Dr. Wayne Isom:
Pump You Up
A few hours after David Letterman was told to go under the knife or risk permanent cancellation, Dr. Wayne Isom, chairman of cardiothoracic surgery at New York Weill Cornell Medical Center, strolled into OR-16 and stabbed him in the heart two times -- or once more than his old network did, as Dave would say. Letterman's heart slowly deflated like a limp, yellowish balloon, and into the punctures the surgeon inserted the tubes of a heart-lung machine that, for the next hour, would do Dave's living for him. "They're controlled stabs," Isom explains. "If they weren't, they'd be fatal."
Isom heads one of the most highly regarded heart-surgery programs in the nation. His team performs some 1,500 operations a year -- he does 300 himself, sometimes four a day -- and he's unwittingly developed a sideline in TV personalities. Before Letterman's quintuple bypass, there were Larry King's quintuple, Walter Cronkite's quadruple, and Jack Paar's single-plus-double valve replacement. "He is one of the two truly great doctors in this field who have built a significant team," says Morgan Stark, regional chairman of the American Heart Association. (The other top doctor, Valentin Fuster of Mount Sinai, admires not just Isom's technique but the way he "gives significant confidence to his patients.")
While Isom, 60, credits his department's boutiquelike structure -- with its own ICU, cardiologists, surgeons, nurses, anesthesiologists, and pharmacy -- those who refer cases to him praise his bedside manner and ability to improvise mid-surgery. "He's not afraid to do a high-risk case," says Letterman's cardiologist, Dr. Martin Post. Like the feisty old guy who asked Isom for a valve replacement, even though he was 90 and had had bypass surgery when he was 70. Three years later, Philip Johnson and his new valve are doing just fine.
Isom "exudes confidence and competence," says Rob Burnett, the Late Show's executive producer. "Actually, when I saw him, I made an appointment for 25 years from now." On the night of his post-op return to TV, a visibly choked-up Letterman trotted out his surgical team for a curtain call -- but the top man was still at work. "Dr. Isom had a conflict," says Burnett, "so we had to have an actor play him, and when he was available, we shot a close-up of him and cut it into the show." For Isom, of course, it was just another bypass.
Dr. Simon Parisier:
Talking to Susan Cheffo on the phone is a remarkable experience -- the 53-year-old Long Island principal of the Bethpage Hearing and Vision School has been profoundly deaf for over a decade. But three years ago, Dr. Simon Parisier surgically implanted a tiny transistor in her ear. It was like opening a door to a new world. "He's exceptional," she says of her doctor. "He's not just a technician. He's someone who is invested in having young children and adults hear who were not able to hear." Cochlear implants transpose sound into electrical stimuli that the brain can interpret. Parisier first started working with them in 1979, but it wasn't until the past five years that the technology really took off. Last year, Lenox Hill hospital's Cochlear Implant Center, which Parisier founded, did 120 implants, some in children as young as eleven months. "Patients don't know how lucky they are," says David Edelstein, the chairman of Manhattan Eye, Ear and Throat Hospital. "He's absolutely the most consistent doctor, whether you see him at eight in the morning on Monday or five in the afternoon on Friday, and you don't know how unusual that is in surgery." Parisier's work is highly controversial within the deaf community. "They accuse us of trying to fix something that's not broken," Parisier says. "Profoundly deaf people are generally ostracized by hearing people. That's what has led to the deaf culture." Although Parisier sees the need that deaf culture fills, he couldn't disagree more with those who suggest that deafness shouldn't be treated. "Of all the handicap populations," he says, "the ones who earn the least are the profoundly deaf. They have limited educational achievements, which makes it tough to find a job. Speech, hearing, and language skills are the tools that you need to achieve an education. And that's really the goal of cochlear implants, not just hearing."
Parisier began his career specializing in head and neck cancer but soon realized it wasn't for him. "Failure in head-and-neck-cancer work means death," he explains. "Different doctors have different personalities; I didn't handle those kinds of failures very well." He dabbled in cosmetic surgery but still wasn't satisfied. Finally, as an ear surgeon, he discovered work that was gratifying both emotionally and intellectually. "Otologists were the first to use the surgical microscope, and that was just fantastic -- the bones of hearing are very pretty -- and you could do a technically sophisticated procedure and restore someone's hearing, and that was like 'Wow!' "
Today he gets the same thrill every time he turns on a toddler's implant for the first time. "It's pretty dramatic," he says. "It's the first sound they've ever heard. And if Mommy's in the room, she's going to cry. It's a great feeling."
Dr. Mary Roman:
Whenever Dr. Mary Roman sees a lanky, limby high-school basketball star, she usually has to tell him or her to stop playing, as much as it breaks her heart. "Sometimes it's their whole lives," says Roman, who's fine-boned, 48, and a mere five-feet-two. "It's what they do best." Roman is a cardiologist at New York Hospital who specializes in the Marfan syndrome, a rare, underdiagnosed genetic abnormality whose most common visible sign is overlong limbs and most common invisible sign is an enlarged aorta. (Many suspect Abe Lincoln had it, as well as Jonathan Larson, the creator of Rent.) Untreated, the disease weakens the body's connective tissue and can kill suddenly and prematurely, almost always with a torn aorta. If caught, it can be controlled with an unstrenuous life, medication, and, if necessary, surgery. Roman first developed her interest in the syndrome in the mid-eighties, when she was doing research on valvular heart disease at Cornell Medical College. She mixes scholarship, teaching, and a clinical practice that includes more than 100 patients. "Patients tell me they go up to people in crowds and say, 'Have you heard of the Marfan syndrome?' " she says. "They do it politely, but they do it, because they've all heard horror stories about it not getting diagnosed until the autopsy." Roman monitors her patients throughout their lives, so she's invited to their weddings and art openings and often meets members of the extended family. It's not hard to see why they like her. "I think," she says, "I have a pretty unintimidating façade."
Dr. Jo Hannafin:
At 5:15 a.m. Dr. Jo Hannafin, orthopedic director of the Women's Sports Medicine Center at the Hospital for Special Surgery, is laying her single scull into the Orchard Beach lagoon for a sunrise row. By 7 a.m. she's in her Upper East Side office, researching the biology of ligament cells as she does twice a week, or she's in the OR, repairing a rotator cuff. Hannafin, a tall, slender brunette, rowed competitively in college, then medical school. But her athleticism didn't overtake her career until she brutally tore the anterior cruciate ligament (ACL) in her knee while cross-country-skiing, and decided to trade in pediatrics for an elective with Dr. Martin Levy, the orthopedic surgeon who operated on her. "He did a lot to encourage me. Plus," she confesses, "the world championships were in the middle of the rotation and I needed someone who would let me disappear for a week." She took home the silver.
Today Hannafin is one of the top orthopedic surgeons and researchers in the country. Her women's clinic, which she runs along with Dr. Lisa Callahan, a cyclist, and Dr. Deborah Saint-Phard, an Olympic shot-putter, is the only one of its kind in the world. "When it comes to reconstructing a knee ligament," says Hannafin, "it doesn't make any difference if you're a male or female surgeon," but, she suggests, in the nonsurgical areas she has an advantage. "If a high-school track star develops a stress fracture, we'll talk with her about her nutritional history, her eating behavior, her calcium intake. We won't just treat her stress fracture.
"That doesn't mean a male physician can't do all these things," she hastens to add. "You don't want to offend the men."
Levy, now a surgeon at Einstein, is not at all offended. "Women and men have different takes on athletics," he says. "It gets into our lives in a different way. Plus, there are subtle issues like, what rubs in your clothing, what does it feel like to have your menstrual period? I can listen to people tell me, but I'm never going to know."
Russell Warren, surgeon-in-chief at the Hospital for Special Surgery, points to Hannafin's effectiveness as an athletic role model. "Jo knows a lot about the psychological problems associated with injuries. Having been there has big value." Particularly to 35-to-50-year-olds. "We understand why they want to keep participating in sports," says Hannafin. "We're not just going to say, 'Your running days are over' and walk out of the room."
On her way to the OR, she points to a wall of photos: a 67-year-old swimmer holding up her gold medals; marathon runners bursting through the finish line. "See that one," she says, indicating a woman in mid-skydive smiling for the camera. "We'd just done her ACL," she says proudly. "She wanted to be able to jump in her Tevas."
Dr. Ellen Birenbaum:
When Lisa arrived at the Robert Mapplethorpe Residential Treatment Facility in 1994, she had all but given up. "I came here to die," she says now. She had been diagnosed with HIV in 1989, but hadn't sought treatment. "I was avoiding it," she says, "medicating myself with drugs." But after eleven months at Mapplethorpe, Lisa was clean, receiving aggressive medical attention for the first time in her life, and well enough to move out. She has since enrolled in college and gotten married, and two years ago, she gave birth to a son. She assigns much of the credit for her turnaround to her physician. "Dr. B. gave me a lot of hope," she says. "She let me know that I can live with the virus."
"Dr. B" is Dr. Ellen Birenbaum, the Mapplethorpe's medical director since Beth Israel hospital created the facility in 1993. But to say that Birenbaum runs a hospice for HIV-infected patients doesn't quite convey how complicated her job actually is. Of the facility's 28 residents, 24 have served hard time; 8 are on parole. In addition to being infected with HIV, each patient also has an average of six other major medical diagnoses -- such as hepatitis C, cancer, and diabetes -- and ingests an average of nineteen medications four times a day. And everyone, like Lisa, has a history of drug abuse. Birenbaum's job is to keep her eye on all of these balls at once.
Birenbaum, 49, has always worked with the urban poor. "I guess I'm a product of the sixties." She shrugs. "If that's not too clichéd." She did her residency at Harlem Hospital from 1980 to 1983, working extensively with intravenous-drug users. "I remember arguing with patients about their methadone and their pain medications, but I really liked working with them," she says. "Often they were far more grateful than other patients and appreciated someone who engaged them."
Her quiet demeanor sometimes seems out of place in the noisy corridors of the Mapplethorpe, but Birenbaum's approach invariably earns patients' respect. "She really listens," explains Leah Strock, who is responsible for the aftercare of all of Beth Israel's HIV patients. "She'll say to a patient, 'This is what we can do; what would you prefer?' It gives the patient a feeling of self-value and self-sufficiency. And that's not something that can be learned in medical school."
Dr. Patrick Fazzari:
Detective Columbo, M.D.
The Columbia University graduate student, a slender and strikingly pretty woman wearing jeans and a black turtleneck, looked absolutely miserable as she slumped in a chair in Dr. Patrick Fazzari's Madison Avenue office. For the past five months, she'd had intense pain in her groin and under her arms; a battery of medical tests at Columbia's Health Center had ruled out MS and other diseases. Concluding her tale, she said, "So many doctors keep throwing up their hands and saying, 'I don't know.' "
Fazzari, a 60-year-old specialist in muscular-skeletal diseases, began to gently draw her out, asking what was happening at school ("I've finished my papers; all my stress is gone; all my ailments should disappear"); whether anything unusual had happened before the pain started (a stress fracture in her ankle when she was training for a marathon); and what medications she was taking (Wellbutrin for depression, Ritalin for ADD, Claritin for asthma). Giving her a comforting smile, Fazzari said, "You're a complicated person." For the first time in the consultation, the 26-year-old woman laughed. "I'll take that as a compliment," she replied.
A doctor in private practice as well as director of rehab medicine at North General Hospital, Fazzari has built a reputation as a medical detective who likes taking on difficult patients. "He's brilliant," says Dr. Paul Wiseman, an internist affiliated with St. Luke's, where Fazzari spent fourteen years as director of rehab medicine. "He's an excellent diagnostician, and he's very humane." Fazzari treats many performing artists (determining the source of injuries by watching musicians play), stroke victims, and journalists suffering from carpal-tunnel syndrome. "If you have pain and it interferes with your life, it's overwhelming," says Fazzari, who often prescribes physical therapy, a visit to a chiropractor, and stress-reduction techniques such as yoga -- using surgery only as a last result.
His diagnosis of the Columbia student: "You're not crazy," he said as an opener. Her right hip was higher than her left and she was limping slightly, he said, and he believed that she'd strained her pelvis and sacroiliac joint by wearing a heavy boot cast after the ankle fracture. Prescribing three weeks of physical therapy, he said, "If I'm right, you'll get better quickly."
Dr. Mary O'Brien, the attending physician at Columbia's Health Service who had referred the student, said, "We send him the challenging cases, where the source of the problem is complex. He stays with people until they recover -- if one thing doesn't give them relief, he'll keep trying."
Dr. Isabelle Germano:
John Fanning, a 72-year-old patient at Mount Sinai, suffers from tremors. He has a slight one in his left arm, but his right arm is rock-steady -- at least until he presses a remote control, turning off a brain stimulator Dr. Isabelle Germano implanted two and a half years ago, and it begins flailing uncontrollably. "I couldn't even drink coffee," he says. "Now I can pick up peas with a knife." The operation -- which had just been approved by the FDA -- took six hours; today it would take half that long, thanks mostly to Dr. Germano's other groundbreaking work. Over the past decade, she has persistently sought the latest advances in neurosurgery, using virtually every new technology before most surgeons had even heard of it, then working with scientists to make it more effective. In 1993, Dr. Richard Bucholz and his team at St. Louis University were developing a prototype of a three-dimensional computer-imaging machine, called the StealthStation, that could pinpoint microscopic lesions during surgery. Germano was the first neurosurgeon on the East Coast to use it, and Bucholz believes her input was essential: "Dr. Germano gave us valuable feedback as to how to improve the ergonomics of the device, a critical step in getting it out of the hands of its inventor and into the hands of neurosurgeons." Partly as a result of Germano's help, there are now about 700 faster, safer StealthStations in the U.S.
Germano averages at least one surgery a day (her longest took 22 hours) and divides the rest of her time among lab research, teaching, patients, two young children, and a husband -- another Mount Sinai neurosurgeon. Though she comes from a long line of doctors in Turin, Italy, her parents begged her to try something else. "They thought that I would be better off doing other things," Germano says, "because doctors have a terrible quality of life. And they were absolutely correct. I gave up everything else in life except my work and my family." She wasted no time making that choice, earning an M.D.-Ph.D. at the age of 24. Today, at 40, she's one of about three dozen female board-certified neurosurgeons nationwide (out of 3,500 or so).
Germano is currently conducting an early gene-therapy trial that, so far, has prevented the regrowth of aggressive brain tumors in two patients who didn't expect to be alive today. Others, like Katherine Fullmer, may never need it. Last fall, Fullmer was planning on having "plain old surgery" to remove a malignant brain tumor, which doctors told her would probably paralyze her right side without vastly improving her prognosis. "If I'd been back at the other hospital," she says, "I would not walk at all. Until I met Dr. Germano, I thought I'd be dead in a couple of days." Germano's computer-guided surgery allowed her to walk within a week, and her tumor hasn't returned. "She's not only the best person to physically do the job but also the most compassionate, and when you've got a cancer in your head, that's a pretty amazing thing to have."
Dr. Sam Daniel:
The three blocks between North General Hospital and Dr. Sam Daniel's private practice on East 119th Street run the East Harlem gamut -- from rubble-strewn vacant lots to spiffy new apartment buildings. For the past few years, the housing has been overtaking the empty space at an impressive pace, and the neighborhood's much-touted recovery, Daniel hopes, will soon extend beyond economics and into health.
As a gastroenterologist, Daniel, North General's medical director, has a unique perspective on neighborhood residents' chronic lack of health care. Hepatitis C, for instance, has been ravaging Harlem, largely undetected, for years. "Prior to 1990, we didn't even have a way of diagnosing it," he says. "Now we know it's causing about 30,000 deaths a year nationwide and is becoming the most common cause for liver transplants in the country. In New York, we're not even sure of the numbers because the Department of Health hasn't gotten itself together to develop epidemiological studies."
Spreading the hepatitis-C gospel -- through workshops, outreach programs at community centers, and pool halls -- has had a ripple effect on aids-awareness efforts. "Hepatitis doesn't have the same stigma as HIV," Daniel points out. "Even though it's probably more deadly. When a person is told that it's possible they're infected with hepatitis C, they'll very quickly go and get tested. There's a lot of co-infection, and while you have them there, you can talk to them about HIV."
Daniel has also begun to address prostate and colon cancer -- North General is developing the nation's first inner-city solid-tumor cancer center. "The big medical centers have for years gotten all the NIH funding," he says. "In the fight against cancer, communities like ours are still losing."
Daniel, who is 49, hasn't always been dedicated to championing Harlem's uninsured. He grew up in Antigua and moved to New York to go to Queens College and Columbia Medical School. "When I finished my training, I worked at St. Luke's-Roosevelt and had a practice on Central Park South," he recalls. "But when I was introduced to this neighborhood, I realized serving this community was a hell of a lot better than the money I was making downtown."
Dr. Freya Schnabel:
Listening To Cancer
Lynda Wertheim just turned 50, but she celebrates February 5, 1998, as her birthday. That was the day Dr. Freya Schnabel, a breast-cancer surgeon at Columbia Presbyterian, performed Wertheim's mastectomy. "My friends even made up a birth certificate with Freya's name on it," says Wertheim. "We talk about her like she's my second mom." Schnabel, 42, is admired not only for her technical skills as a surgeon but also for her boundless empathy. "Breast cancer is emotionally loaded, not just for obvious mortality implications but for numerous quality-of-life issues," says Eric Rose, surgeon-in-chief at Columbia Presbyterian. "You've got to be a very good listener. Freya is an enormously communicative person. Compassion is wired into her."
Seventeen years ago, when Dr. Schnabel began her residency, female surgeons were a rare breed. Rarer still were female breast-cancer surgeons, not to mention Orthodox Jews like Schnabel. In the past year, as part of her practice, women with breast cancer in their family have been coming to her for genetic testing -- especially Jews of Ashkenazi descent, who were recently discovered to have a higher prevalence of mutations in the crucial BRCAI and BRCA2 genes. "My patients are extremely aware of risk figures," says Schnabel, who spends one day a week at South Nassau Communities Hospital in Oceanside, on Long Island. "But there's no reason to ask a question if you're not prepared to cope with the answer."
Schnabel is also medical director of Women at Risk, Columbia Presbyterian's cancer-treatment-and-support program. (Hillary Clinton just co-hosted a benefit for WAR at the Waldorf.) Schnabel was instrumental in turning what was a small pilot program into a major institution that provides lecture series on new drugs and discussions about sex after breast cancer. "The attitude used to be 'How trivial is that? You should just be happy you're alive,' but it's not trivial," says Schnabel, who's never satisfied unless her patients return to fully active lives. Encouraged by Schnabel, Lynda Wertheim followed her surgery with not only a breast reconstruction but also a tummy tuck and a breast reduction. Thanks to Schnabel, Wertheim says, "I have a beautiful body now. I wear strapless dresses."
In her office, Schnabel opens an e-mail on her computer. "Seven years ago, I operated on a 29-year-old," she says, clicking her mouse. A sleeping baby pops up on the screen. "Her first baby girl! Getting that was one of the biggest moments in my career. That's what's supposed to happen."
Dr. Richard Payne:
The Defeat of Agony
Dr. Richard Payne remembers vividly the first time he had to tell a patient she was dying. Payne was a Harvard Medical School graduate in the first year of his neurology residency at Brigham Hospital in Boston. "She wasn't responding to chemotherapy," he says, his baritone growing huskier with emotion. "We could see her lungs getting whiter and whiter each day with pneumonia. I had to ask her if she would want to be resuscitated. I felt like I was shattering this whole person, taking away all her hope. I just wanted to give her this information and get out of the room as fast as I could."
But instead of avoiding the bedsides of the dying, Payne made delivering "a good death" his specialty. As chief of Memorial Sloan-Kettering's department of palliative care, he is a pioneer in end-of-life care. While traditional medical training has treated pain management as an afterthought, Payne teaches students how to better medicate the incurable, so they can get the most out of their final days.
He's also pushing to extend sophisticated palliative services to so-called "low-demand" patients, through a program at North General Hospital in Harlem. Payne's work is focused on changing attitudes as well as bureaucracies: Minority patients are routinely forced to battle racist suspicions that they are drug addicts to get the painkillers they need. "A lot of it is irrational," Payne says. "There isn't a lot of hard evidence that patients in Harlem who have cancer have any higher incidence of substance abuse than anywhere else in New York City or the world. We have to make that quite clear to doctors and pharmacists."
"He's one of my heroes," says Dr. Diane Meier, director of the Lilian and Benjamin Hertzberg Palliative Care Institute at Mount Sinai. "There's a tremendous lack of faith that the dominant white medical culture has the best interests of African-American and Latino patients at heart. Dr. Payne is going to inspire a much greater level of trust, simply by being African-American. And he's spreading that trust not just to individual patients but by teaching white doctors how to better communicate with nonwhite patients."
It isn't the life he imagined as a child. "I'm the eighth-born out of thirteen children, and I was the first one to go to college," he says. "It was unheard of in my family -- a son of an elevator operator in inner-city Elizabeth, New Jersey, going to Yale and Harvard. But that was also the sixties, too. We had a lot more confidence in being able to change the system then."