A Surgeon in...St Louis

A Surgeon in…St Louis

THE SECOND LARGEST CITY IN MISSOURI IS HOME TO HIGHLY REGARDED LIVER TRANSPLANT SURGEON AND RCSI ALUMNA (CLASS OF 1996), PROFESSOR MARIA B. MAJELLA DOYLE, FRCSI (2006) and Honorary Fellow (2023).

Earlier this year, Maria B. Majella Doyle, MD, MBA, FACS, FRCSI Professor of Surgery, was named the Mid-America Transplant and Department of Surgery Distinguished Endowed Chair in Abdominal Transplantion at Washington University School of Medicine in St Louis. She is Director of the HPB Fellowship Program, Director of Liver Transplant in the Division of General Surgery, Section of Abdominal Transplantation, and Vice-Chair of Clinical Affairs for the Department of Surgery at Washington University School of Medicine, as well as Director of the Paediatric Liver Transplant Program at St Louis Children’s Hospital. Her surgical interests at the university are focused on adult and paediatric hepatobiliary and pancreatic surgery as well as liver and kidney transplant.

Majella Doyle was born in Cork and lived there until the age of five when her family moved to Dublin because of her father Ted’s career. Then, when she was ten, they moved again, this time to a property with stables and fields in Wicklow, so that she and her older brother, Howard, who were both keen showjumpers, could keep ponies. Majella’s mother, Marie, worked as a primary teacher while her father was involved in the hotel industry. Majella’s parents still live near Enniskerry. “We used to go to horse shows every weekend,” says Majella. “I was very lucky, it was an amazing childhood.”

After secondary school, Majella studied for a degree in physiology at Trinity. “I had a wonderful time there,” she remembers. “I made great friends and lived in rooms on Front Square. When the Trinity Ball was on there were always people trying to hide in our cupboards.”

Soon after completing her science degree at Trinity, Majella contracted meningitis, and it was while she was in hospital recovering that she first gave serious consideration to studying medicine. “I wasn’t really sure what I was going to do after my science degree and the doctor who was taking care of me said, ‘Why don’t you do medicine?’ There was no history of medicine in our family and I didn’t really know how to go about it, but I applied to RCSI and they offered me an interview. I got in and started the following September.

“I’d had a lot of fun at Trinity, but I really flourished academically at RCSI, and I won a few medals in anatomy, pharmacy and surgery during my time there. I made lifelong friends and always catch up with them whenever I come home. Our class was very close – we have an amazing WhatsApp group, so we are up to date with what people are doing – and it was great to meet up with everyone at our reunion last year.”

Majella initially thought she was interested in pursuing a career as an obstetrician or gynaecologist but changed her mind after rotations in surgery in Beaumont and Drogheda in her final medical year. “We got to scrub in a lot and I was hooked,” she remembers.

After her intern year in Beaumont, vascular surgeon Professor Sean Tierney, FRCSI (1991) encouraged her to apply for the surgical training scheme, and Majella secured a spot at the Mater Misericordiae University Hospital. “I was working with Professor P. Ronan O’Connell, FRCSI (1983) and Mr Gerry McEntee, FRCSI (1982) in GI surgery and on the vascular team with Professor O’Malley. I was also exposed for the first time to Hepato-Pancreatico-Biliary (HPB) surgery, which I really enjoyed. Mr McEntee was also a transplant surgeon, but he did his transplants in St Vincent’s University Hospital, so I wasn’t really exposed to transplant at that time. He was a tough taskmaster but an amazing surgeon so I learnt a lot.”

Majella went on to do a Research Fellowship in the Department of Academic Surgery at Cork University with Professor H. Paul Redmond. “That was a great experience,” says Majella. “It was nice to go back to Cork, to the motherland where I was born, and they accepted me back even though I had left, which is not like Cork people!”

Accepted onto the higher surgical training scheme, Majella then spent what she describes as a ‘great’ year working with Mr Bosco O’Mahony (deceased) and Professor Ken Mealy, FRCSI (1985) at Wexford General Hospital, after which she returned to the Mater. A fortuitous encounter at the IHPBA meeting in Washington DC was to set her career on a path she could not have anticipated.

“I was in my fourth year of training,” Majella remembers, “and I was attending a meeting of the IHPBA Association. Gerry McEntee bumped into Professor Will Chapman; they had trained together in liver surgery, at King’s College London. Will had just moved to Washington University, and they were looking for a fellow, and I was looking for a fellowship. It’s so random the way things happen sometimes! I didn’t know anything about St Louis, and the only thing I knew about WashU was the manual I and everybody else used to carry in our pockets when we were trainees.”

St Louis, MIssouri

Majella completed her surgical training at Tallaght University Hospital and embarked on a Clinical Fellowship in Abdominal Organ Transplant and HPB surgery at Washington University School of Medicine in St Louis, Missouri, in 2005. “I only planned to come for a year to do some training in transplant, as this training gives you a lot of skills that you don’t necessarily get from doing just HPB,” she explains. “I intended to go back to Kings College in London and then return to Ireland. But there were no jobs in Ireland at the time and I was getting on well, so I stayed for a second year to complete the transplant fellowship. And then Professor Tim Eberlein, the Chair of Surgery at Washington University, Will Chapman and another surgeon, David Linehan, recruited me to join the department as a member of the Abdominal Organ Transplant and Hepatobiliary Surgery team. It’s been incredible; I’ve been so lucky.”

Majella started as an assistant professor and has since progressed to full professorship. She started out performing adult liver, kidney, and pancreas transplants along with liver and pancreas cancer resections before undertaking paediatric liver transplants. Subsequently, she became the Surgical Director of the Paediatric Liver Transplant Programme at St Louis Children’s Hospital in 2015. Somewhere along the way, she also found time to do an MBA.

“I decided that if I was going to stay in the US, I needed a better understanding of the business side of healthcare,” says Majella. “And so I completed an MBA at Washington University in 2012. It took 20 months and was a big commitment. Some of the responsibilities given to me in the department such as the role of Vice Chair for Clinical Affairs are as a result of this experience.”

Dr Maria B. Majella Doyle

Majella focuses her clinical research interests on clinical outcomes, hepatocellular carcinoma, liver transplantation, and donor management. She is proud to be the current president of the Americas Hepato-Pancreato-Biliary Association and Councilor of the American Society of Transplant Surgeons.

“A typical week includes elective surgeries on Mondays and Fridays and a clinic on Wednesdays,” she says, “and then sometimes I do surgeries on Tuesdays and Thursdays for living donors. But when you’re on call you just don’t know what’s going to happen. So you live a life of uncertainty. I came back from a holiday on two occasions to transplant sick babies…it’s sort of a crazy life really.”

Surgery call for adult liver, kidney, and pancreas transplants is shared between a team of six, but the paediatric transplant call is shared between just two. “Dr Khan and I do all the paediatric liver transplants. This year already [early November] we have transplanted 21 livers, which may not seem like a lot when there are 52 weeks in the year, but each one is a big time commitment. We do at least ten days of call a month between kidneys, donors and transplants.”

When Majella arrived in St Louis first, she lived in an apartment in the Central West End, a vibrant area close to the hospital, which she describes as being “a little bit rundown, but sort of up and coming” at the time. She stayed there until she met her now husband, Bob Roth, (‘he’s amazing!,’” she says) who works in biotech, and they moved to the suburbs when they married in 2014. “Now we live in a house with a garden and a swimming pool,” she says. “When I first arrived in St Louis it was 105 degrees. Being Irish, I didn’t even know how I was going to be able to breathe! So the pool is great in summer. The winters are cold – not Boston or Chicago cold with big snowdrifts, but we do get a few ice storms – and we get four proper seasons, and spring and autumn are beautiful.”

Majella says St Louis is a very liveable city. “St Louis is nice and small, with a population of 2.8 million. It’s easy to get around. My commute is only 20 minutes in traffic and ten minutes if there’s no traffic. There are big parks and it’s very geared towards families, with great museums and a wonderful zoo.”

Majella and Bob’s son, Rory, is six – “he keeps us all entertained” – while Bob’s two older children, Ryan and Amanda, are both away at college. Ryan, on an athletic scholarship as an ice hockey player, is completing his business degree, and Amanda is interested in attending medical school after completing her undergraduate studies. The entire family loves to ski and goes to Colorado as often as they can get away together; Rory has already decided he wants to be an Olympic skier. “Either that or an artist,” says Majella.

When she can, she gets out on the golf course, but claims not to be very good. “My husband is a much better golfer than I am,” she says. “So he’s always giving me tips.” And she rides a friend’s horses when she gets the chance, having initially tried to learn polo. “That’s what they do here,” she says, “but that proved to be quite difficult, so now I just go for a ride.”

Majella makes the trip back to Ireland several times a year to visit her parents, who still live in Wicklow and her sister, Sarah, who is also a doctor and lives in Greystones. Her brother lives in France. “I’m very much a home bird so I love going back to Ireland,” she says. “We don’t really take vacations anywhere else, other than to ski.” ■