Join David H. Adams, MD, Marie-Josée and Henry R. Kravis Professor and System Chairman of the Department of Cardiovascular Surgery, in discussion with icons of the field of cardiac surgery during the "Legend Series" lectureship for the Department of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai.
Hey, randy, how are you? I'm fine. David yourself, you're doing great. You look you look the same. Well, a little little seedier, but otherwise. All right, well, you look very Professor real and I've really enjoyed looking through some of the stuff that you and DeVos put together. It was hard to pick some of the highlights too, to go over today with everyone. But I thought we'd I thought we'd do that. You know, our goal is to make this very casual and informal and particularly for our fellows and residents. I thought it was would really be a nice chance to understand some of the real pioneers in our field, and you're certainly one of them. So I thought this would be a fun exercise and we really appreciate you agreeing to be our very first legend that we would talk to. Okay, so what we're gonna do everyone is we're gonna take over the next hour. We're just gonna go through some Mhm photographs and ask dr grief about some memories and to sort of highlight some things. And we'll ask him a little bit about about just being a doctor and being an influential leader and how he sort of left all of us with this great platform to continue to build on. So randy. Tell us a little bit about about your early years, this is a picture from 1950 in your boy scout uniform. Okay, well, I had sort of a strange childhood. My father was an army chaplain, so we moved all over the country and to some extent to various parts of the world. I lived in Germany for a while, lived in Hawaii right after World War Two, uh uh went to a number of different schools. There was, it was an interesting way to grow up. Uh I wasn't exposed to a lot of very high powered educational experiences and so on. Pretty much average schools and so on. Probably got a somewhat inflated idea of my own abilities as I went through school. Uh but that that was changed later when I ended up at caltech was in college. No, I I well I'm looking forward to hearing that little bit, but I know we all want to hear a little bit more about this because I think this was the first real uh identifier of what was to come. This is a picture of you winning first place in the Science Fair award at SAN Francisco for a project. I'm still not quite sure I understand, but we're going to take the next two minutes and try and understand it again. What do you say? Excellent. But this this is a very interesting um plot I think for the future for you in terms of your yeah, real impact. But I have a couple of pictures from us to tell us a little bit about that, what you were trying to do with this contraption. And obviously it was a fairly a novel idea because when in first place in anything is not that easy and I don't think I've ever won anything close to first place in a science competition. So, tell us about it. Okay, well, I'm not sure worthy actually came from. Uh but the idea that metabolism was how fast your metabolism ran was a function of temperature. It was something that fascinated me, I guess, learning about cold blooded animals and that there's temperature went up and down. And so, Mhm. I devised this apparatus to try and measure oxygen consumption in fish and it was kind of a Cluj together apparatus. There was this jar full of water in which the goldfish slim, and then at the bottom of that was an inverted plate, in which I could put a measured amount of oxygen. And then the top of the container was a balloon so that it was flexible so that as the oxygen was absorbed out of the water, which I assume would be absorbed into the water is at the same rate as the fish consumed it, that the volume of the chamber would change, and so that would be allowed for by the rubber top. And I control the temperature in this hold apparatus by using the thermostat in our house. My parents were reasonably accommodating when I did it at 60 and 70, a little uncomfortable with 80 and 90, and I couldn't quite get the stat 200, but I did manage to generate a curve which did show of uh actually an exponential relationship between temperature and oxygen consumption, and that's what won the prize, interesting. The guys shaking my hand, there was Shockley was a nobel laureate, a guy who's sort of invented my sister. Yeah, I would say that was a pretty good foundation. Here's here's a drawing from that study that you just explain, which I thought was really quite, quite interesting and I think it was that must have been an early sign of what was to come. Here. You are in your high school graduation, then, randy. Where were you living at that point? Where were you in high school and in northern California? Yeah, I was in Oakland, this was Oakland Technical High School, which is primarily a vocational high school, but they did have an economic program. And so now, now the journey continued. Um and I just wanted to show one picture first, before we go to college, to with your families. Just tell us a little bit about the rest of your family. Well, that's my father and mother there who were both from the midwest. My father's from Wisconsin, my mother from Minnesota, he was a minister, she was a schoolteacher. Uh and then their lives changed in World War Two when he entered the service and Spent the next 15 years or so in the army. It's my younger brother beside me who is an attorney in southern California. And my sister who lives here in new york and is in the art business. She and her husband run a master print business here and in London and paris. So you're now you're off to to caltech. So tell us a little bit about the college years. Mhm. I understand it was a little more competitive at caltech than your high school. Yeah, it was, it was kind of a shock. I, what I went to caltech with a very inflated idea that nuclear physics was probably a field that needed a little work and I would arrive to take care of that. And then I then I ran into our entering class of 200 people, all 200 of whom seemed to be better prepared for college than I was. Uh I can remember complaining to one classmate that I was having trouble getting all my homework done. He said, well, didn't you send for the books during the summer and do the problems? And uh no, that was kind of the environment that I was exposed to, but it was, it was very stimulating and very uncompromising at that time, caltech was all men. Uh there was very little in the way of anything other than academics, Freshman class. All 200 people took exactly the same courses, his math, physics, chemistry, history in english and plus a couple of laboratories and that was it. So the curbs are pretty steep, I guess they were pretty steep. And a lot of, a lot of kids from very good schools are very well prepared and I didn't need to do a lot of scrambling to catch up. But it was good reality check. Well, you did catch up because we know that you graduated yes, in four years, which was pretty much standard then, not so much now, but and randi tell us about the, tell us about what, how you decided during college to become a physician to go to medical school. Well, I was, you know, I had started out, I was body on going into physics, but you know, there are a couple of students in my class and kept thorns in my class. I don't know if you know who he is and he's now you're still at caltech, he's a nobel laureate. Uhh is an expert in black holes and someone. And I was, he was in my class in my section, I used to listen to him and a professor discussed physics problems and that decided me that physics was probably not the fields for me. Uh and I did get interested in biology in my second year. And yeah, I had been sort of wondering what I was going to do when I finished college and one day thinking about, I thought, well, you know, biology is fascinating. I could probably be a biology major. Uh and if I could possibly even be a physician and somewhere in the back of my mind, I think the idea of becoming a physician had been lurking, and it was one of those moments when you feel this is it. This is this is the moment of illumination. And I figured out what what my life should be about. I remember very distinctly where I was standing, where I was at that time. And it was one of the early points in my life where I knew what I was going to do and randi. I am assuming that that was extremely competitive back then to go to medical school, Wall Street sort of didn't exist at that point. So every, you know, at least my experience 10 years later was that was pretty much what what was on the starting blocks for a lot of very smart kids. Well, to some extent, but not caltech. Actually, I was the only kid in my class that went to, that applied to medical school. One other student went to a medical school a couple of years later, but it was medical school was reasonably competitive, but not what it became a few years later. I think most of my classmates went into uh graduate school and various sciences or into industry and so on. So medicine was still was considered a little bit of a sort of trade school sort of thing. Well, here you are. Here you are. One of the trade schools stanford. Not bad. So, so tell us for a minute, randy about medical school. Who on just, just teach us a little bit about what happened in medical school. That that sets you on this journey to be a cardiac surgeon. How that happens? Well, there's a medical go. They're interested in the heart. Or did you go? They're interested in me and a doctor. I went there, interested in being a doctor. Uh it was and I very much enjoyed medical school. College had been a really tough slog and uh not a lot of distractions and so on. Just pretty much hard work most of the time. Uh Medical school. I really enjoyed all of the uh all of the subjects in medical school. Uh But I know but after the first year or so I thought that I would become an internist that seemed to be to be the most intellectual discipline. And I was pretty much persisted in that until in my surgical clerkship I ended up on norm some ways uh service and I ended up there because the intern was in a car accident and they didn't have anybody to do all the scut work. And I was a medical student sort of wandering by and got snagged and I couldn't believe what I was saying in cardiac surgery. And I could see it was immensely exciting, I could see that there was tremendous, there were a lot of things that a lot of problems to be solved. And then the on top of that was this guy who was head of the division at that time was norm Shaun White, who was just a terrific guy who could operate like a like a wizard always seemed to be able to do things that needed to be done, but still was a very down to earth guy who was very interested in teaching other people how to do what he could do. This is unbelievable, this is what I should do. And uh after my junior year I said, well I might as well go talk to dr chumley. So I made an appointment, went to his office and said, you know, I really enjoyed the month I spent on your service last year and I want to be a heart surgeon. And I sort of expected to say, well this is what how the application process goes and this is what you do so on. And he said, okay. He said, yeah, well you're you still have another year of medical school to go. So I said yes. And I was I was planning on doing a medical internship and then I'd like to train with you. And he said, okay, so give me a call a few months before you're ready to come back. And that was it. I called him about half halfway through internship and said uh would like to come and be a resident. You said fine was the in july well, a little different error. Huh? I I heard that, you know, some way was really a little bit different, wasn't he? Like, you know, my only experience that at that level was with David Sabiston. And Sabiston was really, you know, very sort of very rigorous and sort of his ideas about sort of the boot camp in the decade with Dave and, you know, the two or three years of research. And it was, you know, very, very formal by the mid seventies. But I always had the impression I only interacted with with Dr Shumway a few times in terms of visiting professorships and things like that, but he seemed to have a little bit different. Um yeah, sort of approach a little. He was I think he was approach might be a good word, he seemed to be a bit more approachable, then a little more down to earth in that sense. No, he was a very approachable guy. And I don't know, he I think he was he relied on his instincts a lot. You know, when I look at my fellow residents and so on, it was a very mixed bag of backgrounds and so on, and and he would decide that something he thought someone was teachable and he'd take them on. And and almost invariably turned out pretty well, it's gonna say he has a pretty good track record of picking winners. You're pretty good after. I've been on the residency for a couple of years and for early years in the faculty, I used to get a kick out of watching him because at the first of each year, he'd start out with a new chief resident and he'd go, oh, geez, I don't know this guy, I don't know, this is possible to teach this guy how to operate its just off. And then by the end of the year he would say, you know, this new, this guy, I think that's the best guy I've ever seen. And I would happen year after year and he never seemed to realize what he was doing. But he would, he really would, he would teach so well. And then at the end of the year it was true people that came through were transformed, if you will. Yeah, he's, I wish I had spent a little bit more gotten to spend a little more time with him. But the few times that I did, I must say his irreverence for all the formality was refreshing. I remember once David Sabiston was visiting, remember walking behind them while they were walking along and he said to a day, he said they were taking some time to smell the roses. Sabiston looked at him like, are you out of your mind? What are you talking about? That kind of sums it up right there? And I can sort of see norman is a, you know, a casual jacket and open shirt, Jackson and full IBM red, white, red, white and blue, you know, along the way, at any rate, so randy. Now, now we're gonna move on to internship, we're gonna come back to stanford because a lot happened when you went back there. But tell us, I mean, this was an interesting choice for internship. What was behind that? Well, I wanted to go to a city hospital. Stanford's a pretty, was a pretty sleepy place in those days. I mean things like heart surgery and so on, radiotherapy where uh, absolutely, uh, top notch, but in terms of, uh, you know, sort of blood and guts medicine, uh, there, you know, most of the patients were uh, middle class suburbanites and so on and nobody came, nobody came into the emergency room with gunshot holes or stab wounds and so on. So I wanted to go to a place where there was a lot of excitement and also where there was a lot of independence for, for interns. So I applied primarily to city hospitals and Bellevue was my top pick among them and I take it, you've got to see a few gaps, gunshots and stab wounds quite a bit. It was, it was a very interesting year. It's, I really learned how to be a doctor and you know, the interns really ran the service at that time. So I learned to be a doctor and also I met my wife who was a medical student, probably the most important event that occurred during that year. That was probably the most important thing that will happen at Bellevue for you. Hey randi, tell me about the internship. So back then it sounds like it was a little less for you, sort of went that was like a year, like going to high school or college or med school, then internship and then you moved on. That's what happened. It did many. I think the usual pattern still was that you probably went on in residency where you did your internship. I see, but you were matched only for the internship. And then in most cases, the chief of service said, you know, you can stay on and finished residency or resident, either medicine surgery, whatever it was, but that was where it was designed as a standalone year. Uh, and so there was a minority of people who did internship one place and residency somewhere else. Well, you you certainly went back now to what was, you know, if it wasn't during medical school. Certainly during your residency, stanford became one of the real, certainly one of the two or three most influential influential cardiac surgery programs, you know, internationally, during this sort of area. I think that's a fair statement. Yeah, it was, there was a lot going on, you know, in some way, was sort of pretty much on top at all. And of course, when I came back, the year I came back was a year that heart transplantation started. So that was pretty exciting. And that was probably for many people. That was the most exciting thing going on. I think in my own mind, I thought it was really something, but I was also immensely interested in other aspects of cardiac surgery. And you mentioned either randy. Of course, like as most of the icons, it's always about a partnership. And you certainly seem to pick a pretty good partner. Tell us a little bit about what that was like in residency and and beyond with your own family. Yeah, well we uh you know I met him, she was a medical student at N. Y. U. When I was an intern. And then when I went back to stanford at the end of internship, uh we decided to be a good idea. She she can to stanford also. And so she did her last year of medical school at Stanford and then did her residency there and then did a fellowship in pediatric cardiology. So we had the the opportunity to work together in the same patients on the pediatric cardiology patients and cardiac surgery patients. And uh she became a great favorite of uh of norm. Some wise, she was the only pediatric cardiology fellow for several years. And uhh the chief of pediatric cardiology was not the world's greatest clinicians. Shumway sort of used her as his personal pediatric cardiologist. And she had a she had a good time with the old man as well. Yeah, well and the bonds grow. I I love the family business. It sounds like that was a pretty good family business back then for you guys. And you know, it's funny radio I was thinking about when you were talking about Carpentier. Everyone sort of links him to um mitral valve appearance or the father of being a valve reconstruction. But of course he won the Lasker award for his work and biological valve replacement and glitter all died fixation of tissue. And it reminded you like so many of the giants and that error. People sort of think about you is this pioneer and aortic surgery. But of course you are a master congenital heart surgeon as well. Well, I was that was an interest of mine and uh and one of the attractiveness of of stanford was that Shumway was such a great pediatric cardiac surgeon. I have to tell you one story about even myself in pediatric cardiology was uh when I finished training I was doing some pediatrics and uh but my you know, I was uh my schedule was reasonably relaxed and that I only operated every for three months and then I spent three months in the laboratory. And Eva meanwhile was the only pediatric cardiologist and only pediatric cardiology fellow and was just working your tail up, you know, all the cats and everything. And one day I had a referral of a patient for I think was a VSD repair. And night before surgery I went to talk to the patient and parents and I explained, I we're going to put a patch on the whole and so on and uh, got through about five minutes, 10 minutes of explanation and the mother said, said, well, you don't, you don't have to explain all this. Your mother was just here and she told us exactly what was going to happen. So he was looking pretty beat up and I was looking pretty young. Right? Oh gosh, that's a good, that's a good story. This was a good story to. I guess there was a lot going on out there now with transplantation really taking off and there are a lot of, uh, listen, it's been fascinating to be a part of, of the sort of department and the medical environment out there with all of this excitement around transplantation. There's a picture of some way and, and Harrison. But I'm just curious if you can make a comment again about how, how disruptive was that versus the rest of cardiac surgery? Or was this most of cardiac surgery that in terms of the talk? Well, it was it was a huge uproar for a few months. You know, christian Barnard did the first clinical transplant in South Africa. And there's a tremendous blow to Shumway because Shumway had been publishing articles for about six years on the laboratory working dogs and chris partner had never published a single article about anything having to do with the science or the pre clinical work and transplantation. But when when chris barn did that first operation, you know, all over the world, people started doing transplants, heart transplants there, about 100 done in the next year. And almost every patient, you know, jumped right in the box within a few months or a few weeks because nobody had any idea how to manage immuno suppression. And uh, at Stanford, things started relatively slowly. The first operation was in January of 68, Barnett's first one was in December 67. And the early results were the first two patients died. Uh, but there was tremendous, you know, you know, the newspapers were full of it, everybody was giving interviews and so on. Uh this is a subway here in this picture and Chief of cardiology. Don Harrison, who I doubt even knew the dog transplants were going on the laboratory. And suddenly he was the world's medical expert and heart transplantation. You know what you sort of managed by taking residents aside and saying exactly what you guys do and so on and ready for his press conference. But anyway, it was a lot of excitement, but it died down pretty quickly. And within a year almost nobody was doing transplants because the results were so dismal. And there was only some way at stanford and chris Barnard continued in South Africa and some ways. First resident who wrote the first paper with him on the technique, tick lower, continue to do heart transplants at the Medical College of Virginia. But that was kind of it for the next few years. It was very quiet elsewhere in the world. Whereas at stanford transplantation continued at a pretty steady pace. At first about a patient One patient a month and then accelerating to about two or three within a couple of years with gradually improving results. And, you know, there's a lot of laboratory experience, had some idea of how to diagnose rejection and manage immune suppression. Uh There was back and forth between the laboratory and clinic in terms of learning about managing clinical immuno suppression and transplant recipients and radio. I I'll bet that your experience in the lab doing these transplants also translated to technical skill in the human transplants. Because I bet those were pretty challenging. You know, they were. It was and that was, I think one of the ways that some way decide that somebody was going to be a reasonable surgeon if you could do a dog transplant, you're a pretty good surgeon was much harder than doing a human transplant tissues are much more friable in that time. The techniques were, you know, we're all the nasty moses were silk. I mean, uh, not so easy to do good, easy vascular anastomosis and so on. So that was a good, it's a good training program in surgical technique. Well, was also it was also a throwback to academics. I wanted to show our residents and fellows some of this early work that was going on during, during your time there as a as a resident, as you were saying, you were sort of wearing multiple hats. Then correct. Right. And you can see some of these fairly, fairly important sort of reports here all in this field of transplantation with this very tight team that I'm sure that you are very excited to be writing some of these papers. It was a pretty, pretty heady stuff. You know, I think that's a good phrase. That was pretty these are fairly big, big contributions randy, especially at that time in this field. These were all really sort of pioneering reports, very kind of you to say that it was, you know, it was it was fun and it was it was a wonderful opportunity. You remember your first transplant, the first one that you performed? I did uh you know, after the Shumway did the first two heart transplants and then the guy who just was finishing chief residency had stinson did them for the next year or so. It was Shumway assisting. And then the following year uh uh I sort of got the job of being the junior guy on the transplant service. And mhm. You know and Shumway stopped showing up for the operations because they were usually in the middle of the night. Doing an operation is not so tough. And so then uh and after I guess it was it was in january of 1970 I was third year residents, Second year resident uh uh asked me if I wanted to do the next one. I said, you know, I think I would. So so I did the next one. And as I mentioned earlier, you know, I just happened to hit a lucky match. And that patient lived for 26 years for a long time. He was the longest living, was my first heart transplant, longest living one in the world, I guess. You didn't remember that one. I would remember that one. Yeah, that's pretty good. It's just it's interesting to hear that the errors, isn't it? Sort of, you're a third year resident, would you like to do the next one? Sure, I'll do what? And you're right. I'm sure that, I'm sure one thing that's never changed is that they always happened in the middle of the night. That's right. It's incredible how that happens. We'll hear randy is another paper that we've got to talk about for a minute. Which is this your sort of continued interest in hypothermia or how temperature sort of affects metabolism. So, tell us a little bit about your yeah, sort of sort of thought process now and getting interested in hypothermia, which obviously is a contribution that will outlast all of us on this call. Because this is, you know, really opened up an entire new field eventually. But tell us a little bit about this work you were doing and hypothermia myocardial protection. Well, this uh this was a technique that was actually uh invented by norm Shumway. It was local cooling of the heart. Uh uh there are some apocryphal stories uh uh from the early years, uh somewhere in lower working together that they were trying to figure out how to preserve the heart in the new york across clamping. And they tried cooling it as they were exploring the limits of what one could do, how long you could keep new york across clamp they it's kind of boring just standing here watching the clock, we should try and do something, we should cut the heart out and sew it back in and it didn't work for some time. But that was supposedly the impetus to developing surgical technique for heart transplantation. But this was a technique that was used most of the time at stanford cardio, coronary perfusion was not being tried. Uh Someone was convinced that just cooling the heart and operating quickly was the best way to go. Uh As I was coming through residency, this was becoming more of a routine. This paper actually was my experience is the chief resident and all the cases that I did and I did them all with you know, saying I did. There was one thing, I mean somewhere was first assistant on most of these cases, but during my chief residency year and I was trying to figure out some way to write something about local hypothermia. And this occurred to me is just writing up all the cases. It's interesting when I presented this paper, uh number of people came up and said, you know that that that was you know, it was a very good paper and something you know, you shouldn't lie that much. A little bit of lying is all right. But you said you had, I can't fact numbers were here, but maybe 100 coronary patients with mortality rate of two or 3%. That really nobody believes that because it sounds like the back halls of the at the time. I remember those meetings they were if they were fun. So that was what this paper was. It was just a way of saying that this is a reasonably good way of preserving the heart for straightforward open cases. Yeah, I think I think it's underestimated. I obviously still believe that that it makes a good surgeon a much better search and in terms of outcomes keeping the heart cool. So I I continue to call that one a greatly. You are also obviously start introducing aortic surgery out there. Yeah, that was again, to some extent, gift from somewhere he uh didn't like uh the idea of coming in the middle of the night for two sections and we're trying to figure out how to operate on the section. So I got to operate on a fair number of them and and got to see a few more and more patients with aortic disease. And there had only been a handful of cases of arch aneurysm was attempted at stanford and uh nobody had survived. And my time in the laboratory, I had sort of perhaps remembered my old fish experiments and trying to see if I could keep dogs alive after arresting the circulation of lower temperatures. And it turned out to work really well. You know, you could arrest the totally arrest of circulation for an hour. For the most part the dogs survived. So uh patient presented with an arch aneurysm, I told you, I thought this would work. And could I try. It was a junior faculty member by that time. And he said, sure, you know, I can't do any worse than we've done so far uh with various attempts at cerebral profusion. So, so that was the case is that I reported during the first four cases that were profound hypothermia in circulatory arrest for arts replacement. So randy, so much was going on. Honestly you were doing during this time. It sounds like you were starting to do a lot of transplantation. You were you were you were heavily involved in transplantation, heavily involved in aortic surgery, doing congenital heart surgery. a lot was going on. And I guess my question is, how did they wrestle you out of there and back to new york? Yeah, well, uh it's a question perhaps I've asked myself a few times. Uh one of the uh factors I think was uh was Ed Stinson, who was, you know, a very good friend in two years ahead of me and was clearly going to stay at stanford indefinitely because he never bothered to get his his boards and either general or thematic surgery. Uh and I didn't think he related to people to do be doing a heart transplantation stanford. And I felt it was rightfully his bailiwick, he was two years ahead of me and basically had taught me a lot of it and brought me along, but um so, so heart transplantation was sort of taken if you will. Uh there were these other areas that I was interested in that I didn't think I had to be at stanford. And actually it was it was the opportunity to become uh to have my own department uh at a fairly early stage and there's a fairly early stage of my career and it so happened that the guy who ran the surgical program at Downstate in Brooklyn was a very remarkable man who I had met when he was a resident, and I was a medical student at Stanford SAm Coons, who uh was one of the real pioneers in kidney transplantation. And he'd come to Downstate had been at san Francisco for a while, stanford in san Francisco. I had gotten to know him because when I would go and bring back heart beating cadavers, to stanford, to harvest the hearts, he would come down from UCSF and take the kidneys And then he came to downstate, became the chief of surgery and built this big renal transplant program, which nobody remembers anymore. At one point, he was the busiest service in the world. He was doing about between 200 and 250 renal transplants a year And he was looking to recruit a heart surgeon had a program at downstate, but it was pretty more abundant that time. Uh, I mean, nobody was going to come to the middle. No. Senior figure was going to come to the middle of Brooklyn with a program that did 30 cases a year. Yeah. But I'd seen what he had done there and I was convinced that there was an opportunity. So, so that was basically, it was the idea of starting violent program. And tell us, how long were you at Downstate before you came over to mount sign up? It was about eight years. And what happened during those eight years? We used, what was your sort of measure of success of your tenure there? Well, there are a couple of things we really, we built the program to think about the best we could do with the facilities that we had available. I bet Arison organ there. Uh and he became an extremely uh important partner in building heart surgery. Um And we were got up to about 300 350 cases a year, respectable results. We got the congenital program started and got neonatal surgery started. Did the first mustards done and in Brooklyn at that time. So that was pretty successful. We actually started transplantation. Uhh did four patients, one of whom is still alive, actually is one of the longest ones in the world now, 1980. But uh, I didn't feel we had the cardiology and immunology backup we needed. So we stopped doing transplants. And one of the reasons that sign. I was attracted to me because I thought it was a place that we could start the transplant program back up again. Yeah. Tell us a little bit about that recruitment. How did that work? Right. Well, I was, I mentioned the demos, I guess that it was kind of unusual bob Litwak who was the head of the division at that time. I was looking for someone to do congenital heart disease. He'd been quite successful surgeon of pediatric heart disease and Children, but he, like many people of his generation, it was tough to sweat to jump into the neonatal group. It was sort of a different type of certain, extremely meticulous in a tiny, tiny structures. Uh, new new techniques and new materials were needed to do it. And so he came to down state to recruit me to come to congenital heart surgery, sign on it. And uh, and I started looked at, I thought there was an opportunity, but uh, I can say that bob was probably going to retire in a few years and I didn't, I thought well, you know, why not just uh, wow, why not come as the chief? And so I basically put that to him. They were, he was giving me a big recruiting talk and so on after met two or three times. I said, I really would like to come to the outside like bob, but I would like your job. And I said, you know, think about, you know, you know, don't don't tell me what you think right away. Uh, but I think it would work out all right. And he said, well I guess I don't have to think about it. Yeah, that's okay. You can have my job. So that was it. Okay. It was a little surprising to the president and to bob houses who was Chief of surgery, but they perfectly content with that. And so that was how I was recruited. And of course Bob became a great friend and supporter, even admire Lee 10 years. So he stayed with you the entire time. You know, he was sort of retired from active surgery practice. But he maintained a tremendous interest in the educational programs, very helpful and administration to made a lot contributions to making the decision and ultimately the department run. Well, absolutely. That I completely concur with you on that. So we're very glad that he accepted that opera. And we're very glad that you kept him all those years for me to get to work with him as well. So you and and Aronson obviously we're really busy now and I and I didn't want to remind the residents about this continued interest in in in deep hypothermic circulatory arrest, which was fairly pioneering at the time. I assume that this was probably, these are probably pretty unique times back in your early years with canoes and wrapped up. I take it nice. This isn't on the way to the mortgage actually. On the way to deep hypothermic circulatory arrest. I I propose, yep. You know, the first few cases we put in a canoe of ice water, it was, I don't know what the ethics committee would have said nowadays. I'm pretty sure I know what they would have said, putting pages to sleep and then putting them in, taking them off the table and putting them in a canoe full of ice water. That sound reasonable to you. But it shortened the period of profusion cooling and it worked pretty well. It's a little cumbersome. Yeah, it's a little little cumbersome. But again, I, as I said a few weeks ago, um, I think that this really opened up an entire field of disease management that really didn't exist beforehand, at least if it existed. It didn't exist with very successful outcomes. So this is a, You know, I don't know. I think you're looking at the top 10 contribution and cardiac surgery in terms of impacted lives. Oh, it's very calm on. I think it's somewhat helpful. Yeah, I think it's pretty uh remains the mainstay of treatment of of a of a category of disease and cardiac surgery. So I think that's pretty good. And of course you continue to publish all during this time and continued to focus on on protection and ran that lab all the way through, didn't you? You really stayed active again. It was the old old school where you really had an active laboratory, your entire time. You had an active practice here. Well, it was that was something also that I took away from some way that there are a lot of problems that can be approached in the animal laboratory. And uh, I think that was one of the things that was most helpful to me during my career was the, the ability to go back and uh, to see a clinical problem and to see possible solutions that could be tested in the laboratory. Uh And the other thing randy was your, you know, you really did continue to follow the patients. I mean, you really didn't have a very, you know, I think that was another message from the old days at stanford that, you know, you can do um pioneering work. But if you if you're out there on the edge, you really need to follow the patients and report the outcomes. I just do the procedures. I think that was something I always admired about you is that you're really did publish a lot of series. Not by the way, not always with the best outcomes. The point was that that was punished publishing honest outcomes. Well, I I would agree. I think that uh, many areas of medicine still, you know, a tremendous amount about the immediate outcomes and not so much what what happens years later. And I think that's I don't know whether the era of big data is going to correct that. But uh, one of the one of the problems is that we encountered was it's hard to find support to do that, you know, to follow patients for years afterwards costs money have to hire people to contact them to maintain databases and so on and good luck. I'll never get any money for that from the NIH or anything. It's just not very exciting. Uh And to some extent we were able to do that because cardiac surgery generated a fair amount of money in those days and we could devote some of that to following the patients. But I think it's really important message that for young people that when you see things being done, you know outside of the um you know outside for example um I remember for an only started to do try customer appearance. This devices or mitral valve repair and assist devices which at the time was not really being done. I think your obligation is to Yeah TED do it 10 or 1520 times and the reported, I mean what good, bad or otherwise. So I think whenever you take on something new you've got to do that. I think you certainly perpetuated that and left. That's one of the many things that you left us here. You also did a couple of other things. You never have an original idea, everyone. So the micro conclave was such a great idea actually. It really was a great idea. I just followed your lead because another thing that you did really which was transformational at the time was to have a focus meeting on aortic surgery and really bring the world together to talk about it every few years. That was yeah. I mean I have to you know steve Landesman was the guy who really came up with the idea. I mean I recognized it as a great idea but I have to give credit where credit is due. But it was you know, I think you have found with the micro conclave that uh if you put together a meeting that where the focus really is in communicating information and you know trying to teach other people how to do things and learn how other people do things. It really sort of goes pretty well and and randy also, you know, I don't think we can underestimate because of course we have a really flourishing transplant, this this program here. Um and that was something else that really the groundwork you helped lay here with your with your we had kind of a rocky start as you know, we did the first heart transplant of Mount Sinai, the Commissioner of health, didn't feel we had the proper consent from him to do that. Uh the Ceo Chief of surgery Arthur Analysis and I were all three asked for our resignations by the board of trustees, which we submitted because it did result in a lot of publicity and bad publicity, fortunately the patient needed the operation and he did well. Which kind of what some of the venom. But dr Alsace and I got our reservations back in a couple of weeks and the Ceo didn't he had some other arguments with the board of trustees, but but he lost his job over that first heart transplant. It was a very nice guy. Jim Glennon was his name. I remember going to talk to him afterwards and said, you know, I feel terrible about this here. You helped bring me to Mount Sinai and supported me and so on. And I we did this transplant. You've been fired. And he said, well, randi, he said you shouldn't worry too much. He said if you work for Mount Sinai for all of your career I doubt that you're going to make as much money as I'm getting as I'm making by getting fired by mounts on. So well thank goodness they didn't have goodness. The commissioners were a little more relaxed in California. Wouldn't have had the trans fat transplantation at all. So no um you know randy, you obviously built an incredible department. I really like this picture because you know we all stand on the shoulders of the people that came before us and I think that's absolutely true here and all of us that enjoy working in this department right now are so grateful to you and the foundation that you laid here which you obviously didn't. You can see that the group had grown quite a lot from Just You and Aaron said over the years and then dr Litwak and for those of you that don't know Doctor Litwack, he's right here, we could do this, we could have another, it's the part two of this and just have dr retail doctor Litwak stories. But we had to move on. But I think it was a really incredible, incredible run and I'm sure that picture brings back a lot of good memories for you, randy. I think the other thing I'll just mentioned everyone on the college, the the, you know, the, the incredible privilege it is to work. And again, recognized the giants. They're really laid a foundation here and here. Here's a picture with garland and dr Fuster and you randy. And I think it was, you know, even then that's pretty heady stuff, that's a pretty uh I'll put that triumphant up against anyone's, anyone's threesome for sort of a foundational, you know, group of leaders to try and follow in their footsteps. Must have been a lot of fun too. Have that group together in those years, you know, pretty challenging colleagues. Yeah, I think you're, I think the other thing that your career proves, and I certainly say that with mine and my current group of uh colleagues is that it, if you can hang out with really smart people, that's generally very good. That's true. And I think, I think, I think your career certainly is a testament to that. Um and I hope mine will be as well, but this is a pretty, I think pretty impressive picture. Well, randi before we stop, we just gotta get we'll do one more thing, and that's talk about this these this boating hobby of yours. And tell us a little bit about that. How did you get an inkling that you like to be on the water? When did all that start? Well, I actually started when I was early in residency. Uh and uh even I just got married. I think she said, you know, your uh you don't have any hobbies, you know, you sort of work all the time. Kind of a boring person. Uh So she bought a little sunfish, a little sailboat and uh probably the only really major bad decisions she's made during her life because uh I got very interested in sailing and uh we've done a lot of it over the years. Uh and I still have the sailboat now, that picture of here, this is, this was built in South Africa and uh and I sailed it back the same year that you came to Mount Sinai continue to sail it. That looks like a real boat. It's a real boat. It's a pretty fast boat and it's pretty strong boat and it's gone through some pretty serious storms in it without. I was gonna ask you that if you've been, I bet you've had a couple of exciting moments between South Africa and north America. You know that And sailing to and from the caribbean, there's occasionally to hit some rough weather. Uh And uh it's a little humbling. Uh I like this picture as well randi this sort of, I I can see why. I mean if if there if it involves these sorts of contraptions that I guess you do like sailing. This is probably nobody will ever have a picture like this again. GPS does away with all of this. Oh sure. What are you doing here? Andy this is taking a sun site to determine position by celestial navigation. Its principles are pretty straightforward. It's a lot of tedious calculations and so on. But it's amazing you can get within two or three miles of where you are anywhere on the earth. Just by with a sex isn't such as this and an accurate chronometer. Well, well yeah, randy. What I uh what what a journey. And we're so grateful to you for doing Sharon some of your life story with us today. You've obviously had a career that's uh Not going to be emulated too many times. I've picked a couple of highlights I'm particularly proud of. One. Was this one um in 2019 when you received the Lifetime Achievement Award from the 80 s. That's actually a hard one to get. Um they don't get that one out every year. And I can. The people that have won that award are really the, you know, the Mount Rushmore is of the business. So I'd say that was a pretty a real testament to what your peers think about your leadership in this specialty. It's like you and I think the other one that I'll mention that I'm particularly proud of is the fact that we now have a Mount Sinai Randall B Greek professorship here and Mount Sinai and Anish Mall Al Homsi is our first greet professor. But you're, you will always be remembered now here, Eddie long after we're all going because that professorship will really enduring is really a testament to what you've done for all of us through your leadership and I'm extremely grateful to you. You were just an incredible friend and supporter of mine, my for my first several years here and I always remember those those contracts, they kept getting smaller everyone and then finally they were one year contracts and I keep trying to talk him into staying and he kept saying I'll stay one more year and I'll let you know next year. And um, you were an incredible, um, Incredible influence for, for me and also just the legacy of what you've done here. And I must say that I don't think we'll ever have a guy like Zoom. We only have about 50 seats in our conference room and we had 80 people this morning. So I think this has been actually incredibly a real testament to all the, all the friendships and all the people that respect you here now and continue to do that. And we're just so grateful to you for spending this time with us this morning. Thank you very much. It's a great honor to be the first one in your series. Well, we will there. That was an easy choice I think. And I think that you're your discussion with us today really, really validates having you be our first first legend. So I'm really appreciated that. I'm also really grateful to the time that you spent with venus. This is, uh, you know, something that's really meaningful for us and we've recorded this and we'll have this to share with for many years to come. So we're really grateful about that. Thank you. Again, David. Hey, listen, I wanted to, it's 906 We have a couple of minutes. I don't know whether anyone wants to say anything or not and if not, we can leave, but I'm gonna open up the floor for a minute, which is why not zoom. Yeah, this is julie Swain. Hey, randi. And let's see. I gotta think. Here. There we go. Hey, okay. So is Eva there we want to see. Eva. She's here. I don't know whether she wants to come on down. Yeah. We really appreciate the history, great interview, David and just fascinating, fascinating stuff, randi. Yeah. Well, you know, I'm glad you mentioned Eva. Because I think, you know, one thing that I neglected to mention was the support that Eavis provided in laboratory all these years that uh only only the fellows and so on, know how many of the papers that came out with them as first author were actually written by a doctor. We've agreed. Yes. I remember that too. Randy. The shadow writer. That's right. And how many of the great ideas in the laboratory and shepherding through or uh the collaboration with Evil over the years. So very important. Who you pick for your spouse. Mhm. Yes. Good morning, Dr Greene. This is S mail. Thank you so much for taking the time this morning. I really, really enjoyed this conversation and I think we learned so much from, from everything you mentioned your contributions. Of course, the only question I have for you is you know of course over the last hour we saw on the highlights that it seemed like a very straight trajectory of what eventually became a very successful career from the beginning. But if looking back, if there were anything that you or any advice that you would want to impart with us and things that you perhaps would do differently or or things that you learned over the years that you would approach in a different way for the younger for the residents and the younger faculty on the on this zoom call, that would be I'd love to hear more about that. Well, you know when your when your memory starts to fail, the first thing you forgot it is all the failures. Uh huh. And the bad outcomes. Oh uh That's a hard question to answer. I think uh you know the first heart transplant that we did at Mount Sinai was a serious mistake in uh and how to work with uh with a system. You know it probably delayed the institution of the program by a year or two. It probably could have been avoided by by thinking a little more carefully about the impact that would have had on other members of the department or of the institution preparing the ground a little bit better. On the other hand I think there are things over the years that I have. I can't think of specifically that I didn't do because I was low bit hesitant and I suspect that some of some of those things uh you know we're worth doing. It's difficult to to try and do new things. Um But I think if if you can convince yourself that it's the right thing to do and you're doing for the right reason, one should move ahead uh without necessarily achieving consensus with everybody around you. Come on. Uh I think the one of the things that I had available to me over the years uh was the presence in the laboratory. Many of the things that we did, there were somewhat innovative. We'd work out pretty well in the animal laboratory first, and that was a tremendous source of, I think, oh, um, peace, if you will, and that we were doing the right thing, that we had some evidence that this could be done. And we weren't we weren't doing human experimentation without any, um, basis in previous word, that it was that was likely to be successful. So I think, you know, one of the things that I would say to young surgeons so on is you know, look for problems that need to be solved and look for problems that you can think of, other ways of solving them or accumulating information about how to solve them without action, just jumping right in to a new operation concept of disease. And so uh I think there are many things that Can be worked out in the experimental setting 1st. And I think it's it's very helpful to surgeons to do that. It makes life much more intellectually rich. Um and I think that work between laboratory or bench if you will and the operating room is still open, needs to be utilized. Thank you. Okay. Yeah dr grape, Dina and Agnes Topless. Oh my God, how are you? Had a little more than 40 years from the time I was at the universe Chicago. And then later when we tried to recruit your wife at stony brook. But I wanted to add something that perhaps is not known, which is that later on in my career, I needed help and you gave me that help. And I'm recognizing you for being a very just person. Thank you. You're very welcome. Well, randi, we, we all so much enjoyed being with you this morning. Thank you so much for doing this for us. Very welcome. David was extremely, it was extremely, extremely meaningful. I'm getting a lot of text saying how, how meaningful this really was and I really, really appreciate you doing this and we really appreciate all you've done for all of us here right now, we continue to uh, as I say, playing a team that you really set the foundation for. We're really grateful for that. Well, it's very gratifying to see how well the department has done over the last decade or two. It's and pretty amazing. I think we had a good start, but the time has been passed and you know, to run a long letter. This will make one last comment randy. And that was about your discussion today. I think that this really reminds me of yeah, message we have to preserve. Which is this intellectual curiosity. I mean, I think that, you know, cardiac surgery is a field that where where we can get so caught up in the clinical side that we forget about the the document, the intellectual side of it and the documentation of it and also just the creativity and challenging dogma. And I really believe in that. And I know you believed in that. And I think this was a real, you know, this conversation really motivated me to go back and think about that again. I think it was extremely, extremely useful for all of us to be here this morning and we really are grateful to you. Okay? Give our best to even randy, stay safe. We'll see you soon. Okay. Very much. Thank you. Bye.
