What a day!
I was picked up at the hotel at 7:15 to go over to Bach Mai hospital to do my live case. Returning to Bach Mai is always a thrill for me. I have so many powerful memories of this place. Bach Mai was partially destroyed in the bombing of 1972 and there is a very moving memorial in the front of the hospital dedicated to the patients, doctors, staff, and medical students who died at that time. Fresh flowers and incense can always be found placed in front of the memorial – these people are still remembered and mourned today.
Bach Mai is also home to so much of my work in Vietnam and with so many wonderful American colleagues and friends including Charlie Shaeffer, Barry Hackshaw, John Douglas, Eugene Braunwald, Thomas Bump, Sam Shubrooks, Thach Nguyen, Steve Oesterle, Steve Burstein, Bruce Macrum; the list goes on and on. Invariably these US-based physicians have remarked on the heartfelt warmth of their reception and the kindness of the Vietnamese people. They are surprised that the Vietnamese are so willing to put aside the memories of the destructive war. Yet these same physicians have all paid their own way and taken time away from their families and their work to volunteer their time and expertise to help these people on the other side of the world. And on the other side, the patients and doctors at Bach Mai have always appeared pleased and grateful for whatever we did, never expecting more than what we were capable of bringing, or questioning our motives. They are genuinely delighted to see us and have given me the impression that even apart from the work we do for them, that they just plain liked having us as friends. I think there’s a lot of goodness and mercy on both sides of the ocean. And so Bach Mai over the years has come to represent for me the best of my medical life…
When I got to Bach Mai I was pleased to be greeted by so many familiar faces. Although I must admit my pleasure at this reunion was tempered by anxiety regarding my live case. I reviewed the diagnostic angiogram a few more times which did nothing for my peace of mind. Total occlusion of the ostial left anterior descending, complete occlusion of the mid circumflex, poor left ventricular function with an EF of 20%. And I was supposed to do an intervention to the distal portion of a right coronary that looked liked Lombard street. On a Vietnamese VIP. With the cardiology congress of the Association of Southeast Asian Nations watching and an expert panel critiquing. To be fair, there were a number of reassuring factors. First of all, Bach Mai hospital actually more of the latest stents, wires, and balloons than we stock at Eisenhower. I guess they’re free of the FDA and hospital contract restrictions that limit our inventory. Secondly, I was working with a team that did much exactly the way I would: the same way of getting arterial access, the same five diagnostic viewing angles that I take, the same way of thinking of problems, the same philosophy of trying to minimize risk by keeping matters quick and simple. There are definitely advantages to working with people that one has helped to train! Thirdly (and maybe best of all), no matter how the case turned out I would not have to do any paperwork or dictating.
My assistant was Dr. Thai who makes me look like an old man. Really. A very large old man. Despite his youthful and dimunitive appearance, Thai is a hugely experienced interventionalist and I was quite pleased with this partnership. We decided, not surprisingly, to keep things as simple as possible but to be prepared for the worst. After placing a sheath in the right femoral artery, we did an aorto-ilio-femoral angiogram to make sure that the vessels would be suitable for placement of a balloon pump (a device to assist a failing heart) should one be necessary. A sheath was then placed on the left to be used in case of an emergency. We then repeated the diagnostic angiogram (for the benefit of the expert panel and viewing audience). The targeted right coronary artery was then engaged and we decided to place 2 coronary wires instead of just 1 to provide backup support. We decided to try to directly stent the vessel in order to minimize trauma to the vessel and shorten the duration of the procedure. Dr. Thai suggested a Noburi stent as an extremely flexible drug-coated stent that would be easy to deliver. To my immense relief the stent floated down easily.
Meanwhile, the expert panel and the audience, clearly saddened and disappointed with the lack of drama from what appeared to be such a promising case for blood, sweat, and tears, gave us grudging congratulations while trying to goad us into doing less essential and yet more risky lesions while we were there (frustrated Schadenfreude!). They reminded me of a Roman audience at the Coliseum all standing with their thumbs down. Happy to let them down, we finished up with a second stent and escaped with a very satisfactory angiographic result and a live VIP. The patient, who was wide awake during the whole procedure, assured us that he felt fine and had had no discomfort during the entire case. I changed back into my formal clothes for the conference, spoke with the family, posed for some pictures, and then ran out to catch a ride to the conference. Dr. Thai was still doing the case paperwork as I left. I love medicine in Vietnam.
At the conference (which it turns out has about 1700 attendees) I was able to catch most of a great lecture on the global burden of cardiovascular disease given by none other than Michael St. Louis, a high-ranking official from the Center for Disease Control in Atlanta, who also happens to be my brother-in-law. As luck would have it, I was seated right next to Charlie Shaeffer, one of my partners from Desert Cardiology who has so given so unselfishly to Vietnam over the past eight years. Charlie must have been Vietnamese in an earlier life: he starts every day in Vietnam with a jog followed by a bowl of pho (beef or chicken noodle soup).
Later that morning, I served on an “expert panel” where I got to critique someone else’s live case. Many of the other members of that panel were actually holdovers from the earlier group that had tortured me. Somewhat belatedly a number of them told me that I had done a “wonderful job with a terribly difficult case.” I bit my tongue and tried to be the inscrutable Asian.
After lunch I was interviewed by a very pretty Vietnamese reporter who wanted to know what I thought of the progress made by the Vietnamese cardiology community, how interventional cardiology in Hanoi compared to the cardiology in the US, etc… A true test of my language skills, I won’t know how I fared until I get the morning paper. If the police come knocking, I’ll know that I got a few words wrong. Or that my morning patient did poorly overnight.
Well, time to turn in. I’m giving both of my lectures tomorrow morning although I must say the pressure is off after seeing some of today’s performances.
I was picked up at the hotel at 7:15 to go over to Bach Mai hospital to do my live case. Returning to Bach Mai is always a thrill for me. I have so many powerful memories of this place. Bach Mai was partially destroyed in the bombing of 1972 and there is a very moving memorial in the front of the hospital dedicated to the patients, doctors, staff, and medical students who died at that time. Fresh flowers and incense can always be found placed in front of the memorial – these people are still remembered and mourned today.
Bach Mai is also home to so much of my work in Vietnam and with so many wonderful American colleagues and friends including Charlie Shaeffer, Barry Hackshaw, John Douglas, Eugene Braunwald, Thomas Bump, Sam Shubrooks, Thach Nguyen, Steve Oesterle, Steve Burstein, Bruce Macrum; the list goes on and on. Invariably these US-based physicians have remarked on the heartfelt warmth of their reception and the kindness of the Vietnamese people. They are surprised that the Vietnamese are so willing to put aside the memories of the destructive war. Yet these same physicians have all paid their own way and taken time away from their families and their work to volunteer their time and expertise to help these people on the other side of the world. And on the other side, the patients and doctors at Bach Mai have always appeared pleased and grateful for whatever we did, never expecting more than what we were capable of bringing, or questioning our motives. They are genuinely delighted to see us and have given me the impression that even apart from the work we do for them, that they just plain liked having us as friends. I think there’s a lot of goodness and mercy on both sides of the ocean. And so Bach Mai over the years has come to represent for me the best of my medical life…
When I got to Bach Mai I was pleased to be greeted by so many familiar faces. Although I must admit my pleasure at this reunion was tempered by anxiety regarding my live case. I reviewed the diagnostic angiogram a few more times which did nothing for my peace of mind. Total occlusion of the ostial left anterior descending, complete occlusion of the mid circumflex, poor left ventricular function with an EF of 20%. And I was supposed to do an intervention to the distal portion of a right coronary that looked liked Lombard street. On a Vietnamese VIP. With the cardiology congress of the Association of Southeast Asian Nations watching and an expert panel critiquing. To be fair, there were a number of reassuring factors. First of all, Bach Mai hospital actually more of the latest stents, wires, and balloons than we stock at Eisenhower. I guess they’re free of the FDA and hospital contract restrictions that limit our inventory. Secondly, I was working with a team that did much exactly the way I would: the same way of getting arterial access, the same five diagnostic viewing angles that I take, the same way of thinking of problems, the same philosophy of trying to minimize risk by keeping matters quick and simple. There are definitely advantages to working with people that one has helped to train! Thirdly (and maybe best of all), no matter how the case turned out I would not have to do any paperwork or dictating.
My assistant was Dr. Thai who makes me look like an old man. Really. A very large old man. Despite his youthful and dimunitive appearance, Thai is a hugely experienced interventionalist and I was quite pleased with this partnership. We decided, not surprisingly, to keep things as simple as possible but to be prepared for the worst. After placing a sheath in the right femoral artery, we did an aorto-ilio-femoral angiogram to make sure that the vessels would be suitable for placement of a balloon pump (a device to assist a failing heart) should one be necessary. A sheath was then placed on the left to be used in case of an emergency. We then repeated the diagnostic angiogram (for the benefit of the expert panel and viewing audience). The targeted right coronary artery was then engaged and we decided to place 2 coronary wires instead of just 1 to provide backup support. We decided to try to directly stent the vessel in order to minimize trauma to the vessel and shorten the duration of the procedure. Dr. Thai suggested a Noburi stent as an extremely flexible drug-coated stent that would be easy to deliver. To my immense relief the stent floated down easily.
Meanwhile, the expert panel and the audience, clearly saddened and disappointed with the lack of drama from what appeared to be such a promising case for blood, sweat, and tears, gave us grudging congratulations while trying to goad us into doing less essential and yet more risky lesions while we were there (frustrated Schadenfreude!). They reminded me of a Roman audience at the Coliseum all standing with their thumbs down. Happy to let them down, we finished up with a second stent and escaped with a very satisfactory angiographic result and a live VIP. The patient, who was wide awake during the whole procedure, assured us that he felt fine and had had no discomfort during the entire case. I changed back into my formal clothes for the conference, spoke with the family, posed for some pictures, and then ran out to catch a ride to the conference. Dr. Thai was still doing the case paperwork as I left. I love medicine in Vietnam.
At the conference (which it turns out has about 1700 attendees) I was able to catch most of a great lecture on the global burden of cardiovascular disease given by none other than Michael St. Louis, a high-ranking official from the Center for Disease Control in Atlanta, who also happens to be my brother-in-law. As luck would have it, I was seated right next to Charlie Shaeffer, one of my partners from Desert Cardiology who has so given so unselfishly to Vietnam over the past eight years. Charlie must have been Vietnamese in an earlier life: he starts every day in Vietnam with a jog followed by a bowl of pho (beef or chicken noodle soup).
Later that morning, I served on an “expert panel” where I got to critique someone else’s live case. Many of the other members of that panel were actually holdovers from the earlier group that had tortured me. Somewhat belatedly a number of them told me that I had done a “wonderful job with a terribly difficult case.” I bit my tongue and tried to be the inscrutable Asian.
After lunch I was interviewed by a very pretty Vietnamese reporter who wanted to know what I thought of the progress made by the Vietnamese cardiology community, how interventional cardiology in Hanoi compared to the cardiology in the US, etc… A true test of my language skills, I won’t know how I fared until I get the morning paper. If the police come knocking, I’ll know that I got a few words wrong. Or that my morning patient did poorly overnight.
Well, time to turn in. I’m giving both of my lectures tomorrow morning although I must say the pressure is off after seeing some of today’s performances.
