A new role for a new time
By Rhonda Mullen
Christian Larsen was just a boy when he saw his first patient. He used to accompany his dad, a cardiac surgeon, on weekend rounds to check on patients recovering from coronary bypass surgery. When he got older, he'd enter data from his father's research studies into a big IBM mainframe, marking the beginning of a lifelong interest in science and technology.
The elder Dr. Larsen was unusual for his time. In the 1970s, he already was breaking the mold of a stereotypical surgeon by emphasizing patient care provided by teams. He performed heart transplants and sought out Thomas Starzl, who performed the first successful human liver transplant in 1967, to learn about immunosuppression. (Chris Larsen remembers setting up a reel-to-reel projector in his family's living room so that they could watch a movie of one of his father's transplants.) While in private practice in Miami, the father Larsen developed a wound care program, and at one point, he even left surgery to pursue a PhD in biology at the University of Miami Medical Center. Larsen's first mentor, his dad, was willing to take some risks. So, it turns out, is his son.
The trajectory of Larsen's career in many ways resembles that of his father. Described by colleagues across the country as both surgeon extraordinaire and brilliant scientist, Larsen has brought teams of people from many disciplines to provide the complicated care needed for transplant patients, along with developing a new class of immunosuppressive drugs. After his many successes in both the clinical care and scientific arenas, it seems like destiny that Larsen would be chosen for his new role as dean of the Emory School of Medicine, vice president for health center integration at the Woodruff Health Sciences Center (WHSC), and chair of the Emory Clinic board.*
*Additional titles that Larsen has held include the Joseph Brown Whitehead Professor and Chair of Surgery and the Carlos and Marguerite Mason Professor in the medical school.
But it wasn't always so clear to the boy who was fascinated by science and nature and grew up exploring the tide pools of Miami what he wanted to do. He thought he might study marine biology, which in his mind meant he could swim at the beach AND do science.
Then Emory happened. While Larsen doesn't remember any particular point of decision during his undergraduate studies, it became clear to him that he wanted to be a physician, maybe a pediatrician.
His "chief of staff"
As an undergraduate at Emory, Larsen met Clotilde Allard Stanley, a psychology major who had had an international upbringing. Stanley's mother was Mexican, and her father—who died when she was 2—was French. Her mom later married an American, whose career with the Ford Foundation took his new family around the globe. A native Spanish speaker, Clotilde learned English at age 9.
The exotic beauty caught Larsen's eye at a freshman mixer, and the chemistry major spent the evening asking her a stream of questions about her high school in Karachi, her travels, and her family. Larsen later told a friend, "One day I'm going to marry her."
It took until their senior year for Larsen to persuade Stanley to go out with him. Up until then, she thought of him only as a friend, "a person to go to if you needed help with something like a flat tire or chemistry homework."
But Larsen's prediction of marrying her one day is indicative of how he works. When he sets his mind to something, he can figure out how to make it happen. They wed in 1981, a year after graduating from Emory College, when Larsen had one year of medical school at Emory under his belt.
The couple moved into an apartment, long since torn down, near Emory's campus on Clairmont Road across from Athens Pizza. Already in those early years of married life, Clotilde—Cloé to friends—became her husband's sounding board. As Larsen's mother was to his father, she was his rock, support, and sanity. "He's a good talker, and I'm a good listener," she says. By the time his career landed Chris Larsen as chair of surgery at Emory, she had listened so much that she adopted an unofficial title for herself—Larsen's "chief of staff."
As often happens, Larsen didn't stay with the specialty that he had planned to pursue at the beginning of medical school. Instead, he became more and more interested in surgery. He liked the opportunities that surgery presented to make an immediate difference in patients' health and what he describes as its "elegance and beauty." He began thinking of a career in congenital heart surgery, which would marry his interests in children and surgery.
But along the way, nephrologist David Lowance introduced transplantation into the mix. During his rotation with Lowance, Larsen noticed a striking difference between patients who had received a transplant and those on dialysis. "The restoration of health and vitality was evident in the transplant patients," he says.
That observation changed his course once again, and he applied for a residency in general surgery, snagging a coveted slot at Stanford. Larsen's life was about to change again.
Across the pond and back
W. Dean Warren, Emory's chair of surgery at the time, had given Larsen good advice during medical school: "If you're going to be a surgeon, you should really spend your time with the best teachers outside of surgery. Pick the best teachers in areas that will broaden you as a physician."
A year into Larsen's residency at Stanford, he got a chance to reconnect with his old mentor. At a conference in San Francisco, Warren asked, "How is everything going?" Larsen answered enthusiastically. He was great. He loved the training. But when Warren asked, "How's Cloé?," there was a long pause. The fact was, Larsen's work-life balance was almost nonexistent, and his wife, at home with baby Nicole, felt isolated. The dean saw an opening and invited the young surgeon back to complete his residency at Emory. The family started packing.
As a second-year resident, Larsen came under the tutelage of Emory's chief of transplant surgery John Whelchel in the operating room. He also stayed interested in the science behind the techniques that he was learning. When an opportunity came along to study in the lab of renowned transplant surgeon and immunologist Peter Morris at Oxford University, Warren (along with Whelchel and Lowance) once again enabled Larsen to pursue his passion.
The Larsens headed to England, now with two toddlers, for what was supposed to be a year of studies that turned into three.
A year later, Thomas Pearson, who had just finished his surgery residency at Emory, also arrived in Oxford to study immunology. The two surgeons were in staggered years in training in Atlanta and hadn't known each other before, but they soon grew to be fast friends. They rode bicycles to work in the mornings while they talked about ongoing projects in their respective labs. Their families had dinner together on Friday nights.
To this day, Larsen and Pearson continue to work together, run together, and socialize together—especially now that both families are empty nesters. As Larsen began as dean of medicine on January 15, Pearson, who is Livingston Professor of Surgery, assumed the position as executive director of the Emory Transplant Center.
"There is no way that Chris could be doing what he's doing without Tom's support," says Cloé Larsen. "They have each other's back."
When the surgeons finished their training, earning an MD and DPhil, they each had an offer to have a clinical practice and a research laboratory at Emory. Instead they decided to share both. One month Larsen covered the lab and Pearson, the clinical rotation, and the next month, they switched.
They brought complementary skills to the budding partnership. "We both work really hard," says Pearson. "But on ideas and strategy, he's the man. My contribution is, well, I'm the operations person."
Both felt it was important not only to restore health to seriously ill patients via transplant but also to find better long-term solutions to the immunosuppressant therapy that patients had to take ever after to keep their bodies from rejecting the donor organs.
Pearson remembers that they started their lab with an empty room and no funding. They wrote their first grant in 1991. "We had an idea that a particular pathway was important in organ rejection and if we blocked that pathway, we could create tolerance," he says.
"Our research program was always rooted in trying to ask questions and understand biology in ways that would create new opportunities for treatment," Larsen says. "The clinical team knew we were not satisfied with the treatments we had today."
Within 10 years, Larsen and Pearson had built a comprehensive transplant center that integrated patient care and research. They were making progress on their understanding of immunity after transplantation. They had developed collaborations with scientists at the Yerkes National Primate Research Center and with other disciplines across the Emory campus. They had redesigned how clinical care was provided to transplant patients.
The effort was so impressive in such a short time that Oxford came calling. Morris, whom everyone called "The Professor," was retiring, and Larsen was offered the chance to take over his program. It gave him pause. There was the chance to enjoy the prestige of Oxford and to step into the big shoes of a mentor he respected. Pearson remembers standing in the rain outside the DeKalb Farmer's Market and taking Larsen's call about the offer. "You've got to come with me," Larsen told his colleague and friend.
Cloé Larsen and his daughters were willing to go. Pearson, his wife, and two daughters were considering the move. Larsen had a running list of pluses and minuses on whether to go or stay. It tied both families in knots. Then one winter's day as he walked among the Japanese maples that he and Cloé had recently planted, Larsen made his decision. With Pearson, he had built a program in Atlanta and made relationships that were starting to grow and bear fruit. "In the end, I couldn't conceive of starting over or of making the advancements any place else," Larsen says. He stayed.
Larsen's decision turned out to be the right one for patients, his field, his own career, and Emory. It was here that he and Pearson built a truly interdisciplinary program that pulls together surgeons, nephrologists, nurse practitioners, infectious disease specialists, nutritionists, social workers, and pharmacists to improve the experience for patients. Here that they did the pivotal research that eventually led to FDA approval of a new immunosuppressant, belatacept, that causes less long-term damage to kidneys than cyclosporine. Much of that success goes back to Larsen's fundamental approach to everything he touches: building teams.
He has collaborated for more than a decade with Rafi Ahmed, director of the Emory Vaccine Center and a Georgia Research Alliance Eminent Scholar, on protective immunity. The NIH has repeatedly asked the two how they collaborate so well, to pass along the model to less amicable research teams.
Mandy Ford, a basic bench scientist who did her training in autoimmunity at Emory, has been a part of the transplant team effort for nine years and at the university for 14. During that time, she's met frequently with Larsen to talk science, always feeling more inspired when she left his office than when she arrived. Now on the research faculty, she has stayed at Emory not only because she believes in the mission and the work but also because of her mentor. "People make life decisions about where they want to live, raise their family, and have their careers based on Chris Larsen," she says.
Andrew Adams, who also studied with Larsen as an MD/PhD student, returned to Emory as a transplant surgery fellow after a residency at Massachusetts General Hospital—in part because of Larsen. "He's a good person to emulate as a surgeon, scientist, and family man," says Adams, who helped start Emory's islet transplant program to cure diabetes. "There are a lot of good and smart mentors, but he really champions people. He is there to help you succeed, and there is no hint of being in it for his own good."
Larsen recruited another team member, Heather Hamby, for the transplant center's strategic planning effort. She came to know him as someone who respected and valued the perspectives of everyone on the team. However, she did discover a challenge in trying to keep up with him. "He is someone of enormous energy and someone who pushes," she says. "For example, when we ran out of space for the program in Emory Hospital, Dr. Larsen set his sites on the sixth floor of Clinic B. Never underestimate his ability to persuade and convince," she says. Larsen convinced the administration to let him take over the found space, and the Mason Trust donated the support for the renovation to keep the transplant program growing.
Accept no barriers
Larsen takes on his new roles at Emory at a time of acute challenges to health care, in particular to academic, tertiary medical centers that provide care for some of the sickest people in the country. Tremendous downward pressure is being exerted on the finances of medicine, and changes are afoot in the way medical centers and providers are reimbursed. The nation is facing a shortage of doctors, and while new slots are opening up for medical students, the number of residency positions are not keeping pace. Research opportunities have never been better in some respects, but the NIH most likely is facing a budget that will stabilize or decline.
In light of such challenges, why would Larsen want to take on the deanship? He laughs when asked, but his answer is serious. "It might be more comfortable to stay in my current roles, which are challenging enough. But I feel a broad desire to serve people, to share what we've learned in the transplant center and surgery to help Emory rise to meet the challenges of today's environment."
Larsen's new role also carries the title of vice president for health center integration, a function that Wright Caughman, Emory's executive vice president for health affairs, describes as looking holistically at the medical enterprise and working closely with Emory Healthcare. "The new environment requires creativity and courage and someone who can focus us on the areas where we can have the biggest impact," he says. "Chris embraces that. He's a good leader who instills confidence in others and coalesces what he learns to create a synergy in the teams he puts together. He respects no barriers, and I mean that in a good way."
Larsen also has the advantage of already knowing the challenges particular to Emory. But being "home-grown" from his undergraduate years all the way through his professional career could have had a downside. Sometimes trainees aren't taken as seriously when they transition at the same institution from resident to fellow or fellow to faculty member. When Larsen was named chair of surgery in 2009, some of the faculty in his department were his teachers in medical school. "I learned that that's okay," he says. "The relationships have been great, and people have been supportive."
As Larsen considered applying to succeed Tom Lawley, who had served for 16 years as dean of Emory's medical school, he turned as usual to his two sounding boards—his wife and "chief of staff" and the man who has had his back all these years, Tom Pearson.
Through more than 30 years of marriage, Cloé Larsen has come to know her husband as a hard worker with "a lot of drive, energy, and vision." She's fully on board with his new roles, even with the higher profile and the inevitable entertaining role that comes with being the wife of an Emory dean. "I'm all for it as long as I don't have to cook," she jokes, "and you can quote me on that."
Pearson believes that his best friend and collaborator is up to the challenge of these new jobs in this new time. "The amazing thing about Chris is that he is so incredibly competent in diverse arenas and can switch from one to another easily. He can go from discussing state-of-the-art bench immunology to analyzing complex financial spreadsheets, to showing great clinical judgment in the operating room. Being dean will be very challenging. I'm glad we have Chris to do it." EM