Following their evaluation of our grant application — which included submission of our video demonstrating the complete neurological recovery in test subjects following 30 minutes of total brain ischemia — Brad received a letter with their reply. Eagerly, we opened and read it.
Then we read it again.
The NIH reviewers indicated these dramatic brain recovery findings were not significant. This conclusion was reached despite the fact that such neurologic recovery had never yet been achieved anywhere else in the world. Despite our furnishing living evidence that these animals were able to walk and eat and drink after being dead for 30 minutes.
“Not significant?” Astonishing. I was stunned.
As said earlier, we are not entirely surprised when some of our innovations meet resistance by those completely invested in the past. But the NIH should be different, as it is in the business of facilitating new discoveries. We anticipated their excitement at this breakthrough. They recognized our track record, and were aware of their long history of funding our research. Most importantly, they received our video confirming complete recovery after 30 minutes of no brain blood flow. I could only guess they either did not look at it or did not believe it.
We made calls to appeal their decision, but to no avail. Our research is very expensive, and it could not move forward without new funding.
This rejection trampled our chances to explore applying controlled reperfusion after longer intervals of brain ischemia with unwitnessed arrest, and totally stymied our capacity to evolve new methods to treat stroke victims. The curtain suddenly fell on our efforts to change the devastation of brain damage, a now correctable problem.
I just sat at my desk, staring at their letter. I was frustrated, discouraged, and deeply sad for those patients who could not be helped. Yet this negativity was balanced by my knowing that we found the truth — the pinnacle of every scientific journey.
Turning Point
I knew the chances of continuing our study were now zero. No one else would fund this investigation.
It also meant that after 40 years of research, our laboratory must close. I made calls to find new places for my research fellows and lab technicians to work.
But for me personally, this was a momentous juncture.
On the surface, it seemed to nullify my lifelong excitement about developing and then testing an idea in the lab to see if it would ultimately work in patients. The lab is an astounding resource, for it is there that you plant the seeds of your thinking and allow them to bloom, as you grow exhilarated and gratified by the answers. Closing it stops this fruitful pattern.
This setback mirrors setbacks in research, in which failure in one area serves to raise the next question. What if I could do research without an experimental laboratory? I will reveal (in subsequent chapters) how my exploring the unrecognized true nature of the heart’s structure and how it explains both normal and abnormal function — beautifully filled this void and led to unprecedented dynamic discoveries with far-reaching consequences.
The Uncertain Future
This memoir chapter on unwitnessed sudden death (and stroke) is the only one where my lifelong crossing from “bench to bedside” had not been completed. We had not compiled enough experimental data to justify its use in the treatment of patients.
Our intent to explore recovery after extending the periods without blood flow to 60 minutes, then to 90, then 120 had evaporated. Again, for me, the worst part of such abandoned pursuits is being unable to help the patients who would have benefited.
Our studies on sudden death showed we could solve witnessed arrest. That opened the door to helping people with unwitnessed arrest, which opened the door to treatment for strokes. Yet these portals have not remained opened, and rigidity reigns.
Innovation wasn’t to be, at least not for now. But the truth always wins. Again, the only question is: when will it happen?
In the meantime, most recent statistics show approximately 795,000 people suffer a stroke every year. And that’s just in the United States.
Something to think about….
CHAPTER 14
The Teacher’s Highest Reward
Young surgeons are still students after graduating from medical school. They continue to learn by becoming residents and fellows. This educational path in cardiac surgery ends up creating its own version of a family — overseen by their physician mentor who guides them much as would a parent.
Those choosing to pursue scientific investigation will spend two years with a selected research team, whose leader develops an almost paternal role. During this period, the young surgeon’s primary objective is to develop the skills that will shape their future.
They ask questions, learn how to use the lab’s research tools and techniques to uncover answers, and sharpen written or oral presentation skills to help other physicians learn and use their work on their own patients.
Shoulders to Stand on
The educational path is never solitary. The writings of Claude Bernard taught me this. Our trek is only possible when we follow in the footsteps of giants. We must stand upon their shoulders and see what they did not. This starting place is crucial, since absence of such footing leaves us blind to envisioning tomorrow.
My own growth followed this formula. How fortunate I was to spend 18 months at the Cardiovascular Research Institute (CVRI) in San Francisco, overseen by Julius Comroe, and where I worked with Julien I.E. Hoffman.
Dr. Comroe was unique. He was so totally committed to education that he abandoned his career in pulmonary physiology to establish CVRI for young physicians, and create the solid cornerstone needed to start their professional lives. He is no longer with us (passing in 1984), but our abilities evolved from what he taught us. His students, including me, received the teacher’s highest gift.
At CVRI, international fellows come together to acquire a wide range of medical training. They study the heart and the lungs, but also embryology, biochemistry, physiology, and the body’s electrical activity.
Dr. Comroe established two primary educational avenues. First, he provided many prolific laboratories from which each fellow could select to obtain specialty training. Second, he created a series of courses for everyone, involving experimental design, biomedical statistics, mathematics (to design and analyze experiments, and determine meaning of data); plus, there were courses on how to read and edit a paper, present it orally, and how to listen and learn from talks given by others.
I vividly remember when we gave our talks, as he would assign specific chores to ten of the other participants. Each task focused on a different detail as we delivered the first 15 minutes of a presentation. Someone would watch how you used your hands, another observed your facial expressions, another looked at the quality and composition of your slides, another noted how you used your pointer, etc. He would videotape the talks, which you later watched on your own time. You were then armed with all these evaluations, ones that frequently described “how bad you were!”
This made you honestly face the weaknesses of your performance and make midcourse corrections. You then return later with a new five-minute presentation. Appreciating our limitations prodded us toward making an encore performance… to the same detractors who’d candidly pointed out our deficiencies before. Directly confronting our shortcomings made us better presenters.
Dr. Comroe knew the steps needed to fully develop our learning, and guided us into understanding how to use these newfound abilities toward educating others. He taught us that the data from our study’s results was only the first stage. These raw facts set the framework to credibly communicate our findings. Yet he wanted our professional world to contain the whole package. This included not only discovery, but how to effectively share that data with others.
Dr. Comroe and Julien Hoffman were father figures whose influence became part of my worldview. I train my residents and research fellows the same way I was trained. The legacy continues as the baton is passed. This calls bac
k to the immense value, satisfaction, and joy of giving that I learned as a child from my mother and grandmother that I describe in this book’s introduction. For me, happiness is derived not only by helping patients, but also as a teacher, assisting those who in turn will give to others as well.
Launching Fellows at UCLA
When I first met with prospective and new research fellows in my office, I would ask: “Why do you want to study in my laboratory?”
There were three recurring answers.
First, “I want to learn to think differently. I have heard that is something you help your fellows to do.” Indeed, that was my goal.
Secondly, “To hone my skills in writing papers for publication and learn how to make presentations at national conferences.” Everybody knew my prior fellows published numerous papers.
Finally, each emphasized, “I hope to become well-recognized because of research and clinical studies I do with you.”
I knew that nearly all incoming research fellows believed the measure of their success is “numerical” — they think how many publications they create is the benchmark to quantify the effectiveness of our collaboration.
My point of view was completely different.
As they each left my office, I asked them to look up the number of abstracts (summary of a scientific study) that a particular scientific laboratory had presented at the American Heart Association (AHA) meetings from 1973 to 1975, since in their minds, the number of presentations would “validate” the value of a prodigious single team.
They would come back to report, “I found about 140 abstracts were printed over this three-year period.”
I then inquired if this yield of 140 abstracts provided a valuable indicator of the importance of this laboratory’s productivity. The resounding answer was “Yes.”
My final question was, “What new information did you learn from your review of this vast database?” The answer was always, “None.”
This predictable response brings me back to Dr. Longmire’s comment, who appraised these common criteria for academic success by stating that when the promotions committee evaluates the volume of written papers listed in your bibliography, “Sometimes they weigh them, sometimes they count them, but they never read them.”
After the fellows gave their predictable responses, I would let them in on the real goals that I had in mind during their two years in my laboratory.
I would describe an illuminating experience, one that has happened with my prior fellows who uncovered new information: “It occurs while attending a national or international conference, where each participant wears a nametag for identification. When the meeting has a break between sessions, or while you go to the exhibit hall, or attend one of the cocktail parties… some physician walks over, sees your name tag, and asks, ‘Are you the person who wrote the paper on such and such?’ After you confirm that is you, this physician will say, ‘Let me share something with you. On behalf of me and my patient, we are very grateful. Using what you wrote in that paper saved a life.’ In that instant, you begin to understand the true importance of your work.”
The power of this personal experience of being appreciated for one’s contributions65 reveals the correct goal of biomedical research. Reaching this height far surpasses the all-too-common ambition of presenting new work with limited merit. Finding a remedy for someone’s illness — improving or saving a life — reflects the true harvest for your innovative efforts. Your work has meaning.
It’s unfortunate that the belief in quantity (over quality) as a determiner of achievement prevails for many throughout the research community. In the university, this also translates into the “amount of physical space you are provided as the barometer of success” since everyone wants to have a big lab. But here too — it’s not the size of the lab, but what you do in that lab. Yet this consideration is rarely heard as allocation of space remains the perceived touchstone for future accomplishment.
I remember when a senior surgeon, who had just come to UCLA, visited my basement office. He proudly informed me that he had 6,000 square feet of lab space. “That is wonderful,” I replied, and then showed him my lab with 600 square feet of space (a 30 × 20 room). He expressed surprise. “Where is the rest of it?”
I smiled. “This is actually more than I need. The most crucial space required for research is only about eight inches.” As he looked back quizzically, I slowly placed my forefingers on each side of my ears, conveying that the truly important work occurs in the area between them.
Bringing Up the Brood
It was some time after beginning to oversee residents that I was struck again by how patterns in life can be repetitive, as the training of cardiac surgery residents brings them into the fold much like your children. You give them input and guidance, and then observe their output. As with children, you teach students without any certainty of the end result. You don’t know how they will turn out or what pursuits they will follow… and then all of a sudden you see it has paid off.
That can be a study they choose to conduct… or a way of conducting themselves that you didn’t foresee. Again, this is much how it can be with your own offspring, as I was reminded some years ago.
The excitement and challenge of life as a cardiac surgeon and researcher carries a downside. You are up at five in the morning to perform morning rounds with patients and residents, and often don’t return home until ten at night. When do you find time to spend with your children and your wife? You look for ways to make up for all the moments you missed.
Opportunities for one-on-one contact with my children arose during the bounty of international trips I took to conferences to describe my research and clinical work. Every year, I brought each of my daughters alone on a trip with me as I traveled to these different countries. Just the two of us.
One of my favorite destinations was Paris, where it also happened that my hero, Claude Bernard, wrote my bible, “An Introduction to the Study of Experimental Medicine.” On such a trip, I took my oldest daughter, Nicole, when she was 20 years old. We were having a wonderful time, prancing playfully through the Parisian streets. But my lighthearted preoccupation came with a price tag. Small metal barriers lined the street, and voila — my shin hit one of these, causing a gash in my leg.
Even though I was the trained doctor, Nicole, at age 20, took charge. She called upon all her academically-learned French to search out a suitable physician in Saint-Germain-des-Prés. After we mounted a flight of stairs to his office, I received a couple of stitches and an antibiotic ointment. But my discomfort persisted, and before my eyes, Nicole suddenly became both doctor and nurse, comforting me and supervising my “recovery.” Her generosity of spirit was delightful. She cared for me in the way I would nurture my students.
By the time of our trip, Nicole had already started college and was effectively out of our nest, leaving our world for a new one beyond. So it was especially pleasing to witness who she had become. Giving has always been one of my guiding principles. It was wonderful to see that my lovely daughter had taken on this trait.
I felt similarly gratified once my residents and fellows left my academic haven, as I often received a special “kudo” after having trained them for two years. Working in our lab took place in the midst of their overall education, after which they returned to their clinical residency at UCLA to treat patients. The other residents, without lab backgrounds, became curious about our graduates as they repeatedly asked, “How did you develop such a keen ability to sort out clinical diagnoses and treatments?”
The answer reflects the “teaching of thinking” concept that is used to problem-solve research dilemmas. The intense concentration and orderly sorting of facts gets directly transferred into resolving clinical puzzles.
As a result, they use this perspective in their selected fields away from the university. My hope is that these mentor’s “seeds” will guide their future.
I delightedly witnessed a parallel as I watched my daughter Nicole d
evelop her career. She works with computers (and still remains astounded by the snail pace of my understanding of her tasks). Several years ago, she informed me of a promotion that put her in charge of 17 coworkers. Pleased to learn of her advancement, I asked about her goals for this new position. She thought only a moment and answered, “To create an environment where they can learn and grow.”
I was so proud of her, and happy that my attitude had made an impact. As a famous beer commercial once said, “It doesn’t get any better than this.”
Bearing Fruit
The area of study that each fellow pursues after graduating is selected by the student, not the mentor. The highest gift a teacher can receive is if that student becomes a teacher and uses knowledge gained in our laboratory as the jumping-off point for developing their own independent studies to help others.
An additional wish for me would be that someone who worked with me on ischemia / reperfusion injury of the heart might try to generate groundbreaking ideas for using this process of returning blood flow after there’s been an absence of it also in other organs. As previously said, I believe our discovery reflects a biologic process (meaning it occurs in all organs). But until proven, this conclusion is only a personal opinion.
I also fully realized that budding researchers are taking a great risk by electing to address dilemmas in unexplored areas. Failure can damage their reputation and possibly curtail their career. There are no guarantees. Yet a successful pursuit of landmark objectives may favorably launch their future.
Friedhelm Beyersdorf did just this when he returned to Germany. He evaluated restarting blood flow to the leg after its arterial blood supply was blocked. Similarly, Bradley Allen in Chicago would study reflow after lung transplantation, as well as initiate studies on reperfusion damage after liver transplantation.
Every investigation was done completely by them. I had no involvement. But these studies were special for me, as my students were about to stand on the shoulders of their mentor — and travel to places that I had never visited.
Solving the Mysteries of Heart Disease Page 23