An Approach to the Study of the Pulmonary Circulation, Albert L

12 An Approach to the Study of the Pulmonary Circulation Albert L. Hyman, M.D. Professor , Department of Surgery, Medicine, and Pharmacology , Tu lane University School of Medicine, New Orleans, Louisiana Thou shalt have no false gods before with his classical concepts of faith, moral thee! Some of mine have been godlike, ity , and justice . Here, I first came to be some stern, some even cruel, but none electrified by ideas and abstractions. In have been false. Although , like the great college came a standard platter of Ameri lawgiver , none actually walked upon the can education, food but no feast - some Canaan of the pulmonary circulation, classics , some literature, a bit of science. whether wittingly or not, they led me step Then I was off to medical school. by step in an uninterrupted path to that The war with Japan and Germany had study. First was my father , a Tulane just commenced , and the pace of medical educated general practitioner, who was education quickened, leaving little time wont to remind me of my great disappoint for concepts to germinate . Nonetheless, ment with kindergarten "because they those 36 uninterrupted months were am don't teach no doctor stuff there. " Then ple time to elevate new gods. Dr. Richard there was his father, an old-world Hebraic Ashman, chairman of physiology, deliv scholar , litterateur, and moralist , who , ered the first 20 of the daily physiology with my father, had miraculously escaped lectures. Electrophysiology was his major the Odessa pogroms. He spent most of my interest , and on e of the several phenome childhood attempting to inculcate me nan he described still bears his name. From: Wagner WW, Jr, Weir EK (eds): The Pulmonary Circulation and Gas Ex change. ©1994, Futur a Publishing Co Inc, Armonk, NY. 235 236 • THE PULMONARY CIRCULATION AND GAS EXCHANGE Sitting in on those lectures were Dr. patient back to his family and work as George Burch, himself soon to become quickly as possible. He had an enduring widely published in electrocardiography, but quiet concern for his house staff mem and Dr. Sam Levine's nephew, Harold bers , not only during their training at Levine from Boston, a well -known cardi Charity Hospital, but also throughout their ologist in his own right. The curriculum careers. He once postponed an important was rushed, and for many reasons these staff meeting because, as I learned years electrophysiology lectures were complex. later, he had gone to northern Louisiana to Moreover, we had not even studied car help reconcile a former cardiac fellow and diac anatomy. In one of Dr. Ashman's his wife . His student examinations were lectures I had failed to identify correctly always oral, straight from Cecil's textbook, the electrocardiographic appearance of and he enjoyed "helping you out a bit" atrial flutter. In a subsequent discussion, when you faltered. There was also Dr. the great electrophysiologist was far more Robert Bayley, a former cardiac fellow concerned with goading his errant student under Dr. Frank N. Wilson of Ann Arbor. into formulating a concept that would ex He, like Wilson, had a remarkable talent plain how continuous atrial electrical ac for mathematics and applied it skillfully tivity could usurp sinus node function . and often to electrocardiology. He had With my guess that a faster irritable focus devised what has come to be known as the depolarizing at 250-300 times a minute triaxial reference system. Medicine could do it, Dr. Ashman was off with a "porch conferences" (porches had ceiling host of experiments he and I could do to fans) were vibrant with clinical cardiol further test this widely accepted concept . ogy, electrocardiology, cardiovascular He suggested that we go off to his labora physiology , and the invariable "let's see tory-"Never mind the exam, there will be your data" or "can you give us the mathe others and you'll do well ." Many years matical proof." Somehow the other areas later my wife pointed out that the intensity of medicine got much less attention. and dedication I learned as a child had not Undoubtedly the foremost figure in altered, but I had substituted medical sci my early progress was Dr. John Samuel La ence for theosophy and humanism, and Due. He had done medicine at Harvard, the former had become my new "reli internal medicine at Mayo, and a Ph.D. at gion." Electrophysiology , electrocardiol Minnesota. He had only recently turned ogy, and cardiac arrhythmias were chal all of his enormous energy to cardiology, lenges that came along in rapid succession joining with Drs. Ashman, Hull, and Bay while working with Dr. Ashman . ley. With the fortunes of alphabetic stu Further along, my time at medical dent assignments and a high class failure school was largely consumed with new rate , John La Due was my rounding man icons, each with special cardiovascular all through medical school. One soon skills. Dr. Edgar Hull, the medicine chair came to emulate his penchant for thor man, was an unquestioned master of bed ough historical inquiry, complete physical side medicine and cardiac auscultation. exam, and an unabridged write-up . Before At Charity Hospital in New Orleans, pa case presentation, it was wise to spend the tients took to him immediately because he evening in the medical library acquainting knew their hometown physicians. In fact, oneself with current literature related to he seemed to know every physician who the patient's illness. If all went well, the practiced in every parish in Louisiana. He ultimate question was always, "Well, had taught most of them. His was a practi what have you read about this illness cal approach. He sought the correct diag lately?" He wasn't one to let you off the nosis to the extent possible but got the hook easily. Two examples are memora - An Approach to the Study of Pulmonary Circulation • 237 ble . As a second semester student visiting cation was with Dr. Ashman , demonstra the wards for the first time, I was asked ting that the anatomic axis of the heart , as what the "Robinson -Power-Kelper test" seen fluoroscopically, could be predicted was. "I would have to go to the library; it from the ECG taken in the same position. 1 wasn't yet in Cecil's text. " La Due smiled, La Due went on to New York , where , with "Yes, that's a good idea." As we com Wroblewski and Karmen, he was the first menced discussion of another patient, he to publish the use of the cardiac enzyme looked up at me rather surprised and (SGOT) in the diagnosis of acute myocard shouted "Now!" On another occasion, Dr. ial infarction. La Due prodded a less than ardent medical Shortly before I received my medical student to study more and more thor degree, my father's brother, a colorful gy oughly the blood of a patient with unex necologist at Cedars of Lebanon (now Ce plained anemia . On the great day, Dr. La dars-Sinai), Los Angeles, suggested I learn Due finally received all the hematologic his specialty and join him in his practice. data and asked for the student's appraisal This digression was short-lived. My pro of the anemia. "I don't know, Dr. La Due, fessor of obstetrics knew me well, having but you've had me take an awful lot of delivered me about twenty-one years be blood out of her." This was one of the few fore . He agreed to give me an obstetrics times John La Due was ruffled. residency if I would first do a rotating The experience I acquired over three internship at Charity Hospital. His condi academic years with John La Due left an tions were clear: take as many specialty indelible mark on my approach to medi blocks as I could, except obstetrics, and if cine and science. "If you don't know and I still wanted the obstetrics residency at it's not in the library, you have a golden the end of that year, it would be mine. My research opportunity," he would say. Al first assignment was internal medicine, though I worked with him on the wards, in with Drs . Hull, La Due, and Bayley as my the clinics, and in his research laboratory, clinical staff and Louis Levy, another ar it was only years later that he expressed dent follower of Dr. Ashman, as my resi any appraisal of my work or productivity . dent physician. Professor Graffagino, Un Some seven or eight years later, I saw John cle Earl, Cedars, and Los Angeles became in the lobby of the Los Angeles hotel host a pipe dream (and we used pipe cleaners ing the American College of Cardiology in those days to project vectorcardiogra meeting. He insisted that I come immedi phic loops) . It was clear, however , that ately to a private reception honoring him before embarking on a training program in upon his election to the presidency of that cardiology, it was necessary to complete group. At that reception, I was introduced that rotating internship and three more to the cognoscenti of cardiology and the years of general internal medicine . My new specialty of cardiovascular surgery as second rotation was onto Dr. Alton "one of the best damn medical students I Ochsner's surgical ward with a young resi ever contended with." The libations and dent from Philadelphia, Oscar Creech . atherogenic refreshments were lavish, and There was a new surgery , tying off a patent John had probably partaken heavily of ductus , or turning down a subclavian ar both. With Dr. Ashman and Robert Bayley, tery, to the pulmonary artery for Fallot's La Due perfected the concept of electro tetralogy.

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