TMC PULSE

t m c » p u l s e | a u g u s t 2 0 1 4 9 t m c » p u l s e | a u g u s t 2 0 1 4 TMC SPOTLIGHT Q | Tell us about your early years in Midland, Texas. A | Midland Texas was, and is, a very special and unusual place. As you know, the economy is very active out there today. I believe this is the third boom cycle that I have experienced in my life and it's amazing to contemplate all of the opportunities I had growing up. My dad is a petroleum engineer. He and my mom moved out to Midland in about 1960, and he is still there. I think when I graduated high school there were only about 60,000 people living there, but we had extraordinary public educational opportunities. For a city its size, I believe Midland has enjoyed an usual, perhaps unique, concentration of intellectual capital and there was, to my view, a very robust public school system where we students were offered quite an advanced educational para- digm. For example, after graduating from high school, I was admitted to the University of Texas at Austin where I placed out of essentially a year and a half of courses just based on my high school preparation and advanced place- ment testing. This was a real advantage for me as a student. From the standpoint of exposure to medicine, the citizens of Midland have been blessed by really outstanding doctors and a very good hospital. From early in life, I had very positive experi- ences with the doctors who took care of me. I had a big event when I was around 10 years old—traumatic spleen injury that required surgery—which exposed me to some really special caregivers; surgeons, pediatricians, nurses. This experience did, in a strange way, plant the seed of interest in medicine. Q | You have a background as a mathematician. Do you think there is a correlation between mathematics and surgery? A | I do think probably there is. People have often commented on that during the course of my career. One obvious corollary is between geometric thinking and complex reconstructive surgery. In pediatric cardiac surgery, we are often faced with the challenge of congenitally malformed hearts with complicated structures that need to be rebuilt and often reconfigured. It is an advantage, perhaps it is mandatory, for the surgeon to be able to think in a three dimension way and essentially mentally envision the reconstruction in advance of doing the actual repair. We also need to think in terms of the patient's somatic growth and make allowances for appropriate dimensions during the course of life. From a planning perspective, I also see the development of surgical strategy as being, in many ways, mathematical. Many of our patients require multiple, complex cardiac operations over the course of life and in many instances, there are important decision points where the surgeon is faced with options that may have huge short or long term impact on the patient's ultimate outcome. As such, a paramount issue is to be able to think critically about the possible permutations of a particular decision pathway that will have long- term consequences, both positive and negative. Unfortunately, we sometimes see patients in whom a relatively 'easy' short-term solution may translate into an extremely problematic long-term situation. Again, this is mathematical thinking, much as one would have to do to perform a complicated proof of a theorem, beginning with the end in mind and working through the various steps—which will not necessarily be either linear or obvious—to get to the ultimate outcome solution. Q | Did you just have a natural affinity for medicine? What turned you in that direction? A | I guess you never really know you have an aptitude for something until you have a chance to experience it. faCiNG PaGE (Credit: Texas Children's hospital) ChArlEs d. frAsEr jr., M.d., CHieF oF CongenitaL Heart Surgery and CardiaC Surgeon-in-CHarge at texaS CHiLdren'S HoSpitaL, taLkS about How a baCkground in MatHeMatiCS HeLpS HiM to SoLve CHaLLengeS in Surgery, and How innovation HaS driven FetaL diagnoSeS today. Some of my medical professors did comment, from very early on in medical school and then consistently through- out my residency, that I seemed to have a technical aptitude for surgery. So that always bolsters your interest and con- fidence when people are saying that. I hope it was true. I went to medical school at UTMB Galveston. I decided in medical school that I wanted to be a children's surgeon. In fact, I didn't really like surgeons all that much in medical school. They seemed to me to be a bit misbehaved— always gruff and pretty unhappy and unpleasant. So I had this perception that maybe that was necessary, partic- ularly in cardiac surgery. If you were going to be a successful surgeon, you would have to be pretty rough. So I went to Johns Hopkins as a subintern, pretty well intent on not being a cardiac surgeon, but having more interest in pediatric surgery. I was lucky enough to get a match for residency there in general pediatric surgery. I can remember the day Bruce Reitz and Bill Baumgartner walked in. They are nice guys, gentlemen and brilliant surgeons. Certainly you would never say they were anything but courageous as surgeons, but they did it in a way that was very appealing to me. So we just got along really well. And as you might expect, they surrounded themselves with tremendous people at Hopkins. So Bruce came to me after I did my cardiac rotation as an intern and said, 'Look, don't cut off your nose to spite your face. You seem to have an aptitude for this. Why don't you come and join us on the cardiac service side?' So I changed from pediatric surgery to heart surgery. if you walk through our cardiac iCu, it is just remarkable how the kids just do things that we can't do as adults. they respond, they get better and off they go.

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