LEXINGTON, Ky. (Oct. 15, 2010) — Fifty years ago, the brand-new University of Kentucky Albert B. Chandler Medical Center was dedicated, and the university launched its first recruiting drive for clinicians. Eight physicians who answered the call were pediatricians, and among those was Dr. C. Charlton Mabry, fresh out of a post-doctoral training program at St. Christopher’s Hospital for Children in Philadelphia.
Today, at age 80, Mabry is still answering the call of Kentucky families who have children with metabolic disorders. He sees patients weekly in the Mabry Metabolic Unit, named after him in honor of his many legacies and international fame in pediatrics.
Now Mabry has taken a look back at the last half-century of caring for sick children at the UK College of Medicine's Department of Pediatrics in his new book, "First Fifty: A Pediatric Story."
The goal of UK’s first eight pediatricians and those who followed remains the same today as it was in 1961: No Kentucky child should be forced to travel across the state line to receive the best medical care available anywhere. Mabry’s book lays out the path that the university followed to realize that goal through 256 pages packed with compelling stories, accompanied by full-color photos and illustrations.
One reason the book is a good read for medical and non-medical people alike is that Mabry set out to write his story “from the ground up,” as he says, focusing on the patients and their stories rather than a top-heavy history with a view from the administration on down.
He begins by telling the reader about how medical care for children developed in cities like Lexington through the beneficence of milk clinics, charitable organizations that made milk and buttermilk available to children in poverty. In Lexington, the Baby Milk Supply Association was founded in 1914 to meet that mission, and the organization continues today as the Baby Health Service clinic, providing such services as immunizations, x-rays and medications to Central Kentucky children whose families cannot afford private insurance but yet do not qualify for Medicaid.
Mabry describes the private practices of Lexington’s first pediatricians in the 1930s, nearly all of whom hung their shingles in a “pediatric ghetto” just north of downtown. Many of those private practitioners, though wary of losing patients to a university-based pediatrics department, supported efforts in the 1950s to build a state-of-the-art medical center at the university, and today a strong bond remains between UK pediatricians and those in private practice.
“The momentum to have a medical school as part of the University of Kentucky in Lexington hung in the balance initially, as many doctors were fearful of the competition for private patients and wanted the appropriated money to go to their alma mater, the University of Louisville,” Mabry writes in his book. “(Dr. Richard) Elliott, as president of the Fayette County Medical Society, was instrumental in getting a resolution of approval from the local medical society.
But while the primary focus of pediatricians in private practice is on patient care, pediatrics at a university is a three-tined fork. In addition to patient care, a university department functions also to teach and to do research. In his book, Mabry points out how one administration might emphasize one function over the other two, while the next administration might emphasize another.
“How does this book fit into the vision for pediatrics?" said Dr. Tim Bricker, who is the Jacqueline A. Noonan, M.D. Children's Miracle Network Endowed Professor and chair in the Department of Pediatrics at the UK College of Medicine, and physician-in-chief of Kentucky Children’s Hospital. "I saw a department where the senior faculty maybe were not as dazzled by their past as I would have liked to have seen, but more concerning was that the junior faculty and the residents did not know it. And so, I think that part of our future is telling the story of our past and the story of remarkable young people who came here to change the care of the children of Kentucky that had a huge impact, but I would like to have it out there as the goal for every young faculty member to emulate. I think that part of the story of the future is not just how many buildings we have or how many faculty we have or how many grants we have, it is how we behave and it is a goal of a children’s hospital that is truly loved as a treasure of the Commonwealth by the people who live here. I think that the people that built this department and that grew the resources that turned into the children’s hospital have done a lot to have a children’s hospital that is loved and treasured by the Commonwealth, but there have also been some things that have led to some ambivalence. Therefore, the goal for the future is that we have a children’s hospital that people in Kentucky are just as proud of as they are about their basketball team.”
Another point of debate over the decades has been whether clinicians should be generalists or specialists. Mabry explains how UK’s Department of Pediatrics transitioned from the generalists to a staff of mostly subspecialists, a trend mirrored nationally in the increasing number of board-certified subspecialties recognized by the American Board of Pediatrics.
“ I can still remember being in the clinic one day with Dr. Mabry when he walked out of the exam room and he said, 'Davis, come over here, come over here," said Dr. J. Steve Davis, deputy commissioner for the Kentucky Department of Public Health. ”And he took me in an exam room and there was this child who was very, very sick. The child had cerebral palsy and was being tube fed. He introduced me to the family and we talked for a little bit. Then he stepped out in the hall and he didn’t say anything else. He said, 'Come here.' Then he took me into another room right across the hall. He introduced me to that child and that child’s family. It was a bubbling little child of four years old, and just bouncing off the exam table, happy, talking, and laughing. He just said, 'I want to introduce you to one of our medical students.' Then we walked down the hall and he said, 'Let me share something with you. Both of those children have the exact same diagnosis. One of them got missed early on and wasn’t diagnosed early enough to get the treatment program started. The other one got picked up very early and the treatment program got started. The real lesson is don’t ever miss a diagnosis like this. Just always be astute and always be attuned, because there’s a living example of the difference you’ll make in a child’s life.' That sticks with you.”
Mabry also, almost single-handedly and energized by parents who had lost babies, persuaded the Kentucky General Assembly in 2005 to greatly expand its newborn screening program. The program requires that a drop of blood from the heel of every child born in Kentucky be submitted to a state laboratory to determine whether the child has an unseen but potentially fatal disorder. Until 2005, the Commonwealth tested for only five disorders. But Mabry lobbied legislators ceaselessly to strengthen the program, and in 2005, lawmakers adopted Senate Bill 24, which mandated that the state would test for 29 disorders rather than the previous five. Today, the state can identify 44 disorders that could cause blindness, deafness, even sudden infant death syndrome – disorders that in many cases can be successfully treated through medications and special diets.
“Kentucky is one of the states that expanded our newborn metabolic screening program," said Davis. "This is something that Dr. Mabry is one of the American fathers of medicine did in identifying the children who have a metabolic disorder. This is but one step in the circle of newborn screening. You not only have to screen the children, but after you screen the children then we have to make sure that we get them into a care system very early so that we can ameliorate potential problems that can be catastrophic. I can tell you, one of my life’s professional dreams has been the opportunity I had working with Dr. Chart Mabry as he and I worked together very strongly, hand in glove, to see that we got the state metabolic screening program expanded. Certainly he’s the set of shoulders that we all stood on when that occurred.
“To date, we have been rescuing about 100 babies in our half of the state each year from mental retardation, handicapping conditions, disabilities, or death,” Mabry writes.
But by the end of the book, the reader remembers most the child from Wolfe County, born into poverty with a heart condition that would take his life before he became a teenager. He was adopted by a UK pediatric cardiologist who taught him about family bonds and love, and who fulfilled his lifelong dream: to see an island.
Or UK Chandler Hospital’s first patient, an 11-year-old girl from Pikeville who suffered recurrent seizures and spells brought on by a heart problem. Three chest surgeons and the chief surgical resident performed the chest surgery that allowed her to return home 11 days after the operation. Today, at age 57, she is still in good health and living in Pikeville.
Or the mentally disabled mother who, along with her more severely disabled adult children, were institutionalized and whose plight led to Mabry’s own discovery of maternal phelylketonuria (PKU), the first known cause of mental retardation treatable through dietary means.
These patients – and the many others whose stories Mabry tells – form the foundation of his book and the justification for the countless efforts by Mabry and his colleagues to treat and prevent illnesses, disorders and diseases that continue to threaten the children of the Commonwealth.
"I remember that before I was hired, Dr. Mabry was one of the people that I interviewed with," said Dr. Carol Cottrill, professor of pediatrics, UK College of Medicine, and a pediatric cardiologist at Kentucky Children's Hospital. "I guess I was supposed to have understood the workings of the university job by osmosis, but I really didn’t, so Chart sat me down and he was the one who said, you know, if you work here you have to have a commitment to research, patient care and teaching and have to do all three of those well and you have to have documentation of all of those. He told me what I would need to do to be successful in academic medicine.”
Mabry is professor of pediatrics at the UK College of Medicine, a title he has held since 1969. He has also served as professor of pathology (1971-1978) and associate director of clinical laboratories, UK Chandler Hospital (1970-1973). He is certified by the American Board of Pediatrics and the Sub-Board of Pediatric Endocrinology. He received his bachelor’s degree in 1950 at Maryville College in Maryville, Tenn., where he will be honored as recipient of the school’s Distinguished Service Award on Oct. 23, 2010. Mabry was awarded his medical degree from Emory University in Atlanta, Ga., in 1954. He and his wife, Barbara, reside in Lexington and have four children and five grandchildren.
Advance orders for "First Fifty: A Pediatric Story," by C. Charlton Mabry with Barbara Mabry and Jim Niemi, can be placed at www.theclarkgroupinfo.com or by calling The Clark Group at (859) 233-7623. Mail orders can be placed at The Clark Group, 250 E. Short St., (or P.O. Box 34102), Lexington, Ky. 40588. The cost is $39.95, plus $7 for shipping and handling.
