Of babies and the board room:
Art D'Harlingue, MD

Arthur D’Harlingue, MD, is trying to get out of the office to
check on his tiny patients down the hall in the Neonatal Intensive Care Unit (NICU). But every time he moves toward the door, his phone rings, an assistant hands him a note requiring a response, or a physician wanders in his office seeking consultation. Dr. D’Harlingue takes it all in stride, unruffled by the complexity of issues, or demands on his time or patience.

“I thrive on adrenaline,” he acknowledges, “but I have this sort of quiet adrenaline. I maintain it in a calm, quiet way.”

Good temperament to have when you’re called upon to do a lot of things fast, in critical situations, to the most fragile infants, requiring delicate procedures and the deftest of touches.

Also a good temperament to have in a board room, where a different
sort of intensity and delicacy must be managed—a deft touch with finances and priorities and consensus building that keeps the hospital moving in the right direction.

Dr. D’Harlingue is comfortable in both worlds, with babies in the NICU and as a long-time member of Children’s Hospital & Research Center Oakland’s Board of Directors.

“I feel a great sense of duty and loyalty to Children’s Hospital,” he says about his work in both arenas.

It’s a sense of duty and loyalty that was formed at an early age.
Dr. D’Harlingue grew up in St. Louis, Missouri, where his family owned a grocery store. The oldest of five kids, and the only boy, he remembers bicycling over to D’Harlingue’s Market after school to help behind the counter.

He continued helping out at the market and living at home while attending St. Louis’ Washington University.

Then, at 19, his father died suddenly from a stroke, leaving even more responsibilities on his young shoulders. There were four younger sisters and his mom to help and the family business to maintain, all while continuing his studies. It’s the kind of experience that colors a lifetime.

“It taught me responsibility,” he says.

Dr. D’Harlingue began college as an engineering major but was soon, as he puts it, “bored out of my mind.” A biology class his sophomore year piqued his interest and started him on the path toward medicine. He wouldn’t become an engineer, but he would one day be a high-end user of medical engineering’s cutting edge technology.

Try as he might to leave home to attend medical school, only his hometown’s St. Louis University School of Medicine accepted him. Still, helping in the family business was no longer an option. “I told my mother it’s time to sell the business, and she went on to do real estate, her second career.”

At first, Dr. D’Harlingue thought he’d specialize in hematology/oncology, but while interning at Stanford Medical Center he “caught the critical care bug.”

“The high intensity, dealing with crises, the hands-on procedures—the whole thing caught my interest,” he says.

Dr. D’Harlingue continued his training as a fellow in neonatology at Stanford, where he was excited by the promises of the relatively new field. But he recalls one incident early on where he was confronted by its limitations.

“We did everything we could to help this baby survive,” he says. “He was a full term infant, a beautiful boy, and he had a problem called Meconium Aspiration Syndrome and pulmonary hypertension. Back when I was a fellow, we lost one or two babies a month from that combination. We did everything we could to help that baby’s lungs recover and ultimately there was nothing else to do. That baby died. Maybe it was early in my training, but I saw the sorrow in that family, their beautiful baby boy, it was gut wrenching…”

“That family stuck with me for a long time in my mind,” he continues, “it’s not like I can picture them anymore, it’s more of a feeling I had. Here’s the futility, too bad we can’t do something different. I mean, where’s the magic bullet that can make that baby better?”

A few years later, the “magic bullet” arrived in the form of Extracorporeal Membrane Oxygenation (ECMO), a procedure using an artificial heart-lung machine that takes over the work of the lungs, allowing a baby’s lungs time to heal.

By then, Dr. D’Harlingue had joined the staff of Children’s Neonatology department, where Barry Phillips, MD, was establishing the region’s only level 3 neonatal intensive care unit. Children’s sent Dr. D’Harlingue down to LA in a Lear jet with a sick baby to see if the ECMO machine could help.

“Here’s some horribly critically ill kid,” Dr. D’Harlingue recalls, “and you’re just praying for him to hang in there till we get there. We took off from Oakland Airport—the Lear jet just roared up there to the sky. I’d never been in a small jet before, it took off like a rocket. We got to LA Children’s, put the kid on ECMO, and he recovered.”
Bolstered by that experience, and others like it, Children’s decided to invest in its own ECMO. Dr. D’Harlingue, self-styled “lover of procedures,” was one of the first three docs at Children’s to be trained in the procedure. Today, the hospital has one of only four ECMOs in California.

“Since then, we’ve done 320, maybe 325 ECMO procedures,”
says Dr. D’Harlingue.

Recalling the number of ECMO procedures done at Children’s is one indication of why Dr. D’Harlingue is well-suited to his role on the Board of Directors. He has institutional memory, and knows the nuts and bolts of medicine. As medical director of the NICU and president of the medical corporation that manages it, he also understands how to run a successful business.

He first served on the board from 1991 to 1994 as part of the medical staff leadership. That’s usually enough of a stint to cure doctors of interests in boards and duties beyond the examining room. But it seems to have had the opposite effect on Dr. D’Harlingue.

“I like being involved with the direction of the hospital,” he says, “the success of the hospital is important to the community we serve, and to the kids we serve.” He was re-nominated and elected to the board in 1996 and has remained on it ever since.

“I bring a very balanced position to the board,” he explains. “I’m not afraid to express physicians’ needs, but I’m there to represent all the different needs. Not just physicians, but also its nursing needs, what kids need, plus trying to understand financial issues that balance against those.”

But he never loses sight of his patients.

“I get a little cranky if I’m not doing patient care,” Dr. D’Harlingue admits.

Finally managing to get out of the office, Dr. D’Harlingue makes his afternoon rounds in the NICU. He checks on Baby Jane Doe, a 2–pound girl dropped off at Kaiser by an unwilling mother and brought to Children’s NICU.

“She’s fine,” he says, reaching in to her incubator and touching her tiny hand, “she just needs to put on a little weight.” Eventually, he winds his way over to Alexander, a baby with intestinal complications that have kept him in the NICU longer than most infants.

“I try to get him to smile,” Dr. D’Harlingue warns, “but he’s very stingy with his smile for me. He smiles at all the nurses, but I have to really work at him to get a smile…”

Maybe it’s the new Oakland A’s outfit Alexander is wearing, something Dr. D’Harlingue bought for him at last week’s playoff game, or maybe Alexander heard the A’s won that game, and that series, but after being hoisted by Dr. D’Harlingue into a sitting position, Alexander looks his doctor square in the eye and breaks into a sweet grin.