In March 1982, Dick and I started coronary angioplasty using a fixed balloon that had a 5-7 % chance of failure leading directly to emergency by-pass surgery, sometimes performing CPR all the way to the OR. I never would have been able to withstand that stress alone. I credit Dr. Allen for our sustainability, keeping our acute closure rate to 3 % with less than 1 % mortality.
Over-the-wire balloon technology was developed in 1984. We started performing acute balloon angioplasty in myocardial infarction patients. This procedure occurred years before stents became available. We performed those procedures individually because we were on call every other night for this procedure. I clearly remember multiple cases where Dr. Janet Smith or Dr. Terry Henkel would arrive at Audubon with an acute MI patient. I would walk in the room to start the procedure, and they would stay for the entire procedure: one, for emotional support, but more importantly, to take over medical care of the patient so I could concentrate on the procedure.
I truly saw three minds were better than one.
That first week, Dick Allen told me he always ruled out four potentially life-threatening diseases when seeing a patient with chest pain and a normal EKG: dissecting aneurysm, pericardial effusion / tamponade, pulmonary embolism and pneumothorax. The importance of ruling out these diagnoses clinically was the fact there was no access to rapid diagnostic technology: no echo and no CT angiogram. We had only angiography. During the first nine months of practice, like all cardiologists, I encountered many patients with chest pain and a normal EKG. However, I attributed the diagnoses of three patients to using Dick’ s rule out criteria. The cases included an aortic dissection with a very unusual presentation; a pulmonary embolus with minimal but recurring shortness of breath, and a case of pericardial tamponade in the ER resulting in bedside pericardiocentesis.
Even though I had performed the required 125 cardiac catheterizations for fellowship, all but five to six the procedures were completed using the femoral technique. I was shown the brachial artery technique at Georgetown, using the classic interrupted stitches to close the artery. Bob and Dick taught me to place a purse string stitch in the adventitia prior to the catheter being introduced and simply close the purse string at the end of the case. The advantage to their technique was better control of bleeding, not compromising the vessel diameter and improving efficiency.
As the first female to join the group, Jan set a very high bar for herself. Starting with her first pregnancy as a CVA physician, she traded call with her partners during her pregnancy so that while she was on maternity leave, her call was already covered. Not once, but four times, she generously accounted for her night call with each child. While times have changed, with more women in medicine, challenges around pregnancy and maternity leave continue to face women in medicine. Jan was an early trailblazer for women in cardiology, also focusing her care on women’ s cardiovascular health.
Throughout those early years, I felt supported by the physicians at CVA. They also became my friends. Dr. Henry Post and his wife invited Emily and me to their home our first weekend in Louisville. We went to Lakeside Swim Club before we ate dinner. While Emily and Angie spent time getting to know one another, Dr. Post informed me he knew I had run the Marine marathon in 1978. He asked if I knew how to swim.“ Please,” I thought,“ a 57-year-old man asking a 32-year-old runner if I could swim.”
Ten laps( 500 meters) later, I climbed out of the pool totally exhausted. I sat there while Henry completed his one-mile swim without effort. I found out later the one-mile swim was almost a daily routine for him.
A few weeks later Henry invited me to play tennis on a Saturday morning. Since we both lived in the Highlands, I was told to meet at the Bellarmine courts at 8 a. m. As I pulled up in my car, his first words to me were,“ Why did you drive?” The message was clear, ride your bike.
After retiring at age 65, Dr. Post joined Dr. Jerry Lacy, other Louisvillians and myself climbing Mount Ranier. At age 40, I was convinced I could match his physical feats on this trip. On the third
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