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Right:Dr. Marshall Bouldin IV, changing the way diabetes patients are treated in Mississippi. Left: Dr. Annette Low, infusing her practice by teaching patients about lifestyle changes.

Dr. Annette Low and Dr. Marshall Bouldin IV wouldn't presume to give advice to other married medical couples. They just know that their combined energy and commitment work better together than they do apart — even if their relationship has been described as "The Dragon and the Catfish." (That was how Bouldin's brother described them in a song he wrote for their wedding reception.)

Low (the dragon, a nod to her Chinese heritage) is associate professor of medicine at the University of Mississippi and founder of one of 20 Centers of Excellence in Women's Health in the country.

Bouldin (the catfish, symbol of the Mississippi Delta) is associate professor of medicine and director of the Diabetes and Metabolism Center. He has established a network of diabetes clinics in Jackson and in the Delta that have dramatically improved the outcomes of diabetes patients across the board regardless of race, gender, ability to pay or socioeconomic status.

Low's parents are both Chinese, but they had untraditional hopes for their four daughters. They were living in Australia, with three of their four girls, when her parents decided they wanted the daughters to read and write Chinese. Her father moved his business to Hong Kong, where the now four daughters got a good grounding in Chinese culture. But her parents also realized that tradition and custom would put limitations on how successful their daughters would be. They moved to Guam, the westernmost United States territory, where his daughters would have the advantage of a western education.

Low graduated magna cum laude from the University of Washington in Seattle and earned a medical degree from Johns Hopkins in 1988.

Bouldin's family was among the first landholders in the Mississippi Delta. His great grandfather (the first Marshall Bouldin), merchant and farmer, built the mercantile store that is now Ground Zero Blues Club in Clarksdale. His grandfather was also a farmer, but somehow the farming gene failed to express itself in Marshall Bouldin III, the now famous portrait artist who has hundreds of his paintings exhibited all over the country, including many in the nation's capitol.

"I've been told that there was quite an upheaval in the family when my father announced that he was going to be a painter full time at the same time my mother told the family she was going to medical school," Bouldin said.

Bouldin graduated from Ole Miss summa cum laude, enrolled in Johns Hopkins medical school, then took two years off as a Rhodes scholar in Oxford, England. By the time he got back to medical school in 1985, he was in Low's class.

"He was only the fourth Mississippian I had ever met," Low said. "We used to hang around together but didn't date for a long time. I just thought we were too different in every way." It wasn't just the cultural differences that concerned her. "I'm an extrovert; he's an introvert. I would like to go out with friends all the time, and he would prefer to be alone in the library." She didn't know at the time that Bouldin had his own take on compatibility. "Marshall told me that his parents were as different as any two people could be, but had a happy marriage with four sons."

And something else Bouldin had that must have swayed her: a mother who was a perfect model for an independent, successful female.

"I don't think my grandfather forgave my mother until she graduated from medical school. He was in the restroom with the fathers of some of her classmates. One was bragging about how smart his son was, and how he would have been first in his class if it weren't for 'that darned woman from Clarksdale.'" She was the only woman in her medical school class at the University Tennessee. She practiced many years in Memphis and flew her own plane from the farm in Clarksdale to her practice in Memphis. "We thought it was perfectly normal to go load up in the truck and watch for mother coming home from work in an air plane."

Once Low was convinced about her compatibility with Bouldin, she still had to come to terms with living in Mississippi. "I knew he was going to come home to practice. That's all he talked about." When they finished residency training at the University of Virginia in Charlottesville, he went to practice with Internal Medicine Associates in Tupelo, and she went to the Street Clinic in Vicksburg. It was in Vicksburg that she decided not just that she could live here, but it could feel like home.

Holding back obvious emotion, she recalls the death of her sister, Karen, who had come to visit her and died of pneumonia. "I just had never experienced Southern hospitality before. My patients, people in the community were amazing. They just enfolded us in love and caring. I think I knew then I could belong here."

Bouldin joined her at the Street Clinic in 1993 where they stayed until 1998. "When we decided to get married, we polled her patients and asked if she should change her name. The vote was almost unanimous. No. So Dr. Low she remained.

At that time, they never had any intention of practicing in academic medicine. "We just weren't on that career path," Bouldin said. "If you plan to be in academic medicine, you don't just start practicing right after residency." In fact they had contracts in hand to be hospitalists in a Jackson hospital. Before they signed, someone suggested they talk to Dr. Dan Jones, medical center vice chancellor for health affairs now, then director of the hypertension division.

Jones himself had a similar background in private practice before he entered academic medicine, and he saw something in the two that the medical center needed. Ten minutes into the meeting, both Bouldin and Low knew "our course had changed dramatically."

For Low, it meant working on the Center of Excellence in Women's Health, to bring a system to fruition that would focus on the needs of women at all stages of their lives. Both Low and Bouldin practice as members of a large multidisciplinary team that gives each team member a large measure of responsibility and the freedom to give their opinions on how patients are managed.

For Bouldin, his charge was "to do something about diabetes" in this state. "Dan said he couldn't commit any faculty or any resources at all to it, but there was a clinic with some nurses. After a couple of meetings we had our plan worked out. He told me that if it worked in the university it would be good, but the real test would be if it worked outside Jackson."

In 2003, Bouldin was able to tell Jones that he had passed the test. In every clinic site, his team had reduced blood sugar (hemoglobin A1c) by an average of two points. And for every point the blood sugar is reduced, the risk of complications decreases by 35 percent.

Caryl Sumrall, a nurse practitioner who works with both Low and Bouldin, says their enthusiasm and work ethic are contagious. "There are a lot of smart capable people on our team, but not one of them minds stuffing envelopes, or taking over for someone else or just doing whatever it is to get the job done. It's because they have Marshall and Annette as role models and because we all understand and appreciate the ultimate goals here."

Dr. Cass Pennington, director of the Delta Health Alliance, says they've been a Godsend to the Delta. "I think Marshall's car could find its way up here without a driver."


July 2007

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