Solving the Mysteries of Heart Disease

by Gerald D Buckberg

  Essentially, nothing has changed in 20 years!

  Only a few minor enhancements have occurred in the treatment of sudden death patients. The protocol is nearly identical to what it was two decades ago. This lack of growth and progress has been nothing less than stunning.

  I have not let this rejection stop me. I and others have continued to publish papers. We have conducted additional clinical studies with nearly identical results in 34 patients, with patients undergoing an average of 72 minutes of CPR before our treatment successfully brought them back to life.

  We have applied for grants for further research based upon our outcomes. They have not been forthcoming. In fact, we were told by the National Institutes of Health reviewers that our findings were “not significant” — even though no one, either nationally or internationally, had ever achieved such a consistent reversal of an injury that was considered lethal.

  Only my travels around the world, training surgeons and perfusionists one at a time, has advanced this new approach to sudden death. Why? It turns out that leaders in the medical community in positions to influence change… don’t always like to consider new methods. This rigidity also results from an unwillingness to consider an uncomfortable premise: that presently accepted conventional approaches — fail many patients.

  This chronic obstruction to progress is not limited to my work on sudden death. It happens with most of my clinical discoveries. Throughout my long career, we have introduced what should be remarkable and historic shifts in thinking about major cardiovascular issues — in managing heart attacks, sudden death (and possibly stroke), congestive heart failure, pacemakers, the relationship between a heart’s structure and its ability to function correctly, and others.

  While some of our breakthrough discoveries have become widely implemented, many others still have not.

  Truth remains truth, yet I have learned firsthand over these five decades of research and practice, that willingness within the general medical community to adopt truly innovative avenues of treatment… is startlingly rare.

  Different Perception

  There is no demand for change when one perceives what they are doing as successful. If we can now save 15% of people from sudden death, that’s a considerable improvement from when it was 10%, and many feel that this “50% increase” in survival reflects a fine contribution. I don’t disagree, but my point of view is a bit different: how do we address the 85% of sudden death patients that die because of our present approaches?

  People like Connie are the exception: someone who is willing to listen and leave the comfort zone of repeating yesterday. Yet instead of being hungry to explore new ideas and methods, too many of our colleagues follow entrenched patterns that lead to well-known, yet unacceptable (to me) outcomes. Such rigidity leaves our patients at risk of suffering the limitations of conventional treatments.

  It comes down to a choice: embracing scientific inquiry, or maintaining a steadfast adherence to traditional ways. Perhaps not a momentous problem if this was simply an academic debate. But lives hang in the balance. From my point of view, when people can be helped, you do whatever you can to save them. Especially if there have been proven results.

  Phenomenal Quest

  Despite all this, I remain optimistic. Our profession has the marvelous opportunity for each practitioner to gain pride in helping others by facing the imperfections in our current methods. Understanding flaws in the process now leads us to ask the next questions and steers us toward finding their solutions. This is the nature of growth.

  We must recognize that the attitude of remaining content with past successes can quickly turn into a barrier to future growth. A balance must exist between welcoming the positive achievements of standard treatments — even when they may help 95% of the population — while simultaneously asking why the other 5% are not benefited. Acknowledging that we fail in those 5% creates a stimulus for future progress.

  The nature of life is motion. We can witness this by looking out at the world… or peering deep inside ourselves to understand why our heart might fail to perform its assigned tasks. Any form of stagnation — even when fueled by self-satisfaction — opposes natural evolution. Our medical education must always continue to progress.

  How lucky I am to have been taught by some of the greatest minds in medicine; to be given the opportunity to conduct leading-edge research on some of the most debilitating and prevalent medical conditions known to man; to travel the world and share ideas and solutions with other professionals… and now with the general public.

  This is the story of a kid from the Bronx who just wanted to be the local dentist, but through a series of fortunate events, encounters, and lessons, became a passionate contributor to cardiovascular research and surgery, touching the lives of many. While not all of my discoveries have been utilized to their full potential, that has never slowed me down. There is always so much more to learn and do.

  As you read this book, you will realize that we have found practical and effective answers to many of the most pervasive and serious heart ailments that I described in my introduction. The upcoming chapters will reveal that solutions exist, but they have not been used — despite their initial and successful applications with patients from around the world.

  I am confident that these ideas will succeed because the truth will win… but when?

  CHAPTER 2

  A Series of Fortunate Events,

  Encounters, and Lessons

  I have been curious for as long as I can remember. But my early observations and pursuits aimed more toward art than science. I loved to draw.

  I had no problems in school, so I was surprised when summoned to meet the principal of my public junior high school. Having no clue about what I had done, I was completely caught off-guard when he grinned and said:

  “You’re doing very well here. We’d like you to go to Science High School or Stuyvesant High School.”

  These were the two premier high schools in New York and to be encouraged in that direction was quite an honor. So what was my answer?

  I wasn’t interested in either, since I did not care for science. I just wanted to play basketball.

  In truth, I did have other ambitions. I’d grown up in a lower middle-class environment in New York’s Bronx. Life wasn’t easy for most families and I saw you had to work for everything you got. So I would take jobs at different neighborhood businesses: the tailor shop, grocery, vegetable store. I delivered packages from the meat store. As I got older, I’d work summers as a busboy and waiter at lodges in the Catskill Mountains in upstate New York to make money for college (while playing basketball in my free time). I paid for all of my education myself.

  I believed I would earn my future, rather than expect it to be given to me. I didn’t want to rely on anyone else. In fact, I always wanted to be independent of other people. I wouldn’t learn until years later that this was the wrong goal. My life would never be independent, but rather interdependent.

  During my youth, I looked and found only two in my world that seemed truly self-reliant: my doctor and my dentist. Respected. Professional. Comfortable. Autonomous. That was what I wanted most. So when it came time to make a decision about my future, I consulted with both men. Unexpectedly, it was my doctor who advised dentistry, suggesting that path would allow me to achieve my aims with less work.

  So as a teenager considering college, my decision to pursue a profession in the health sciences was hardly altruistic, but came simply from my desire to be self-sufficient. I became a pre-dental student at Alfred University, and then, during my sophomore year, transferred to Ohio State University to continue my studies.

  Alas, my time in dentistry was short-lived.

  In fact, all it took was one visit to the dental lab with my cousin Herb Urell, who was already in Ohio State’s dental program. As I watched him grinding and drilling on a set of model teeth, I quickly realized this was not how I wanted to spend my next eight years in school, let alone an entire ca
reer. Suddenly, I didn’t know what I would do.

  Fortunately, I found my answer the next day during my first class — in zoology. The teacher presented a lesson on the organization of the cardiovascular system. A red dye was injected into the blood vessel system of a frog and the sight was unbelievable! I still remember sitting in the lab, looking at the inside of the frog and thinking, “My God, this is beautiful. It’s so organized. Artistry in nature.”

  At that instant, I realized, “I’m going to be a doctor.”

  This lovely visualization of the arrangement of the blood supply, its graceful balance from side to side, the blood nourishing all the organs in an elegant way stoked a flame of curiosity that burns even brighter today.

  I fell in love with the heart.

  So my goals changed by my sophomore year in college. Self-sufficiency was not going to cut it as my primary ambition. I also needed to be thoroughly interested, highly engaged, and willing to be challenged. I was going to be a cardiologist.

  The Investigator

  Applying to medical school was an education in itself. Each applicant visited different institutions in the hope that this personal appearance would help them in the selection process. Interviewers frequently would ask what we were reading. I always cited The Cry and the Covenant, written by Morton Thompson.

  It described Phillip Semmelweis, an Austro-Hungarian physician who worked in a maternity ward in Budapest in the 1800s, and focused upon his discovering why women were mysteriously dying of “childbed fever” after giving birth. He observed this almost always happened in women whose babies were delivered by the doctors in the hospital. In sharp contrast, almost no deaths occurred in women whose babies were delivered by midwives at their homes. Naturally, he wondered “Why?” He reasoned that better results should be expected in women whose babies were delivered at hospitals.

  He realized that after the doctors delivered the baby, they would go across the street to the autopsy suite to examine bodies of the women that had died the day before. The doctors then returned to the hospital to deliver more babies.

  Germs were not a consideration in health care yet. But Semmelweis wondered if the doctors could be transmitting the infection from the dead women to the live mothers.

  To test this, Semmelweis had the medical students and interns in the maternity ward wash their hands between patients. Miraculously, the women whose babies they delivered immediately stopped dying.

  The answer was simple. He told the doctors to just “wash your hands.”

  Imagine the reaction of these leaders of medicine, who consider themselves to be titans, after being told they were responsible for this spread of childbed fever because they transmitted a lethal infection due to their dirty hands. Their reaction was immediate and fierce. They became infuriated and castigated Semmelweis.

  He had the truth, but no one was listening. Sadly, he spent the rest of his life trying to make others aware of this correctible cause of a major disease, but to no avail. He ended up dying without ever knowing he was right.

  Truth eventually won out. Germ theory and general cleanliness guides physicians’ actions today as they move from one patient to another.

  His story impacted me. I was stirred by the beauty and majesty of the creative discovery, and was saddened by the opposition to such truth, and stunned by the reaction that created barriers to believing such a simple and straightforward solution.

  I thought, “How could this be?”

  Little did I realize that this classic issue confronts any new idea that may change conventional thinking. The innovative path toward discovery is often challenged by initial rejection, yet my pursuit of such truths would become the motivation for the journey I would take during my next five decades of my medical career.

  A formidable journey that was first set in motion when I entered medical school.

  First Failure, First Lesson

  The challenges started as I took my initial anatomy test at the University of Cincinnati College of Medicine, which I entered in 1957.

  I had learned the material backward and forward. I was confident. So when our papers were handed back, I was aghast to see the big “D” on my test.

  It was the first-ever D of my scholastic career. In my chosen field of study! I was shocked. Destroyed. I thought my medical career was over. I walked out of that class in a daze. Everything I dreamt about was not going to happen.

  I went back to my fraternity and didn’t tell anyone what had occurred. I just sat alone on the back porch staring out. Other fraternity members were going about whatever they were doing, talking with each another, laughing, shouting. None of it mattered. They could’ve been a million miles away. I heard nothing they said. I was in my own world, and not a very pleasant one.

  How could this happen to me?

  I tried to calm myself and look at the problem. How could I fail when I always worked so hard? How did I get a D in the very subject I wanted to study? I was an A student.

  I didn’t screw up because I was stupid. That much I knew. What I came to realize is I didn’t truly understand what I had studied, and I did not recognize what was really being asked on this test.

  That’s when I had a realization.

  As I looked out from the porch, a new understanding began to form. I had memorized specifics about each and every artery, vein, muscle, joint, and nerve in the body. What I had failed to understand was their inter-relationships. The body is a whole, and my trying to separate its components by aiming to become an expert in each piece would never replace the importance of understanding the interactions of one part upon another — the hallmark of their relationships.

  It became an epiphany that would change my life.

  It was here that I first began to realize that the real objective was interdependence. This process existed within the body — and between those with whom I would study, work, and explore the riddles of medicine.

  Yearning for Learning

  The irony is the distress caused by my early failure on this exam simultaneously introduced another critical lesson, one that has served as a fundamental guidepost during my entire professional career. As I would learn from many of the great minds that I’d come to admire, failure is not the end, but rather, only stimulates the next beginning. You cannot be afraid of it. It is one of your greatest motivators.

  I compare this process to ascending a mountain that represents education. Every mountain has a series of peaks and valleys, and what educators and practitioners must decide when one peak is reached, is whether to remain self-satisfied, relish the success of overcoming this peak, and look down at other climbers… or to take advantage of this privileged vista and look upward to see the next peak that is not apparent to those still in the valley. Pursuing the latter means creating a plan to descend into a new valley, and a willingness to do the hard work needed to reach the subsequent peak.

  That lowly D surely placed me deep in the valley, but I now understood what it took to reach the mountaintop: never giving up, while welcoming the next unanswered question. I was going to climb to the peak, and eagerly look for the one that would follow.

  I was developing the mind of a researcher.

  This newfound appreciation and dedication to learning served me well, as both my grades and my understanding of the interconnections of the human body greatly improved. I was a hard worker, nearly always studying till midnight or one in the morning. My drive was never for the grades, but to solve whatever problem presented itself. By the end of my second year in medical school, I could easily see myself as the cardiologist I first envisioned when I dissected the frog.

  Yet another revelation would be coming my way.

  New Direction

  As a result of my new outlook, I was particularly excited to be taking a summer fellowship in cardiology (a fellowship is a period of specialty training).

  During one of our rotations, my fellow student cardiologists, faculty, and I were faced with a patient who was believed to have
narrowing of the aortic valve (called aortic stenosis). He was being evaluated for chest pain and early signs of heart failure. The role of our cardiology team was to confirm this diagnosis.

  We were to do that by first placing a blood pressure measuring tube into the main artery (aorta) that distributes the blood throughout the body, and then through the aortic valve into the left ventricle (one of the two ventricle chambers in the heart, which fills with blood and then contracts to pump it into the body). From these two measurements, we would be able to establish the difference in pressure between the aorta and ventricle chambers — and determine if the patient had narrowing of the aortic valve.

  A catheter (a small flexible tube through which we can give or withdraw fluid, or slip in an instrument) was to be inserted through an artery. It would be aimed toward the heart and then pushed past the heart valve into the ventricle. We spent two hours trying to traverse that bulky valve and it was simply not possible. So we called in the cardiac surgeon.

  This was all foreign to me. Up until this point, I didn’t know anything about heart surgery at all.

  The surgeon came in, thoroughly proficient, full of assurance. We told him what we needed to know. He simply nodded and confidently began.

  “Give me the alcohol sponge. Now give me a syringe with a needle on it.”

  He anesthetized a small spot on the chest and easily inserted the needle directly into the left ventricle, connected it to tubing to measure and record the pressure, and confirmed the diagnosis — all within a minute!

  It was so simple that it was unbelievable. He knew what the job required and went about it immediately and efficiently.

  Yet the most impressive event occurred the next day, when he joined our discussion of this case in the cardiology / surgery conference. To my astonishment, the cardiologist and cardiac surgeon seemed to have an equal understanding of the disease process and its management. Soon after, I attended the operation on this patient, my job being to watch the blood pressure on the recording machine while I observed the surgeon performing all the steps needed to correct the narrowed valve.