For Adela Casas-Melley, MD, joining Nemours Children's Hospital in Orlando this year marked a double homecoming.
Not only was she returning to her home state. She was also coming back to the healthcare company that helped shape the surgeon she is today.
"The thing that has always attracted me to Nemours is the culture," said Casas-Melley, who began her career at the Nemours/Alfred I. DuPont Hospital for Children in Wilmington, Del.
"Whether it's a physician or a nurse or a respiratory therapist - everyone understands we're all here for the child," she said. "We will do whatever is necessary to make sure the child is cared for just the way we would want our own child to be treated. I can sincerely tell a parent: 'I'm going to take care of your baby just like I would my own.'"
Casas-Melley took the reins as division chief of pediatric general surgery at Nemours Children's Hospital in February. The 10 years between her two Nemours appointments took her all the way to South Dakota, where she successfully built a new pediatric surgery department at Sanford Children's Hospital in Sioux Falls.
Then late last year, when her mentor and former partner at Nemours' Delaware hospital, Stephen P. Dunn, MD, called her about the opportunity in Orlando, it seemed like the right time.
"I loved living in South Dakota, but my husband was miserable there," she said. "After 10 years, it was time to come home."
Born in Havana, Cuba, Casas-Melley was raised in Miami and attended public schools there. She went on to Emory University in Atlanta to earn her undergraduate degree and a master's degree in medical science.
The first person in her family to go to college, Casas-Melley had wanted to be a physician for as long as she can remember. She entered medical school with the intention of wanting to become a neonatologist.
"I loved taking care of little babies," she said. "But I realized I was a better fit for surgery than for medicine. Once that became clear, it was easy for me to navigate toward pediatric surgery."
Casas-Melley completed her medical degree, internship and general surgery residency at the Medical College of Georgia. She completed her training under Dunn at St. Christopher's Hospital for Children in Philadelphia. When he joined Nemours, she followed him to continue performing kidney and liver transplants for pediatric patients.
After six years in Delaware, an opportunity to build a pediatric general surgery practice from scratch was too good to pass up.
"They were building a brand-new children's hospital, but it was still two years away from completion," Casas-Melley said. "Aside from a pediatric orthopedic surgeon and pediatric anesthesiologist, they had no other pediatric surgical subspecialties. I decided it was a challenge worth taking on."
Casas-Melley took on the challenge even as she and her husband, Peter, a software engineer, were managing a growing family. When they moved to South Dakota, they had three boys under age 4 and she was eight months pregnant with her fourth son.
Six months later, the pediatric surgery division had completed 600 cases -- compared to 125 for the entire year prior. Casas-Melley was able to recruit additional pediatric general surgeons as well as pediatric specialists in urology, ENT, neurosurgery and ophthalmology. By the time she left, pediatric general surgeons at Sanford Children's Hospital were doing 1,400 cases a year.
Meanwhile, her husband had stepped down from his position with Lockheed Martin to manage the home front for seven years.
"I've really learned, as the years go by, that when people tell you 'You can do it all,' it's a lie," Casas-Melley said. "You can't do it all, so you need to have a very supportive spouse that is really able to cover all the holes you can't fill.
"He went to the parent meetings and took the kids to music lessons and soccer games. When I was the only pediatric general surgeon in the entire state for two and a half years, I didn't have a lot of extra time."
In Florida, her husband is glad to be back at work since the boys - Peter, 13, Matthew, 12, Patrick, 11, and Daniel, 9 - are older.
Casas-Melley is now working to grow the general surgery division at Nemours Chidlren's Hospital, where she is recruiting two or three surgeons to join herself and Tamarah J. Westmoreland, MD, PhD. She is working to grow not only the number of surgeons, but also the complexity of cases they take on.
"Things have really progressed quicker than I thought they would," she said. "We can do almost any procedure on pediatric patients."
Due to her experience in complex liver procedures and transplantation, she has been able to perform the Kasai procedure for babies born with biliary atresia. The division also offers total colectomies with pouches for children with familial adenomatous polyposis and for those with forms of colitis.
Casas-Melley has also introduced single-site laparoscopy, allowing procedures like appendectomies to be completed entirely through the belly button.
As the division grows, Casas-Melley says she wants physicians in the area to feel free to access its surgeons as a resource.
"We are very open to discussing any questions they have," she said. "If a patient comes into their office, and they're not sure whether the patient needs to be seen by a surgeon, we're more than willing to pick up the phone and discuss that with them. They're the primary physician, and we're willing to work with them very closely to determine the best care for their patients."