A November trip to Chicago served as the culmination of an elective cardiology sub-internship I would later recognize as a turning point in my medical training. It was my first time attending the American Heart Association Scientific Sessions, and in 2006, I anticipated discussions of drug eluting stent safety, and results from the Open Artery Trial (OAT) assessing late angioplasty for occluded infarct-related arteries. Actually, the highlight for me took place just prior to the opening plenary session, as I watched Professor Eugene Braunwald address a crowd of trainees with a precursor to his lecture on “Adventures in Cardiovascular Research.”
Now a cardiology fellow at Brigham and Women’s Hospital, I have since had the privilege of interacting with Dr. Braunwald at our own Fellows’ Reports. I have heard him retell the story of the advent of transbronchial and later transseptal cardiac catheterization; of defining the natural history of severe calcific aortic stenosis prior to the adoption of widespread surgical intervention; of the dramatic discovery of “functional aortic stenosis” (now known as hypertrophic obstructive cardiomyopathy) in a young patient in the operating theater; of the realization that carotid sinus stimulation not only alleviated angina, but normalized ST segment elevation in a patient in the throes of MI, leading to a revolutionary idea in thrombolysis…
The narratives are extraordinary. Speaking in a low rumble, he is crystal clear, careful to identify events by the proper chronology, and to give credit to co-investigators he mentions by full names. He refers to his colleagues and their collective scientific legacies as his intellectual offspring. He emphasizes the importance of focusing on big questions and the act of choosing a mentor as the single most consequential career decision one can make. He peppers his stories with personal anecdotes of unlikely collaborations started at the taxi stand, or over dinner at the local housing complex of the former National Heart Institute. And then he goes on to summarize “ten tips for a successful career in translational research.”
Effortlessly, he continues to command a crowd, bringing together generations that include visiting students and longtime disciples. We listen in silence, amazed and delighted by the old stories. In them, cardiology as we know it comes to life. In our minds, we contrast the world he depicts with the more familiar hospital wards and research laboratories of today. He recounts how, at my age, he became Chief of Cardiology, and not long thereafter, Chair of Medicine. He talks of the nonexistence of investigational review boards or of informed consent. At its simplest, there was an observation. And from that careful observation, there were possibilities.
Bearing witness to these stories is invaluable. For me, these experiences provide context for what we set out to do everyday in academic cardiology. There is little more powerful than hearing Dr. Braunwald tell of a difficult time, then watch him light up as he describes how a perceived mistake blossomed into discovery. It provides a humanizing and inspiring complement to reading about his latest successful randomized clinical trial.
As many of us wrestle with the future of academic research in an era of constraints, his words provide perspective. Trainees of my generation grew up with the ideality of the academic physician-scientist as the “triple threat” master clinician, scientist and educator. Listening to Dr. Braunwald, I am reminded that this construct is actually relatively new, matured over the last half-century with the advent of hypothesis-driven research. This opened up an already rich world of clinical observations to even richer possibilities afforded by the ready path from bench to bedside, and back.
These days, it can be difficult to maneuver the wards or labs of academic institutions without daily reminders of the growing demands and all-consuming complexities inherent in modern clinical care, scientific research, and post-graduate training. In an increasingly scrutinized clinical environment that values volume, and in the future, outcomes; an increasingly competitive research environment that rewards big science while remaining vulnerable to political volatility; and an increasingly strained training environment that defaults to longer, specialized tracks while simultaneously limiting hours and hands-on experience, many are questioning the viability of the path to “triple threat.”
But as Dr. Braunwald notes, much as the concept of the academic physician-scientist evolved before, it is evolving again. The profound, perhaps inevitable changes underway are providing new opportunities for creative thinking, including better utilization of available resources by forging new collaborations to approach existing challenges. As he hints, the thrombocardiologist of the twentieth century is becoming the diabetocardiologist of the twenty-first, and so on. Opportunity is here, and those that persevere in novel ways, guided by an inner compass grounded in promoting health and healing patients, will make important contributions.
And therein lies the value of activities like Early Career Day. It is through these kinds of programs that I have had the opportunity to interact informally with the greats of our profession, to hear from thought leaders in unconventional forums as they share a bit about their experiences as they happened, with sometimes surprising result. These reflections are critical for fostering context and confidence, a sense of possibility, particularly beyond the confines of any one local institution. It is easy to underestimate the impact this can have on trainees.
Back at McCormick Place later that Saturday, I watched with pride as the second-year fellow with whom I had worked as a medical student presented the case of a patient with an unusual manifestation of amyloid heart disease for the Laennec Clinical Cardiology award; that fellow would later become my attending and research collaborator. It was the first time I felt I was part of a cardiology community. And it was inspirational.
Dr. Taqueti is a member of the American Heart Association's (AHA) Membership & Communications Committee, Clinical Cardiology Council; this viewpoint is adapted from her volunteer activities with AHA’s Connections newsletter.