Issue link: https://tmcpulse.uberflip.com/i/356141
t m c » p u l s e | a u g u s t 2 0 1 4 10 t m c » p u l s e | a u g u s t 2 0 1 4 Children are so amazing in the sense of how well they tolerate surgery and how quickly they recover. I can remember an epiphanous case that really opened my eyes to the notion of being a children's surgeon. It was a child who had a gunshot wound. At that time, at UTMB, we took care of the whole of the state, because every child that came from a county that didn't have a county hospital came to UTMB for care. So we had a huge children's hospital there. Now they don't, unfortu- nately. But this little girl was from somewhere up in North Texas, and she had a terrible gunshot wound to the buttocks. And I remember wondering how she would ever possibly recover from that horrible injury. And I'll be darned if she didn't just heal. It was just remarkable how well she healed. And I remember thinking that this was almost miraculous. So I started learning about the physiology of children, and this notion that you could do these operations that would transform lives for decades was very appealing to me. And also just the way that the children respond to treatment. 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. So it is very gratifying. And I just started to see that fit with my personality. You see a problem, you fix it, you see an immediate result. And I kind of liked that connection to therapy. Q | Looking at innovation, what are some things that you are doing today that you couldn't have done five years ago? A | Well, we are almost uniformly making fetal diagnoses for all new- borns. It is an aberration to have a newborn who comes to us and is diag- nosed post-natal. I just operated yes- terday on a child who was a post-natal diagnosis, and we were all shocked. And this child came through a sophisticated health care system. The imaging has just gotten better and better, and the knowledge has gotten better. So that has allowed us to move into the realm of fetal planning. Fetal intervention is still pretty much experimental in the cardiac world, but definitely fetal planning, that's part of our norm now. We start seeing these children early in gestation, we meet the families, we plan for delivery, and we discuss contingencies. That's a big change in the last five to ten years. It's sort of a standard of practice now for newborn management, and it has, of course, allowed us the proposition of fetal intervention. Q | What are the cases that you find the most satisfying? A | Well, I tend to be referred a lot of challenging cases. That's been my rep- utation of late. I just came down from the clinic, seeing a child who's got a lot of complicated problems, cardiac and non-cardiac. So, to me, that's intriguing, because every child that comes through that referral network, we have to do a lot of head-scratching. Each one is different from the last one. And in some of them, no one has seen cases like theirs before. We had one just this week, no one had ever seen it, no one had ever heard of it. And that's quite amazing. Q | What do you do with that kind of case, when there is no precedence from which to work? A | Well, that's the great thing about being in our field. I think you do have to innovate and improvise a lot. That can be from a technological standpoint, applying something that you didn't apply to that before. And then, even in the categorical conditions where you think it would become more boilerplate, there are always nuances in difference with anatomy, presentation and physi- ology. But as far as operations, my signature operation is probably the arterial switch operation. I've just done lots of them, and had a really good track record. (Credit: Texas Children's hospital)