Q&A

 

Why are you interested in Alzheimer’s research?
I lost my father to Alzheimer’s, and I saw him suffer for more than eighteen years. I saw him go through all the stages of the disease, right from very mild memory loss all the way to his death. My father and my mother were role models for me and I noticed all the struggles they went through as older patients. It still drives me.

What are some innovations happening in Madison?
This center is unique in focusing on pre-symptomatic phases of Alzheimer’s. During this stage—when there is not enough damage in the brain to cause symptoms—if we can find an effective treatment, we can stop the disease right there. It’s like preventing, if you will, Alzheimer’s. One day hopefully we’ll have a cure.

What are some advances?
We give antibodies that target the abnormal protein in the brain called amyloid protein. Almost all patients with Alzheimer’s have the protein deposited in their brain, which we think is one of the major reasons why they develop Alzheimer’s. These abnormal proteins kill brain cells, and eventually you have memory problems. These antibodies attack and dissolve the proteins. There’s some evidence coming in that these antibodies can clear the brain from this abnormal protein over time. The big question is, when you clear the brain of this amyloid protein, will it result in an improvement of symptoms?

Another area of research for which we are very well known is special brain scans that will pick up amyloid protein and some other changes in the brain that we know take place as we follow the disease. The third area is treatment. We are trying to find out if [statin] drugs can be useful in Alzheimer’s disease, especially during the pre-symptomatic phase. My own interest is in hormone treatment. 

 

What makes GHC unique? 
GHC has always been a primary care-based organization. Preventive care has always been a focus here—coordinating patients’ care. And then the not-for-profit cooperative aspect is also very unique. That has flavored the organization, I think, in a really positive way.

What is the biggest challenge in health care today?
The cost of health care overall has spiraled up and up. We need to find a way to provide high-quality care to everyone in the country in a cost-effective manner. And there’s absolutely no reason we should not be able to do that, because most of the rest of the developed world does that.

What would you change about today’s medical field?
I think there needs to be some rebalancing of the system so there are more primary care providers. Overall that’s something that’s done in other parts of the world. So encouraging medical students to enter primary care in higher numbers. I can only comment from studies that I read, but I think the very high debts they come out of school with today combined with the higher salaries of specialty care—presumably that’s what drives people’s decisions.

 

What is so fascinating about a kidney?
The kidney does so many different things. Laypeople aren’t aware that it clears toxins. It has a role in controlling blood pressure; it has a role in anemia. It’s a more complex organ than what people may think on the surface, and kidney failure affects people in a lot of different ways.

What are some misconceptions about the specialty?
I didn’t appreciate how you get to know people really well. When people are on dialysis, they’re in the dialysis unit week after week, year after year, and you really get to know the patient, their family, the whole situation, for better or for worse. Being on dialysis is, and I don’t want to give the wrong impression, it’s kind of like a little fishbowl because you’re there all the time. Things that you may not be aware of in terms of family dynamics, for instance, over time come out, and I think that’s a little different from other fields.

Do you foresee any significant breakthroughs for the field of nephrology?
People are trying to develop artificial kidneys, trying to culture kidney cells, to grow kidneys that are implanted. I think there will be some evolution in that direction, but I don’t think it’s going to happen in my career.

 

Thinking back twenty years, is this what you thought you would be doing?
When I went to med school, I never thought I would do obstetrics. I sort of went into the rotation thinking, “Oh, I just have to get through these six weeks.” And I really, really enjoyed it. I think my experience being born prematurely definitely kind of intervened into that. I was born eight weeks early, so I made a connection with a lot of patients while on that rotation. [Editor’s note: Stafeil was born at St. Mary’s.]

What is one thing that few patients know about your job? I think a lot of patients probably don’t realize how many times we have to give bad news. A lot of patients, I think, in the waiting room feel that, “Oh, we’re just here to get cool pictures on the ultrasound.” Some patients don’t always understand why the wait times are a little bit longer and things like that, but unfortunately there are a lot of times that what is expected to be sort of a normal ultrasound or a normal pregnancy can change pretty quickly. And I think a lot of patients sort of take it for granted that while pregnancies usually are normal, very low-risk pregnancies can become high-risk pretty quickly.

How do you tell someone that there is a problem with a pregnancy? It’s not easy, but just being open, up front with them and being honest with what you’re seeing and what the implications are, and just spending the time that they need to talk about it. Unfortunately I can’t spend an hour with every patient going over it, but I think just sitting down with them and answering the immediate questions and being there for them in any way that you can be there.

 

What do you like best about your job?
My job often consists of high-stress situations requiring immediate decision-making responses and patient treatment. As anesthesiologists, we place patients in a state of controlled unconsciousness for surgery, and are then the physicians responsible for the maintenance of their vital physiologic parameters such as blood pressure, heart rate and respiration and for the resuscitation of their body fluids [blood, crystalloid] and electrolytes. Emergent surgical patients often come to us in a critical state, sometimes dying, and it is our job to resuscitate them and keep them alive while the surgeon repairs their damages. Although I enjoy the challenge of this critical, rapid-paced thinking and provision of care, probably the most rewarding part of my job is the gratification my patients show me for my care following their successful surgical procedures.

Tell me about a patient you’ll never forget.
I do several medical mission trips a year to different countries. I’ve provided anesthesia, I think, in about ten different countries now, and I travel with both our University of Wisconsin surgeons and an international nonprofit group [ReSurge]. That’s a patient I’ll never forget [pointing to photo on a nearby brochure]. That’s Gian. She was burnt in a fire when she was about a year old and had facial burns and essentially burns all over her body, and we’ve done reconstructive surgery on her and she’s now a happy ten-year-old child. I’ve taken care of her three times. 

 

Why did you choose your specialty?
From an early age I wanted to be a doctor. I later thought I wanted to be a neurosurgeon but the outcomes sometimes for them were just not pleasant to me. I’ve always been fascinated with physiology and the heart. Our patients usually come with some horrible thing where they’ve had a heart attack and can hardly do anything, and we do revascularization or replacement of a valve and then they regain. It’s like a phoenix from the ashes. They come back to where they were. So that’s why I felt this was a good fit for me.

What is the most rewarding thing about your job?
Taking care of sick people involves getting to know them. You have to know their point of view and values, and that has to go into what you’re doing. It has to start right from the first time you meet them and it has to be a part of everything you do. What they want and what their values are dictate what happens. Without a doubt, it’s the human interaction that makes it great. I’ll have someone come up to me and say, “Oh, Dr. Gilliam, you operated on me fifteen years ago.” There is nothing more satisfying.

 

Describe the dynamics of treating patients of all ages.
It’s something we do every day, all the time, and it’s what makes family practice interesting, because we have so much variety with what we do as far as the kind of problems we take care of. And sometimes it transitions in the same room. Yesterday I saw a mom, she had her child along; I got done taking care of the mom and she says, “Will you take a look at so-and-so. Because I think he’s got an ear infection.”

Tell me about a patient you will never forget.
Scotty. Young gentleman with Down syndrome who I met when I first came here and was able to take care of until he passed away about two years ago. Scotty had a number of physical deformities and a lot of arthritis. It was difficult for him to raise his arms or even to reach out, but every time either I or my nursing staff walked in the room, before he talked to us, he had to give you a hug. And before you left, he had to give a hug. He was one of those patients that every time you saw him, it tugged at your heart, but you also left the room feeling better. So it could have been a crummy day, terrible things could be going on, but when you see Scotty, you left with a smile.

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