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Life Lessons from Modern-Day Greats in Cardiovascular Disease

2009; Elsevier BV; Volume: 103; Issue: 2 Linguagem: Inglês

10.1016/j.amjcard.2008.11.003

1879-1913

William C. Roberts,

Cardiovascular Health and Risk Factors

In July 1996, interviews of prominent cardiovascular specialists began appearing in The American Journal of Cardiology (AJC). Listed in Table 1 are the names of the 62 cardiovascular internists whose interviews have been published in the AJC. One interview was done by Dr. Mark Silverman, 2 by Dr. J. Willis Hurst, 1 by Dr. Charles Stewart Roberts, 1 by Dr. Colin Ku Lo Phoon, and the others by me. Three interviews focused on medical topics rather than on the interviewees, and they are not further considered in this presentation.Table 1Interviews of cardiovascular medicine specialists published in The American Journal of Cardiology, 1996 to 2008 (n = 62)Eric Jeffrey TopolCarl John PepineJames Thornton WillersonKenneth Hardy CooperJoseph Stephan AlpertWatkins Proctor HarveyJohn Willis Hurst⁎Interviewed by Mark Silverman.Joseph Kayle PerloffJesse Efrem EdwardsCharles Richard ContiHoward Bertram BurchellWilliam Watts ParmleyWilliam Howard FrishmanDean Michael OrnishRobert Ogdon BonowDean Towle MasonEugene BraunwaldGeorge Allan BellerJoseph Cholmondeley GreenfieldLeslie David HillisNorman Mayer KaplanDouglas Peter ZipesRobert McKinnon CaliffNanette Kass WengerBernard John GershAndrew Peter SelwynDean James KeriakesArthur Garson, Jr.Jeffrey Michael IsnerEdward David FrolichScott Montgomery GrundyRobert Alan VogelBurton Elias SobelFerid MuradRobert Anthony O'RourkeSteven Evan NissenSpencer Bidwell King IIIWilliam Peter CastelliRobert RobertsWallace Bruce Fye IIIEugene Austin Stead, Jr.†Interviewed by John Willis Hurst.Anthony Nicolas DeMariaBertram PittBarry Lewis ZaretChristopher John Dillon Packard∥Topic interviews.Franz H. MesserliTerje Rolf Pedersen∥Topic interviews.Joseph LoscalzoValentin FusterDonald Carey HarrisonHenry Arthur SolomonHollis Bryan BrewerHarvey Stanley Hecht∥Topic interviews.Barry Joel MaronMyrvin Harold EllestadWilliam Clifford Roberts§Interviewed by Charles S. Roberts.Richard John Bing†Interviewed by John Willis Hurst.Jean Schlatter Kan‡Interviewed by Colin K.L. Phoon.Melvin Mayer ScheinmanRobert William (“Bobby”) BrownJames Stuart Forrester IIILawrence Cohen Interviewed by Mark Silverman.† Interviewed by John Willis Hurst.‡ Interviewed by Colin K.L. Phoon.§ Interviewed by Charles S. Roberts.∥ Topic interviews. Open table in a new tab Interviews of 8 cardiovascular surgeons also have appeared in the AJC, and their names are listed in Table 2.Table 2Interviews of cardiovascular surgeons published in The American Journal of Cardiology, 1997 to 2006 (n = 8)Michael Ellis DeBakeyDenton Arthur CooleyJohn Webster KirklinDavid Coston Sabiston, Jr.David Kempton Cartwright CooperFrancis RobicsekMagdi Habib YacoubLawrence Harvey Cohn Open table in a new tab In addition to the 70 interviews in the AJC, 74 others (with me as the interviewer) have been published in the Baylor University Medical Center Proceedings (Table 3), but they are not further considered in this piece.Table 3Interviews by William Clifford Roberts published in the Baylor University Medical Center ProceedingsBaylor physicians Robert Peter Perrillo Lloyd Wade Kitchens, Jr. David Wesley Barnett David Joseph Ballard William Clifford Roberts Adrian Ede Flatt George Kennedy Hempel, Jr. J.B. Howell Joseph Allen Kuhn George Justice Race Virginia Pascual Michael Emmett William Mark Armstrong Marvin Jules Stone William Levin Sutker Ronald Coy Jones Perry Edward Gross Jimmie Harold Cheek Barry Wayne Uhr Robert Wilson Jackson Carolyn Michele Matthews George Marion Boswell, Jr.Baylor nonphysicians Göran Bo Gustaf Kintmalm Luz Remedios Tolentino Robert Pickett Scruggs, III Boone Powell, Jr. Wilson Weatherford Joel Tribble Allison Fred David Winter, Jr. Mark Timothy Parris Gary L. Davis Gary Dale Brock Peter Allen Dysert, II Julie Michelle O'Bryan Zelig (“Zeck”) Lieberman Herman Grant Lappin Martin Alan Menter Albert Julio Alvarez Harold Clifton Urschel, Jr.Visiting professors John Flake Anderson Gerald Bernard Appel John W. Hyland Robert William Schrier Joyce Ann O'Shaughnessy Larry Harold Hollier Daniel Earl Polter Charles Stone Bryan Jonathan Martin Whitfield Richard Vaille Lee Andrew Zolton Fenves Gregory Gordon Dimijian Glenn Weldon Tillery Peter Emanuel Dans Clement Richard Boland, Jr. Donald Wayne Seldin Elmer Russell Hayes Ellen Taylor Seldin Robert Lee Fine Thomas John (Jock) Murray Jay Donald Mabrey Matthew Whitfield Ridley Donald Alan Kennerly Robert Ogden Bonow Barry Cooper David Westfall Bates Robert Gary Mennel Robert Steven Galvin Paul Bernard Convery Carolyn Maureen Clancy Irving David Prengler Lynne Anne Marcum Kirk Zaven Hogop Chakmakjian Lee Marshall Nadler Priscilla Larson Hollander Open table in a new tab Certain data on the 59 cardiovascular internists and on the 8 cardiovascular surgeons (a total of 67 interviews) are listed in Table 4. Their ages when interviewed averaged 65 and 74 years, respectively. Most were born from 1926 to 1950. Eleven (17%) were born outside the United States. Of the 52 internists who grew up in the United States (1 was born abroad), 26 (50%) grew up in the Northeast, mostly in New York City (15 of 26); 11 grew up in the middle portion of the United States, 15% in the Southeast, and 14% in the West. Seven of these 67 had no siblings. Of those with siblings, the interviewees were most often the first children (>50%). Ten of the 67 interviewees (15%) had lost parents when the interviewees were 20% on college varsity teams. The interviewees had averages of 2.7 and 3.1 children, respectively. Ten of the 59 cardiovascular internists (16%) and none of the 8 cardiovascular surgeons were divorced. The interviewees' first publications came at relatively early ages (mean 29 years, range 23 to 36). (That finding is of interest, because the present average age of a recipient of his or her first National Institutes of Health research grant is 42 years.) All of these interviewees were highly productive, and 41% had >500 publications in medical journals. A number were presidents of the American Heart Association or the American College of Cardiology, and 7 of the surgeons were presidents of ≥1 national surgical organization. About 1/3 of the interviewees' mothers worked, and also 1/3 of the interviewees' spouses worked. Seven were married to physicians, but only 2 practiced. Fewer than 1/3 were overweight. Six had PhDs in addition to their MDs. Of the 59 cardiovascular internists, 24 (41%) were Jewish, as was 1 of the 8 cardiovascular surgeons. Of the 54 cardiovascular internists who attended college or medical school or did training in the United States, just over half had some training at an Ivy League university or medical center (not including, however, such institutions as New York University, Johns Hopkins University, or any school in the South, Midwest, or West). None of these 67 interviewees could be considered heavy alcohol users: 1+ represents drinking wine at a social event, 2+ usually daily wine, and 3+ includes spirits.Table 4Data on the intervieweesVariableInternists (n = 59)Cardiovascular Surgeons (n = 8)Age (yrs)41–91 (mean 65)59–88 (mean 74)Years of birth 1901–19259 (15%)5 (63%) 1926–195045 (76%)3 (37%) 1951–19545 (8%)0Country of birth United States53 (90%)5 (63%) Outside the United States6 (10%)3 (37%)State of childhood residence Northeast (26/52 [50%]) New York15⁎One interviewee was born outside the United States but grew up in New York City. Pennsylvania4 Connecticut1 New Jersey4 Massachusetts1 Maryland1 Middle United States (11/52 [21%]) Indiana1 Ohio4 Minnesota01 Oklahoma2 Texas41 Southeast (8/52 [15%]) Virginia1 Georgia4 South Carolina1 North Carolina01 Louisiana11 Alabama1 West (7/52 [14%]) California51 Wyoming1 Utah1No. of siblings None5 (8%)2 (25%) 1–554 (92%)6 (75%)Hierarchy of interviewees in the families with >1 child First child29/54 (54%)3/6 (50%) Last child12/54 (22%)2/6 (33%) Middle child12/54 (22%)1/6 (17%)A parent died when interviewee was aged ≤20 years8 (14%)2 (25%)Competitive athlete High school only31 (53%)7 (88%) College also13 (22%)5 (63%)Children157 (2.7%)25 (3.1%) 02 (3%)1 (12%) 12 (3%)0 223 (39%)1 (12%) 321 (36%)3 (38%) 49 (15%)1 (12%) 52 (3%)2 (25%)Divorced10 (17%)0Age (yrs) at first publication24–36 (mean 29)23–34 (mean 29)Publications in medical journals¶One interviewee who was not in academic medium was excluded. 50024/58 (41%)5 (63%)President of the American Heart Association, the American College of Cardiology, or a major surgical society21 (36%)7 (88%)Mother worked21 (36%)2 (25%)Spouse worked19 (32%)2 (25%)Married a physician5†Only 1 practiced. (8%)2†Only 1 practiced. (25%)Overweight19 (33%)2 (25%)PhD5 (8%)1 (12%)Jewish24 (41%)1 (12%)Ivy League education‡Brown University, Columbia University, Cornell University, Dartmouth University, Harvard University, Princeton University, the University of Pennsylvania, and Yale University; does not include New York University, Johns Hopkins University, or any school in the South, Midwest, or West. College13/54§The other 5 had all their training abroad. (24%)0 Medical School12/54 (22%)1/5∥The other 3 had all their training abroad. (20%) Houseofficership11/54 (20%)1/5 (20%) Fellowship15/54 (28%)0 At least 1 of the 428/54 (52%)2/5 (40%)Drinks alcohol (0–3+) None6 (10%)1 (12%) 1+16 (27%)0 2+24 (41%)0 3+7 (12%)6 (75%) Uncertain6 (10%)1 (12%) One interviewee was born outside the United States but grew up in New York City.† Only 1 practiced.‡ Brown University, Columbia University, Cornell University, Dartmouth University, Harvard University, Princeton University, the University of Pennsylvania, and Yale University; does not include New York University, Johns Hopkins University, or any school in the South, Midwest, or West.§ The other 5 had all their training abroad.∥ The other 3 had all their training abroad.¶ One interviewee who was not in academic medium was excluded. Open table in a new tab Some characteristics of the parents of the 67 interviewees are listed in Table 5. One or both members of the 25 couples (37%) were born outside the United States. In 42 couples (63%), 1 or both parents attended college; in 8 of the 67 couples, 1 or both were physicians; only 2 (3%) were divorced; the average number of children was 2.8; and the interviewees were the only children of 8 couples (12%).Table 5Data on parents of intervieweesVariableValueOne or both born outside the United States25 (37%)Attended college (1 or both)42 (63%)Were physicians (1 or both)8 (12%)Divorced (after interviewee was born)2 (3%)No. of children185 (mean 2.8) 18 (12%) 224 (36%) 318 (27%) 49 (13%) 56 (9%) 62 (3%) Open table in a new tab The major commonalities among these 67 interviewees are listed in Table 6. Without exception, their parents were devoted to their children, love was abundant in their homes, education was heavily stressed by their parents, the home atmosphere provided an enormous curiosity to learn, nearly all were superb students, all had a passion for medicine, and all worked exceedingly hard. Most slept <6 hours per night, and all were incredibly focused on their goals. Writing was a major priority, and they all worked hard at it. Most were good teachers and good mentors. In my view, all were very competitive. They had strong character. Most had a good capacity for friendship, alcohol played little to no major role in their lives, and most maintained healthfulness.Table 6Commonalities among intervieweesParents devoted to childrenAbundant love from parentsEducation stressed by parentsEnormous curiosity to learnSuperb studentsPassion for medicineWorked exceedingly hardSlept little (<6 h)Incredibly focused on goalsGood writersGood teachers and mentorsCompetitiveStrong characterGood capacity for friendshipConsumed little or no alcoholMaintained healthfulness Open table in a new tab I have selected to reproduce small portions from 2 interviews: those of Dr. Eugene Braunwald,1Braunwald E. Roberts W.C. Eugene Braunwald, MD: a conversation with the editor.Am J Cardiol. 1998; 82: 93-108Abstract Full Text Full Text PDF PubMed Google Scholar the most renowned cardiologist of the 20th century, and Dr. Michael E. DeBakey,2DeBakey M.E. Roberts W.C. Michael Ellis Debakey, MD: a conversation with the editor.Am J Cardiol. 1997; 79: 929-950Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar the most renowned cardiovascular surgeon of the past century. Dr. Braunwald was born on August 15, 1929, in Vienna, Austria, and lived his first 9 years there. Roberts:Can you discuss your life in Vienna? Braunwald: My memory of that period falls into 2 very distinct phases: before and after March 13, 1938. On that date the Nazis occupied Austria in the so-called Anschluss. My childhood was idyllic before that. We lived in one of the elegant areas of Vienna, I went to an excellent school and had private tutors in English and piano. My parents were very interested in opera, and by the time I was 6 they had begun taking me to the Vienna State Opera. Vienna was a gracious city in the 1930s, the cultural capital of central Europe. Then, suddenly, on March 13, 1938, everything changed. I recall vividly the enthusiastic crowds welcoming Hitler and his troops marching into Vienna. My father's and other Jews' businesses were taken over several days later and their liquidation was begun. We lived in constant terror from March until the end of July 1938, when we escaped from Austria. Many people in our situation, of course, did not escape. Roberts:Before March 13, 1938, you lived next to your father's business? What was your father like? Your mother? What were your day-to-day activities, not only at school, but at home in those more pleasant moments? Braunwald: Our apartment was just off the Schottenrink, Vienna's major thoroughfare, close to the University and to the State opera. I saw a good deal of my father because the proximity of our apartment to his business allowed him to have lunch with us quite frequently. In childhood, both of my parents had been too poor to receive an education beyond high school. My father was fifth generation Viennese, and my mother was born in a small town in the east of what was then the Austro-Hungarian empire. Her family fled to Vienna at the end of World War I because of an anti-Jewish pogrom in her town. My father had built a successful wholesale clothing business by the time I was born, and we enjoyed a very pleasant life. The 3 most important things that I learned from those early years were: a central focus on the well being of the nuclear family; a reverence for learning; and an interest in classical music. As I just mentioned, we lived not far from the University of Vienna, and when I was 6 or 7 years old my mother took me for walks in the Stadtpark adjacent to the University. She would point to the University and say to me, “You will be a professor there someday.” Because my parents had been deprived of an education themselves, they made my education their highest priority. Roberts:Did you have intellectual discussions at the dinner table at night or at lunch time? Braunwald: I remember discussions of history, economics and politics at the dinner table. My parents probably did emphasize such discussions because of their own lack of higher education. Of course, there was much talk about music. Actually, my parents had met in the standing room area at the Vienna State Opera! Roberts:Although your parents were poor initially, your father became quite successful? Braunwald: Yes. By the time of the Anschluss he had a prosperous business, but the Nazis quickly sent SS officers to liquidate all Jewish businesses. The officer who was assigned to my father's business had, I believe, been imprisoned for the assassination of Chancellor Dolfuss of Austria several years earlier. I got to know this SS officer because sometimes he came over to the apartment for lunch or coffee. Roberts:What was he like? Braunwald: He was cold and businesslike but always polite, as he went about destroying our livelihood. The liquidators themselves were able to make off with most everything, and therefore he wanted the process to be rapid and complete. Roberts:How did it come about that your father was arrested by the Nazis within a couple of months of their invading Austria? Braunwald: It was the proverbial knock on the door in the middle of a night in May 1938. I remember being awakened by my parents at about 3:00 A.M. My mother was hysterical, screaming, “They are taking your father away.” He had 15 minutes to get dressed and to say goodbye to us. I now recall that he was remarkably stoic about it. Then my mother, my younger brother and I ran to the window and saw him herded into an open truck with 15 or 20 other men. They were then driven off to the railroad station. Roberts:How did your mother get him back? I gather he came back the next day? Braunwald: Yes. It is incredible what life can hinge on. When “our” S.S. officer came to the business the next morning, he asked for my father. My very upset mother said he had been taken away, presumably to a work camp. He shrugged his shoulders. (My mother and I subsequently talked about this event innumerable times.) Then came the pivotal moment, she said something along the following: “You need him back because you have liquidated only half of the business, and if you get him back you can liquidate the rest. Look how much richer you would be.” He replied, “You might be right.” He then phoned the depot to find that my father was about to board the train. My mother only overheard his side of this conversation in which he pulled rank on the officer at the depot, saying, “I don't care if you are a full colonel in the German army, I am a captain in the SS and I want this Jew returned!” So it ultimately became a matter of authority. By 11 A.M. my father was returned to us. He had been gone for only 8 hours, but it was a very close call. If my mother had not acted at that moment, none of our family would have survived, and of course, we wouldn't be having this interview. Roberts:From that point it was about 2 months before you escaped? What happened in the interim? Braunwald: My father had actually begun preparations for our escape in March immediately after the occupation, but he redoubled his efforts after his brief arrest. There were several opportunities for him to leave Vienna alone and to try to bring us along later, but he refused to allow the family to be separated. He insisted that we stay together even though that made escape more difficult. But he obviously calculated correctly. We left at the end of July 1938, in something that resembled the Sound of Music story, except that there was no music. We ended up in London, totally destitute, literally with only the shirts on our backs. We were taken care of by a relief agency. I spoke a little English because of the special tutoring I had received, but my parents did not then speak a word of English. (They later learned English in night school.)… Roberts:What was it like growing up in your family and in Lake Charles, Louisiana? DeBakey: First, Bill, I was blessed with parents who were both highly intelligent and exceedingly kind and generous in their temperament and psyche. They lived almost exclusively for their children. They wanted to give us the best of everything, and they believed education was crucial. They were both first generation immigrants, having come to this country as children. Because they believed that a good education was essential to prepare us for a fulfilling life, they always encouraged us to excel in our studies. For example, they urged us to go to the local library once a week and choose any book we wanted to read. We had a small but very good library in Lake Charles. I came home from the library one day and told my Father that there was a wonderful set of books there, but you could not borrow them; you had to read them in the library. He asked me the name of the book, and I responded, The Encyclopaedia Britannica. He said, “Well, we will get it.” I don't remember how many volumes there were at that time—not as many as there are today—but he purchased the complete set. All of us, my brother, sisters, and I, before we went to college, had each read that whole set of The Encyclopaedia Britannica. That is how important it was to us, not only from an educational standpoint, but mainly because we enjoyed reading. All of us excelled at school; we all led our classes. My sisters all led their classes. They were smarter than I was; at least they were a little more studious. My brother and I wanted to play and do other things. The one thing that I never got an “A” in was deportment. In those days we had a deportment grade, and I had great difficulty with it because I would finish all my studies and would get bored because the teacher was dealing with material I had already mastered. In what we then called grammar school or elementary school—I think I was in the fifth or sixth grade—the classes were divided into 2 sections—A and B—and the same teacher taught both classes. While she was teaching one class, she would give the other class a study period of 30 minutes, after which she would go back to the other side. She noticed I was sitting in the center, paying attention to what she was doing, whether she was in my class or the other one. So near the end of the class, she said to me one day, “I notice that you are paying attention to both classes, would you like to take the exam for both of them?” I said, “Sure.” I took both exams and was permitted to skip a grade because I passed the exam. School was fun for me because I enjoyed learning new things. My parents had always emphasized to all of us the joy of learning. I studied, learned, and earned good grades, and I think that became a habit. Roberts:Did your parents go to college? DeBakey: No, but they were self-educated, read widely, and had remarkably critical minds and retentive memories. Roberts:And they pushed education to the hilt. DeBakey: Yes, absolutely. Roberts:I presume you read the book or books that you got from the library once a week? DeBakey: Yes, regularly. Roberts:From age 6 through age 17, I calculate that you must have read over 600 books outside of school. DeBakey: Yes, at least, plus the encyclopedia. I was a voracious reader. In fact, we had to go to bed at a certain time. We would do our lessons—our parents would make sure we had done our lessons—and then if we had time, we would read the library book or sections of The Encyclopaedia Britannica. Often, we were all going to The Encyclopaedia Britannica at the same time. Of course we would not read the same thing. Usually by 10:00 o'clock, our parents wanted us in bed, because we had to get up early. Our Father was a very early riser, and we all had assigned chores, to encourage self-discipline and responsibility, even though my parents had a house staff. By 5:00 A.M. we were up. I guess I got habituated to the early rising. That came in handy, because when I first started as a freshman in college, I lived in a dormitory, and the boys were raising cane all night. I wanted to study, but couldn't because of the commotion. I would just go on to bed, and get up at 3:00 or 4:00 in the morning and do all my studying while it was quiet. So I got into the habit of getting up early, and it does not matter what time I go to bed now; I still arise at 5:00 A.M. I read The New York Times and The Wall Street Journal in about 30 minutes. After that I can get some of the things done that I may not be able to do during the day—work on a manuscript or attend to some other paper work. Getting up early has been of great value not only in my surgical practice, but also in allowing me an additional couple of hours beyond that of the average person. Fortunately, I manage well on 5 or 6 hours of sleep a night, just as my Father did. Roberts:So if you get 5 hours sleep a night, and you are 88 years old, you have slept only 14 of your last 68 years? DeBakey: You are probably right about that. If you sleep 8 hours a night (one-third of every day) and you live 60 years, you have really lived only two-thirds of that time or 40 years. So whatever you can take from your sleep extends your conscious living. Roberts:So you are 88 years and a maximum of one-fifth of your life has been spent sleeping. DeBakey: That is about right. And that gives me a tremendous advantage. People ask me, “How in the world could you write nearly 1,500 articles in that period of time?” If you live your life long enough and you have enough time, you can do it. Roberts:Yes, but you don't waste a minute. You spend very little time commuting. You live 5 minutes from the hospital. DeBakey: In fact, I deliberately chose to live near the College. When I first came to Houston, I rented a house that was also only about 10 minutes from here….