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The Joy and Value of a Career in Cardiac Surgery

Wednesday, April 26, 2006

Every other year, the University of Michigan Congenital Heart Center holds a reunion in Ann Arbor for “graduates” of our program.  Many former patients and their families return from around the country and it’s always a thrill for all of us to see them again and catch up on their lives.  At our last reunion, one young man walked up to me and introduced himself.  Jim stood at least 6 feet 3 inches, a bit taller than me, and possessed an athletic build as well as an engaging personality.  He explained that he always wanted to meet me.  Jim is now 17 years old, the captain of his high school football team and an excellent student.   He plans on attending college in a year, hoping to be a heart surgeon some day.  He said that he wanted to meet the person who made it all possible.  Jim was born with transposition of the great arteries and I repaired his heart with an arterial switch operation when he was 4 days old. 

From the very beginnings of our specialty, cardiac surgery has held a special aura for those who practice it.  We are called upon to treat some of the sickest patients with the most complex problems in the hospital.  The ability to correct a congenital cardiac defect, repair a malfunctioning heart valve, restore blood flow to an ischemic heart, or even to replace the heart entirely are among the most energizing yet humbling experiences a physician can have.  To hold the heart in your hands, work inside of its chambers, and restore the health of a gravely ill patient is a privilege few people ever get to experience.  I have enjoyed that privilege for 25 years and there is nothing less “special” about it today than there was when I did my very first open heart operation. 

Perhaps few specialties have experienced as many external pressures lately as cardiac surgery.  In the past few years, the lay press, congress, third party payors, the legal profession, and even our patients have assaulted our specialty.  Technological and pharmacological advances have affected our patient volumes.  It is little wonder why fewer and fewer medical students and general surgery residents no longer believe that cardiac surgery will be an exciting area in which to spend their professional lives.  Long hours, eight or nine years of residency, and an uncertain job market have taken their toll.  Word spreads fast.  Last year, only about 2/3’s of the available cardiothoracic residency positions in the United States were filled by the match process.  So what can someone like me say to encourage those on the front end, those with their entire professional lifetime ahead?  Appropriately, the importance of life style, family time, and other quality-of-life issues we all hear so much about assume a much greater importance today when those entering the medical profession choose a future specialty.  It might be easy for me to put forth the usual platitudes:  cardiac surgery is challenging, exciting, rewarding, glamorous, etc.  Well, so are a lot of other jobs with better hours, more control of your life, and less stress.  Cardiac surgery is also demanding, time consuming, exhausting, and unpredictable.  If all of these aspects of the specialty don’t appeal and challenge you, perhaps cardiac surgery isn’t your cup of tea.  The rewards of a career in cardiac surgery don’t come easy, nothing this worthwhile ever does. 

What of the “naysayers,” those who feel that cardiac surgery will disappear in the future due to the advent of better medical therapies and percutaneous approaches?  Perhaps heart surgeons have been a bit spoiled.  After all, many of us have made rewarding careers doing coronary bypass surgery and it is that aspect of our specialty that is changing the most.  All specialties change.  In fact, very little of what I do today in the operating room did I actually learn as a resident and fellow.  In the current era, many cardiac diseases are treated by newer and better techniques.  That’s good for all of us.  But other conditions, some considered untreatable in the past, cry out for novel surgical approaches.  There will always be new technical advances and the cardiac surgeons of tomorrow will need a different skill set than the ones of today.  Tomorrow’s heart surgeon will need to be facile not only in open surgical techniques, but percutaneous approaches, gene therapy, immunology, bioengineering, and even molecular biology.  It’s a daunting task, but those drawn to this specialty have never been afraid of a challenge.  No other specialist will have the breadth of knowledge combined with the surgical skill to treat heart disease. 

My clinical practice revolves around the surgical treatment of congenital heart defects.  Perhaps one of the most rewarding aspects of that specialty is that I have the opportunity to construct something in the operating room, to make something where nothing existed before.  To me, the challenge of creating a new pathway from the left ventricle to the aorta in a child with double outlet right ventricle or inserting a conduit in a baby with pulmonary atresia is special reward and extremely gratifying.  Equally special is the opportunity to have such a powerful effect on someone’s life at its very beginning.  A congenital heart surgeon always has 3 patients for every operation he or she does:  the child and two parents.  To see the joy in a parent’s eyes when you tell them that their child’s heart operation was completed successfully and their child will go home healthy is beyond words.  Unfortunately, however, it is also true that not every outcome is perfect and this particular specialty is also accompanied by moments of great sadness as well.  We are often called upon to operate on children with extremely high-risk conditions, many life threatening, a burden that can take a heavy toll on any physician.  Many parents ask how they can ever thank me for giving their child life.  I always ask them to send me a picture from time to time so that I can watch them grow up.  Christmas time is filled with cards, letters, and pictures of kids of all ages, enjoying their lives. 

I firmly believe that a career in cardiac surgery is as rewarding and fulfilling today as it ever was.  Many new challenges await and the specialty will surely change.  But for those drawn to the opportunities that new knowledge and techniques will no doubt bring to our specialty, the future is limitless.  The training will be difficult, the hours long, the days unpredictable…but the rewards are immeasurable.  

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