TMC PULSE

18 T M C » P U L S E | J U N E 2 0 1 8 "Long before I knew that I was coming down to Houston, we all knew about the Fondren-Brown OR with a combination of terror and awe because it had a reputation as being a fearsome environ- ment for surgeons to work in," said Alan Lumsden, M.D., who became chief of cardiovascular surgery at Houston Methodist DeBakey Heart & Vascular Center in 2008. "Most of the trainees were scared of Dr. DeBakey when they came through the program," Noon said. "That's because, if you didn't get things done the way they were supposed to get done, he would strongly criticize you. But he was able to get the most out of everybody who worked for him." DeBakey's residents were required to undergo a rigorous two-month stint in the cardiac OR and ICU, where they remained on call 24/7 without leaving. Their confinement was demarcated by a physical red line that was taped around the unit. "The red lines are famous in the [cardiovas- cular] world because the fellows who were going in the ICU rotation were shown the red lines and told that if they stepped across that red line in the next two months, they'd be fired," Lumsden said. "I assumed it was part of the urban legend about the place." Accounts of DeBakey's ICU were passed down and shared cohort after cohort, generation after generation. To those who never endured his training, it was hard to tell fact from fiction. But it wasn't an urban legend at all. Michael Reardon, M.D., a cardiac surgeon at Houston Methodist who trained under DeBakey from 1978 to 1983, recalled only getting to see his pregnant wife and baby girl on Saturdays when they visited him at the hospital to deliver clean socks and underwear. He would see them for half an hour at a time and then go back to being sequestered in the ICU. "There was a window at the back, or the front, of the ICU that would open about [an inch]. At about two in the morning, I'd go open the win- dow and stick my nose out just to smell the air," Reardon said. The training wasn't meant to be cruel. The purpose was plain and simple: To ingrain respon- sibility and accountability in surgeons. "[Patients] can die at our hands, or they can get much better in our hands. If they die after you've operated, it is on you. You made a contract with that patient," Reardon said. "That's one thing that Dr. DeBakey taught us: It's attention to every detail because, if you don't and if they die, it's your fault." A great leader Because of DeBakey's intense approach, many who trained with him—including Noon and Reardon—became part of an elite league of sur- geons who ascended to the highest rungs of their profession, pioneering new surgical interventions and making their own marks on medical history. But the price of admission was trial by fire in the Fondren-Brown OR. "The great leaders in surgery aren't the indi- vidual surgeons," Reardon said. "The great leaders know how to spot talent and develop talent. Dr. DeBakey was a great organizer: He organized one of the greatest operating rooms and ICUs that allowed them to do these things. Then he spotted talent, organized that talent, and gave that talent not just permission, but incentive to achieve." The OR was ground zero to many firsts, starting in its inaugural year. DeBakey and Noon performed the world's first simultaneous multi- organ transplant in August 1968. In 1980, Noon led a surgical team that performed the first angio- plasty and the first rotational atherectomy that same year. But national momentum in cardiac surgery was plateauing around the time the center began construction. Interest in heart transplants waned due to poor survival rates from organ rejection. Between 1964 and 1980, no new major landmarks in transplantation were made in the country, but important progress in immunology research helped lay the groundwork for future innovation. In particular, the development of cyclosporine— an immunosuppressive drug that prevents the body from rejecting kidney, heart and liver trans- plants—significantly improved transplant success rates and renewed hope in the field. In 1985, surgeons performed the first heart- lung transplant in Texas. In 1998, Reardon performed the first successful autotransplant for cardiac malignancy. In 2005, Lumsden and Reardon pioneered the first hybrid procedure in the country to repair a large aneurysm of the aor- tic arch, during which they lowered the patient's body temperature until it reached a deep hypo- thermic state to effectively stop the heart. "If I see further, it's because I stand on the shoulders of giants. We didn't get here all on our own," Reardon said. "We got here because people The great leaders in surgery aren't the individual surgeons. The great leaders know how to spot talent and develop talent. Dr. DeBakey was a great organizer: He organized one of the greatest operating rooms and ICUs ... . Then he spotted talent, orga- nized that talent, and gave that talent not just permission, but incentive to achieve. — MICHAEL REARDON, M.D. Cardiac surgeon at Houston Methodist Hospital George Noon, M.D. in the operating room decades ago. Alan Lumsden, M.D. Credit: Courtesy of George Noon, M.D. Michael Reardon, M.D.

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