Doing the right thing

This story was published in the spring 2024 issue of 12th & Marshall. You can find the current and past issues online.

Nearly 30 years ago, Richmond native DAVID D. LIMBRICK, MS’95 (PHIS), MD-PHD’01 (PHTX), had a chance encounter during a medical school rotation that altered the course of his life. Discovering his passion for neurosurgery and academic medicine on the MCV Campus lit a fire that fueled Limbrick’s next two decades: an internationally-celebrated career at Washington University in St. Louis where he led research and cared for children living with brain tumors and malformations of the brain.

In 2023, Limbrick returned to his alma mater as the James W. and Frances G. McGlothlin Chair of the Department of Neurosurgery — a leadership role previously held for 30 years by HARRY F. YOUNG, M.D., the renowned mentor Limbrick met during that fateful neurosurgery rotation. Recently, we sat down with the two physicians to discuss leadership, the importance of good teachers and the future of neurosurgery at VCU.

Many of our readers may know who you both are, but I think they would love it if you introduced each other. Dr. Limbrick, who is Harry Young?

DL: Dr. Young is someone who finds his way through life by always doing the right thing for other people. I’ll try to summarize Dr. Young in a quick story. He has always been known for his commitment to his patients and the strong relationships he shares with them. In medical school, I remember a period where I spent every Tuesday in his clinic meeting his patients and watching him interact with them. Many of those nights I would be in his office and, between phone calls to patients, he would help me, and I was just a medical student. Those nights were acts of generosity.

And Dr. Young, who is David Limbrick?

HY: At his core, Dr. Limbrick is a great problem-solver. Surgically, he handles the most complex cases, sometimes performing operations in utero, and he’s helped make these operations safer and simpler. He wants to advance the field and make it better for patients. He also leads an important portfolio of research, and with research there’s hope. He brings tremendous enthusiasm to every aspect of his work, and I think we have recruited an excellent person who has the organizational leadership skills to make us one of the really outstanding departments of neurological surgery in the country.

When did you decide that you wanted to pursue a career in medicine?

DL: There are definitely people who know from a young age that they want to be a neurosurgeon, but my path was something that evolved over time. During college at William & Mary, and for a few years after, I actually worked as a musician. I really enjoyed that experience, but at the same time I had an opportunity to volunteer in DR. ROBERT DELORENZO’S neuroscience lab here at VCU. I became involved in a number of projects, and I was drawn to the scientific method where you can ask a question, test a hypothesis and work to find an answer. That was fun for me, and I applied to medical school based on that experience.

HY: I grew up in Ohio, and two of my classmates in our small school were sick. One of them had a brain tumor, and that certainly made an impression on me. At the same time I have always enjoyed meeting and talking to people, finding out what makes them tick. Then you add the opportunity to study and treat conditions of the brain, which I think is the crown jewel of the human body, and medicine is a pretty good calling.

The two of you share a history on the MCV Campus that begins with education. Dr. Limbrick, can you describe your experience as an M.D.-Ph.D. student and what drew you to neurosurgery?

DL: I was working in a neurology laboratory, and at the time I thought I would pursue neurology — specifically working on epilepsy. But in the latter days of medical school, I rotated through neurosurgery and I had a number of experiences with the faculty that simply changed my life. Dr. Young and a few other faculty members invited me to participate in surgical cases. That was very compelling.

I distinctly recall one patient who presented with a ruptured aneurysm. They needed a highly-involved, intense surgery that required both technical expertise in microneurosurgery and an understanding of the fundamentals of neuroscience and the research on which clinical practice is built. I experienced the energy in the operating room, and participated in certain parts of the closure.

These mentors encouraged me to pursue neurosurgery, and they gave me opportunities to get enough of a flavor of neurosurgery that I refocused my goals. In retrospect, I recognize that I’ve always enjoyed the parts of my life in which I’m using my hands — playing music, of course, but my research also required micro instruments and fine movements. Neurosurgery brought all of these elements together in a way that made a lot of sense.

Dr. Young, what do you remember about David Limbrick the student?

HY: He was just excellent. I've seen hundreds of students over the last 50 years, and he was among the very best. He struck me as very intelligent and he demonstrated excellent judgment. You could also see the keen interest he had in medicine and trying to help people. He prepared himself with a good foundation of medical knowledge, and he had the drive, intensity and seriousness that neurosurgery requires. He also had a unique set of skills and abilities, too, a sixth sense. When he was only a medical student, he could evaluate a patient and come up with a treatment plan as well as someone in their third or fourth year of residency.

Dr. Limbrick, what has it been like to come back to your hometown, and return to the MCV Campus where you went to medical school?

DL: I’m really honored to be part of an institution that is growing at an incredible rate while doing incredible things. VCU Health is also an institution that has cared for members of my own family, so all of these elements make it both a special professional opportunity and a personally fulfilling one.

I grew up here, my family has roots here and I’ve always felt connected to this community. As far as making the decision to return to Richmond, my wife, who is a writer, put it best. She framed the decision around the decades we spent in St. Louis, the amazing opportunities I encountered at Washington University and the skills I honed there. And she asked a simple question: ‘Wouldn't it be gratifying to take all of that back home to serve your community?’

What does the Department of Neurosurgery do really well today that sets us apart from other institutions?

DL: Regardless of the area of our discipline — whether that’s spine, vascular, pediatrics or functional neurosurgery — we take great care of patients. To be more specific, our team is composed of expert surgical technicians, and I think a lot of that has to do with years of Dr. Young and the faculty he led always doing the right thing, sacrificing to do the right thing for patients. That really is the fabric of this department.

HY: One of the foremost things we do is educate. We really prepare medical students, residents and fellows well. It’s our mission to make each generation better and better. We also take great care of patients, and we have some programs that are outstanding. For instance, DR. KATHRYN HOLLOWAY’S movement disorder program. She trained with us and now is a national leader in deep brain stimulation, and she cares for veterans through a Parkinson’s Disease Research, Education and Clinical Centers grant from the U.S. Department of Veterans Affairs.

What are the department’s opportunities for growth and how will we get there?

DL: I would love to see us build the research enterprise in the neurosciences even further so we can bring innovative new treatments to our patients. The goal is to generate evidence-based medicine that starts within a VCU laboratory and then makes it all the way to clinical trials and, ultimately, to taking even better care of our patients.

It’s important to note that clinical trials may sound like research, but they’re more than that. Clinical trials are the platform for getting the most innovative treatments to patients — that's the key thing. 

We have excellent examples of bringing innovative treatments forward in our subspecialty programs. For instance, in our epilepsy/functional and cerebrovascular neurosurgery programs, and our traumatic brain injury program. I am particularly looking forward to the enormous opportunities to build world-class programs in neuro-oncology, advanced spinal neurosurgery, and, of course, pediatric neurosurgery, where we have a new state-of-the-art children's hospital.

HY: We have a long history of taking science from the laboratory bench to the clinic. In the 1970s our head injury center received a lot of attention for intracranial pressure monitoring. We were one of the first groups to study that and make clinical use of the findings. We proved that controlling intracranial pressure helped reduce mortality for patients with severe head injuries. That’s outstanding work that began in a laboratory of five or more people doing seminal research. We would take that research, make translational progress and be able to apply that science at the bedside. To do that we need to stand on the shoulders of our Ph.D. and basic researchers. Continuing to grow the research enterprise is critical, and that’s one of Dr. Limbrick’s strong suits.

Simultaneously caring for patients, conducting research and leading a department is a demanding challenge. How do you maintain the balance that enables you to perform all of those functions effectively?

DL: I have benefited from building teams of people who believe in a shared mission, and empowering them to do great work. Just this morning, I met with a team of our researchers who are all incredible in their own right. Allowing them to lead in their areas is something that gives them and me great satisfaction. As long as you have really great people who are skilled, smart and motivated, they will move their own areas forward with oversight and mentorship. That’s how I’ve struck balance up to this point, so that's what I'm trying to do now. Any success that the department has, or I have, will be based on the leadership of the other faculty and staff.

HY: It's very important to be seen. Someone told me once that leadership is 80% visibility. The patients, residents, staff — everyone wants to see you. For years I’ve seen Dr. Limbrick patiently doing all of the things that have prepared him for this. I know he’s ready to lead and that the best is yet to come.