Doctor in the House

Dr. Kyla Terhune walks briskly along the corridors of Vanderbilt University Medical Center, dashing between her last surgery of the day in the O.R. and her first afternoon patient in The Vanderbilt Clinic. With long curly hair pulled back in a ponytail, the tall, slender surgeon still wears her surgical scrubs.

“I like to wear street clothes when I see patients,” she says. Today, however, there’s been no time to change.

Time is of the essence in this busy physician’s life.

An assistant professor of surgery and anesthesiology, the mother of two also shepherds 290 first-year students as head of Hank Ingram House on The Martha Rivers Ingram Commons at Vanderbilt. Joining her in this living and learning community is her husband of 12 years, Richard “Rick” Keuler Jr.; their two children, Tate and Amelia; and their dog, Sackson.

“Hank’s House,” as it’s affectionately called, is the largest of the 10 houses on The Ingram Commons. Each is guided by a professor who lives with and mentors the resident students. Frank Wcislo, associate professor of history and European studies and dean of The Ingram Commons, says the living-learning experience helps first-year students successfully transition into life at the university by connecting them with each other and with upperclass undergraduates, graduate students, faculty, staff and administrators.

A beautiful cluster of classic buildings located in the southeastern part of campus adjacent to Peabody College, The Ingram Commons is phase one of Vanderbilt’s College Halls system. Construction is slated to begin on phase two, College Halls at Kissam, in May 2012 (see the Collective Memory article in this issue). When completed, Kissam’s two colleges will house about 660 upperclass students in four halls, led by two faculty directors-in-residence and four resident graduate fellows.

Dream Team

Terhune is the first new head of house to be appointed since The Ingram Commons opened in 2008, as well as the first physician to hold that position. Keuler is the first attorney to live there. While Terhune is officially in charge, it’s very much a team project.

“I absolutely would not be able to do it without Rick’s assistance, support and hard work,” she states.

Terhune’s schedule is challenging. Rising most mornings at 5:30, she walks across campus to the Medical Center to start her 12-hour day there: performing surgery, checking on post-op patients, seeing other patients in the clinic, educating medical students and residents, conducting research, and conferring with other attending physicians. After dinner with her family in The Commons Center dining room, she begins the second shift: meeting with the house advisory council and resident advisers (RAs), attending house events, informally counseling students, and spending time with her own children.

In addition to caring for their children, Keuler has a part-time solo law practice and does pro bono legal work in the community. He plans activities for the undergraduates, sends out many of the house notices, and also attends house meetings.

“We combine our strengths,” Terhune says. “Rick does a good job of organizing things, and he’s good at technology. And he’s just more fun.”

“I’m good with groups,” Keuler says, “but Kyla is better at interpersonal relationships.”

“They’re a dream team for us,” says Wcislo. “There’s a good match between their skill sets as a physician and an attorney and those needed to mentor 18-year-olds.”

Living the Dream

Born in Fayetteville, Ark., the 37-year-old Terhune came to her career in academic medicine somewhat later than most of her peers. She attended Princeton University, where she met her husband and graduated magna cum laude in 1996 with a degree in molecular biology.

“I always wanted to be a physician,” she says. “But I needed to work to make some money in order to attend medical school.”

A native of New Jersey, Keuler received a bachelor’s degree in politics and teacher preparation from Princeton in 1996. From there he went to law school and also taught some classes at an inner-city high school in Washington, D.C. While he studied law at Georgetown University, Terhune taught chemistry and biology and lived in the dormitory at St. Andrew’s, a private boarding school in Middletown, Del. A state-champion tennis player and point guard in high school, Terhune also coached women’s tennis and basketball at St. Andrew’s.

As soon as Keuler earned his J.D. degree in 1999, the couple married and Terhune began medical studies at the University of Pennsylvania. She gave birth to their son, Tate, in 2003. The next year Terhune earned her M.D. degree and was admitted to Vanderbilt’s residency program. Keuler has been the children’s primary caregiver since 2004.

As a general surgeon, Terhune is a minority in her chosen profession. Although the number of women medical-school graduates has nearly doubled since 1979, and number of female surgical residents has almost quadrupled since 1970, women are still underrepresented in the academic surgical sciences. According to the Association of American Medical Colleges, women hold just 18 percent of surgical faculty positions in the U.S. today. At Vanderbilt the percentage is somewhat lower, with 17 women making up 12 percent of the 138 surgical faculty members.

Surgery, however, wasn’t Terhune’s initial career choice. “I thought I wanted to be a psychiatrist,” she says, “but when I really looked at it, surgery seemed a better fit for me. I enjoy working with my hands, and surgeons work on problems they can try to fix mechanically.”

She finished surgery and critical-care residencies at Vanderbilt in 2011 and became board-certified in both areas. During her residency, she also spent a year of research with her mentor, Dr. John Tarpley, BA’66, MD’70, professor of surgery.

“She’s an outstanding clinical surgeon, terrific with patients and their families, careful, and compulsive,” Tarpley says. “As a surgical educator you are either a judge or a coach. I call her a ‘playing coach.’ She coaches people to improve by breaking down difficult tasks into workable, solvable bits.”

Terhune has already won several teaching awards, including the 2010 Hillman Award presented by fourth-year students to the single resident or fellow whom they deem the best teacher. She also received the David C. Leach Award from the Accreditation Council for Graduate Medical Education for developing the Intern Bootcamp, a two-day skills session for incoming surgery, anesthesia, medical and emergency medicine interns. In addition, she’s held skill sessions throughout the year, teaching interns such things as how best to communicate with patients, technical skills like suturing and knot tying, and mock emergency code simulations.

“I wanted to teach them the kinds of things I wish I’d been exposed to when I was an intern,” she says. “I still remember the gut-wrenching feeling of walking into the [surgical intensive care unit] that first day.”

That same desire to prepare students for their chosen professions motivated Terhune to take on head-of-house responsibilities on The Commons. “I thought I could make a contribution because many freshmen want to be premed. They see me leaving early in the morning and coming back late at night. I share what I can about my day with them, and we discuss it.”

As the first physician in her family, Terhune didn’t realize how the demands and pressures of a medical career would affect her and her family.

“Being a physician not only impacts my life but also that of my family,” she says. “Any time I’m on call, my husband is, too, because he’s the primary caregiver for our children. If students are going to commit to study medicine, they need to be aware of the implications of that decision.”

Creative Partnership

Terhune’s clinical and educational responsibilities at the Medical Center, her past experience teaching and coaching high school students, plus living in a house system at Princeton and St. Andrew’s, made her an ideal candidate for head of Hank’s House, says Dean Wcislo. Having a Princeton and Georgetown graduate, former Philadelphia lawyer and stay-at-home father sealed the deal.

Keuler also models an alternative vision of success for the students of Hank’s House through his role as stay-at-home father and community volunteer. “Knowing there are other definitions of ‘making it’ besides having a high-powered career helps to ground students when they encounter academic difficulties,” Wcislo says.

“They’ve been wonderful to work with,” says house president Tanner Floyd, a freshman from Clarksburg, W.Va. “Learning about their lives has been incredible and extremely educational. They’re a great resource because so many students are premed or prelaw.”

Although Hank’s House is the largest house on The Ingram Commons, Terhune and Keuler work hard to create a sense of community and inclusiveness for all residents. Every week they hold Friday Family Night at their apartment, where students enjoy chocolate chip cookies, snacks, soft drinks and games. They also invite faculty colleagues to share their professional and intellectual passions at house dinners. Recent guests have included Dr. Mark Denison, Craig–Weaver Chair in Pediatrics and a professor of pediatric infectious disease, who spoke with the students after they viewed the movie Contagion.

Another night the residents watched a documentary about sustainable agriculture, followed by dinner at Tayst, Nashville’s first “green”-certified restaurant. There they had a chance to discuss the future of food with owner and executive chef Jeremy Barlow, BA’95.

Hank’s House residents participate in service-learning activities, such as teaching science to students in neighborhood public schools. And they play hard, too, competing with the other houses in intramural sports and hosting informal mixers, movie nights and dances. Men and women live on different floors, and security is tight, requiring key passes to enter the building and travel between floors.

The couple has been very creative in establishing face-to-face relationships with every student, says Wcislo. He cites as an example how they communicated to the students the importance of civility in the house.

“They covered a large whiteboard with a lot of off-color language,” he remembers. “Then they added this sentence: ‘She lives here, too’—a reference to their 3-year-old daughter, Amelia, who was playing on the floor beneath the whiteboard. Many of the freshmen have younger brothers and sisters, so they got the message.”

Family Affair

Both Terhune and Keuler say the Commons living-learning experience is a positive one for the whole family. Their 8-year-old son, Tate, agrees. “I have lots of friends at Hank’s House,” he says proudly. “I see them everywhere.”

“In many ways it’s our preferred way to live,” Terhune says. “It’s intellectually and emotionally stimulating. It’s great to be able to change my train of thought as I walk back across campus from the hospital: I use a part of my brain that I don’t always use, having conversations I wouldn’t otherwise have.”

Keuler appreciates the opportunity to make an impact on the students. “The transition from high school to college wasn’t easy for me at times,” he says. “I want to be able to help Vanderbilt students who also might be having a difficult time making that transition.”

“Surprisingly, the students don’t interfere with my sleep,” says Terhune. “Our apartment is very quiet, and we aren’t awakened to deal with emergencies, unless they are life-threatening. The RAs take care of health and discipline issues through the dean of students, and the students know my patients come first.”

“It’s been really good,” Keuler says of the whole experience. “The energy and enthusiasm of the students is exciting—and tiring.”

If there’s a downside to living where you work, Keuler says, it’s the lack of privacy. Another drawback is having little time together as a couple, says Terhune.

“But we enjoy so much what we’re doing at Hank’s House,” she continues, “that we think of it as our time together.”