Reflections on 7,000 Operations and 25 Years as a Surgeon

The following essay appeared in The Morning Call Website Opinion Page on Sunday, November 19, 2017

It’s hard to believe that so much time has passed. After 4 years at Muhlenberg College, 4 more years of medical school at the University of Pennsylvania, and 8 years of residency at the Thomas Jefferson University Hospital, I’ve now hit the milestone of 25 years in surgical practice and 7,000 operations at Lehigh Valley Health Network. It feels like yesterday that I was the new guy in town. And now today, the new recruits look to me for advice –the kind of sage advice that only experience and perseverance can provide.

My reflections are naturally bittersweet. Like most, I tend to dwell more on my mistakes and the things I wished I could have done differently. I think about the missed opportunities and the times that I was too cautious or too bold. The road has been long and demanding, full of speed bumps and challenges. There were many times that I wondered if I would make it through. And though I’ve persevered, my heart still knows little rest. In the quiet of night, I often think about the patients I could not save. Their memories remain with me, along with the emptiness of knowing that my best just wasn’t good enough.

One such patient is Trina Green from Ashland, Schuylkill County; her picture remains on my desk. I met Trina shortly after her 40th birthday. Just one year prior, Trina was diagnosed with breast cancer. She had undergone what was believed to be curative surgery, but sadly, the cancer returned, having spread to her lungs. Unfortunately, there was little I could do surgically. Trina was an avid Phillies fan, like me. Prior to her passing, Trina enjoyed one last Phillies game, sitting in my seats at Citizens Bank Park. The photograph on my desk was taken at that game, showing Trina so happy, as if she had not a care in the world. Her effervescent blue eyes sparkled with joy, as she cheered on her Phillies for the last time. Her memory and those beautiful eyes still haunt me.

Trina Green, holding the Phillies #1 sign, enjoying one last Phillies game with her sister-in-law and best friend, Linda Duell.
Trina passed away on March 13, 2006, at the age of 42.

Yet, there is also great satisfaction and accomplishment upon reflection. Over the years, I’ve touched many lives, more than I take the time to sometimes realize. One is Mischel Satunas of Bethlehem. At 49-years old, Mischel underwent a life-saving third-time, triple-valve open heart surgery, a procedure rarely performed. Prior to meeting me, she was turned down multiple times for surgery, saying that she was too high risk and that her symptoms were all in her head. She recently celebrated her 6-year anniversary from that successful surgery and has become a spokesperson and champion for women with heart disease in our community.

Dr. Raymond L. Singer hugs Mischel Satunas of Bethlehem at the Lehigh Valley Heart and Stroke Walk at Northampton Community College, Bethlehem Township, in 2015, four years after he performed a third-time, triple-valve open heart surgery on her.

Mischel would say that a smile, a touch of the hand, a kind, but confident word to let someone know that they’re going be fine makes all the difference. Patients cherish those personal moments the most, knowing that their doctor cares for them with respect and empathy. The lesson here is simple. Treat every patient as if they were your own family.

I’ve often said that I was lucky because I came from a family of patients, not doctors. My father had three cancers before he passed away. My amazing 94-year old mother is twice a cancer survivor and had heart surgery herself many years ago, and yet she continues to fight on. I’ve sat in many doctors’ waiting rooms.

I’ve witnessed the physical impact of cancer and chemotherapy. I’ve felt the pain that comes from surgery and I’ve endured the sadness of saying goodbye to someone I love.

Treating patients as if they were your own family is the key to enjoying a long career in medicine. In many ways, it’s all that really matters. Doctors can go to the best schools and learn every new procedure, but they will never truly succeed unless they learn to treat the patient, not just the disease.

This advice of “treating the patient, not the disease” is hardly new, nor mine, but goes back thousands of years ago to the teachings of Hippocrates and Maimonides. It’s as old as the Golden Rule, “Treat others as you would wish to be treated.”

Yes, I’ve been blessed to have enjoyed a rewarding career at a magnificent hospital, living in a wonderful community, raising two beautiful daughters with my wife. I’ve worked with the same staff, the same nurses, and the same dedicated colleagues for all 25 years. I’ve said many times that the reason I’ve never left is because I know in my heart, whatever success I enjoy, it’s because of the team that surrounds me.

I hope to keep the flame burning for years to come. When you love what you do, it’s not work, so retirement is not on my to-do list for now. Besides, I rather be in the operating room with these young, talented professionals, than chasing golf balls in the woods.

But no matter what the future holds for me, today I am filled with gratitude for my patients and their families, my colleagues and staff, and most of all, my family, for always being there for me. To all, I say with deep appreciation and love, thank you.

Link to The Morning Call Website Opinion Page Publication

Off-Pump (Beating Heart) versus On-Pump Coronary Artery Bypass Surgery

Below is a discussion of a follow-up article published in the New England Journal of Medicine by Dr. Grover and colleagues, showing favorable results for conventional coronary artery bypass over off-pump beating heart coronary bypass surgery. The same Veterans Affairs 2009 study showed similar results at one year.

No doubt, there are select times when the beating heart approach is preferred, for example, when the aorta is calcified. Most surgeons' experience, including mine, is that the conventional coronary artery bypass approach allows for more precise sewing and better protection of the heart. This would explain why the technique of beating heart coronary bypass surgery continues to drop in the U.S. to fewer than 20% of cases. I suspect it will now be used fewer than 10% of cases.

This article may have other implications. Some surgeons tout off-pump as "better" or "safer," usually under the umbrella of "less-invasive." Understandably, patients desire safer, less-invasive procedures, with quicker recoveries. In many areas of heart surgery, techniques have been developed to yield these desired results, such as trans-catheter valve procedures and aortic stents. But for patients who require multi-vessel coronary artery bypass surgery, this long-term study suggests that the beating heart technique may not be better than the conventional approach.

The most important thing for patients is to discuss all options with their surgeons. There are surgeons who have mastered a particular technique that may yield better outcomes than reported in research studies. Many excellent surgeons continue to develop better ways to improve the safety and outcomes for our patients. Ask your surgeon for his/her experience and results, no matter the technique. Patients should also research public report cards on surgeons and seek a second opinion whenever possible.

I'm grateful to our academic leaders such as Dr. Fred Grover and I'm proud to be part of the Society of Thoracic Surgeons, for their hard to improve the health and safety of our patients.

_____________________________________________________________________

Newer method of open-heart surgery carries more risks, study finds

The older method of doing open-heart surgery, in which the heart is stopped and a pump circulates blood through the body, leads to higher survival rates than a newer method of operating while the heart is beating, which doesn't require use of the pump, according to a new study. Why it matters: Coronary-artery bypass surgery is…

Team Matters

Thanks to the miracle of modern technology, I'm posting this blog from 35,000 feet up over this beautiful country of ours. I'm traveling to attend a course on minimally invasive mitral valve repair in California.

One of my favorite movies is "Up in the Air" with George Clooney. In the film, he loves being in flight, traveling across the country for his job. There is a certain serenity, a time to reflect. I agree. I find it very relaxing, one of the few times I am completely alone with my thoughts, while enjoying the view of God's work below.

Tonight, my thoughts are with my team. At the center of that team are four special women who I have had the privilege of working with for as long as I can remember --Mindy Snyder, Carol Shannon, RN, Pam Olivieri, and Lisa Garloff.

Mindy is our practice manager. Mindy is the heart and soul of our practice. Carol is one of the most experienced and talented cardiothoracic surgery nurse in the country with 35 years of experience! Pam is our office scheduler who manages thousands of patient appointments every year, somehow keeping up with emergencies and constant changes. Lisa is our O.R. scheduler, who ensures that every patient that goes to the operating room is ready and safe to proceed.

Together, they are the core of our practice. They work so hard and rarely get the recognition that they deserve.  I know that whatever success I may have enjoyed over these past 25 years, it is largely due to my team --the entire team-- exemplified by these four amazing professionals. To me, it's more than just a team, it feels like family.

Indeed, what separates our cardiothoracic team at Lehigh Valley Health Network is that we are a family. All of our surgeons, physician assistants, nurses, and staff are truly special. Patients sense this when they come to our office and when they are cared for in our operating rooms and our intensive care units.

Yes, I've been fortunate to travel far and wide for my career, as I am doing tonight. And in all my travels, I know, I'm the luckiest surgeon in the world to have the finest team at home.

"The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime." --Babe Ruth