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Insight into the Mind and Heart of a Cardiothoracic Surgeon

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ElectLive

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Atlanta, GA
Have you ever wondered what goes on in the mind of a heart surgeon? Wondered if the day-to-day chores with someone's life in their hands ever becomes monotonous? Wonder if they will be (or were) at their very best when it's your surgery, your heart? I think the vast majority of us would agree that heart surgery is one of the most important moments in our life. But for our surgeons, it's just another day at the office. Or is it?

I'm posting an excerpt below from a speech by the President (at the time) of the Society of Thoracic Surgeons, at the fourtieth annual meeting in 2004, entitled "Quo vadimus?" The address itself was lengthy and focused upon the general role of heart surgeons in the ever changing world of medicine and beyond. It concluded with a very personal story by the President that I just felt needed to be shared with our own patient "society":


"Years ago I used to write. Usually late at night. Usually focused on the college student's search for meaning, for purpose. Usually struggling with the reconciliation of idealism with reality. I still have a small package of those writings. One of those, written at the time of the death of Martin Luther King, Jr, poses an unfinished task:

Must I grow up?
How it hurts to see the world as it is
For years I've known
That men are less than they should be
Now I fear I only begin
To see how much
Is there not one honest human
Who dares to face
All of the truth?
I cannot, I will not
Accept this state
I throw the gauntlet out,
Hopeless as the joust may be!
Rather I would face all the rest at once
Than this one I must first subdue
But I know there's no one else,
I must begin with me

Thirty-five years later, I'm still working on me. Like you, the path I chose was very focused. We worked. We studied. We worked. By day and by night. Week after week. Month after month. College contemporaries of ours became millionaire businessmen, engineers, and lawyers. Was it worth it? Am I better off than Joe Johnson with his lodge in Vail and his compound in the Caymans?

DARN RIGHT I AM! You see, I called 21 ICU an hour ago and Mr Malone has an index of 3.5 and moves all four to command. Mr Malone, you see, was just in Atlanta on business from Charlotte. Then his chest hurt and he couldn't breathe. He hit the emergency room cold and sweating after 24 hours. His left ventricular end-diastolic pressure (LVEDP) was 38 and his ejection fraction (EF) was 20. His baggy heart was cursed with diabetic strings for vessels. Worst of all was the pain, over and over, the pain. V-fib after induction. No blood pressure except from compression until the internal paddles kissed his departing soul. Eight of us, a team working together almost wordlessly, held Mr Malone's heart in our hands yesterday. Today his index is 3.5 and all four move to command.

Do we share this, you and I? Do you feel the intensity that I feel with every operation? It is the Grand Joust in the Tournament, and each time the opponent, the one I must subdue, is myself. I must defeat my self-doubt with preparation. I must battle my ignorance with knowledge gleaned from others. I must overcome inattention to detail with focus and commitment. I must fight the unexpected with tenacity. I must overcome progressive limitations of physical skill with experience. I must subdue my pride with the understanding that the squire and the armorer and the horse are often more critical than I. Mostly I win. Sometimes I'm knocked on my rear end! But every time there is the rush, the feeling of a unique and personal contribution to the interdependency of human souls. Yes, we share Mr Malone, you and I.

We are fortunate, you and I. We are fortunate to taste this aphrodisiac almost daily. But the Operating Room is a treacherous mistress. The operation is a great and singular event, but it is a problem, this intoxicating total immersion into responsibility for another's life. Tasks of daily living and daily work seem less vital, almost trivial sometimes by comparison. Importantly, the activities that we must undertake to preserve the environment in which we work, to preserve the opportunity to help our patients, present very delayed gratification compared with Mr Malone.

Surgery is threatened today. We must reinvent ourselves not only to adapt to changing technology, but also to be the initiators of progressive change. We must work together to defeat the forces that would reduce us to operating room technicians. We must become the champions of quality and value in medicine. We must be tenacious advocates of patient education and empowerment.

There are mountains to move. I believe that great mountains are moved by great faith. But mountains are moved stone by stone and the faith that moves mountains is the faith that you will carry your stone and I will carry mine. And we carry these stones, not for you, not for me, but for Mr Malone."



Now, this was a Presidential Address, so you may be wondering if there's a bit of hyperbole in this story. Perhaps. Let me add to this story, though. Six years later in this surgeon's life, 40 years after he became a resident, he operated on someone who in my mind was even more important than Mr. Malone. He operated on me. For those that haven't read, my surgery and return to normal was nearly perfect. There was one glitch - heart block which later required a pacemaker. So, after my surgery, this surgeon walks out to tell my wife how the surgery went, just another daily chore from the last 40 years. My wife said that despite his well-trained clinical composure, she was able to notice that he was visibly shaken by sharing the news of my outcome because of the one glitch. In her opinion, she would not have expected much more emotion from him had I not even survived, and she was taken aback by his concern.

I didn't speak to him until the next morning, 24 hours after the surgery. There was no emotion then, nor did I expect there to be. At the time, I was on top of the world, considering how well I felt given the circumstances. He explained the complication and I just sort of shrugged my shoulders and said something jokingly like "well, sure could have been a lot worse." He didn't smile, or hardly even blink for that matter. See, there is a difference between patients and surgeons I think. Most patients see heart surgery pre-surgery and think what might go wrong, then post-surgery how it could have been worse. Surgeons see heart surgery pre-surgery and think nothing should go wrong, then post-surgery what should have been better.

Now, not every surgeon out there may have the same passion of this surgeon, and even for those that do, absolute perfection will always be the impossible chase. But I'd be willing to bet there are hundreds, if not thousands, of leading heart surgeons out there who would have very similar stories and personal commitment to share. We can, and should, expect our surgeon to be at their very best for us.

I spent several hours in total talking to my surgeon. Sadly, all of it was about the details of my surgery. I may not have not gotten the good fortune to know him personally, but I consider myself very lucky to have been able to read this insight into his character. It's not just about skills and experience, it's the person inside, who they are. This post is dedicated to my surgeon and the many, many others out there just like him. Thank you for all that you do.
 

BDMc

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Wow! What a wonderful post! It's nice to see the surgeon's view/perspective. What a great person he is! Thank you!
 

Lynlw

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So I'm guessing you found the webcasts i mentioned? :)
 

Boston Tiger

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I spent several hours in total talking to my surgeon. Sadly, all of it was about the details of my surgery. I may not have not gotten the good fortune to know him personally, but I consider myself very lucky to have been able to read this insight into his character. It's not just about skills and experience, it's the person inside, who they are. This post is dedicated to my surgeon and the many, many others out there just like him. Thank you for all that you do.
I was lucky enough that my surgery had to be scheduled one of the Brigham and Womens' teams trips to Rwanda, so my wife and I got to hear a bit about something other than my own surgery. It was impressive to hear (and read on the web) about the efforts of the whole team to go and provide cardiac surgery in one of the poorest countries on earth. It also gave me something to talk about with one of my ICU nurses, who had gone on that trip and the one the year before.

Thanks the post, and more importantly, thanks to the wonderful men and women in the cardiac care units who save lives every day.
 

ElectLive

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So I'm guessing you found the webcasts i mentioned? :)
Well, I was looking for those webcasts, and happened upon this on the way, and got a little distracted. :) The full text of this was published in The Annals of Thoracic Surgery. I hadn't thought to look for a webcast of the address yet, but that will probably be my next research adventure...
 
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