|FEATURES Summer 2001|
Neonatologist F. Sessions Cole loves working with families. As a physician and leader of the Division of Newborn Medicine at the School of Medicine, Cole is responsible for some 10,000 babies a year. With that, he handles some of the area's most extremely premature infantsall with the utmost care and devotion
Harrison James Acord was born on September 14, 1999, at BarnesJewish Hospital South. His parents, Cassandra and James Acord, had known for months before Harrison was born that he had a diaphragmatic hernia and there was only a 20 to 50 percent chance he would survive. After meeting with numerous specialists and worrying countless hours during Cassandra's pregnancy, the Acords were hopeful that surgery following Harrison's birth would repair the hernia and save his life.
When Harrison was 12 hours old, however, F. Sessions Cole, the Park J. White, M.D., Professor of Pediatrics and professor of cell biology and physiology at the School of Medicine, entered Cassandra Acord's hospital room with Rick Martin, associate professor of pediatrics, to tell her Harrison had other problems, and he would die. "The bottom of my world dropped out," she says.
Harrison had an extremely rare condition called Fryns syndrome, which causes unusual facial features, hand and foot abnormalities, poor lung development, and, in many cases, diaphragmatic hernias.
Although the Acords were devastated by the news Cole delivered, they were struck by his warmth and kindnesswords often used to describe Cole. "Dr. Cole had this gift of telling us what we needed to know and how we needed to hear it. He was very caring," Cassandra Acord says. "He's a wonderful doctor on many levels, but it's the compassion he showed us that sets him apart."
Cole, also head of the Division of Newborn Medicine at the School of Medicine, ultimately is responsible for 10,000 infants annually, or about 40 percent of those born in the St. Louis metropolitan area. In addition to overseeing care of babies in the BarnesJewish Hospital South nursery and in the Neonatal Intensive Care Unit (NICU) at St. Louis Children's Hospital, he supervises nurseries at Missouri Baptist Hospital and at Christian Northwest Hospital.
He relishes caring for newborn infants. "By treating them, I can take care of children whose outcomes are the longest possible outcomes in medicine," Cole says. "And I love working with families."
Joan C. Downey, assistant professor of pediatrics at the School of Medicine, calls Cole the consummate clinician. "He is concerned about every aspect of the patient's well-being, from the cutting edge of what medicine has to offer to the familial, social, and societal context in which the patient and family live," she says.
Each year, Cole personally cares for approximately 650 newborns. Much of his time is spent treating infants in the NICU at St. Louis Children's Hospital. Babies heremany of them born prematurelybattle myriad problems.
In neonatal intensive care units across the country today, babies born 16 weeks early and weighing only 1.3 pounds can survive. These infants, called extreme preemies, are tiny enough to fit in a human hand.
"Dr. Cole had this gift of telling us what we needed to know and how we needed to hear it. He was very caring," Cassandra Acord says. "He's a wonderful doctor on many levels, but it's the compassion he showed us that sets him apart."
A typical extreme preemie, who lives in an incubator, may not be strong enough to draw air in and out of his or her lungs without a breathing machine. The baby's intestines often are immature, and food is provided intravenouslythrough a small plastic tube inserted into a blood vessel in the preemie's belly button. This tube also is used to withdraw blood regularly for testing. During the first few weeks of life, the preemie receives multiple blood transfusions to replace the lost blood. The infant also is at risk of bleeding in the brain and of infection.
A recent article in The New England Journal of Medicine documented that of the 8 percent of extreme preemies who survive, half of them are normal. The other half are mentally or physically disabled and can have general slowness in mental growth, seizures, and problems seeing, hearing, talking, walking, and using their hands and feet.
Cole, who has become a national figure in the bioethical debate about how much should be done to save these infants, says this is the first study to tell parents the chance of survival for an extreme preemie and what happens to the ones who live. "But we still don't have any reliable methods for predicting which of the babies are going to be normal and which are going to be severely affected," he says.
In the NICU, Cole advises each family individually. But two factors always play a role: whether the baby's clinical condition can be helped by available machines and medicines, and the family's expectations and perceptions.
"Some families have lost children or had significant complications in getting the baby to this point," he says. "Religion also is important sometimes. Some families have great faith that God is working through the doctors, and some families feel that God is working despite the doctors."
The process is dynamic, as the baby's condition, the family's perceptions, and the infant's response to medical interventions change often. "No family wants a baby to suffer needlessly," Cole says. "On the other hand, no family wants to give up hope. We help families define the boundaries of hope, which sometimes are pushed out and sometimes become very narrow."
The son of a television repairman and homemaker in Providence, Rhode Island, Cole decided between his junior and senior year at Amherst College that he wanted to become a doctor. He was a history majorhis only exposure to medicine had been a summer internship in an operating room at Rhode Island Hospital.
"My father and I were fishing, and he asked me what I was going to do," Cole says. "Without much discussion or thought, I announced that I thought I'd be a doctor."
During the first week at Yale University School of Medicine, Cole was so intimidated by his classmates' intellect and scientific knowledge that he bought a one-way bus ticket home. He buried it beneath clothes in a dresser drawerbelieving he might need to leave school quickly and never return. The ticket remained in the drawer.
In medical school, Cole had a hard time deciding whether to specialize in internal medicine or in pediatrics. In the end, he decided he wanted to treat children. "Kids wanted to get well," Cole says. "I found that if I wanted a patient to get well more than the patient wanted to get well, I felt frustrated. I never felt frustrated with children."
He considers teaching a daily opportunity to be challenged. "It's an excuse to learn moreboth about myself and about a topic," Cole says.
Cole trained at the Children's Hospital Medical Center in Boston and at the United States Public Health Service Hospital in Brighton, Massachusetts. He also completed a research fellowship in neonatology and cell biology at Brigham and Women's Hospital in Boston. His fellowship was in the laboratory of Harvey Colten, whom he followed to Washington University School of Medicine in 1986.
When Cole joined the Department of Pediatrics as director of the Division of Newborn Medicine, he was one of four full-time neonatologists. Today, the division has 16.
In addition to his administrative duties, Cole teaches medical students, residents, and fellows. He considers teaching a daily opportunity to be challenged. "It's an excuse to learn moreboth about myself and about a topic," he says.
Cole was honored by students in 1993 with a Clinical Teacher of the Year Award. And for his role in helping two medical students start an extracurricular program called Students Teaching AIDS to Students (STATS), he won a First Aide Award from the St. Louis Effort for AIDS in 2000. Medical students involved with STATS now provide AIDS education to 5,000 middle-school students in the St. Louis area each year; Cole remains one of the group's faculty advisers, along with Gregory Storch, professor of pediatrics.
William A. Peck, executive vice chancellor for medical affairs and dean of the School of Medicine, calls Cole a tremendously talented physician and leader. "He is a deeply committed neonatologist, and he has done an excellent job of guiding the Division of Newborn Medicine."
In the future, Cole believes the School of Medicine must use its resources to understand birth defects and prematurity, in addition to treating them. "We have the resources to understand the molecular and cellular mechanisms that control development," Cole says. "I think these resources are critical for taking the next step to improve the outcomes of babies."
And he will continue his personal crusade for children by educating area policy-makers on children's issues.
"Sessions Cole is an advocate for children," says Alan L. Schwartz, the Harriet B. Spoehrer Professor and head of the Department of Pediatrics. "This is one of his core values, one that he lives each day. Our children today and tomorrow are better off because of Sessions Cole."