Newhall displays a unique kind of courage—the willingness
to become personally involved with patients on the brink of life and death.
"Dr. Betsy"
On a recent Friday morning in clinic, Tuttle-Newhall, wearing clogs and pants with her white
coat, opens the door to a patient room and is greeted with smiles and hugs. Ellen Haines*,
52, has come from Nashville, Tenn., for a check-up. As always, her sister, Virginia Mills*
of Raleigh, is along for support. "The three of us have been through a lot
together," explains Mills. "We're old friends."
Haines keeps her oversized coat pulled tightly around her. Her face is puffy from
medication and her smile is weak—a recent bout with pneumonia and anemia have left
her short of energy. Even so, she's eager to chat—the conversation ranges from the
most recent episode of the TV show, ER, to Haines's trip to Vanderbilt to hear
Tuttle-Newhall address the faculty recently. "I was so proud of her," she says.
"She makes you proud to be a woman," Mills chimes in.
A diabetic since the age of 10, Haines received a kidney-pancreas transplant at Duke in
1997. Tuttle-Newhall performed her surgery and was there when she came back to Duke a year
later with life-threatening pneumonia. "I was so relieved to see her there,"
says Haines. "I knew she would take care of me." Haines lingered in intensive
care, but eventually went home to begin a slow recovery. For years, she has lived with
only one functioning kidney, and now it has begun to show signs of failing. Tuttle-Newhall
talks with her matter-of-factly about arranging another kidney transplant. Haines would
need to be on dialysis while waiting for the kidney, she says.
Haines nods, and looks down at a folded piece of notebook paper on which she has
written a list of her medications and some questions. She and Tuttle-Newhall go back and
forth about medications and what her doctor in Nashville says. Finally, Haines gets to the
question that's really on her mind. "How long would a person live—if you just
did nothing?" Mills protests, and Tuttle-Newhall tells Haines she's crazy. She
explains that once the kidney fails, it wouldn't be long at all. "Death is
forever—you know dialysis can't be that bad," she chides. Later, while examining
Haines, she takes her hand and says softly, "You know I was teasing you before. I
will honor whatever you tell me to do." She looks over at Mills and back to Haines.
"We just don't want to lose you."
A hug, instructions about bloodwork, and "Dr. Betsy" is off to the next room.
Eileen Bailey*, a young mother of two from rural eastern North Carolina, says hello and
tosses Tuttle-Newhall a bag of chocolate candy. During months in the hospital, Bailey
always kept a dish of candy on her bedside table. "Nurse bait," she says,
laughing. After liver transplant surgery with multiple complications and a long and
painful recovery, Bailey has been relatively healthy.
She laughs as she describes how Tuttle-Newhall spent time educating her children, ages
seven and nine, before she left the hospital. "She let my son watch while she put in
my drainage port," she laughs. "It's been great, because she made them feel a
part of my recovery—they're so strict with me now!"
Bailey has gone back to her clerical job in a physician's office. But over the last
several months, her blood platelet count has increased significantly. Tuttle-Newhall
recommends "taking out" her spleen, by disconnecting it from the rest of her
organ system. She explains the process in detail. Bailey listens intently, then deadpans,
"Well, you better do it quick, my Medicaid runs out at the end of this month."
As Tuttle-Newhall shakes her head in disbelief, Bailey explains that Medicaid won't
cover her anymore because she's working. Her husband is on disability, and she can't
afford her own insurance. The physician she works for doesn't offer a healthcare plan. Her
medication alone costs several thousand dollars each month. Tuttle-Newhall carefully goes
over the list of medications with Bailey to see if there are any she can discontinue.
Later, back at her workstation she relates Bailey's predicament to the other
physicians, nurses, and social workers. No one is surprised. "This happens all the
time," says Tuttle-Newhall. "Eileen is honest. She could try to beat the system
by not working, or by getting paid under the table, but she's honest." She makes a
phone call to Duke vascular radiologist, Dr. Paul Suhocki. He agrees to help, and the
procedure is scheduled for the following Tuesday.
Bailey is impressed, but not surprised by the lightning swift response. "She'll do
anything she can to help you," she says.
The Last Bastion of Primary Care
In a world
where the once-sacred relationship between doctor and patient is fast becoming
a memory, Tuttle-Newhall believes she has found the last holdout. "I follow my
patients two to three years before we transplant them, I take care of them in the
hospital, and I follow them for years after their surgery," she says. "Maybe
that's old fashioned and idiotic."
Although she's been in the minority as a woman in surgery at Duke, she says she has
enjoyed a sense of teamwork and camaraderie from the beginning. She admits to having a
reputation for being extremely protective of her cases—no one treats her patients
without consulting her or her detailed instructions. "She can be very tough to get
along with, and uncompromising if she thinks there's anything that might jeopardize the
safety of her patients," says surgery chairman, Dr. Bob Anderson. "But I would
say that's true of most good surgeons."
"There's a level of personal commitment here, sometimes at the physician's
expense, to provide quality and continuity of care," says Tuttle-Newhall. "My
partner, Brad Collins, and I are essentially the same person—we communicate
exhaustively…Trust me, that kind of physician-directed care is very hard to
find."
Because she is a woman, and a southern small-town native, Tuttle-Newhall has an unusual
bond with many of her patients from the start. She grew up in Madison, N.C., a town she
describes as having "six stoplights downtown and 3,000 people on a warm day."
Her father sold Chevies and Oldsmobiles in Madison for years, and her mother, a retired
schoolteacher, served several terms as mayor. She has three older sisters—a social
worker, an elementary school teacher, and a nurse—who all live nearby. The family's
roots on their father's side go back for generations in the same community.
Her first transplant patient is still one of her close friends—J.T. Hubbard,
"the Hot Dog King" of Dillon, S.C. Hubbard spent three months in intensive care,
and his wife, "Miss Emily, came every day and sat out in the waiting room with her
Bible," says Tuttle-Newhall. "The three of us got to be very good friends."
During their many conversations, the antics of Tuttle-Newhall's home companions, two cats,
came up a lot. When the Hubbards finally went home, they thought a cat would be good
therapy—and they named him "Tuttle" in her honor.
Along with a photograph of "Tuttle," Tuttle-Newhall has a framed photo of a
young man in his 20s and his wife. For "Eddie," Tuttle-Newhall wasn't able to
provide a happy ending. "He and I had talked about it, and he wasn't going to do
well," she says. "I said ‘If it comes down to the point where there's
nothing more I can do for you’ … and he said, ‘You've got to let me
go.’" She did as he asked, and he spent his last hour of life, unhooked from
machines, peacefully talking with his family.
"We have the kind of relationship with our patients to be able to have those
discussions," says Tuttle-Newhall. "You're allowed entrance into a place in the
family where sometimes, you're not sure you should be. But they want you there. And that
can be very very hard."
*not her real name
