The Making of A Heart Surgeon
Growing up, I always wanted to be an engineer. I loved tinkering with wires, cables, batteries and make model planes and cars.
Mathematics and sciences were easy for me. History, geography and languages were foreign; I always struggled with those subjects.
Not sure why, but I always felt at ease solving math problems and learning about chemical interactions and about the speed of things; speed of trains moving from one station to another or the speed of sound or for that matter the speed of light.
Those abstract concepts always seemed to be easier to comprehend and recall than memorizing and reciting a poem or a verse form the scripture.
Memorizing was hard, understanding biologic or physical concepts seemed much easier.
Growing up as a child, like all children, I enjoyed playing and investigating on my own more than studying what the teachers or my parents wanted me to learn.
It was not until I had to face my first challenge in middle school when all ninth graders in my old country of Jordan, when I had to sit through a government-required examination before passing into tenth grade, that I was challenged and faced the threat of failure. To fail was not even imaginable, thus I applied myself to my fullest. My parents were surprised. They did not know what happened to me to had transformed from a kid who never studied to one who applied himself endlessly!
The taste of success was sweet, and from there on, I became a serious student with high scores; even in the topics I did not like or particularly care for; languages, history, geography and religions. Even those became somewhat enjoyable.
Despite my hard work and doing well on all my school topics, the memories of my particular aversion to the non math and science topics never left me.
To this date at my age of sixty-three, sometimes I wake up from nightmares dreaming that I was back in school, about to take a final exam in languages, having forgotten to open the book that entire year, yet I was about to take a final exam. What a frightening feeling that is. And it keeps coming back, year after year.
That dream has happened to me so many times over the years; that now when it comes back again, I say to myself in my sleep; “Oh don't worry, it is that same dream again, just ignore it. It will go away!!!!”
Growing up, I always wanted to be an engineer. I loved tinkering with wires, cables, batteries and make model planes and cars.
Mathematics and sciences were easy for me. History, geography and languages were foreign; I always struggled with those subjects.
Not sure why, but I always felt at ease solving math problems and learning about chemical interactions and about the speed of things; speed of trains moving from one station to another or the speed of sound or for that matter the speed of light.
Those abstract concepts always seemed to be easier to comprehend and recall than memorizing and reciting a poem or a verse form the scripture.
Memorizing was hard, understanding biologic or physical concepts seemed much easier.
Growing up as a child, like all children, I enjoyed playing and investigating on my own more than studying what the teachers or my parents wanted me to learn.
It was not until I had to face my first challenge in middle school when all ninth graders in my old country of Jordan, when I had to sit through a government-required examination before passing into tenth grade, that I was challenged and faced the threat of failure. To fail was not even imaginable, thus I applied myself to my fullest. My parents were surprised. They did not know what happened to me to had transformed from a kid who never studied to one who applied himself endlessly!
The taste of success was sweet, and from there on, I became a serious student with high scores; even in the topics I did not like or particularly care for; languages, history, geography and religions. Even those became somewhat enjoyable.
Despite my hard work and doing well on all my school topics, the memories of my particular aversion to the non math and science topics never left me.
To this date at my age of sixty-three, sometimes I wake up from nightmares dreaming that I was back in school, about to take a final exam in languages, having forgotten to open the book that entire year, yet I was about to take a final exam. What a frightening feeling that is. And it keeps coming back, year after year.
That dream has happened to me so many times over the years; that now when it comes back again, I say to myself in my sleep; “Oh don't worry, it is that same dream again, just ignore it. It will go away!!!!”
When I graduated from high school and came to Knoxville, Tennessee to pursue my college education. It was engineering I wanted to study, and so I did the first year until I took a course in the “Slide Rule”. Today most people would not even know what a ‘slide rule” is or what it looks like!
After passing the first course in “slide rule” in my freshman year in 1971, I started a second course in advanced slide rule in the fall of 1972. Within two weeks, I decided that I could not memorize all the “jerky” movement that I had to remember to use the not so easy “rules”, thus I dropped that class.
I knew then “no slide rule” meant no engineering future. All engineering students had to master the slide rule; it was the right-of-path.
I had to switch my major; all because of the slide rule.
My roommate at the time was a pre-medicine student. I envied him for learning about biological sciences, chemistry, physics, and microbiology and thus decided to jump into his academic track. A decision that I have never regretted; although it added another fifteen years of education to my pursuit of my medical degrees.
Interestingly enough, one year after I dropped out of engineering; prompted by the “slide rule”, the hand–held calculator came about. And in no time, the slide rule became history and went into oblivion; never to be seen again on college campuses.
To this date I wonder, what would my career be like, if the hand-held calculator arrived two or three years earlier! Would I have ever become the physician that I am now, or would I have become the mechanical engineer that I imagined myself to be as a child!
One fateful spring day during my sophomore year, my college friend David Davis, invited me to spend a weekend at his home in Lenoir City, Tennessee. There, he taught me how to water-ski for the first time.
It was a very special weekend, not only because I learned to water-ski, but more. When at the breakfast table, his mom, Reba, asked me: “Son; what are you going to become when you grow up?”
“A doctor”, I said.
“What school are you going to apply to?”
“I do not know”, I said
“A doctor, then you should go to this school in Atlanta; Emory University, they call it. They make good doctors there”. Reba said.
So I took her advice and after finishing my time at my junior college, I applied to Emory, got accepted and transferred to Emory College.
Coming from Knoxville Tennessee to Atlanta was a big culture shock, almost as big as the culture shock from coming from Amman to Knoxville.
Atlanta was a “big” city at the time. I recall in January 1973, the population of Atlanta was over 1.5 million people; a fraction of what it is now.
Emory College was much more demanding than what I had been accustomed to in my prior junior college.
Competition was high; course loads were much greater; it required constant studying in order to make the grades.
Towards my senior year in college, and after taking an elective course in the medical school in human neurobiology, a topic I became very interested in, I decided to pursue a PHD in that field.
After passing the first course in “slide rule” in my freshman year in 1971, I started a second course in advanced slide rule in the fall of 1972. Within two weeks, I decided that I could not memorize all the “jerky” movement that I had to remember to use the not so easy “rules”, thus I dropped that class.
I knew then “no slide rule” meant no engineering future. All engineering students had to master the slide rule; it was the right-of-path.
I had to switch my major; all because of the slide rule.
My roommate at the time was a pre-medicine student. I envied him for learning about biological sciences, chemistry, physics, and microbiology and thus decided to jump into his academic track. A decision that I have never regretted; although it added another fifteen years of education to my pursuit of my medical degrees.
Interestingly enough, one year after I dropped out of engineering; prompted by the “slide rule”, the hand–held calculator came about. And in no time, the slide rule became history and went into oblivion; never to be seen again on college campuses.
To this date I wonder, what would my career be like, if the hand-held calculator arrived two or three years earlier! Would I have ever become the physician that I am now, or would I have become the mechanical engineer that I imagined myself to be as a child!
One fateful spring day during my sophomore year, my college friend David Davis, invited me to spend a weekend at his home in Lenoir City, Tennessee. There, he taught me how to water-ski for the first time.
It was a very special weekend, not only because I learned to water-ski, but more. When at the breakfast table, his mom, Reba, asked me: “Son; what are you going to become when you grow up?”
“A doctor”, I said.
“What school are you going to apply to?”
“I do not know”, I said
“A doctor, then you should go to this school in Atlanta; Emory University, they call it. They make good doctors there”. Reba said.
So I took her advice and after finishing my time at my junior college, I applied to Emory, got accepted and transferred to Emory College.
Coming from Knoxville Tennessee to Atlanta was a big culture shock, almost as big as the culture shock from coming from Amman to Knoxville.
Atlanta was a “big” city at the time. I recall in January 1973, the population of Atlanta was over 1.5 million people; a fraction of what it is now.
Emory College was much more demanding than what I had been accustomed to in my prior junior college.
Competition was high; course loads were much greater; it required constant studying in order to make the grades.
Towards my senior year in college, and after taking an elective course in the medical school in human neurobiology, a topic I became very interested in, I decided to pursue a PHD in that field.
For the next three years, I immersed myself in studying human anatomy, physiology, biochemistry, pharmacology and so on.
After three brutal years to get my Doctor of Philosophy in Neurosciences and another equally demanding three more years to get my Doctor of Medicine, I graduated as a physician; only to find that all the ten years of graduate education were barely enough to get me to do the first work-up on one sick patient.
The next five years in general surgery were exceedingly demanding. The number of hours I worked each day were too many, and many nights went without any sleep. Operating continuously for what at times seemed endlessly, with breaks only to grab a quick meal or to have a bathroom break was exhausting. But that was the right of passage.
Training in surgery at Grady and Emory-affiliated hospitals was a much sought-after opportunity for every surgical trainee in the country. Thus I felt privileged to have such an opportunity to work at such great hospitals with world-class faculty. It was a very rewarding experience.
The experiences gained were second to none. General surgeons graduating from Emory were very much sought after. We all were well trained.
In my senior year in general surgery training, a family event led me to interrupt my training and travel to my hometown, Amman to see about a family member with heart trouble. During that trip, I came to know a young cardiologist who had just retuned form completing his fellowship at the prestigious Texas heart institute. In those few days while I was in Amman, Dr. Dibbs would take me with him to make rounds on his heart patients.
Upon returning back to Atlanta, I decided that cardiac surgery was going to be my future.
The application deadline to the cardiothoracic surgery program at Emory was about to close. I went to the CT Surgery Office; hand filled and delivered my application to the Chief’s secretary.
To fulfill the requirements, I asked the director of my general surgery program Dr. Richard Amerson to write my letter of recommendation. He did. In fact, he must have written a “glowing” letter, because on the day CT surgery applications were reviewed, my “hand-written application” was nowhere to be found. The reviewing committee had only Dr. Amerson’s letter of recommendation as proof of my interest in applying to their program. Had it not been for his letter, I probably would not have been accepted that year, if ever.
While the review committee was meeting, I was called by one of the committee members who inquired about my application. I explained that I indeed had submitted my application and was committed to a career in cardiac surgery if I was offered a position!
To my surprise, he told me on the phone: “we will accept you based on Dr. Amerson’s letter. But you need to fill another application”.
After three brutal years to get my Doctor of Philosophy in Neurosciences and another equally demanding three more years to get my Doctor of Medicine, I graduated as a physician; only to find that all the ten years of graduate education were barely enough to get me to do the first work-up on one sick patient.
The next five years in general surgery were exceedingly demanding. The number of hours I worked each day were too many, and many nights went without any sleep. Operating continuously for what at times seemed endlessly, with breaks only to grab a quick meal or to have a bathroom break was exhausting. But that was the right of passage.
Training in surgery at Grady and Emory-affiliated hospitals was a much sought-after opportunity for every surgical trainee in the country. Thus I felt privileged to have such an opportunity to work at such great hospitals with world-class faculty. It was a very rewarding experience.
The experiences gained were second to none. General surgeons graduating from Emory were very much sought after. We all were well trained.
In my senior year in general surgery training, a family event led me to interrupt my training and travel to my hometown, Amman to see about a family member with heart trouble. During that trip, I came to know a young cardiologist who had just retuned form completing his fellowship at the prestigious Texas heart institute. In those few days while I was in Amman, Dr. Dibbs would take me with him to make rounds on his heart patients.
Upon returning back to Atlanta, I decided that cardiac surgery was going to be my future.
The application deadline to the cardiothoracic surgery program at Emory was about to close. I went to the CT Surgery Office; hand filled and delivered my application to the Chief’s secretary.
To fulfill the requirements, I asked the director of my general surgery program Dr. Richard Amerson to write my letter of recommendation. He did. In fact, he must have written a “glowing” letter, because on the day CT surgery applications were reviewed, my “hand-written application” was nowhere to be found. The reviewing committee had only Dr. Amerson’s letter of recommendation as proof of my interest in applying to their program. Had it not been for his letter, I probably would not have been accepted that year, if ever.
While the review committee was meeting, I was called by one of the committee members who inquired about my application. I explained that I indeed had submitted my application and was committed to a career in cardiac surgery if I was offered a position!
To my surprise, he told me on the phone: “we will accept you based on Dr. Amerson’s letter. But you need to fill another application”.
I had always known that Dr. Amerson was highly respected and influential. What I did not know that his words were so decisive.
Years later, when Dr. Amerson needed to have a cardiac surgeon on stand-by for an intervention he needed, he requested that I be at his side. It was another great honor he bestowed on me.
Dr. Amerson was one of the most beloved surgeons Emory knew. All residents who trained under him, held him in the highest esteem. He was a great teacher and a great man. To this date, his memories are alive among his former students, residents and patients.
Emory had a great list of world-class surgeons. My former Chairman of Surgery W. Dean Warren, well known for the Warren-Salam Distal Spleen-Renal Shunt; an operation Drs. Salam and Warren had devised to surgically treat a deadly condition in patients suffering from portal hypertension, a condition that causes severe blood congestion in the liver and spleen, causing back-up of blood in vessels in stomach and esophagus, leading to rupture of small blood vessels causing at times life threatening bleeding. Dr. Warren, in addition to being the Chairman of Surgery at Emory University at that time, was the President of the American College of Surgeons, a position highly regarded and respected by all surgeons in the United State and throughout the world.
Dr. Warren was a great surgeon, excellent educator, yet had tremendous sense of humor, especially with the people he liked. I think I was one of the lucky ones.
When I worked on his service, I made a point of arriving to the hospital at 5 o’clock every morning. I made rounds on his patients, wrote my notes and was ready to report to him by 7 am.
He rewarded me in the operating room. He took the time to teach me and instruct me, even though I was the intern on his service.
One day, I was dictating discharge summaries on the ward, when he showed up, un-announced to perform a procedure on one of his patients. He saw me dictating, and in his distinct southern accent said: ”Omaaaar, come and help me do this procedure.” I jumped and said “Yes, Sir”.
He looked at me and with a smile he said: “It is only your career that depends on it”.
Like an attentive soldier I assisted him, hiding my smile and realizing that, in a way, he was paying me an off-hand compliment. Or so I thought!
General surgery training was hard. It was time consuming. Many long hours at work, without breaks; on-call all night long, every third night; and in-hospital call every third weekend.
Then came a three year CT surgery-training program that made the general surgery seem like a “walk in the park”.
Cardiac Surgery training was an experience much more demanding than anything I had expected, even after completing five grueling years of general surgery.
In general surgery I did thousands of elective and emergency operations; from hernia repair to major orthopedic trauma, to multi-organ damage in motor vehicle accidents and the list goes on. Despite all of that, cardiac surgery training was a shocker.
When I started my first day as Cardio Thoracic Surgery resident, I realized that I was starting back as an “intern” in heart and chest surgery. I was treated as a beginner. I knew very little about operating on the heart. The attending surgeons, the senior residents, the operating room nurses, the ICU and floor nurses all treated me and my co-residents as “an intern” who needed to be taught, instructed and guided. I even felt, the cleaning ladies and men around the operating rooms looked at co-residents and me with suspicion and mistrust, or so I felt!
I quickly realized that, in order to survive, I had to forget as having been a “Chief Surgery Resident” only few days earlier, and to accept my new role a “starting resident” one more time.
On my first day on the job, I was guided into the “heart rooms”, received instructions from every one, and was shown by my senior resident on how to open the sternum and harvest an internal mammary artery, and place a patient on cardiopulmonary bypass.
From there on, I was assigned to one operating room; prepared patients for surgery, opened chests harvested internal mammary arteries and placed patients on cardiopulmonary bypass. Once that all completed, the attending surgeon would come into the room and perform the key portion of the operation, leave the room then me along with the anesthesiologist “take” the patient off the heart lung machine and close the breastbone and overlying skin and take the patient to the intensive care unit. Every effort was made to ensure that patients did not need to return to operating room for further exploration for bleeding. “Take back” to the operating room was always associated with “weak” work and thus was to be avoided.
Training in cardiothoracic surgery at Emory was hard in the 1980s. The “eighty hour work week”, currently enforced, was not even a consideration. My contract with the hospital administrator was simple: “work the hours assigned by the hospital administration”.
My day would start with the alarm clock going off at 5:30 in the morning; a quick shower, a sandwich and drive to the hospital to be there no later than 6:30 am to make rounds on the several dozen patients in the intensive care units and floors.
By 7:30 am, the first case is ready to go to sleep, thus be in the operating room on stand-by, lest the patient’s blood pressure drops or heart stops during induction of anesthesia and have to “crash” on bypass. Thankfully, such was a rare occasion.
On a typical day, I would “scrub-in” on three heart operations; opening the first, bounce to the second then move to the third case and finish it at 7 or 8 pm. If lucky, I would have had a 10-15 minute break between second and third case to grab a much needed quick lunch.
The volume of cases during my training was huge. So was the opportunity to see many complex cardiac cases. To see and do as many cases as possible, although very hard and taxing on the body, was always what an aspiring young surgeon wanted. The more cases you scrubbed on, the more likely the attending surgeon would let you do portion of the operation.
Learning how to do first time operations was challenging. Learning how to do second time operations; “redo’ operations was a totally different experience.
On a good day, heart surgery is fraught with disasters if a miss-step happened. Such was the dreaded fear particularly in “opening” the chest of patients who had had prior heart operations. To do so was to increase the case complexity by many levels of order. Typically, it took minutes to open a first time chest and place on cardiopulmonary bypass. While for “redos”, it took an hour or more to carefully reopen the breastbone, carve the heart from the overlying bone, identify the aorta and right atrium and place the patient on bypass. After having done thousands of heart operations; many hundreds of which were second or third time redoes, to this date I still dread a redo case. It is time consuming, hard on the back, takes twice as long to perform and is riskier than first time operations. There is nothing enjoyable about a redo operation.
My first year in training in cardiac surgery was brutal. Start work at 6:30 in the morning and finish the evening rounds at 8:30 or 9 pm, then head home for dinner, study some if I had any energy left, catch few hours of rest, then back to work and take all an night call every second or third night.
The weekend calls were even more painful. The call started at 7 am Saturday morning and continued uninterrupted, in the hospital, until all operations are done on Monday night. It was not unusual to spend a shift of sixty or sixty-five hours in the hospital taking care of patients, rounding operating and taking naps in between.
I recall vividly times when my wife would show up with a bag of groceries full of sandwiches, fruits and deserts, that she prepared for me. Thinking back, without my wife, I do not think I could have endured that brutal cardiac surgical training. She encouraged me do it.
I recall days when I would wake up and start my day fatigued, keeping myself awake with coffee during the day, only to increase my hand tremor because of the coffee, and at times to be screamed-at by my professors for not keeping steady hands. It was a constant struggle of staying awake with tremor or falling asleep during long and hard operations. I choose the tremor. Later on, I learned that taking small doses of Inderal took care of the fine and troubling tremor.
Years later, when Dr. Amerson needed to have a cardiac surgeon on stand-by for an intervention he needed, he requested that I be at his side. It was another great honor he bestowed on me.
Dr. Amerson was one of the most beloved surgeons Emory knew. All residents who trained under him, held him in the highest esteem. He was a great teacher and a great man. To this date, his memories are alive among his former students, residents and patients.
Emory had a great list of world-class surgeons. My former Chairman of Surgery W. Dean Warren, well known for the Warren-Salam Distal Spleen-Renal Shunt; an operation Drs. Salam and Warren had devised to surgically treat a deadly condition in patients suffering from portal hypertension, a condition that causes severe blood congestion in the liver and spleen, causing back-up of blood in vessels in stomach and esophagus, leading to rupture of small blood vessels causing at times life threatening bleeding. Dr. Warren, in addition to being the Chairman of Surgery at Emory University at that time, was the President of the American College of Surgeons, a position highly regarded and respected by all surgeons in the United State and throughout the world.
Dr. Warren was a great surgeon, excellent educator, yet had tremendous sense of humor, especially with the people he liked. I think I was one of the lucky ones.
When I worked on his service, I made a point of arriving to the hospital at 5 o’clock every morning. I made rounds on his patients, wrote my notes and was ready to report to him by 7 am.
He rewarded me in the operating room. He took the time to teach me and instruct me, even though I was the intern on his service.
One day, I was dictating discharge summaries on the ward, when he showed up, un-announced to perform a procedure on one of his patients. He saw me dictating, and in his distinct southern accent said: ”Omaaaar, come and help me do this procedure.” I jumped and said “Yes, Sir”.
He looked at me and with a smile he said: “It is only your career that depends on it”.
Like an attentive soldier I assisted him, hiding my smile and realizing that, in a way, he was paying me an off-hand compliment. Or so I thought!
General surgery training was hard. It was time consuming. Many long hours at work, without breaks; on-call all night long, every third night; and in-hospital call every third weekend.
Then came a three year CT surgery-training program that made the general surgery seem like a “walk in the park”.
Cardiac Surgery training was an experience much more demanding than anything I had expected, even after completing five grueling years of general surgery.
In general surgery I did thousands of elective and emergency operations; from hernia repair to major orthopedic trauma, to multi-organ damage in motor vehicle accidents and the list goes on. Despite all of that, cardiac surgery training was a shocker.
When I started my first day as Cardio Thoracic Surgery resident, I realized that I was starting back as an “intern” in heart and chest surgery. I was treated as a beginner. I knew very little about operating on the heart. The attending surgeons, the senior residents, the operating room nurses, the ICU and floor nurses all treated me and my co-residents as “an intern” who needed to be taught, instructed and guided. I even felt, the cleaning ladies and men around the operating rooms looked at co-residents and me with suspicion and mistrust, or so I felt!
I quickly realized that, in order to survive, I had to forget as having been a “Chief Surgery Resident” only few days earlier, and to accept my new role a “starting resident” one more time.
On my first day on the job, I was guided into the “heart rooms”, received instructions from every one, and was shown by my senior resident on how to open the sternum and harvest an internal mammary artery, and place a patient on cardiopulmonary bypass.
From there on, I was assigned to one operating room; prepared patients for surgery, opened chests harvested internal mammary arteries and placed patients on cardiopulmonary bypass. Once that all completed, the attending surgeon would come into the room and perform the key portion of the operation, leave the room then me along with the anesthesiologist “take” the patient off the heart lung machine and close the breastbone and overlying skin and take the patient to the intensive care unit. Every effort was made to ensure that patients did not need to return to operating room for further exploration for bleeding. “Take back” to the operating room was always associated with “weak” work and thus was to be avoided.
Training in cardiothoracic surgery at Emory was hard in the 1980s. The “eighty hour work week”, currently enforced, was not even a consideration. My contract with the hospital administrator was simple: “work the hours assigned by the hospital administration”.
My day would start with the alarm clock going off at 5:30 in the morning; a quick shower, a sandwich and drive to the hospital to be there no later than 6:30 am to make rounds on the several dozen patients in the intensive care units and floors.
By 7:30 am, the first case is ready to go to sleep, thus be in the operating room on stand-by, lest the patient’s blood pressure drops or heart stops during induction of anesthesia and have to “crash” on bypass. Thankfully, such was a rare occasion.
On a typical day, I would “scrub-in” on three heart operations; opening the first, bounce to the second then move to the third case and finish it at 7 or 8 pm. If lucky, I would have had a 10-15 minute break between second and third case to grab a much needed quick lunch.
The volume of cases during my training was huge. So was the opportunity to see many complex cardiac cases. To see and do as many cases as possible, although very hard and taxing on the body, was always what an aspiring young surgeon wanted. The more cases you scrubbed on, the more likely the attending surgeon would let you do portion of the operation.
Learning how to do first time operations was challenging. Learning how to do second time operations; “redo’ operations was a totally different experience.
On a good day, heart surgery is fraught with disasters if a miss-step happened. Such was the dreaded fear particularly in “opening” the chest of patients who had had prior heart operations. To do so was to increase the case complexity by many levels of order. Typically, it took minutes to open a first time chest and place on cardiopulmonary bypass. While for “redos”, it took an hour or more to carefully reopen the breastbone, carve the heart from the overlying bone, identify the aorta and right atrium and place the patient on bypass. After having done thousands of heart operations; many hundreds of which were second or third time redoes, to this date I still dread a redo case. It is time consuming, hard on the back, takes twice as long to perform and is riskier than first time operations. There is nothing enjoyable about a redo operation.
My first year in training in cardiac surgery was brutal. Start work at 6:30 in the morning and finish the evening rounds at 8:30 or 9 pm, then head home for dinner, study some if I had any energy left, catch few hours of rest, then back to work and take all an night call every second or third night.
The weekend calls were even more painful. The call started at 7 am Saturday morning and continued uninterrupted, in the hospital, until all operations are done on Monday night. It was not unusual to spend a shift of sixty or sixty-five hours in the hospital taking care of patients, rounding operating and taking naps in between.
I recall vividly times when my wife would show up with a bag of groceries full of sandwiches, fruits and deserts, that she prepared for me. Thinking back, without my wife, I do not think I could have endured that brutal cardiac surgical training. She encouraged me do it.
I recall days when I would wake up and start my day fatigued, keeping myself awake with coffee during the day, only to increase my hand tremor because of the coffee, and at times to be screamed-at by my professors for not keeping steady hands. It was a constant struggle of staying awake with tremor or falling asleep during long and hard operations. I choose the tremor. Later on, I learned that taking small doses of Inderal took care of the fine and troubling tremor.
In my first year as cardiac surgery fellow, I became interested in heart transplantation; a procedure that was new at the time. I volunteered my services to become the “heart harvester” by learning how to operate on brain-dead heart donors after families had consented to donate much-needed organs for transplantation. As a young resident, I become the one to be called whenever there was a heart transplant. I would assemble my team, ride the ambulance from my hospital on Clifton Road, to DeKalb Peachtree Airport, where typically a Learjet would be waiting to fly my team and me to a donor hospital in another city. The adrenalin rush in those nights and days was awesome. For a young resident to have a team under his command, an ambulance, a private jet, then another ambulance ride to a strange hospital in a remote city was awesome. Quickly, I started enjoying those experiences. In a short time, I would transform from a resident to an independent surgeon treated with the respect afforded only to established and highly regarded surgeons.
In my time, I must have harvested a hundred hearts from all over the country. I was flown to Miami, Houston, Dallas, Chicago, New York, Nashville and the list went on. All in private jets.
Two trips were most memorable. One was on the evening of June 6 1986 when at about 9 pm, I received a call to go for a donor heart in New York City.
My wife was due anytime that week with our first child. That day we had gone to our obstetrician who told us that delivery was likely to happen in the next day or two.
Thus we had called my wife’s mom and dad and they came over to stay with us in anticipation of our first child’s arrival.
So as the call for me to go to New York came, I looked at my wife and asked her if I should go or decline!
My wife said: “I feel fine, go ahead”.
So by 11 pm, I was at Emory Hospital being picked up by an ambulance and on my way to “my” Learjet and onto New York.
Two hours later, we arrived to the hospital, examined the donor heart after opening the chest and to my surprise, the heart just did not look as vigorous as the prior ones that I had harvested. I called the Atlanta based team and discussed the findings; “right heart appeared larger than usual, contraction was sluggish, blood pressure was soft and the CVP was high”.
Back then we did not have transesophageal echoes available in the operating rooms to fully examine all cardiac chambers and their functions, thus I had to rely on my visual examination of the surfaces of the heart along with the blood pressure, heart rate and central venous pressure to determine if the heart was good enough and worth harvesting.
Harvesting a weak heart was the most dreaded fear for me and for the entire team. The only thing worse than w weak heart is a second a “type mismatch”. My paranoia on those two issues kept me out of trouble. I always checked and double-checked that the blood type matches were correct, and that the heart looked “good” once I opened the sternum.
On examining that heart in the New York hospital, it just did not look strong enough to me. I was fearful that removing the heart after infusing it with protective solutions, packaging it in ice-cold preservatives, putting it in sterile packaging then in an ice-filled cooler and flying it to Atlanta to be implanted in a critically ill patient would be too much of a risk. That heart just did not look good enough to harvest.
After discussion with the team in Atlanta, I turned down the heart and flew back home, empty-handed. Harvesting, transporting and implanting a weak heart was recipe for absolute disaster. Implanting a bad heart would have meant immediate death for the recipient. A responsibility, I did not want to take. In my career of harvesting about one hundred hearts, I turned down two. I never lost any of my heart transplant patients. I came back empty-handed to Atlanta. I had mixed feelings. But I felt I made the right decision. I did not want to take the chance and bring back a bad heart.
So I returned home about 5 am in the morning on June 7, 1986. Soon upon my arrival, my wife told me that she was feeling contractions coming at regular intervals and was sure that time had come to go to the hospital, and so we did.
We arrived to the maternity ward at about 7 am. We were greeted and situated into the lush delivery suite. As we were waiting for the doctors and nurses to examine my wife as she was going through labor, I sat in a recliner chair next to her, and fell asleep.
To this date, my wife keeps reminding me, that I slept through most of her labor to be awakened in mid afternoon, only minute before she delivered our son, Rashid.
I had heard from other parents of how exciting it is when one has a newborn child, particularly the first one. No matter how such is described, the experience one goes through could not be described in words.
As soon as I held my newborn son in my arms, I felt as if I grew several feet taller, my world all of a sudden became mush more colorful. I felt as if I that child gave me new powers that I had never imagined before. My world took a whole new shape. My life at that moment had a new and different meaning; a different meaning that was surreal.
My father in law and I, after seeing that my wife was well and getting much needed sleep, went to have a late lunch at a nearby restaurant. As we walked out of the hospital on that sunny day, I felt as if I was walking on air. I had feelings I did not know existed. It was delightful.
The other interesting “harvest”, was when a young woman was critically ill and unstable. She needed an urgent heart transplant or else we were afraid she would not last another day.
A heart became available in Phoenix, Arizona; much too far for the 3.5 hours total “ischemic time’ allowable for heart transplant. When we added all the land travel time plus the air travel time and the time to perform the operation, we were well beyond the total safe time for the conduct of the operation.
Even with a fast Learjet, we could not cut the total time to 3.5 hours.
Faced with such a dilemma, the hospital made a call to the United States Air Force Command and requested assistance in transporting the heart in a military supersonic jet. Sure enough, the request was granted. I travelled with my team to Phoenix via our usual private Learjet, harvested the heart and helicopter flew us to military airport in Phoenix, where two US Air Force F-15s were on stand-by on the runway with their engines running. The helicopter landed, my tall assistant Johnny Mack carried the heart-containing cooler and handed it to the lead F-15 pilot who immediately taxied-on the runway, followed by the second F-15, then took off to Atlanta and the second F-15, turned back after ensuring safe take off of the lead jet.
We flew back to Atlanta in our “slow” Learjet and from there made to the hospital. By then, the operation was near its successful conclusion.
Interestingly, I learned later that the F-15 pilot pushed the engine so hard that by the time it landed, it had to go through major engine maintenance.
And so it was, it took the United States Air Force along with a team of Emory surgeons to save one young woman’s life. That was an awesome experience. It was a great lesson on how an entire nation puts its resources to save the life of one of its citizens.
One of my dear former mentors, professor, partners was the late Ellis Jones, MD; a world-class surgeon. He was a perfectionist in the operating room. His operations were more like work of art than complex heart operations. He demanded neat operating fields, quiet rooms and attentive residents, nurses and anesthetists. He was a very quiet man. And he expected every one else to pay attention to the operations and to be equally quiet. His skills in performing coronary artery bypasses were the envy of every resident surgeon, and every accomplished surgeon for that matter. We all wanted to perform coronary artery bypasses with the “Jones finesse”!
To get to scrub with Dr. Jones was considered a privilege. To have him “assist” us a case was a sign that one has made it!
I scrubbed many dozens of cases with Professor Jones. I learned his techniques. I memorized his every steps. I took care of his patients in the most meticulous of fashion. Day after day, week after week and month after month, I worked with Dr. Jones diligently performing my portion of the operative procedures waiting to “move-up” to the right side of the table to perform the “surgeon’s” part of the operation.
I almost gave up, until one day, unexpectedly the phone rang in the room where Dr. Jones was operating and I was assisting. My friend, the head operating room nurse, Gena Spector, a petite, vocal and quick-wit young woman answered the phone. In a loud voice she screamed: “Dr. Lattouf; It is President Carter on the Phone, he wants to speak to you. Can you take his call?” I was stunned!
I had no idea what that was all about, absolutely no idea! I had no prior contacts with President Carter. Why would President Carter call me? How would he know that I was in that operating room at that time on that day?
I looked at Dr. Jones. He looked at me with surprise in his eyes. I did not know at the time how to react!
Dr. Jones and I stopped operating and froze in our places.
I asked permission to take the call.
“Sure” He said.
I walked to the phone.
I said hello. On the other side it was a female voice! Not a man’s voice!
It was the secretary of President Carter, not the President himself!
It was the secretary of the President inviting me to have a lunch with the President the following week to discuss a book he was about to release. I gladly accepted the invitation.
As I hung up the phone with the “President”, I returned to the operating table, only to find that Dr. Jones had moved to the assistant side of the table and gave me the surgeon’s side.
Dr. Jones looked at me and said; “if you are good enough for President Carter, then you are good enough to do my cases”.
And so it was. President Jimmy Carter contributed to my education in heart surgery.
From there on, I gained Dr. Jones confidence and started preforming more and more of his cases.
Ellis Jones was truly a gifted surgeon, a great teacher and a remarkable educator. He taught so many students, residents and surgeons and saved thousands of lives.
Not a day goes by without me thinking of him as I apply many of his techniques in the operating room. I affectionately tell my residents as I pass certain skills, that I learned this one from the late Professor Jones.
Great surgeons never die; they just pass their skills to their colleagues, students and residents, who in-turn pas them on to their students, residents and colleagues.
Couple of years ago, I was operating with one of my residents. I taught him a technique that I had learned from Dr. Jones and accordingly I credited Dr. Jones with the steps.
That evening, unexpectedly I ran into Mrs. Beth Jones and her lovely daughters at an event. I shared with Mrs. Jones and her daughters that Ellis “through his teachings saved another life that day and that he continues to do so every day as we, his former residents pass his teachings to our residents”.
There were smiles and tears.
To your memory, I dedicate this chapter Dear Ellis.
May you rest in peace.
