By Colleen Deguzman The Monitor, McAllen, Texas
WWR Article Summary (tl;dr) Dr. Jennifer Garza is going on her second year as the chief of surgery at Rio Grande Regional Hospital in McAllen. She is the only female pediatric surgeon in the Valley.
The Monitor, McAllen, Texas
Dr. Jennifer Garza started working at Edinburg Medical Center at the age of 10 as the "head plant cleaner," a position created by her father, who was a physician there and wanted to give her the chance to realize what she was capable of.
She spent the following summers working in the hospital, moving up to filing in her teens and answering phone calls in college. Though she joked about her mundane tasks, she was gradually trusted with more responsibility.
What Garza did not know was that decades later, she would dedicate her life to giving children the opportunity to realize their potential. Just like Garza's dad did for her.
An Edinburg native, Garza, 47, is going on her second year as the chief of surgery at Rio Grande Regional Hospital in McAllen. Granddaughter to Garza Pharmacy founder Leonicio Garza, she is the only female pediatric surgeon in the Valley, according to the hospital, and has been there since 2007.
However, she said that she did not choose the medical field right away. Garza said she was pulled by her intuition to study medicine after studying art history for two years at the University of Texas Rio Grande Valley. Before switching to a biology track her junior year there, Garza's father told her, "Medicine is not a right because you think you are smart. It is a privilege, so treat it as that."
She has since kept those words close to heart.
'I walked out and knew it would be surgery' After graduating from UTRGV with a bachelor's in biology, Garza attended the University of Texas Medical Branch in Galveston. As part of her program, her last couple years there were spent in rotations between medical subspecialties. In rotations, students spend a few months in each medical field to learn about the distinctive demands of each before picking a specialty.
Surgery was Garza's last rotation, and she remembers taking it as a sign to be patient about her future career. As part of her surgical rotation, Garza assisted in a Whipple procedure -- an eight-hour long open abdominal surgery on the pancreas. Her role was to retract, which is to hold the patient's muscle, skin and spleen with a surgical tool during an operation.
That was the moment, in that crowded operating room, she decided to become a surgeon.
"I didn't even get to see what was going on because there were so many people there, but it just felt so good and so right," Garza said, smiling. "I walked out and knew it would be surgery."
After graduating from UTMB, she began her five-year general surgery residency at St. Mary's Hospital in Waterbury, Connecticut, a Yale University program. As a surgical intern there, Garza spent time in rotations that exposed her to the subspecialties in surgery.
For her plastics rotation, she was placed in a craniofacial pediatric clinic, a surgical specialty that reconstructs facial deformities. The clinic was located in New Haven, Connecticut, and Garza called it serendipity that she was placed there.
At the clinic, she learned that surgeons began their days by reviewing patients' charts and photos to determine where to operate first. In the hours spent constructing their approaches, doctors considered children's school schedules.
"They would do all of this so that the kid would be made fun of less, or hopefully not at all," Garza said. "And I just thought to myself this is what it is about -- making kid's lives better."
After the meeting, she remembers walking to the pediatric surgery office to ask what her next steps were toward becoming a pediatric surgeon.
'We can't keep letting this happen' Garza paused two years into her residency at St. Mary's Hospital to do research at Boston Children's Hospital with Harvard University. But before leaving, her mentors from Galveston, Dr. Stanley Dudrick and Dr. Jonathan Rhodes asked her for a favor.
Dudrick and Rhodes invented total parenteral nutrition, TPN, a method of feeding when a person cannot eat or drink normally. Through a tube that connects to one of the larger veins in the chest area, patients receive a nutrient fluid that supplies all the body's needs.
Short bowel syndrome, SBS, is the most common reason for a child or baby to be TPN-dependent. Also known as short-gut, the condition leaves a child unable to absorb nutrients normally due to lacking a part of their functional small intestine.
However, TPN is just a temporary solution. Dependence on the fluid for an extended time damages the liver, and though it bought patients more time, children with dire bowel cases such as short-gut later died of liver failure.
Knowing that she was going to conducted research at Boston, Garza's mentors asked her to find out why TPN was causing the fatal liver condition.
Before leaving to Boston, Garza said she understood the vastity of the problem ahead.
At Boston Children's Hospital, Garza worked with many children with bowel problems, but there was one case she said she would never forget -- that of a 7-year-old girl diagnosed with short-gut syndrome who was surviving on TPN.
Garza was assigned the girl's case during her first year of research. She recalled that while doing rounds one morning, the girl told her that she was not like the other children. Garza recalled the girl saying that she did not feel well because of her lines (her scars) and that "the angels" told her that it was her time to go.
"Of course I encouraged her to continue fighting and to have hope," Garza said through tears. "But by this time, I knew enough about medicine at that point to know that if a patient is telling you that, especially a child, you should probably listen."
The girl said "the angels" told her she was ready, but asked to live to her eighth birthday, which landed on the next Saturday, Garza recalled. She died of liver failure the following Wednesday.
"When I received the word, I walked straight to Mark Puter's office and told him that we can not let another one of them die," Garza said. "We can't keep letting this happen."
Dr. Puter is the pediatric surgeon at Boston Children's Hospital, and with nutrition pharmacist, Dr. Kathleen Gura, they agreed to partner with Garza in efforts to prevent TPN treatment from causing liver failure.
A matter of fate Before research began, Garza learned that physicians of Boston Children's Hospital tried achieving the same feat 20 years earlier. Though many theories only lead to dead-ends, their research heavily investigated the fat contents of TPN fluid and its possible correlation to liver damage.
TPN solution is composed of three main elements: sugar, protein and fat. Since past physicians of their hospital had already started studies on the fat component, the research group of three decided to start there -- another fateful moment for Garza.
They soon discovered that a majority of the fat administered in the fluid was comprised of Omega-6, a compound they learned to be pro-inflammatory and responsible for agitating the liver. In search of a replacement for Omega-6, they discovered that Fresenius Medical Care, a German medicine supply company just created Omega-3, also called Omegaven, an anti-inflammatory fatty compound they did not have any purpose for, yet. Garza, Puter and Gura had the new fluid shipped to them and with a group of mice, tested the effects of the compound.
In their trial, half of the mice were administered Omega-6, the original TPN fluid. As expected, all of them soon experienced liver failure. The rest of the mice were treated with Omegaven, and Garza said that they were astounded by what they witnessed: not only did the Omegaven group stay healthy, but the solution healed the damaged livers of the mice who were previously issued Omega-6.