Valavanur A. Subramanian, Minimally Invasive Heart Surgeon
The Chairman of the surgery department at Lenox Hill Hospital, Valavanur Subramanian was the first physician in the country to conduct what’s known as midcab (minimally invasive direct coronary-artery bypass) heart surgery, in which arteries are bypassed through small incisions without opening the sternum.
You’re a pioneer of “off-pump” heart-bypass surgery, in which you operate on a beating heart without the aid of a heart-lung machine. How many of your patients qualify for this?
We do them all this way—one third of them with smaller, two-to-three-inch incisions and the rest with larger incisions because you have to bypass two or three arteries.
How many of them have to be switched to a heart-lung machine in mid-procedure?
Out of 2,000 patients, just 2.6 percent. And in the last two years, it’s just been 0.9 percent. The defenders of on-pump say the pump has worked well for 50 years. I always say the beating heart has been good for ages.
What’s better about it?
There is less length of stay at the hospital, and they’re extubated more quickly. Even staunch defenders of on-pump bypasses do off-pump operations on patients they view as high-risk—patients who had previous surgeries or angioplasties which made going on-pump and through the sternum a difficult decision to make. So we asked the question, if it’s good for higher-risk, why isn’t it good for lower-risk?
You’ve recently made the procedure even less invasive—with the help of a robot.
Yes, it’s called robotically assisted multi-vessel bypass. We use the robot to make a small incision where we can see everything. Then we operate with the help of an endoscopic stabilizer, a positioning device that can move the heart via a separate hole in the chest. The patient goes home in 48 hours. The sternum is never opened. In just the last couple of months, we did the very first triple bypass this way. It’s a real breakthrough.
Will everyone operate with robots in the future?
The younger generation of surgeons are more skillful at playing with technology. They’re into video games. And they’re adopting this robotic technique. It’s a mind-set. It’s going to happen.
How old are you?
I’m 63. But I’m young at heart.
Carolyn Brockington, Neurologist
Carolyn Brockington is your basic New York overachiever: Vassar grad, former Mount Sinai chief neurology resident, and director of Beth Israel’s Stroke Prevention Program—by age 33. Now, still shy of 40, she plans to devote the (many) years ahead to finding new ways to prevent and treat strokes, especially among African-Americans.
What got you interested in stroke prevention?
For a long time in neurology, doctors would go in to see a patient with Parkinson’s or MS or stroke, knowing they weren’t really going to be able to accomplish anything. But when I graduated from medical school, things were changing, especially with strokes. Hospitals were beginning to administer medicine intravenously to burst open a clot and restore blood flow. It’s exciting to be at the forefront of new things. I feel I’ve arrived at the right time in the right place.
What makes New York a good place to work with stroke patients?
We have the best technology and large, high-quality academic institutions, so we’re able to offer comprehensive care—I work together with neurosurgery, radiology, and rehab to treat my patients. The flip side is that it’s hard to get acute patients into the emergency room quickly. Coming from the West Side to the East Side—in rain, during rush hour—isn’t easy. The most effective treatment we have for combating the effects of stroke—intravenous t-PA—only works within a very short window: three hours after the first signs of symptoms. So if you don’t get the patient in on time, what good are the technologies?
Many people don’t seem to realize how critical it is to get help fast. Why is that?
For many years, people who suffered heart attacks didn’t think it was an emergency. Now people go straight to the ER. We want to do the same with stroke—to get people to realize it’s an urgent situation.
You do a lot of outreach, especially in the black community.
Being an African-American, it’s important for me to focus attention on groups with a high incidence of stroke, such as African-Americans and Hispanics. I lecture at the hospital and at community centers, and I do screenings at churches like Abyssinian Baptist in Harlem. We discuss ways to prevent stroke and to identify its symptoms. It’s not glamorous work, but hopefully we’re empowering people.
Marcus H. Loo, Urologist
When East meets Upper East Side: Fifteen years ago, when Marcus H. Loo (who is the first to make jokes about being a urologist named . . . ) finished his residency and joined a Park Avenue practice, he simultaneously opened a Canal Street branch. He’s been shuttling back and forth ever since, building cultural and therapeutic bridges.
What is your own background?
My parents grew up in China and came to this country in the forties to go to university. I was actually born at Columbia Presbyterian. My father, being a businessman, moved us to Hong Kong when I was young. I always greatly admired my dad in that he could go seamlessly from speaking English to Chinese.
Is the patient-doctor relationship very different on Park Avenue and Canal Street?
Down here, to see a Western-trained doctor is a great leap of faith. Patients will often see a traditional herbalist or acupuncturist first, and if they aren’t improving, they’ll come to me. Whereas the patients on Park Avenue are often very well-informed.
How do you tap into an insular culture?
The Chinese community is actually quite small. The majority of the news that they get is through two newspapers. And it’s changed considerably. I have patients asking about in vitro fertilization, laparoscopic surgery. When I first started, a Chinese male would never voluntarily talk about erectile dysfunction. Now he’ll ask about Viagra.
What do you say to people who insist on going to herbalists?
I don’t dissuade them. But I always tell them that we’re here if you’d like another viewpoint. When people don’t have a grounding in Western medicine, how do you communicate that they have a cancer of the kidney that they can’t feel, that is causing the blood in their urine, and that if you don’t take it out, it’s going to progress? I often tell them to bring their family in. That helps.
How has your work affected your own cultural identity?
Ultimately it’s about the impact on my kids. I live in Westchester. And a lot of the Chinese-American kids, when their parents suggest going to Chinatown, they say, “I don’t like the food, it’s dirty.” My kids love it. I’m as American as anybody. But if you’ve been privileged to get a good education, you have to give something back. Park Avenue doesn’t need another urologist.
Alejandra Gurtman, Infectious-Disease Specialist
In the age of SARS, AIDS, anthrax, and smallpox, the fight to wipe out the world’s deadliest bugs has never been more urgent. As clinical assistant for the Division of Infectious Disease at Mount Sinai Hospital, the founder of the hospital’s Travel Health Program, a consultant to the city on anthrax and smallpox, and principal investigator of the AIDS International Training and Research Program, Alejandra Gurtman is a one-woman germ-fighting army.
You started your career just as HIV was exploding. What was that like?
When I started, in 1983, I felt I had the tools to make a big impact on someone’s life—maybe even to cure them. But after HIV, the focus went from fixing the patient to managing long-term relationships. I’ve seen HIV moms deliver babies, and grandfathers see their grandchildren born. It’s been amazing.
Recently you’ve been focusing on travel medicine. Why?
It sort of happened by accident. People would call me and say, “I’m going to South Africa. What shots do I need?” Mount Sinai didn’t have a travel program, so I created one. We offer pre-trip advice, immunizations, and post-travel treatment. It’s been recognized as one of the best programs of its kind.
How has SARS changed travel medicine?
For one, it’s helped people realize the importance of seeing an expert before traveling. People often don’t consider that, especially if they go to “safe” destinations like France or Italy or Canada.
Are you worried about sars coming to New York?
Yes, but we’re fortunate because we’ve learned from other countries and we’re better prepared now than they were to contain it.
You’ve worked with the city on anthrax and smallpox.
A year before 9/11, I started talking to city agencies about working on an anthrax vaccine, and they said, “No! Too scary.” But a week after 9/11, I was asked to join an advisory committee on bioterrorism. We met with Mayor Giuliani twice a week at the command center; our job was to educate him. Then the anthrax cases started to appear, and I was asked to treat patients from the New York Post. On smallpox, I’m starting two new studies in the summer; we’re hoping to create a safer vaccine.
What breakthroughs in your field do you hope to see in your lifetime?
I think we may have vaccines for HIV, for diabetes, for MS, even for cancer. In the same way vaccinology was taken to a different level in the twentieth century—think of the eradication of smallpox—it’s going to be taken to a different level in the twenty-first. And I really wish for an HIV vaccine.
Steven Schwarz, Pediatric Gastroenterologist
Treating children with severe developmental disabilities is no small task: Often the patient can’t speak at all, let alone articulate what, specifically, hurts. As chairman of pediatrics at Brooklyn’s Long Island College Hospital, Steven Schwarz has discovered that solving his patients’ nutritional problems can dramatically transform their overall health.
What kinds of nutritional problems do you treat?
Take a child with severe cerebral palsy. Even swallowing may be impossible. If you can’t swallow, you can’t eat. You’ll never build stronger muscles. It’s devastating. Half the time, you have institutions where workers have to spend every hour of every day just trying to feed these kids.
So what’s the solution?
We’d likely do a surgery called a percutaneous gastrostomy, where a feeding tube is inserted directly into the stomach. Amazingly, sometimes we can remove the tube a year later because the muscles have grown strong enough for the child to to eat!
And what about other situations?
We see a lot of kids with acid-reflux problems, which is common in a lot of the population but can be really troubling for children. Also, autistic children often have more idiosyncratic problems—like they’ll refuse to eat or drink completely, or won’t eat anything textured, or will eat but not drink and end up incredibly dehydrated. We use intensive therapy to broaden their culinary universe.
What do you find most rewarding about your work?
People sometimes say to me, “Why are you doing this?,” meaning that I deal with people with very little potential, people who are a drain to the health-care system. But what people forget is that the parents really love their children—helping these families, that’s the reward. Who am I to say who’s “worth it” or not?