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t m c » p u l s e | n o v e m b e r 2 0 1 7 30 30 Spotlight Late last year, after decades in Massachusetts, THOMAS MacGILLIVRAY, M.D., traded Boston winters for Houston summers and became Houston Methodist's chief of cardiac surgery and thoracic transplant. While many heart surgeons work with congenital heart disease in children, MacGillivray is bringing attention to congenital heart disease in adults. Q | Tell us about your background. A | I grew up in the Boston area. I had my educa- tion and training up in the Boston area. I trained in surgery and cardiac surgery at Massachusetts General Hospital, and I stayed there for almost 19 years after I finished training. Q | What made you decide to go into cardiac surgery? A | My dad was a surgeon. My dad had trained in internal medicine, too, first, but decided to be a sur- geon. I consciously made a decision to keep an open mind. So I literally went through all of my rotations in the third and fourth year of medical school with that approach. When I did pediatrics, I approached it with the idea that I want to be a pediatrician. When I did psychiatry, I approached it as, I'm going to do this rotation like I want to be a psychiatrist. I loved every minute of medical school, but I ended where I started. I wanted to be a surgeon. I don't know why, but I remember specifically the first day of my internship. They had a little lunch for us. One of the administrators said to me, 'Well, what kind of surgeon do you want to be? And I said, 'Well, I don't really know. I'm really interested in pediatric sur- gery, maybe trauma, but I want to keep an open mind. But I know for absolute certainty that I don't want to be a heart surgeon.' I'd never done a cardiac surgery rotation. Back in those days, cardiac surgery was sort of a juggernaut in medicine, and I had these misconceptions that all it was you did was two or three operations and there wasn't really any thinking or patient care involved. We spent a lot of time during our residency training on the cardiac surgery service, and I realized it was com- pletely the opposite of what I thought—except for it being technically very demanding, which it continues to be. One of my professors once said, 'General surgery is like flying a Cessna, but cardiac surgery is like flying an F-14.' And he's right. Q | What did you learn about cardiac surgery during those formative years? A | You had to be ever-vigilant about what was hap- pening with the patient. Patients could be very, very unstable, very sick. With really precise operations, you'd make people much better—not just keep them from dying, but allow them to have a much-improved quality of life. If you did a very good operation, the patient did well. If you didn't do a very good operation, you could take somebody who was not that sick and kill them. The management of patients in post-oper- ative care, in the intensive care unit, required really intensive care. You have to be able to identify subtle changes in their course and intervene. I found it excit- ing, exhilarating really. You could actually see yourself getting better at it the further along you went. And then, my exposure to congenital heart disease was that, but on steroids. You found these poor babies