This is the year that I turn 60. It is difficult to comprehend. My age is more than a decade beyond the age of my parents when they died — mid 40s for both of them. Ironically, it’s the age when I, as I suspect for many women, can fully dedicate myself to personal goals and the legacy I wish to leave.
It is also the time to travel more, to play more tennis, and to enjoy my good health knowing that is my greatest privilege. After decades of school, training, and raising three kind, independent children with goals of their own, I saw my last child graduate from college this year. I am now an “empty nester” and looking forward to the freedom and opportunities that provides.
I was raised in a middle class, blue-collar family in the Maryland suburbs of Washington, DC, in what many would consider a traditional upbringing. My father, the oldest son of Croatian immigrants and a high school graduate, was savvy and driven — a self-employed small businessman with several contracting/construction companies. He learned the trade as a U.S. Navy Seabee in World War II.
My mother, the daughter of an Irish alderman and a homemaker in Pittsburgh, did it all. She was a high-energy, independent woman who, in addition to caring for her four children and the household, and volunteering at school, helped my dad with his business and worked outside the home during a few lean years.
Me, my brother, and two sisters — I was No. 3 of 4 — went to Catholic school and grew up in a close community. Dedication to family, respect for others, and academic excellence were expected. I loved to read from a young age, and biographies were my genre of choice. I was in awe of Helen Keller, Abigail Adams, Clara Barton, Harriet Tubman, and Louisa May Alcott. Every yearbook in grade school attests to my goal of becoming the first woman president — a goal that is more achievable today than it was when I was 10 years old.
The nontraditional part of my upbringing came in my adolescent years. My father died of rapidly progressive cancer when I was 12, and my mother died of a brain hemorrhage when I was 14. This landed me in “Orphans’ Court,” where my younger sister and I testified that we wanted to stay in our current home and live with my brother and sister, then only 22 and 20 years old, respectively.
My brother became my legal guardian and life went on with a gaping hole that was rarely discussed, and lots of hard work and odd jobs by all of us to pay the bills. I chose to stay in my all-girls Catholic school and work to pay the tuition because I enjoyed the friendship, environment, and freedom that came with an all-girls education. I appreciated the uniform that hid my inability to afford new clothes, the lack of posturing for the boys, and the ability to be involved in sports and leadership roles without gender boundaries.
Next, it was on to the University of Maryland, College Park, where, as a Maryland State Scholar, I was able to attend school tuition-free. The odd jobs continued — refereeing basketball, cleaning houses, working at the Student Health Center, lifeguarding — to pay my living expenses. There wasn’t a lot of time for political involvement or even career counseling.
My love and aptitude for science and my experience with two personal medical tragedies had me headed toward a nursing career. A former high school teacher asked if I had ever considered medical school — honestly, I had not. That type of career was never part of my world. But I followed up on the idea and researched medical schools.
I could only afford the application fees of five schools, and attended only two interviews because I couldn’t afford out of state travel. I was thrilled and overwhelmed to be accepted to Johns Hopkins University School of Medicine and am grateful to the financial team at Hopkins who worked with me to provide a combination of scholarships and student loans that eventually allowed me to accept the position — a decision that would change my life in many ways.
My years at Johns Hopkins were the first time I had the freedom to focus on my career goals and I saw the world as offering endless opportunities. Infectious diseases and vaccinology became an immediate favorite; it was amazing to me that we had the scientific ability to prevent disease in entire populations.
This was the mid-1980s, and the world was also grappling with a new virus and a new disease: AIDS. I cared for many tragic cases of AIDS as a student and beyond and witnessed stark health inequity for the first time. I attended many of my patients’ funerals. It was impossible to not be changed by that epidemic.
I met my future husband at Johns Hopkins — we married two days after graduation — and headed to Vanderbilt University to begin what would be eight years of training for him in vascular surgery, and seven years of training for me in infectious diseases and public health.
Honestly, we moved to Nashville with more than a little trepidation. My husband, Dan, was from Seattle, and I had lived my entire life in Maryland. The culture and reputation were different. The newspaper was, well, a local newspaper, with local headlines rather than the national politics to which I had been accustomed growing up with the Washington Post.
What began with hesitation ended with a love of a city and community that remains today. Southern hospitality and friendship are real, and Dan and I were welcomed into the community with more barbecues, pool parties, and casseroles in the first few months than we had experienced in our young lives.
At Vanderbilt, I established professional relationships that have become lifelong friendships. My mentors there read like a catalog of “Who’s Who in Infectious Diseases and Vaccinology,” and three decades later we have come together to fight the COVID-19 pandemic. I have always appreciated my great fortune to have trained with and been supported by this stellar group of individuals.
While still in training, my husband and I had two sons, and our world was changed for the better. This is one of the most tenuous times for women faculty — those years with young children. It is tempting to move to part-time work or to careers with defined hours. I wouldn’t be truthful if I said I never considered it. However, I loved what I did, and I hoped that my career would be long. I wanted something that would challenge me for 30 years or more.
The additional benefits to my family were children who grew up with “normal” being two full-time working parents who shared the housework and school and sports drop-offs. We both fell asleep while reading the kids their bedtime stories.
There was certainly a division of labor between my husband and me: I was better at play dates and filling out the school forms and he usually handled the yard work and the dog walks. We both made meals and did the dishes; he coached the baseball teams, and I coached the basketball teams. For the most part, however, duties were shared equally. I smile when I see my grown sons sharing housework as the norm and not the exception.
Without family in Nashville to help, the work-life balance and finances were challenging, and a good night’s sleep was rare. The next juncture in our lives came when training ended. We loved Nashville, but we missed family — Dan’s in Seattle and mine in Maryland. We wanted our children to have extended family nearby, so we chose to move near their only living grandparents in Seattle.
Dan had a job when we moved, and I did not — leading several of my mentors to caution about “following my husband.” But I was confident and I wasn’t moving just anywhere; I was moving to one of the epicenters of the infectious diseases universe: the University of Washington, and the start of the Bill and Melinda Gates Foundation’s work in global health. I had no choice but to be independent of my mentors back in Vanderbilt and to establish my own research in Seattle. In a division heavy with critically important HIV and sexually transmitted diseases work, I studied vaccine-preventable diseases of children and adults.
The first year in Seattle was not easy. Looking back, I am fortunate to have faced this year with the energy of youth! I was pregnant with my third child, living in a new city, and working in a new job. Of course, my No. 1 stress continued to be childcare — something that would resonate with women two decades later.
We had a series of unfortunate events: two stolen cars, a sewage disaster, and an electrical surge that fried all our appliances. I recall my husband and I walking into Sears with two young boys and a newborn, pointing to the first refrigerator, oven, and dishwasher we saw, and saying, “We’ll take one of each.” We gradually become part of the school and neighborhood communities there, and it is impossible to thank every person who stepped forward in my life to help in big and small ways — another group of friends whom I will cherish forever.
On the career front, my daughter made her first trip to work with me when she was 3 days old so I could meet with new colleagues to get the Shingles Prevention Study off the ground. Meanwhile, my mentors back in Vanderbilt continued to push my career along, recommending me for policy committees, journal reviews, editorials and talks, and listening at the other end of the phone when the day was particularly challenging.
After seven years with the University of Washington, another opportunity came along: to lead the Rotavirus Vaccine Program at PATH, a global health nonprofit based in Seattle that worked closely with the Gates Foundation. Here in the United States, we had just recommended vaccines to prevent rotavirus and human papillomavirus. At this time, children in other countries did not have access to these vaccines, even though their morbidity and mortality from the consequences of these infections was greater.
This was a big step. I loved academics and had just been promoted to associate professor. Would I be able to return to academics? Would I forever scar my children by traveling too much? In the end, I was inspired by the mission of PATH and motivated by the opportunity to take my learnings from domestic vaccine research and apply them internationally.
I took the job at PATH. With the support of the University of Washington leadership I retained my academic appointment there so I could continue to teach and mentor students and research trainees.
Professionally, the next decade was one of the most memorable of my life. I traveled the world, met new people, and did impactful work on rotavirus, human papillomavirus, Japanese encephalitis, influenza, and other vaccines. My family and friends supported me throughout, and for four of those years we had live-in au pairs who cared for our children and broadened their horizons.
I traveled to dozens of low-resource countries and collaborated with leaders in countries around the world and with colleagues at WHO, CDC, NIH, GAVI, UNICEF, domestic and international vaccine manufacturers, and the Gates Foundation. At PATH, I learned leadership and business practices that I had not learned in academics. While not the major emphasis at PATH, I continued to publish peer-reviewed manuscripts, hold leadership positions in professional societies and policy committees, and lecture nationally and internationally.
My children were able to accompany me on occasion, although not as much as I would have liked, given their school and extracurricular schedules. I have a treasure trove of stories: encountering a family of warthogs while jogging, being a stowaway on a South African tour bus in Senegal, and eating some interesting (and delicious!) food. My most gratifying moments were in the later years, seeing children receiving vaccines on which our team had worked.
I always (and still) bring beach balls for the kids — they pack easily, can be “assembled” in the field, and yield lots of laughs. Of course, the staff at Target are always puzzled when I empty their shelves of beach balls just before a trip.
In 2015, I had the opportunity to return to Maryland to lead the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine. A renowned institution, they were recruiting a leader to succeed the founding director, a legend who led the center for 40 years. The goals of the CVD aligned with my own: achieving health equity through research and delivery of vaccines domestically and internationally.
A primary driver for my interest in returning to academics was to nurture the next generation of vaccine leaders. My mentors had been so generous during all stages of my career; it was my turn to do the same. While not intentional, most of my direct trainees since joining CVD have been women. I am as inspired by them as I was by my mentors. These women are resilient, innovative, dedicated and independent, and I am convinced they will change the world.
What did I value in my mentors? While I always appreciated the advice and support that they gave, what I valued most were the opportunities they provided for me, the ways they empowered me, and the confidence they gave me to take chances and take the bold next step. We need to create opportunities for others, which is why I am confident the next generation will rise to the challenge. Perhaps we will finally elect the first woman president.
Excerpted from Lessons Learned: Stories from Women Physician Leaders by Deborah M. Shlian, MD, MBA.