Doctor Q&A: Larry Rand
How did you choose perinatology as a specialty?
Pregnancy has fascinated me since I was a little kid. A pregnant belly is an amazing thing. If you stop and think about it — you can't design a better machine! But sometimes things veer off course, even slightly, and result in complicated situations for mothers or babies or both. In those instances especially, this work can help change the course of their lives, and in turn, their family's lives. That's what drives me, what makes me proud to be a perinatologist.
Why did you become a doctor?
I grew up with a dad who was ill. Here I was — a kid, an adolescent, a young adult, sitting on the other side of the stethoscope, trying hard to understand what was being said to me and my family. I was saddened and frustrated at how hard it was for doctors to explain things, to teach us what was happening, or just to take the time.
For me, cutting-edge medicine is more than just having the latest technology and the best people. What makes you the very best is also being able to help the patient understand what's going on, to help them become a partner in the process. It is very important to me to teach the patient, just like I would teach my colleagues, what their disease is about and how we are going to try to approach it. I spend a lot of time at the whiteboard, drawing it out and trying to make sure they feel as comfortable with the information as possible.
I think the old adage is true, that knowledge is power. But knowledge also gives you peace of mind and the calm to approach the situation.
Why did you choose UCSF?
As a New York native, when I was recruited by UCSF to move out to California, I thought I could never do it — I could never leave my roots and family on the East Coast. At first, I wasn't even going to accept the interview! But — smart people that they are — they were sure it would be a great fit and convinced me to fly out and take a look for myself and meet the people here.
Sure enough, within the first hour or two of the interviews, I was hooked. The people I met were indeed of a caliber that's hard to describe. I remember thinking that this is where I'd want to be if I were a patient. And that did it.
What was it about the people you met during that interview that impressed you?
I could see it in the eyes of the doctor who was interviewing me that day, her drive and interest and worry about these patients and, in this instance, the excitement of fetal surgery to help them overcome what they were facing. It was an electric, energetic atmosphere, but also warm and loving — and that is exactly the kind of balance that's important to me in a doctor. I saw that in this doctor, and very quickly in all my interviewers that day.
UCSF has the people, the drive, the science, the technology — but perhaps one of the strongest pulls for me is the sophistication of the research. It stems from truly wanting to make a difference, to change things now, and to do so in an innovative way. Fetal surgery is one of the best examples of that. UCSF is where it all began — this is where the very first procedure took place, where people thought "outside the box." Something that no one thought was possible was made possible.
You once described UCSF as a last stop. What did you mean by that?
This is a hospital where you can have the most grounded birth experience imaginable, with a sage midwife at your side and memories that will truly last you a lifetime. But this is also the center to which providers in California and around the country send their patients when they're having serious difficulties with their pregnancies.
This place is not about getting the patient in and out the door — this place is about the patient and what they're suffering with and how we're going to fix it. The people here go out of their way to come together as a group and find a solution.
UCSF is the last stop because this is where we are going to take care of you. This is where you'll get what you need, whether your case is simple and straightforward or as difficult and rare as can be.
You cared for Meghann Bauer when she was pregnant with twins. Can you explain the condition that threatened her babies?
In twin-to-twin transfusion, the two babies share one single placenta rather than each having their own. It's kind of like two tenants living in a building and having to share plumbing as opposed to each having their own — there's no control over how much each one gets or how well they share their resources.
Within this shared placenta, the "plumbing" is an intricate network of blood vessels, and in twin-to-twin transfusion, one twin sends blood to its co-twin and that twin can't return that blood. So, one twin ends up with way too much blood in its circulation and is overloaded with volume, while the other is severely anemic and doing poorly. Ultimately both twins can get extremely sick and are at risk of dying.
How was she treated?
Meghann underwent a fetal surgery called laser ablation. To disconnect the blood vessels that are communicating with one another in that shared placenta, you need to put a device into the uterus that allows us to burn these bad connections.
This is not a simple process. You need a team of experts to take care of both the mother and the fetuses — three patients. That includes anesthesiologists who specialize in fetal procedures, pediatric surgeons, perinatologists like myself, neonatologists who specialize in newborns, and nurse specialists. It also includes pediatric medical social workers who help with organizing everything and support the patient and her family through the crisis.
You need the best possible people on the team to give you the best outcome possible — and UCSF attracts that team!