Dr. Luke Wall likens his clinical pediatric immunology practice to staring up at the stars. “There are certain things we can see, and we know,” he said. “But there’s a tremendous amount that is unknown. Even the volume of knowledge that has been documented, which is huge, the mystery and the unknown still goes so much deeper than that.”
Wall’s experience practicing medicine during the pandemic was often terrifying. “It really took all of us by surprise. Now, only two years out, it’s hard to imagine how crazy things were. We were operating blindly. We had no anti-virals, nothing to treat our patients with. It made us so fearful for our patients with immunodeficiency. We were literally back to the early frontiers of medicine.”
Within his practice, at the main campus of Children’s Hospital in Uptown New Orleans, Children’s Hospital Outpatient Center of Baton Rouge, and Children’s Hospital Northshore Center in Covington, he sees everyone from the tiniest newborns to young adults up to 21. Within a range of allergies and immune disorders, his work can be routine or, during COVID, heartbreakingly tragic. But he’s never been surer of his calling.
The first in his class
Wall and his wife Nicole both grew up in the little town of Springfield, a farming community about an hour outside of New Orleans, just west of Ponchatoula. On his dad’s side, the family all farmed strawberries. “I grew up running barefoot through strawberry fields,” he recalled. His dad made his living as a commercial fisherman, crabbing and shrimping in between working in petroleum plants. His mom had a salon business, cutting hair at home. Wall’s interest in medicine was an anomaly. “I used to watch ‘Chicago Hope’ and ‘ER’ on TV, which, even though it was Hollywood, did show some of the challenges of medicine. But I didn’t know anybody personally who was a doctor.”
Growing up in the country, Wall was captivated by wildlife and the rhythms of nature. “I had a strong interest in biology life sciences.” And while his family wasn’t formally educated, their natural curiosity and healthy leavening of common sense was formidable. “In so many ways farmers are scientists, always experimenting to see what works.” About 20 years ago, his father started an aluminum welding business serving boats and trucks. “He’s a genius, my dad. Without any formal training, he can do anything he sets his mind to.”
His grandparents on his mom’s side were equally resourceful – thinkers and readers who loved to figure out how things worked. Wall was in high school when he decided to become a doctor. His maternal grandparents supported him from the beginning. “They always believed I could do it,” he recalled. At one point, when his grandmother needed surgery, she asked her doctor if her grandson could watch. “While that didn’t happen, the doctor did arrange for me to come in and observe another procedure. That was my grandmother.” To this day, although these grandparents are no longer living, Wall thinks of them both, every time he makes a milestone. “When I told them what I wanted to do, I saw they knew it was going to happen.”
Wall was the first graduate of Springfield High School to go to medical school. His wife Nicole trained as an RN, also the first in her family to pursue a medical career. She worked at Children’s first, capturing Wall’s interest with her experiences as he started medical school. “Her passion for her pediatric patients and the close bonds she formed with the staff made an impression on me.” Wall attended LSU for his undergrad and did the rest of his training at The School of Medicine, LSU Health in New Orleans. After a pediatrics residency at Children’s Hospital, he worked another year as chief resident, homing in on allergy and immunology as his focus. The couple lived in Kenner while he was in school, and moved to Hammond when they started a family.
In addition to his clinical work, Wall, 42, serves as an assistant professor of Pediatrics in the Clinical Allergy/Immunology Division, also at LSU Health New Orleans. He is certified by the American Board of Pediatrics and American Board of Allergy and Immunology. “There is a growing population of children with allergies and immune disorders. I enjoy working with families to solve their children’s health issues and watch them grow into productive people.”
Anything but typical
On an average day, Wall sees children in clinic, many with common pediatric issues, like asthma, nasal allergies and skin conditions. “I love my specialty because you always have to be vigilant that something else might be going on, something deeper causing the problem.” Until the pandemic, the most profoundly ill children he treated were diagnosed, sometimes as infants, with severe combined immunodeficiency (SCID), a genetic defect that prevents the immune system from doing its job. Infants with SCID appear healthy at birth but are highly susceptible to severe infections. Thankfully, it’s a rare condition, but these little ones presented the most challenges. In the most severe cases, the only option is a bone marrow transplant. Other children are treated with special infusions or antibiotics.
COVID was a game changer in every way, a frightening unknown disease that he worried would decimate young vulnerable patients, especially those who suffered from SCID. “We were afraid it would cause severe illness and death in many of our patients,” he recalled. Fortunately, that turned out not to be the case. Many of his patients literally went into a bubble until the vaccination was available to them or the current surge would decrease case transmission. Because the families of these at-risk patients essentially removed themselves from society, they were able stay alive, he said.
The worst nightmare
Wall and his wife know 15 people personally who died from COVID-19, some younger, healthy friends. “It was so scary. We lost some patients. Losing even one is a tragedy. The COVID pandemic has disproportionately impacted patients with underlying medical conditions, including children with medical complexities.”
While he expected some of these patients to have more serious reactions to the virus, another scenario took him and his colleagues at Children’s by surprise. That was when a child came in with MIS-C — multi system inflammatory syndrome in children – after being exposed to or having COVID. “In every case that I’ve seen, this was presenting in otherwise completely healthy children. These weren’t sickly kids that were at the doctor a lot. They were completely happy and healthy.”
Then the unimaginable happened. Typically, four to six weeks after COVID, a severe immune deregulation would occur. Everything in the child’s system would become inflamed including the heart, lungs, kidneys, grain, skin, eyes and gastrointestinal organs. The child would run a fever, have a rash, GI symptoms. In the severe cases, the children have gone into shock and heart failure. “Some of them never even had first symptoms,” he recalled. “A month later, within 24 to 48 hours, a completely healthy child would land in ICU and wind up on life support.
“I’ve seen these patients spiral downhill faster than anything in my career, from infants up to teens. This is a brand-new condition. We were flying blind.” Early in the pandemic, Wall and his team started seeing alerts from the CDC, cases occurring in Europe. Then they started seeing it here, in the U.S. Then in New Orleans.
“We did our best to stabilize, but really no one really knew what was causing this. What specialty does this fall under, rheumatology, immunology, infectious disease? Who was steering the ship?” At Children’s the medical staff took a multi-disciplinary approach to treating these patients. Wall was called upon to help augment the immune response, to use various biologics and medication to reduce the inflammation.
He is grateful that most of the several dozen he treated with MIS-C made a full recovery. But not all. “This was a new problem. We hadn’t seen this before. There’s a lot of research being done to try to figure out what’s happening and why, to identify why the children are at risk. Relying on the old-fashioned art of science and medicine and clinical reasoning is what it takes to figure out what was happening. But it’s still a mystery.”
As a father to three children of his own, Wall was devastated for families affected at all levels by COVID-19. He was sometimes frustrated with the lack of awareness and grave concern shown by some families in dealing with potential exposure. Wall struggled mightily when he found himself in social situations where interactions called science into question.
“I have a lot of acquaintances who were not very familiar with what was really happening with this virus,” he recalled. “They spoke out strongly against masking, vaccines, statements based out of not understanding what was happening. I couldn’t be around that. We basically shut down our social life as a family outside of work. When I’d go to the hospital, I’d be surrounded by patients who are so afraid of getting the virus they were fearful to come into see their doctors. We took extreme precautions.”
All the noise surrounding the pandemic stems from what Wall sees as a fundamental misunderstanding. “Of course, I wish that more people would have a deeper trust in medical professionals and their own medical provider as well as a trust in science,” he said. “I think the problem is, the general public thinks when science makes a statement it is an absolute fact. But really, that statement is what we know right now, it’s based on the data at this moment in time.”
It is critical that doctors make statements in a way that both inspires confidence and is always transparent, he added. “Medical science depends on an ever-evolving process. We expect to get new and better and more accurate information. We make recommendations based on that ever-evolving information.”
Protecting the weakest
As the pandemic continues to have a ripple effect on societal health, Wall is more resolved than ever to protect his vulnerable patients. “I feel like this is what I am called to do. In fact, this is the entire reason that Children’s Hospital was built in the 1950s, to care for children during the polio pandemic.
“We have the same heart today, taking in the weakest and doing whatever it takes to give them the best life they can have,” said Wall. “The Bible refers to these as “the least of these,” meaning, the ones that society has forgotten,” he said. “It is my calling to protect and heal them to the best of my ability. I’m fortunate to be surrounded by multidisciplinary teams and an institution that shares this mission. So, the fact that the COVID pandemic has severely impacted this part of society is quite tragic to me.”