Washington People: Douglas Char

Douglas Char’s first deployment as a physician with a federal disaster medical assistance team took him to New York City in response to the 9/11 terrorist attacks. Char and his colleagues treated injuries of firefighters and police as the first responders recovered bodies and removed debris from what was known as “the pile” at the World Trade Center complex.

The magnitude of the devastation shook Char, but he was inspired by the support his team received from residents — New Yorkers cheered as the bus that carried Char and other members of his team passed through neighborhoods each morning. The bond between the people working at the site also heartened him.

“Yes, we were there to support workers on ‘the pile,’ but we were part of something so much bigger,” he said.

A professor of emergency medicine at Washington University School of Medicine in St. Louis, Char, MD, has since deployed to New Orleans, after Hurricane Katrina in 2005; Haiti, following the massive 2010 earthquake; and most recently, Saipan in the Northern Mariana Islands, after a super typhoon in October. He recently was transferred to the incident management team in the Office of Emergency Management within the U.S. Department of Health and Human Services.

When he isn’t running to disasters, Char can be found tending to local emergencies at St. Louis Children’s and Barnes-Jewish hospitals, treating conditions ranging from gunshot wounds to burns to broken bones. He has the added challenge of helping patients battling addiction and mental illness, as well as making diagnoses in older people with dementia.

In addition to his noted clinical skills, Char is heralded as a gifted teacher and administrator. He helped start the emergency medicine residency at Washington University in 1995 and then directed it for almost 15 years.

Char was the residency program’s assistant director when David Tan, MD, was an intern and resident in emergency medicine 22 years ago. Now an associate professor of emergency medicine at the School of Medicine, Tan was struck by Char’s genuine, personal interest in people and his love of teaching. “He is very patient with his students and eager to share his knowledge,” Tan said. “He is a real gem on our faculty, and we are lucky to have him.”

Brent Ruoff, MD, director of the Division of Emergency Medicine, said the breadth of Char’s career is unusual. “He has an amazing intellect and is very curious,” he said. “He looks at learning as an opportunity and turns opportunities into expertise. It’s phenomenal to have someone so reliable and with such high-performance standards in our division.”

Char discussed his life and career in emergency medicine.

Tell us about your childhood.

I grew up on the island of Oahu in Hawaii. My dad is a lawyer, and my mom is a nurse. Education was always emphasized in my family.

I have a very large family — 32 first cousins on my dad’s side and 15 first cousins on my mom’s side. During my childhood, most of my large family gathered for monthly birthday potlucks and other occasions.

Many of my relatives, including my parents and two older siblings, went to college or graduate school on the East Coast. When it came time for me to choose a school, I picked Boston College, and my identical twin, Daniel, decided on Tufts University, also in the Boston area.

How did you decide on emergency medicine?

I knew in middle school that I wanted to become a physician. But it wasn’t until I was a resident in internal medicine at the University of Colorado, Denver, that I discovered the specialty of emergency medicine. A former Boy Scout, I realized that I liked to figure out problems and fix them, especially when time is of the essence.

What is it like to practice emergency medicine?

Every shift is different, and you have to come to work ready to handle anything. Some of the cases — such as treating severe infections, broken bones and heart attacks — become pretty routine. The hardest ones are the cases that you can’t figure out what’s wrong and the patient is getting worse in front of you.

Cases in elderly patients are the most challenging to diagnose because they often have multiple chronic conditions. A patient may come in with confusion, abdominal pain and difficulty breathing, and they could have heart failure, COPD, asthma or any number of other conditions.

How has your field changed?

Previously, we’d admit someone who was sick but often didn’t have a definitive diagnosis. Now there is an expectation that we do more sleuthing before admitting someone, and we use MRIs and ultrasounds and a vast array of technology to diagnose patients with all different types of problems.

Also, patients in the younger generation are used to instantaneous information and expect diagnoses before leaving the ER.

You are treating patients who are in very vulnerable situations. What effect does that have on you day after day?

We are taught in medical school to be empathetic but to try not to take the person’s situation personally. That’s sometimes easier said than done.

I also think taking care of people when they are at their most vulnerable makes you work harder and be the best that you can be. You realize that child could be your kid or niece or nephew or neighbor. It’s the same with adults. You realize that patient could be your parent or grandparent.

Is there a case that sticks with you?

Cases with young people stick with you in particular. I remember treating a little boy who had been in a van that rolled over while coming off a highway ramp. When he got to the emergency room, he was coding from chest trauma and had blood all over his face and airway. Normally I would have used a tool to intubate him, but I had to intubate him with my fingers because there was so much blood and debris in his mouth and throat. We got him to the operating room, and he survived.

How does your disaster medicine work help you when you are taking care of patients in the emergency room?

When I come back from a disaster scene, I don’t sweat the small stuff. I have just left a place where people are living in tents and don’t have medical resources. They are focused on finding loved ones and food and housing. These experiences help you refocus on priorities and make you grateful to have water, power and the technology and resources to care for our patients.

Tell us about your personal life.

My wife, whom I met at Boston College, teaches math at St. Louis Community College-Forest Park. We have three children: Justin, an aerospace engineer in New Zealand; Robyn, a third-grade teacher in Minnesota; and Corinne, a psychiatric social worker in Missouri. After raising three children, my wife and I are just beginning to take some trips as a couple. We recently visited my son in New Zealand, where we saw lots of sheep, penguins and dolphins. We also went whitewater rafting and kayaking.

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