Andreas Gruentzig performed the first coronary artery balloon angioplasty (plasty) in 1977. Shortly after that, Doug completed his medical education and training and determined to contribute to the field Gruentzig’s work had spawned. In 1984, just as things were taking off, Doug developed a cervical disc with neurologic impairment of his right arm. That’s when his neurosurgeons broke the bad news: his interventional cardiology career was over. Or was it?
Doug elected physical therapy including cervical traction rather than the proposed surgery. The career disruption elicited a deep depression. This prompted him to seek psychiatric care. It also made him aware of the steep price many people in his field were paying for repeated exposures to life-and-death situations. This created a dilemma akin to soldiers in battle, including the associated problems of burnout, depression, substance abuse, PTSD, and suicide.
Over months, the neurologic and psychologic symptoms improved. Defying the experts’ predictions, he was able to resume an interventional cardiology career and follow in the footsteps of many cardiac interventional and surgical heroes. As he describes in chapter 12: “My high-risk plasty career could not have occurred without two things:
Doug’s cardiology practice included thirty-one years of care for American veterans in four different university-affiliated Veterans Affairs (VA) hospitals. The culmination of his academic and VA career was a five-year (1995–2000), sixteen-hospital, VA Cooperative randomized clinical trial. The Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) trial and registry compared plasty with bypass surgery for high-risk patients with acute coronary syndromes.
Doug followed his academic stint with fourteen years of private practice in rural America, where he applied the AWESOME hypothesis in the real world. Today, coronary angioplasty with stents has become the standard emergency care for acute myocardial infarction and other medically refractory, acute coronary syndromes. This book recounts the role Doug played in the plasty revolution, the price he paid for his success, the debt he owes to many heroes, and his hopes for the future for patients and care providers.
Themes of Different Drummer
A Cardiologist’s Memoir of Imperfect Heroes and Care for the Heart
Keywords: medical memoir; cardiology history; physicians' mental health; clinical research; Veterans Affairs healthcare
BISAC categories; Medical/ Cardiology; Medical Diseases/ Cardiopulmonary; Health and Fitness/ Diseases/ Heart
Doug elected physical therapy including cervical traction rather than the proposed surgery. The career disruption elicited a deep depression. This prompted him to seek psychiatric care. It also made him aware of the steep price many people in his field were paying for repeated exposures to life-and-death situations. This created a dilemma akin to soldiers in battle, including the associated problems of burnout, depression, substance abuse, PTSD, and suicide.
Over months, the neurologic and psychologic symptoms improved. Defying the experts’ predictions, he was able to resume an interventional cardiology career and follow in the footsteps of many cardiac interventional and surgical heroes. As he describes in chapter 12: “My high-risk plasty career could not have occurred without two things:
- the shared courage of many of my high-risk patients and their families, and
- the psychiatric care I received throughout much of my medical practice.”
Doug’s cardiology practice included thirty-one years of care for American veterans in four different university-affiliated Veterans Affairs (VA) hospitals. The culmination of his academic and VA career was a five-year (1995–2000), sixteen-hospital, VA Cooperative randomized clinical trial. The Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) trial and registry compared plasty with bypass surgery for high-risk patients with acute coronary syndromes.
Doug followed his academic stint with fourteen years of private practice in rural America, where he applied the AWESOME hypothesis in the real world. Today, coronary angioplasty with stents has become the standard emergency care for acute myocardial infarction and other medically refractory, acute coronary syndromes. This book recounts the role Doug played in the plasty revolution, the price he paid for his success, the debt he owes to many heroes, and his hopes for the future for patients and care providers.
Themes of Different Drummer
A Cardiologist’s Memoir of Imperfect Heroes and Care for the Heart
- In less than fifty years, the in-hospital mortality of heart attack was reduced nearly tenfold. Coronary artery revascularization by coronary artery bypass graft surgery and coronary angioplasty with stents revolutionized the care for patients with acute coronary syndromes especially for patients suffering acute myocardial infarction or heart attack.
- Many of the advances in medical understanding and care derive from advances in clinical research such as the prospective, randomized clinical trial. Developed largely in the twentieth century, the research discipline is called clinical epidemiology and the process has been referred to as the quest for evidence-based care.
- The United States Veterans Affairs healthcare system provides medical and mental health care for America’s Veterans, who have earned that care by their service to our country. University – affiliated VA Hospitals train doctors, nurses, pharmacists, technologists, and other healthcare providers. The VA Research Service is one of the largest, and most productive, sponsors of clinical research in the world.
- Facing human suffering and death expose healthcare providers to significant occupational hazards. Doctors, nurses, and other providers have among the highest rates of depression, burn out, substance abuse, divorce, and suicide, among professions. Healthcare providers should be encouraged to ask for and accept mental health care for themselves, as well as for their patients.
- War has traditionally been viewed as one of the principal human activities that provides the opportunity to develop and demonstrate heroism. American physician, psychologist, and philosopher, William James (The Varieties of Religious Experience) proposed that humans need to find alternatives to war for the development of courage and demonstration of heroism. The practice of medicine is an alternative to war as a potential source of heroic action.
- I am thankful for the medical career, that became my calling and my ikigai. I am grateful to the many heroes who guided me by modeling behavior worthy of emulation.
- Every person is on his or her hero journey - the journey of one’s life. Asking for and accepting mental health care for myself, and providing care for others were important parts of my journey.
Keywords: medical memoir; cardiology history; physicians' mental health; clinical research; Veterans Affairs healthcare
BISAC categories; Medical/ Cardiology; Medical Diseases/ Cardiopulmonary; Health and Fitness/ Diseases/ Heart