By Arthur Lightbourn
When he’s not hammering away at home improvement projects, gardening or writing poetry, you’ll find him trying to save lives in the intensive care units at the new Sharp Memorial Hospital in Kearny Mesa.
Dr. David Willms is director of critical care services at Sharp.
Last month, in recognition of his achievements, contributions and research over 22 years in critical care, a specialization that administers to and monitors patients whose conditions are often life-threatening, he was honored with induction as a Fellow of the American College of Critical Care Medicine.
We interviewed Dr. Willms at his home in Del Mar where he lives with his wife, former critical care nurse and now golf pro, Patty Atkins, and their sons.
The 54-year-old physician is 5-foot-10, 165 pounds, with hazel eyes, and sandy brown hair graying at the temples. He speaks with a hint of a Texas drawl.
And why not?
Willms was born in Big Spring, Texas, while his father served as a pilot stationed at a nearby Air Force base. The family later moved to Lockhart, Texas, outside of Austin, where his father took up farming. Willms was the eldest of two brothers and a sister.
He developed an early interest in science and in high school decided he wanted to be in some field of science where he could be of help to people. “And medicine fit the bill for that,” he said.
As an undergraduate at the University of Texas at Austin, he earned a B.A. in psychology, graduating in 1978 with honors.
Four years later, he earned his medical degree from Baylor College of Medicine in Houston, followed by an internship and residencies in internal medicine at the University of Texas Science Center in San Antonio, and a fellowship in pulmonary and critical care medicine at UCSD (1986-1989).
He joined Sharp Memorial in 1990, serving in various capacities until his appointment as director of critical care in 2002.
The new expanded 368-bed Sharp Memorial Hospital, called the Stephen Birch Healthcare Center, was completed in 2009. It has two state-of-the-art intensive care units (ICUs) with a total of 48 beds, “and we tend to run close to full at all times,” Willms said.
“It’s almost always a life-threatening situation,” he added. “It might be from trauma, a motor vehicle crash. It may be after major or complicated surgery. It may be after heart surgery. All patients after heart surgery go to the intensive-care unit.
“Or it might be a medical condition like pneumonia or respiratory failure or sepsis, severe infection. Any of those might get you transferred into the ICU.”
Sharp Memorial is home to San Diego’s largest emergency and trauma center and, as such, many of its trauma patients end up in intensive-care. Sharp is also renowned for heart surgeries and multi-organ transplantations.
Willms, in addition to being board certified in critical care, is also a board certified pulmonologist, so that much of what he does in the ICU involves treating respiratory problems.
“So I do certain procedures that involve putting tubes into the windpipe to assist breathing and I run mechanical ventilators or breathing machines,” he said.
A common cause of respiratory failure is chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, a disease affecting at least 12 million U.S. adults, caused often by smoking.
While there is no known cure for COPD, fortunately it can be managed. The first step is to stop smoking, Willms said. Then, there are medications available to ease the breathlessness and improve lung function.
“COPD has a major impact in our ICUs because in the very advanced cases, patients can develop respiratory failure and are much more prone to severe pneumonias that require ICU management.”
Over the span of his career, Willms said, there have been “phenomenal” advances in critical care.
“Especially in the last decade,” he said, “there has been an increasing pace of evidence-based therapies,” eliminating those therapies that were found to be no longer useful and replacing them with more effective therapies.
“The way we ventilate patients with various respiratory disorders has changed drastically in the last 10 to 15 years,” he said.
A ventilator is a mechanical device that forcibly delivers air and oxygen into the lungs. It can be 100 percent oxygen if the patient requires it, or a mixture of air and oxygen. The job of the ventilator is to simulate normal breathing for the patient.
“One of the major diseases we treat and that I’m an expert in is called ARDS, Acute Respiratory Distress Syndrome. Back in the 1980s and even the ’90s, it was common, when patients were on the ventilator to use very large volumes of air for each breath to try to improve their oxygen levels.
“What we learned through animal and human research was that was actually harmful to the lungs. It was hurting patients rather than helping them. So we learned to ventilate people’s lungs at a much lower volume of air and prevent some of the injurious effects of the breathing machine.”
There have also been significant advances in trauma care, he said, and improvements in devices to support patients who are in heart failure — who otherwise die.
“One of the biggest killers in the ICU is sepsis,” he said, “which is an overwhelming infection that causes the body to lose control of its responses and damages organs, all of them.
“Over the last 15 years or so, there has been a series of sepsis treatments that have been developed, not just antibiotics, but the best ways to treat patients with fluids and with other supportive care.”
Willms admits that in working with the seriously ill on a daily basis, it’s difficult not to get caught up in the drama and the sadness of some of what goes on in the ICU.
“But part of what we are charged to do as critical care professionals is help people not only survive or get cured, but sometimes we’re there to help people be comfortable and as free of pain as possible and to be psychologically supportive through the end of their lives if that’s what happens to be happening.”
Asked what improvements in critical care he would hope to see in the near future, he offered the following: “A much more potent, effective, and specific pharmacologic therapy for severe sepsis (infections) would be one of my dreams and that is something I’ve worked on in research for a number of years. Not an antibiotic, but something that reverses the organ failure effect of sepsis.”
The lay term for sepsis is blood poisoning.
Once an infection gets established and causes severe sepsis, releasing a number of poisons into a patient’s blood stream, causing “all of the bad things connected with sepsis,” including low blood pressure, respiratory failure and kidney failure, it has a mortality rate of between 30 to 50 percent.
“It’s a terrible killer,” he said. “We and others have been able to reduce the mortality by implementing a whole variety of therapies,” but “what we need are drugs that will turn off that cycle of development and release of those poisons into the blood stream.
“Another [hoped-for advancement] would be new developments in the field of respiratory failure that would allow us to better support breathing. That might be a better mechanical ventilator or a different device that would help the body stabilize after respiratory failure.”
Outside of his medical practice, Willms is involved as an entrepreneur in medical device design and production. “A friend of mine and I have started a company, Pacific Partners in Innovation, based locally here in Oceanside, to make medical devices that we hope will improve safety for patients and for health care providers, mostly in the hospital setting.”
David Willms, M.D.
Recently inducted as a Fellow of the American College of Critical Care Medicine, Dr. Willms is director of critical care at Sharp Memorial Hospital and medical director of the respiratory therapy program at Grossmont College, El Cajon.
Big Spring, Texas, 54 years ago
: B.A. with honors in psychology, University of Texas, Austin, 1978; M.D., Baylor College of Medicine, Houston, Texas, 1982; internship and residency in internal medicine, University of Texas Health Science Center, San Antonio, 1983-1986; fellowship, pulmonary and critical care medicine, University of California, San Diego, 1986-1988.
Married to golf pro Patty Atkins. Four children, Alex, 12, Kurt, 13, Austin, 22, and Zachary, 24.
Gardening, home improvement, literature, writing poetry.
“Don’t take the elevator. Climb the stairs at work, run, work out at home, live a healthy lifestyle and eat a healthy diet.”
Fitzgerald and Hemingway: "Works and Days," by literary biographer Scott Donaldson.
“Million Dollar Baby” and “The Night of the Iguana.”
Favorite vacation area:
California’s central coast around Santa Barbara
“My experience in medicine shows me every day the potential abruptness of life so out of that I think it’s important to make every day count.”