This week we take a trip back in time to reminisce about what it was like to be a fellow under famed pediatric cardiology pioneer Dr. Alexander S. Nadas. Who better to tell us about what life was like under this giant than 4 present-day giants who lived through it and got their start working for Professor Nadas. Joining the podcast in a live recording from the Boston Children's Cardiology 75th Anniversary Alumni Reunion on May 3rd are Dr. Roberta Williams, Dr. John Barry Keane, Dr. Patricia Rompf and Dr. Thomas Hougen. All have many stories to tell and they share their remembrances and insights in this special episode honoring the memory of the founder of the cardiac program at Boston Children's Hospital - Dr. Nadas.
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Episode Transcript
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Speaker 1 (00:16):
Welcome to Pdiheart Pediatric Cardiology Today. My name is doctor
Robert Pass and I'm the host of this podcast. I
am Professor of Pediatrics at the Icon School of Medicine
at Mount Sinai, where I'm also the Chief of Pediatric Cardiology.
Thank you very much for joining me for this three
hundred and fortieth episode of Pdheart. I hope all enjoyed
last week's episode on the concept of hands gripped strength
(00:38):
and its possible role it may play in the assessment
of our patients with congenital heart disease. For those of
you interested in exercise physiology, I'd recommend you to take
a listen to last week's episode with doctor Adam Powell
of Cincinnati Children's Hospital. As I say most weeks, if
you'd like to get in touch with me, my email
is easy to remember. It's Pdheart at gmail dot com.
(01:00):
This week we have an extra special treat for the podcast.
Last weekend, I had the pleasure and honor of attending
the Boston Children's Cardiology seventy fifth Alumni Reunion, which occurred
on May third and fourth in Boston. The occasion was
a celebration of the history of the important cardiology program
at that institution that has fostered the career of so
(01:21):
many cardiologists throughout the world, and in so doing has
improved the lives and health of literally thousands upon thousands
of children worldwide. As part of this program, on May third,
at the end of the day, the organizers arranged for
a thirty minute session focusing on the Alexander Nadus years,
with the goal of hearing about what it was like
(01:42):
to work with doctor Natus, who was, as we all know,
the founder of that program. Just in case some don't know,
Doctor Alexander Sandor Natus was born in November of nineteen
thirteen and he died in May of two thousand. He
was the founder of the cardiology program at Children's Hospital
Boston after immigrating to the United States from Budapest, Hungary.
(02:04):
After practicing as a pediatrician in Greenfield, Massachusetts for three years,
he was invited by doctor Charles Janeway to come to
Boston Children's Hospital and start a program to care for
children with congenital and other heart problems in the early
nineteen fifties. His first trainee was the famed cardiologist Abraham Rudolph,
who himself had an illustrious career. Doctor Natus was professor
(02:28):
of pediatrics at Harvard Medical School and won just about
every award that existed for both pediatricians and cardiologists, and
rightly so. Despite his many accolades as a clinician and researcher,
it's clear that his role as a founder, educator, and
leader were the things for which he is best remembered.
And today, in this episode, will replay the conversation we
(02:50):
had last week during the symposium, in which we spoke
with a few of his trainees from the nineteen seventies,
who all have gone on to have wonderful careers, including
doctor ROBERTA. Williams, Doctor Barry Keane, doctor Patricia Romp, and
doctor Thomas Hougan. All got their starting cardiology with doctor
Natis at Boston Children's Hospital. Rather than comment too much further,
(03:13):
let's go straight into the recording from last Saturday, and
here's some of the warm and fun memories of these
masters of cardiology, how they got their start with the
amazing doctor Alexander Natas, And so here we go.
Speaker 2 (03:26):
All right, Well, I am very excited today and I'm
very appreciative to Ed and the organizers of today's symposium.
I have a distinct honor of being able to interview
for giants right here, and what a wonderful way to
end the day today. I just really can't say enough.
Ed just introduced everyone. I'll just again remind everybody we
(03:49):
have doctor ROBERTA. Williams, who's the former Chair Pediatrics at
UNC and former Chief of Pediatric Cardiology UCLA, also pioneer
and pediatric cardiology, critical care and eco cardiography, really a
remarkable individual. We have, of course doctor Barry Keane, the
former cath Lab director here at Boston Children's. I know
(04:10):
when I heard Barry was coming, there was no chance
I was not coming because it's a rare opportunity to
see our good buddy Barry. Doctor Patricia Romp really really
the pioneer of pediatric cardiology and Rhode Islands, and that
seems like I was always looking at tracings that you
brought to doctor Walsh an EP when I was a fellow.
(04:31):
And then of course we have doctor Tom Hougan, the
former chief of Pediatric Cardiology at Children's National DC Children's.
Speaker 1 (04:37):
And Professor of Pediatrics at Georgetown.
Speaker 2 (04:40):
So basically the purpose of today's talk is to learn
a little bit more about what it was like when
doctor Natus was running the show. And so let's start
with doctor Keene Barry. I'm wondering if you could share
with us how did you end up at Boston Children's Hospital,
how did you meet doctor Natus, and how did he
even become a cardiology fellow at all?
Speaker 3 (05:00):
Thank you very much, this is a great honor. The
first thing I'd like to say is that the best
thing that ever happened to me was that Claire agreed
to marry me in nineteen sixty eight in Mallett's Bay
near Burrington, Vermont. David Brown knows this area well, and
(05:23):
I was a cardiology fellow at UVM with number one
Art Levy, who had been a Natives Fellow in nineteen
sixty three, prior to which he had been a superb
figure skater of Olympic caliber and a friend and classmate
of Dick Button at Harvard and also a Major League
(05:45):
baseball prospect. And number two b was Bert to Bacon,
who founded the cardiology group at UVM and who after retiring,
came to Children's Hospital for one year to learn more
about eco cardiography, which he did at UVM for another
ten years after that. Both of these made pediatric cardiology
(06:08):
fascinating for me. They recommended me to his asn and
I was accepted into the fellowship program, and just before
the project. At start of that program, my draft number
was changed from four to one a almost overnight, so
(06:29):
I was going to be drafted. So we decided that
I could volunteer, and I told doctor Nadas and he
promised me that my place in the program would be
waiting for me when I got out. In September of
nineteen sixty eight, we set off in Claire's v W
bug with the right hand drive, and some two thousand
(06:54):
miles later we arrived at Fort Port, Louisiana. It was
striking to me that on the way the soil color
changed from dark to red about halfway through the trip.
Others like Mark Alexander actually was spent time in Fort Polk,
(07:14):
and as did Bill of Bill and Emily, who used
to do all our photography for us. In September of
nineteen seventy, we drove north after the two years to
children with their infant son John and a new v W.
We were met by Don Philer wearing his signature bow
(07:36):
tie and the fellows there at the time included ROBERTA.
Mike Fried, Bob Freedom, Sultan Mescow, Patty Rumph and Sala Rockenmacher,
and some others. The terrific staff taught us. Who taught
us included Ami Rosenthal, Grant LeFarge, URTIs Ellison, Olimietnam from
(08:02):
the Harvard School of Public Health, Bill Plouth, Walter Gamble
who could fix anything, Richard and Stelevant Prague, Greer Monroe,
and Ken fellows who taught us to take the best
pictures and much other stuff. Besides the cathlab and the
department staff included Joni Michel Tish and her mother who
(08:28):
did ecges, Jeanine Cartier Margie who was operated on incidentally
for valver p S prior to the balloon era, Barbesizarrow,
Deirdre and Hugh from Ireland, Janice Burnett, Mark Warren, the
best tech probably in the whole of the USA, and
(08:50):
many others. Some of a es N's more acceptable remarks included,
I'm a benign autocrat. I don't get ulcers I give them.
As I look around the room and see our own
United Nations, I just hope we're doing better than them.
(09:14):
He also had organized the people of the street that
he lived in, Benton Street in Wellesley, and he called
them the Philosophical Society of Benton Street, and they summoned
me there one time and presented me with the with
the cardiology department with the portable defibrillator. When his retirement
(09:38):
was rumored at the end of a staff meeting, he
went to the blackboard and he wrote in big letters
N A D A S. Then he erased the S
and he replaced it with a big L. And that's
how we've found out about Bernardo coming. Both Bernardo and
(10:02):
Jim Locke were extraordinarily kind to Claire and me in
our time there. I also have to say a few
words about Don Peiler, who was a wonderful mentor. He
taught me how to cathagorize babies, and whenever we had
a bad day, he would come in and sit down,
(10:24):
often on an upturned waste paper basket and remind me,
I know you're feeling down, but just remember you get
to come here and try to make things better every day.
And I couldn't help but think, how could one not
fall in love with this marvelous people and this wonderful place.
(10:46):
Thank you to Ed and Tal as well as everybody else.
Speaker 4 (10:50):
Thank you.
Speaker 2 (10:58):
Well, Barry, thank you so much for those wonderful words.
I feel like I was there myself. That was really wonderful,
and I know everybody is just so thrilled to see you.
And if Don Feiler taught you had a calf, then
I guess in a sense he taught all of us
how to caf because we all learned from you. So
thank you for everything, Doctor Williams. I was going to
(11:26):
ask you, how did you meet doctor Natus and how
did you end up being a fellow at Boston Children's Hospital?
Thank you?
Speaker 5 (11:39):
What's that?
Speaker 6 (11:45):
I had planned to be a cardiologist since the eighth grade,
so I went to medical school to be a cardiologist,
not a doctor. But I had written my senior theme
in high school on new techniques and heart surgery, and
I still have the notes, and it's just amazing what
(12:09):
I was writing about, how to go on the pomp
and how to approach the micro valve and things like that.
And I'd done a lot of research on phone of
cardiography and vector cardiography and remote monitoring, EKG monitoring and
(12:31):
early early defibrillations. One of the interns where I was
a medical student. Actually was so insistent that I go
up and look at the program that he filled out
the application for me and sent it in. So I
ended up coming up for the rotation and doctor Natus
(12:54):
offered me a spot two years. Hence I actually realized
I wasn't going to have enough years of pediatrics for
the board exams and wrote him and said can I
come one year later? He didn't save a spot for me.
He said, you're showing up in nineteen seventy.
Speaker 2 (13:15):
Sounds like the benevolent tyrant that I'm understanding him to
have been. And you know, you are obviously a pioneer,
Doctor Williams, in so many areas, particularly critical care and echo.
I was wondering, in regards to all of your innovations
in echo, what were doctor Natus's thoughts about that? I mean,
(13:36):
here he is the great ouscultator examiner of children. Was
what was he thinking or what did he say to
you when you were starting to, you know, come up
with all innovate in the area of imaging.
Speaker 6 (13:51):
Well, I was visiting him during his sabbatical in London
on the way with Lucy Peresi to go to Sicily
and he said, you know, there's this thing called ultrasound,
and you do sound waves, so you will do ultrasound.
(14:12):
He's sort of planning people's lives like that. So he
was very much in favor. When my first echo book
came out, on Mode Echo, he wrote the ForWord and
the last sentence said, who knows, but perhaps one day
(14:36):
echo cardiography will have the same place in the work
up of patients as to ekg and chest ecks rate
a day. So we tried to overcompensate for that.
Speaker 2 (14:52):
I see, and I guess his word was basically the
loss when he told you you were doing echo. I
guess there was no choice at that time.
Speaker 7 (15:00):
I know, I really hated to hear this.
Speaker 2 (15:05):
Of course, you became a pioneer in the field, so
I guess he had had a good idea.
Speaker 7 (15:10):
Throw me in the briar. Pietr.
Speaker 2 (15:11):
Yeah, I say, well, doctor Hogan, I was wondering, what
role did doctor Natus play in you're becoming a pediatric cardiologist.
How did you meet him? How did that happen?
Speaker 4 (15:25):
I have a little story, some of which is true.
Speaker 8 (15:30):
Now.
Speaker 5 (15:31):
Roberta said she got interest in cardiology in eighth grade.
I heard about this program when I'm six years old. Now,
I didn't apply right away because I wanted to see
how ab Rudolph would recommend it. Now, aber Rudolf came
from South Africa with no salary.
Speaker 4 (15:51):
I don't know. He moonlit somewhere. I don't know where.
Speaker 5 (15:56):
So I decided I'll apply in nineteen, I mean two,
nineteen fifty three.
Speaker 4 (16:02):
It's fine.
Speaker 5 (16:04):
I heard nothing, nothing from the program till March of
nineteen seventy three, and I had never interviewed at Children's.
I was finishing a post call night in pediatrics at
UCLA in the cafeteria and the page operator called my name.
(16:25):
You remember they used to have overhead pages. There's a
phone call. So I got the phone call and I
identify myself. Well, the operator said, there's a phone call
from Boston. Thought, who do I know in Boston? Anyway,
I picked up the phone. I heard this voice, Tom
(16:45):
Alex Natis, come to Boston.
Speaker 4 (16:49):
Write me a letter. Click.
Speaker 5 (16:53):
Now that told me a lot about doctor Natus. He
was really short on dialog. You're not going to argue
with him. It's his word is basically law, as ROBERTA said.
And so a year and a half later, I showed
up and did my fellowship. And it's when you're in
the middle of an intense fellowship, it's really like the
(17:17):
fog of fellowship. You're working hard, you want to please everybody.
You can't do that, but you try. Particular doctor Natus
had very high standards. And it's only after you step back,
either you go to another hospital or you become an
(17:37):
attending All of a sudden, you're the physician of record
for this patient at Boston Children's Hospital Cardiology, world famous program,
and your name is on the list that you are
the attending physician. And after you have a chance to
look back, and obviously time at its memories, as Peter
(17:59):
Lang said earlier, and you think about how your fellowship
you wanted to be. It wasn't necessarily like that, but
you wanted to be. And people said, well, it's the
best of times and the worst of times. No, it
was the times period. So you look back and you
(18:19):
realize what a phenomenal opportunity was to train and Barry
here taught me a great deal about squash, a little
bit about cathorization.
Speaker 4 (18:32):
Roberta was wonderful.
Speaker 5 (18:33):
Mentor Echo didn't really help, particularly when color came out
because I was color blind, so I decided to spend
time in the cath lab with Berry and it was remarkable.
And like many early experiences, what you learn during those
years of training stays with you for a lifetime, and
(18:56):
that's the case with probably most of us. Now, Natus
heard about me, and I'm not a ringer on this
because I trained where Arthur Moss was the head of
pediatrics and Forrest Adams was the head of pediatric cardiology,
and they're.
Speaker 4 (19:13):
The authors of Moss and Adams.
Speaker 5 (19:15):
Big textbook was there in tenth edition. Now, so I
someone spoke and also doctor Natus was a little suspicious
recruiting somebody from California. However, Don Feiler was recruited from
LA Children's Hospital back to Boston, so he had I
(19:37):
had one other person ahead of me coming from California,
and I thought it was a pretty good recommendation right there.
Speaker 2 (19:46):
Wow, quite a story, you know, doctor Hogan, you're known
for having trained many fellows yourself over many years. What
do you think was the biggest difference between how we
interact with and train fellow today versus how doctor Natas
interacted with you back in the early nineteen seventies.
Speaker 4 (20:10):
Well, every patient was doctor Natus's patient.
Speaker 2 (20:14):
Yeah, oh, doctor Romph. We're always excited either one, either one, Okay.
Speaker 7 (20:21):
Okay, I'm on. How I met doctor Natis was I
was in Kentucky at medical school and Jackie Newton had
three days of cardiology. She invited doctor Natas. So doctor
Natas came and Jackie said to me on the second day,
she said, Patty, I want you to go out to
(20:41):
lunch with doctor Natas. And I I thought okay. So
I went out to lunch with them, and doctor Natas
started quizzing me about what I wanted to do, and
I said, well, I'm going to go into pediatrics, and
I think I want to be a pediatric psychiatrist. My
father was a psychiatrist, and I decided when I was
(21:03):
nine years old that I was going to be a
psychiatrist like he was. So I said, I think I
want to be a pediatric psychiatrist. So we had lunch
and we sat there and he put his hand over
and he said, Patty, I want you to come to
Boston on your elective next month. Jockie says, you have
a month to go anywhere you want. To come to
(21:24):
Boston so I thought, that's good, Okay, I'll do my
interviews at Philadelphia Children's in New York on the way
and then go to Boston. And never been in the Northeast,
And so I came to Boston. It was a very
busy five weeks. One of the senior fellows hurt us
(21:48):
back and couldn't come in for three weeks, and so
I worked very hard and I had a wonderful, wonderful time.
And Doctor Natis was unbelievable. I mean, I think the
thing he's done to my life, he made my life.
So the day before I was leaving, he called me
over to his office and he said, how was your
(22:11):
visit here? And I said, oh, it's been great. I
loved it, and I'm starting to change my thinking about
what I want to do. And he said, good, because
you have a pediatric cardiology fellowship here when you finish
your pediatrics. He said, I don't know what I can
do much about your internship, he said, because we got
(22:32):
this Janeway guy, this gross guy, and this Rosen guy
on the committee, and they don't like women, he said.
And that made sense to me because I had my
medical school class with sixty eight people and there were
two females, and back in those days, every interview I
went to the first question, I was asked, are you
(22:53):
going to use this or you're just going to have
babies and run a house or whatever. So doctor he
just said to me, you have your cardiology fellowship when
you come back. And then I went on home. And
two months later was the match program came out and
I got called to the Dean's office and I walk
(23:13):
in and there's all these people around. I thought, what
did I do now? And uh, and he opens this
letter and he said, you just got an internship at
Boston Children's Hospital. I mean, my whole life changed at
that moment.
Speaker 2 (23:29):
And where your washrer was your father angry with you
that you were not becoming a psychiatrist.
Speaker 7 (23:35):
I had totally given up the thought. I mean I
fell in love with pediatric cardiology during those four weeks.
Speaker 2 (23:41):
Literally I was wondering, Doctor Romp, if you could share
with us any favorite quotes or things.
Speaker 7 (23:48):
That very cold month I was coming from the South,
came into Boston in December.
Speaker 2 (23:54):
Wow, any favorite quotes of his or wisdom that he
imparted to you during all the years you worked with him?
Speaker 7 (24:03):
Well, he was a tremendous influence all my life.
Speaker 2 (24:06):
I see, well, doctor Hagan, I was asking you if
you could maybe contrast how you deal with and how
we all deal with cardiology fellows today in comparison to
how doctor Natus would with you when you were a fellow.
Speaker 5 (24:26):
In my time a fellowship here was seventy four to
seventy seven that I had two years of active duty
and got recruited back in the Navy.
Speaker 4 (24:35):
I got recruited back to be a faculty member.
Speaker 5 (24:38):
So I was around trainees for most of my professional life.
A couple of things, and Natis's program was the very
family oriented, that is, he looked after everybody, but slightly different.
He carried a great deal, but he expressed that carrying
(25:00):
a little differently from time to time. He was basically
all business and the fellows.
Speaker 4 (25:08):
I remember.
Speaker 5 (25:10):
As a fellow, you come into a program, it's like
your father in law. You first have fear. Then after
a time you see what's going on and other people
that he's built the program around, you have respect, and
(25:30):
then you develop an admiration. And I think that's very
important for fellows to understand that transition. At least for me,
it was so he cared about our fellows. He expected
a great deal and limited his expression of your accomplishments.
Speaker 4 (25:58):
It was dis expected.
Speaker 5 (26:00):
I remember taking the cardiology boards. Some of you don't
know what they are probably, and they're very competitive, and
so I took them and I waited for two or
three weeks for the results and I passed. So I
going to see doctor Natas and I said, doctor Natis,
I passed the boards. Yeah, I found out three weeks ago.
(26:25):
Get back to work.
Speaker 4 (26:29):
Now.
Speaker 5 (26:30):
I think the fellows that I was around and helped
train at other institutions were expecting a little bit different
kind of relationship. I think the pressures were a little
bit different. The amount of knowledge was much greater, and
lacking a program of historical memories, it's difficult to re
(26:59):
establish relatively new program. And that's the advantage here is
that you have a wealth of history here. There's over
two hundred years at pediatric cardiology between the four of.
Speaker 4 (27:10):
Us, and I think that's pretty good.
Speaker 2 (27:13):
And we're here absolutely, Doctor Williams, you are a noted
educator in pediatrics and pediatric cardiology. I'm wondering if I
could pose the same question to you, how would you
contrast the way doctor Natus interacted with the fellows in
(27:35):
your era versus how you teach fellows today.
Speaker 6 (27:40):
I think we were a fairly small family then, so
you spent a fair amount of time with everyone, and
we didn't have sub sub specialists at that time. What
I've seen now in training is there's so much more
(28:01):
to know. Fortunately, AI is going to fix it, so
we don't actually have to know anything. And I think
that's a good thing, because the amount of knowledge you
know in the different areas of imaging, electric physiology and
clinical care is just so great that it's not comfortable.
(28:28):
And I think this is given in a great tsunami
when someone starts their fellowship training. I am amazed that
at Children's Hospital Los Angeles, the fellows that come through
(28:48):
after about three months they sound like faculty. I mean,
it's just amazing they're subjected to so much. But the
other thing was that when we were training, there was
a balance of VSDs, like simple VSDs and regular TETs,
(29:11):
and now the complexity is so much, and also the
burden of illness on the patients is so much, so
there's this dealing with a sense a little bit of
moral injury. I mean, it's there. There's so many things
that they're seeing their patients go through that it takes
(29:32):
a certain amount of strength to be able to learn
how to manage that. So I really admire the Fellows nowadays.
And I think when people say that, oh, they just babies,
they get every third uh, and they only every third
every fourth night, or they have certain restrictions on ours.
(29:58):
Just the mental end, the mental energy of every time
you come on service, there's a whole new population of patients,
the whole new set of problems. We could see the
same patient three days in a row. I mean, it
was just amazing. And so we underestimate how much stress
(30:23):
there is in training now and I fully endorse having
protections against that and field that we really need to
continue that.
Speaker 2 (30:34):
Yeah, it certainly seems from what we learned this morning
that that has changed quite a bit of Children's and
that those to use your term protections have been enabled
to hear at Children's. Well, we're getting to the ends
of this session and I didn't want to monopolize this.
This is a rare opportunity to speak with four giants
in our field. I'm wondering if anybody in the audience
(30:55):
had any questions for doctor Romf, doctor Williams, doctor Hogan
or doctor ca yep, Phil soft Well.
Speaker 9 (31:06):
I don't have questions, but I'll tell a couple of anecdotes.
ROBERTA left pretty much when I kind of was just
getting started in cardiology, and Patty was a referral. But
Tom Hougan was the attending the very first night I
started in pediatrics, which I mentioned earlier, was on cardiology.
And Vicky de Leone, who probably nobody remembers here but
(31:29):
Tom remembers, was a brand new fellow. And Tom you
lived out in Sherburn, right, and so he used to
stay overnight.
Speaker 4 (31:37):
If something was going to happen, he would just sleep
on his couch.
Speaker 9 (31:41):
And we had a tetrology patient who needed a cath
and so we came down to the cath lab about
six o'clock with the patient, Vicky and I and Tom
looks at the patient and starts telling us all the
things we've done wrong, including no IV. These patients get dehydrate,
He's going to have a text spell. And you know,
(32:02):
I was like second day of internship. So anyway, it
was a good lesson in the old style of training,
which was good for all of us here and Barry
probably a lot of people don't know. He was the
EP doc for a long time before Ed went to
the mess General and then I sort of trained with Ed.
(32:24):
Barry did the EP studies and there was this big,
giant machine where he had to turn all the little
dials to change the the pacing intervals and other things,
and then and then a machine that printed out the paper.
And Barry was just sort of perfect for it. He
had the patience to sit there and twiddle the dials
(32:46):
and tell us what was going on and then have
us do the measurements. And so that's how Ed and
I kind of learned our epore before we did other things.
So thank you to both of you for training us
in for the other two for Patty hadn't ever heard it,
for all you've did.
Speaker 7 (33:02):
Okay, the ekg's had to be cut up and pasted
on the paper and then you know, machines didn't read them.
The first week I was in cardiology, I remember doctor
Gamble took us all up on there were just four
fellows that year. It took us up on the fifth
floor and took us to a little room and he said,
(33:23):
doctor just wants to make sure you all know how
to choose KG paper because I could get in an emergency. Uh,
I don't know how to do it. That was one
of my first introductions to doctor Gamble. But the Wholter
monitors in those days, I remember normal Restio was sitting
in a room watching this thing go by for hours.
(33:46):
You read Wolter monitors hour by hour. They weren't read
by machine. The second floor cath lab when I came
there as an intern, used to not have the only
floral you was click on, click off for about two seconds,
and the X rays were piled up and were pushed
(34:07):
in with a broomstick. Go bang bang bang bang bang.
By the time I came back from my fellowship, that
lab had floral and the baby lab was in the
basement was about bilateral sinnies. That's how things have changed
in years.
Speaker 2 (34:28):
Wow, very interesting. Phil was mentioning an unknown skill of
Barry to the younger people that he was the initial electrophysiologist. Here.
Many of us in the audience remember another thing that
Barry used to do for us, which was to keep
us healthy by playing squash with us. And I just
wanted to thank Barry for beating me routinely consistently at
(34:51):
least two or three times a week all the years
I was a fellow. Was one of my great memories.
Never minded losing to you. Even when you would play
me in a five point game, spot me four points,
so I would still lose by far.
Speaker 10 (35:06):
I just have one Doctor Nadas comment, I don't know
how many people in this room had to do the
trip to Greenfield duty. What you would do is doctor
Natus would pick one of the first year fellows, and
I got picked. I had only been up here for
about two weeks. And you would go to doctor Natus's
(35:30):
house in Wellesley. He would look at your car, and
if it was a piece of junk like mine, you
would take his car and then you would drive him
out to Greenfield. He would see a few patients have lunch,
and then drive back and he would grill you the
whole time. And it was very intense actually. And the
(35:53):
other thing, unbeknownst to me, he would time how long
it took you to get from Greenfield back to Wellesley
and calculate what your average mile per hour speed was.
And I think if you were over a certain number,
there would be a black mark put next to your
name in his.
Speaker 6 (36:11):
Book, Can I mention a little bit about Natus's driving ability.
Speaker 2 (36:20):
Only because he's not here?
Speaker 7 (36:22):
Oh, yes he is.
Speaker 6 (36:26):
That man would put his foot down accelerate and to
take it off and put his foot down accelerate, and.
Speaker 7 (36:36):
He just drove.
Speaker 4 (36:39):
Like that the whole way.
Speaker 7 (36:41):
It was just it was crazy.
Speaker 5 (36:46):
Roberta has a problem with driving because she was on
the sidewalk on a Longwood Avenue once in her little
car trying to get to the ICU. Because there's too
much traffic. She decided to go on the sidewalk and nobody.
Speaker 6 (37:00):
Stopped her right Brookline in Longwood.
Speaker 7 (37:03):
Yeah, that was rush hour.
Speaker 11 (37:08):
My name's Lori Armsby, and I just had a question.
It's just fascinating for me to hear that Natus picked
you out of other trainees or somehow saw something in
you that caused him to make that phone call to
say come to Boston. It might not be fair to
(37:29):
ask you, you know, what about you did he see?
I'd loved if you have that insight. I'd love to
hear what about you did he see? And did he
value as a really young person and that showed him
that you had promise. If you don't know that about yourself.
I just wonder if you could comment what did he
(37:50):
see in young people that he valued and saw that
promise that turned out to be careers like you all have.
Speaker 6 (37:58):
He had great insight, He did.
Speaker 2 (38:09):
Well certainly with this for I think true words were never.
Speaker 11 (38:14):
Spoken, yes exactly, And it just fascinates me that he could, maybe, Patricia,
what did he see in you as a young trainee
in that lunchtime that that he wanted to continue did.
Speaker 7 (38:29):
Quite a bit that day, He said, I was a
hard worker. Some of the things they put up their
curiosity had our to take care of people and help
people and not communicate, I guess.
Speaker 6 (38:43):
I argued with him about whether the second heart sound
uh with an ASD could move point two seconds, and
we discussed those kinds of things quite a lot.
Speaker 2 (39:03):
Seems to me like the standards felt quite substantially from
her to me, Well, I think at this point we're
going to wrap this up. I want to thank our
esteemed guests. It was really delightful to learn about that era.
Speaker 8 (39:25):
Well.
Speaker 1 (39:25):
As I record this now a day or two out
from the event in Boston and back in New York,
so many thoughts go through my mind. It was so
inspiring to hear from doctors Williams, romp Hogen and Keen,
and so interesting and fascinating to hear about the early
days of cardiology at Boston Children's and how much of
an impact doctor Natas had on each of their lives.
(39:47):
It seems that doctor Natis was quite a wonderful arbiter
of cardiology potential, as evidenced by the careers of these superstars.
It was a particular joy to see my old friend
and mentor, doctor Keene, who was always so kind to
me and all of our cofellows. The entire weekend was
really a special one, and what a wonderful idea doctors
(40:08):
Gava and Walsh had in organizing this. Some of you
may know that I am a big baseball fan, and
particularly a fan of the New York Yankees. Love the
Yankees or hate them. One thing that they've always done
each year that everyone loves is the so called old
Timer's Day, in which the older players of yesteryear are
invited back to come out on the field and hear
(40:31):
the cheers of their old fans and also congregate and
relive their past lives. As many young boys, I wanted
to be a New York Yankee, but my talent was
woefully inadequate to ever seriously entertain that idea. However, for
just one weekend, I think I had a sense of
what it might be like to be a former Yankee
and come back for the weekend and hang out with
(40:53):
the friends of my youth, the people who you fought
battles alongside. Maybe I never hit a pinch hit home
run a World Series game, but the stakes back in
the mid nineteen nineties were even higher when we were
caring for HLHS patience or doing some of the first
oblations ever performed in children. Though I never will have
the joy or feeling of being a Yankee, I do
(41:15):
feel that I did get that joy that the older
players must feel when they come back and relive their
youth and retell the old stories on Old Timer's Day.
I had that feeling this past weekend, and for this
I am profoundly grateful to the organizers of this conference.
I am also grateful to the admission board of that
Fellowship program at that time, headed by doctor Michael Freed,
(41:38):
who was so good as to take a chance on
a kid from Brooklyn. I hope I've made them proud
to conclude this three hundred and fortieth episode of Pete
Heart Pediatric Cardiology. Today, I've chosen to pick one of
the favorite artists of one of today's guests, Professor Barry Keene.
Like Doctor Kean, the great lyric tenor John McCormick was
(41:59):
born born in Ireland, and he started his early training
in Ireland and had a notable career in opera for
the first decade of that career. However, he was really
always more drawn to the concert stage, and though having
one of the truly glorious operatic tenor voices of the
first part of the twentieth century, he focused his efforts
on concerts and recitals. Today we hear McCormick in a
(42:22):
very rare live nineteen twenty nine recital with his longtime
recital pianist Edwin Schneider singing what was one of McCormick's
signature great hits, I Hear You Calling Me, which was
written in nineteen oh eight by Harold Hartford and Charles Marshall.
After today's brief interview, Doctor Keene reminded me of his
(42:43):
love of McCormick, and so I thought who better than
to usher out today's episode Thank you for joining me
for this wonderful step back into time, and thank you
to the organizers of this Boston Children's Symposium for inviting
me to interview these giants of cardiology. I wish all
good week.
Speaker 3 (43:06):
Call me.
Speaker 12 (43:15):
You called me when abou moon had been on light.
Before I went from you in a too long night.
Speaker 8 (43:30):
I came.
Speaker 13 (43:33):
Bet you remain.
Speaker 8 (43:38):
To you before the water last, to be.
Speaker 13 (43:47):
The car the stars.
Speaker 4 (43:52):
Long Ah, you call.
Speaker 8 (44:08):
Ling me, not at all caring inladness of your voice,
the worse that made my longing heart to rejoice.
Speaker 7 (44:23):
You spoke.
Speaker 13 (44:25):
To you emanber Mo Steals they.
Speaker 8 (44:39):
Music you all.
Speaker 12 (44:53):
Ah.
Speaker 3 (44:56):
You let me.
Speaker 8 (45:08):
Oos have a strang we re length between.
Speaker 12 (45:19):
Bad your gras for mussy grassy green, I stann.
Speaker 8 (45:33):
Do you behold me?
Speaker 12 (45:37):
Leave me you revots through all the.
Speaker 3 (45:52):
Between.
Speaker 8 (46:06):
Oh reely me
Welcome to Pdiheart Pediatric Cardiology Today. My name is doctor
Robert Pass and I'm the host of this podcast. I
am Professor of Pediatrics at the Icon School of Medicine
at Mount Sinai, where I'm also the Chief of Pediatric Cardiology.
Thank you very much for joining me for this three
hundred and fortieth episode of Pdheart. I hope all enjoyed
last week's episode on the concept of hands gripped strength
(00:38):
and its possible role it may play in the assessment
of our patients with congenital heart disease. For those of
you interested in exercise physiology, I'd recommend you to take
a listen to last week's episode with doctor Adam Powell
of Cincinnati Children's Hospital. As I say most weeks, if
you'd like to get in touch with me, my email
is easy to remember. It's Pdheart at gmail dot com.
(01:00):
This week we have an extra special treat for the podcast.
Last weekend, I had the pleasure and honor of attending
the Boston Children's Cardiology seventy fifth Alumni Reunion, which occurred
on May third and fourth in Boston. The occasion was
a celebration of the history of the important cardiology program
at that institution that has fostered the career of so
(01:21):
many cardiologists throughout the world, and in so doing has
improved the lives and health of literally thousands upon thousands
of children worldwide. As part of this program, on May third,
at the end of the day, the organizers arranged for
a thirty minute session focusing on the Alexander Nadus years,
with the goal of hearing about what it was like
(01:42):
to work with doctor Natus, who was, as we all know,
the founder of that program. Just in case some don't know,
Doctor Alexander Sandor Natus was born in November of nineteen
thirteen and he died in May of two thousand. He
was the founder of the cardiology program at Children's Hospital
Boston after immigrating to the United States from Budapest, Hungary.
(02:04):
After practicing as a pediatrician in Greenfield, Massachusetts for three years,
he was invited by doctor Charles Janeway to come to
Boston Children's Hospital and start a program to care for
children with congenital and other heart problems in the early
nineteen fifties. His first trainee was the famed cardiologist Abraham Rudolph,
who himself had an illustrious career. Doctor Natus was professor
(02:28):
of pediatrics at Harvard Medical School and won just about
every award that existed for both pediatricians and cardiologists, and
rightly so. Despite his many accolades as a clinician and researcher,
it's clear that his role as a founder, educator, and
leader were the things for which he is best remembered.
And today, in this episode, will replay the conversation we
(02:50):
had last week during the symposium, in which we spoke
with a few of his trainees from the nineteen seventies,
who all have gone on to have wonderful careers, including
doctor ROBERTA. Williams, Doctor Barry Keane, doctor Patricia Romp, and
doctor Thomas Hougan. All got their starting cardiology with doctor
Natis at Boston Children's Hospital. Rather than comment too much further,
(03:13):
let's go straight into the recording from last Saturday, and
here's some of the warm and fun memories of these
masters of cardiology, how they got their start with the
amazing doctor Alexander Natas, And so here we go.
Speaker 2 (03:26):
All right, Well, I am very excited today and I'm
very appreciative to Ed and the organizers of today's symposium.
I have a distinct honor of being able to interview
for giants right here, and what a wonderful way to
end the day today. I just really can't say enough.
Ed just introduced everyone. I'll just again remind everybody we
(03:49):
have doctor ROBERTA. Williams, who's the former Chair Pediatrics at
UNC and former Chief of Pediatric Cardiology UCLA, also pioneer
and pediatric cardiology, critical care and eco cardiography, really a
remarkable individual. We have, of course doctor Barry Keane, the
former cath Lab director here at Boston Children's. I know
(04:10):
when I heard Barry was coming, there was no chance
I was not coming because it's a rare opportunity to
see our good buddy Barry. Doctor Patricia Romp really really
the pioneer of pediatric cardiology and Rhode Islands, and that
seems like I was always looking at tracings that you
brought to doctor Walsh an EP when I was a fellow.
(04:31):
And then of course we have doctor Tom Hougan, the
former chief of Pediatric Cardiology at Children's National DC Children's.
Speaker 1 (04:37):
And Professor of Pediatrics at Georgetown.
Speaker 2 (04:40):
So basically the purpose of today's talk is to learn
a little bit more about what it was like when
doctor Natus was running the show. And so let's start
with doctor Keene Barry. I'm wondering if you could share
with us how did you end up at Boston Children's Hospital,
how did you meet doctor Natus, and how did he
even become a cardiology fellow at all?
Speaker 3 (05:00):
Thank you very much, this is a great honor. The
first thing I'd like to say is that the best
thing that ever happened to me was that Claire agreed
to marry me in nineteen sixty eight in Mallett's Bay
near Burrington, Vermont. David Brown knows this area well, and
(05:23):
I was a cardiology fellow at UVM with number one
Art Levy, who had been a Natives Fellow in nineteen
sixty three, prior to which he had been a superb
figure skater of Olympic caliber and a friend and classmate
of Dick Button at Harvard and also a Major League
(05:45):
baseball prospect. And number two b was Bert to Bacon,
who founded the cardiology group at UVM and who after retiring,
came to Children's Hospital for one year to learn more
about eco cardiography, which he did at UVM for another
ten years after that. Both of these made pediatric cardiology
(06:08):
fascinating for me. They recommended me to his asn and
I was accepted into the fellowship program, and just before
the project. At start of that program, my draft number
was changed from four to one a almost overnight, so
(06:29):
I was going to be drafted. So we decided that
I could volunteer, and I told doctor Nadas and he
promised me that my place in the program would be
waiting for me when I got out. In September of
nineteen sixty eight, we set off in Claire's v W
bug with the right hand drive, and some two thousand
(06:54):
miles later we arrived at Fort Port, Louisiana. It was
striking to me that on the way the soil color
changed from dark to red about halfway through the trip.
Others like Mark Alexander actually was spent time in Fort Polk,
(07:14):
and as did Bill of Bill and Emily, who used
to do all our photography for us. In September of
nineteen seventy, we drove north after the two years to
children with their infant son John and a new v W.
We were met by Don Philer wearing his signature bow
(07:36):
tie and the fellows there at the time included ROBERTA.
Mike Fried, Bob Freedom, Sultan Mescow, Patty Rumph and Sala Rockenmacher,
and some others. The terrific staff taught us. Who taught
us included Ami Rosenthal, Grant LeFarge, URTIs Ellison, Olimietnam from
(08:02):
the Harvard School of Public Health, Bill Plouth, Walter Gamble
who could fix anything, Richard and Stelevant Prague, Greer Monroe,
and Ken fellows who taught us to take the best
pictures and much other stuff. Besides the cathlab and the
department staff included Joni Michel Tish and her mother who
(08:28):
did ecges, Jeanine Cartier Margie who was operated on incidentally
for valver p S prior to the balloon era, Barbesizarrow,
Deirdre and Hugh from Ireland, Janice Burnett, Mark Warren, the
best tech probably in the whole of the USA, and
(08:50):
many others. Some of a es N's more acceptable remarks included,
I'm a benign autocrat. I don't get ulcers I give them.
As I look around the room and see our own
United Nations, I just hope we're doing better than them.
(09:14):
He also had organized the people of the street that
he lived in, Benton Street in Wellesley, and he called
them the Philosophical Society of Benton Street, and they summoned
me there one time and presented me with the with
the cardiology department with the portable defibrillator. When his retirement
(09:38):
was rumored at the end of a staff meeting, he
went to the blackboard and he wrote in big letters
N A D A S. Then he erased the S
and he replaced it with a big L. And that's
how we've found out about Bernardo coming. Both Bernardo and
(10:02):
Jim Locke were extraordinarily kind to Claire and me in
our time there. I also have to say a few
words about Don Peiler, who was a wonderful mentor. He
taught me how to cathagorize babies, and whenever we had
a bad day, he would come in and sit down,
(10:24):
often on an upturned waste paper basket and remind me,
I know you're feeling down, but just remember you get
to come here and try to make things better every day.
And I couldn't help but think, how could one not
fall in love with this marvelous people and this wonderful place.
(10:46):
Thank you to Ed and Tal as well as everybody else.
Speaker 4 (10:50):
Thank you.
Speaker 2 (10:58):
Well, Barry, thank you so much for those wonderful words.
I feel like I was there myself. That was really wonderful,
and I know everybody is just so thrilled to see you.
And if Don Feiler taught you had a calf, then
I guess in a sense he taught all of us
how to caf because we all learned from you. So
thank you for everything, Doctor Williams. I was going to
(11:26):
ask you, how did you meet doctor Natus and how
did you end up being a fellow at Boston Children's Hospital?
Thank you?
Speaker 5 (11:39):
What's that?
Speaker 6 (11:45):
I had planned to be a cardiologist since the eighth grade,
so I went to medical school to be a cardiologist,
not a doctor. But I had written my senior theme
in high school on new techniques and heart surgery, and
I still have the notes, and it's just amazing what
(12:09):
I was writing about, how to go on the pomp
and how to approach the micro valve and things like that.
And I'd done a lot of research on phone of
cardiography and vector cardiography and remote monitoring, EKG monitoring and
(12:31):
early early defibrillations. One of the interns where I was
a medical student. Actually was so insistent that I go
up and look at the program that he filled out
the application for me and sent it in. So I
ended up coming up for the rotation and doctor Natus
(12:54):
offered me a spot two years. Hence I actually realized
I wasn't going to have enough years of pediatrics for
the board exams and wrote him and said can I
come one year later? He didn't save a spot for me.
He said, you're showing up in nineteen seventy.
Speaker 2 (13:15):
Sounds like the benevolent tyrant that I'm understanding him to
have been. And you know, you are obviously a pioneer,
Doctor Williams, in so many areas, particularly critical care and echo.
I was wondering, in regards to all of your innovations
in echo, what were doctor Natus's thoughts about that? I mean,
(13:36):
here he is the great ouscultator examiner of children. Was
what was he thinking or what did he say to
you when you were starting to, you know, come up
with all innovate in the area of imaging.
Speaker 6 (13:51):
Well, I was visiting him during his sabbatical in London
on the way with Lucy Peresi to go to Sicily
and he said, you know, there's this thing called ultrasound,
and you do sound waves, so you will do ultrasound.
(14:12):
He's sort of planning people's lives like that. So he
was very much in favor. When my first echo book
came out, on Mode Echo, he wrote the ForWord and
the last sentence said, who knows, but perhaps one day
(14:36):
echo cardiography will have the same place in the work
up of patients as to ekg and chest ecks rate
a day. So we tried to overcompensate for that.
Speaker 2 (14:52):
I see, and I guess his word was basically the
loss when he told you you were doing echo. I
guess there was no choice at that time.
Speaker 7 (15:00):
I know, I really hated to hear this.
Speaker 2 (15:05):
Of course, you became a pioneer in the field, so
I guess he had had a good idea.
Speaker 7 (15:10):
Throw me in the briar. Pietr.
Speaker 2 (15:11):
Yeah, I say, well, doctor Hogan, I was wondering, what
role did doctor Natus play in you're becoming a pediatric cardiologist.
How did you meet him? How did that happen?
Speaker 4 (15:25):
I have a little story, some of which is true.
Speaker 8 (15:30):
Now.
Speaker 5 (15:31):
Roberta said she got interest in cardiology in eighth grade.
I heard about this program when I'm six years old. Now,
I didn't apply right away because I wanted to see
how ab Rudolph would recommend it. Now, aber Rudolf came
from South Africa with no salary.
Speaker 4 (15:51):
I don't know. He moonlit somewhere. I don't know where.
Speaker 5 (15:56):
So I decided I'll apply in nineteen, I mean two,
nineteen fifty three.
Speaker 4 (16:02):
It's fine.
Speaker 5 (16:04):
I heard nothing, nothing from the program till March of
nineteen seventy three, and I had never interviewed at Children's.
I was finishing a post call night in pediatrics at
UCLA in the cafeteria and the page operator called my name.
(16:25):
You remember they used to have overhead pages. There's a
phone call. So I got the phone call and I
identify myself. Well, the operator said, there's a phone call
from Boston. Thought, who do I know in Boston? Anyway,
I picked up the phone. I heard this voice, Tom
(16:45):
Alex Natis, come to Boston.
Speaker 4 (16:49):
Write me a letter. Click.
Speaker 5 (16:53):
Now that told me a lot about doctor Natus. He
was really short on dialog. You're not going to argue
with him. It's his word is basically law, as ROBERTA said.
And so a year and a half later, I showed
up and did my fellowship. And it's when you're in
the middle of an intense fellowship, it's really like the
(17:17):
fog of fellowship. You're working hard, you want to please everybody.
You can't do that, but you try. Particular doctor Natus
had very high standards. And it's only after you step back,
either you go to another hospital or you become an
(17:37):
attending All of a sudden, you're the physician of record
for this patient at Boston Children's Hospital Cardiology, world famous program,
and your name is on the list that you are
the attending physician. And after you have a chance to
look back, and obviously time at its memories, as Peter
(17:59):
Lang said earlier, and you think about how your fellowship
you wanted to be. It wasn't necessarily like that, but
you wanted to be. And people said, well, it's the
best of times and the worst of times. No, it
was the times period. So you look back and you
(18:19):
realize what a phenomenal opportunity was to train and Barry
here taught me a great deal about squash, a little
bit about cathorization.
Speaker 4 (18:32):
Roberta was wonderful.
Speaker 5 (18:33):
Mentor Echo didn't really help, particularly when color came out
because I was color blind, so I decided to spend
time in the cath lab with Berry and it was remarkable.
And like many early experiences, what you learn during those
years of training stays with you for a lifetime, and
(18:56):
that's the case with probably most of us. Now, Natus
heard about me, and I'm not a ringer on this
because I trained where Arthur Moss was the head of
pediatrics and Forrest Adams was the head of pediatric cardiology,
and they're.
Speaker 4 (19:13):
The authors of Moss and Adams.
Speaker 5 (19:15):
Big textbook was there in tenth edition. Now, so I
someone spoke and also doctor Natus was a little suspicious
recruiting somebody from California. However, Don Feiler was recruited from
LA Children's Hospital back to Boston, so he had I
(19:37):
had one other person ahead of me coming from California,
and I thought it was a pretty good recommendation right there.
Speaker 2 (19:46):
Wow, quite a story, you know, doctor Hogan, you're known
for having trained many fellows yourself over many years. What
do you think was the biggest difference between how we
interact with and train fellow today versus how doctor Natas
interacted with you back in the early nineteen seventies.
Speaker 4 (20:10):
Well, every patient was doctor Natus's patient.
Speaker 2 (20:14):
Yeah, oh, doctor Romph. We're always excited either one, either one, Okay.
Speaker 7 (20:21):
Okay, I'm on. How I met doctor Natis was I
was in Kentucky at medical school and Jackie Newton had
three days of cardiology. She invited doctor Natas. So doctor
Natas came and Jackie said to me on the second day,
she said, Patty, I want you to go out to
(20:41):
lunch with doctor Natas. And I I thought okay. So
I went out to lunch with them, and doctor Natas
started quizzing me about what I wanted to do, and
I said, well, I'm going to go into pediatrics, and
I think I want to be a pediatric psychiatrist. My
father was a psychiatrist, and I decided when I was
(21:03):
nine years old that I was going to be a
psychiatrist like he was. So I said, I think I
want to be a pediatric psychiatrist. So we had lunch
and we sat there and he put his hand over
and he said, Patty, I want you to come to
Boston on your elective next month. Jockie says, you have
a month to go anywhere you want. To come to
(21:24):
Boston so I thought, that's good, Okay, I'll do my
interviews at Philadelphia Children's in New York on the way
and then go to Boston. And never been in the Northeast,
And so I came to Boston. It was a very
busy five weeks. One of the senior fellows hurt us
(21:48):
back and couldn't come in for three weeks, and so
I worked very hard and I had a wonderful, wonderful time.
And Doctor Natis was unbelievable. I mean, I think the
thing he's done to my life, he made my life.
So the day before I was leaving, he called me
over to his office and he said, how was your
(22:11):
visit here? And I said, oh, it's been great. I
loved it, and I'm starting to change my thinking about
what I want to do. And he said, good, because
you have a pediatric cardiology fellowship here when you finish
your pediatrics. He said, I don't know what I can
do much about your internship, he said, because we got
(22:32):
this Janeway guy, this gross guy, and this Rosen guy
on the committee, and they don't like women, he said.
And that made sense to me because I had my
medical school class with sixty eight people and there were
two females, and back in those days, every interview I
went to the first question, I was asked, are you
(22:53):
going to use this or you're just going to have
babies and run a house or whatever. So doctor he
just said to me, you have your cardiology fellowship when
you come back. And then I went on home. And
two months later was the match program came out and
I got called to the Dean's office and I walk
(23:13):
in and there's all these people around. I thought, what
did I do now? And uh, and he opens this
letter and he said, you just got an internship at
Boston Children's Hospital. I mean, my whole life changed at
that moment.
Speaker 2 (23:29):
And where your washrer was your father angry with you
that you were not becoming a psychiatrist.
Speaker 7 (23:35):
I had totally given up the thought. I mean I
fell in love with pediatric cardiology during those four weeks.
Speaker 2 (23:41):
Literally I was wondering, Doctor Romp, if you could share
with us any favorite quotes or things.
Speaker 7 (23:48):
That very cold month I was coming from the South,
came into Boston in December.
Speaker 2 (23:54):
Wow, any favorite quotes of his or wisdom that he
imparted to you during all the years you worked with him?
Speaker 7 (24:03):
Well, he was a tremendous influence all my life.
Speaker 2 (24:06):
I see, well, doctor Hagan, I was asking you if
you could maybe contrast how you deal with and how
we all deal with cardiology fellows today in comparison to
how doctor Natus would with you when you were a fellow.
Speaker 5 (24:26):
In my time a fellowship here was seventy four to
seventy seven that I had two years of active duty
and got recruited back in the Navy.
Speaker 4 (24:35):
I got recruited back to be a faculty member.
Speaker 5 (24:38):
So I was around trainees for most of my professional life.
A couple of things, and Natis's program was the very
family oriented, that is, he looked after everybody, but slightly different.
He carried a great deal, but he expressed that carrying
(25:00):
a little differently from time to time. He was basically
all business and the fellows.
Speaker 4 (25:08):
I remember.
Speaker 5 (25:10):
As a fellow, you come into a program, it's like
your father in law. You first have fear. Then after
a time you see what's going on and other people
that he's built the program around, you have respect, and
(25:30):
then you develop an admiration. And I think that's very
important for fellows to understand that transition. At least for me,
it was so he cared about our fellows. He expected
a great deal and limited his expression of your accomplishments.
Speaker 4 (25:58):
It was dis expected.
Speaker 5 (26:00):
I remember taking the cardiology boards. Some of you don't
know what they are probably, and they're very competitive, and
so I took them and I waited for two or
three weeks for the results and I passed. So I
going to see doctor Natas and I said, doctor Natis,
I passed the boards. Yeah, I found out three weeks ago.
(26:25):
Get back to work.
Speaker 4 (26:29):
Now.
Speaker 5 (26:30):
I think the fellows that I was around and helped
train at other institutions were expecting a little bit different
kind of relationship. I think the pressures were a little
bit different. The amount of knowledge was much greater, and
lacking a program of historical memories, it's difficult to re
(26:59):
establish relatively new program. And that's the advantage here is
that you have a wealth of history here. There's over
two hundred years at pediatric cardiology between the four of.
Speaker 4 (27:10):
Us, and I think that's pretty good.
Speaker 2 (27:13):
And we're here absolutely, Doctor Williams, you are a noted
educator in pediatrics and pediatric cardiology. I'm wondering if I
could pose the same question to you, how would you
contrast the way doctor Natus interacted with the fellows in
(27:35):
your era versus how you teach fellows today.
Speaker 6 (27:40):
I think we were a fairly small family then, so
you spent a fair amount of time with everyone, and
we didn't have sub sub specialists at that time. What
I've seen now in training is there's so much more
(28:01):
to know. Fortunately, AI is going to fix it, so
we don't actually have to know anything. And I think
that's a good thing, because the amount of knowledge you
know in the different areas of imaging, electric physiology and
clinical care is just so great that it's not comfortable.
(28:28):
And I think this is given in a great tsunami
when someone starts their fellowship training. I am amazed that
at Children's Hospital Los Angeles, the fellows that come through
(28:48):
after about three months they sound like faculty. I mean,
it's just amazing they're subjected to so much. But the
other thing was that when we were training, there was
a balance of VSDs, like simple VSDs and regular TETs,
(29:11):
and now the complexity is so much, and also the
burden of illness on the patients is so much, so
there's this dealing with a sense a little bit of
moral injury. I mean, it's there. There's so many things
that they're seeing their patients go through that it takes
(29:32):
a certain amount of strength to be able to learn
how to manage that. So I really admire the Fellows nowadays.
And I think when people say that, oh, they just babies,
they get every third uh, and they only every third
every fourth night, or they have certain restrictions on ours.
(29:58):
Just the mental end, the mental energy of every time
you come on service, there's a whole new population of patients,
the whole new set of problems. We could see the
same patient three days in a row. I mean, it
was just amazing. And so we underestimate how much stress
(30:23):
there is in training now and I fully endorse having
protections against that and field that we really need to
continue that.
Speaker 2 (30:34):
Yeah, it certainly seems from what we learned this morning
that that has changed quite a bit of Children's and
that those to use your term protections have been enabled
to hear at Children's. Well, we're getting to the ends
of this session and I didn't want to monopolize this.
This is a rare opportunity to speak with four giants
in our field. I'm wondering if anybody in the audience
(30:55):
had any questions for doctor Romf, doctor Williams, doctor Hogan
or doctor ca yep, Phil soft Well.
Speaker 9 (31:06):
I don't have questions, but I'll tell a couple of anecdotes.
ROBERTA left pretty much when I kind of was just
getting started in cardiology, and Patty was a referral. But
Tom Hougan was the attending the very first night I
started in pediatrics, which I mentioned earlier, was on cardiology.
And Vicky de Leone, who probably nobody remembers here but
(31:29):
Tom remembers, was a brand new fellow. And Tom you
lived out in Sherburn, right, and so he used to
stay overnight.
Speaker 4 (31:37):
If something was going to happen, he would just sleep
on his couch.
Speaker 9 (31:41):
And we had a tetrology patient who needed a cath
and so we came down to the cath lab about
six o'clock with the patient, Vicky and I and Tom
looks at the patient and starts telling us all the
things we've done wrong, including no IV. These patients get dehydrate,
He's going to have a text spell. And you know,
(32:02):
I was like second day of internship. So anyway, it
was a good lesson in the old style of training,
which was good for all of us here and Barry
probably a lot of people don't know. He was the
EP doc for a long time before Ed went to
the mess General and then I sort of trained with Ed.
(32:24):
Barry did the EP studies and there was this big,
giant machine where he had to turn all the little
dials to change the the pacing intervals and other things,
and then and then a machine that printed out the paper.
And Barry was just sort of perfect for it. He
had the patience to sit there and twiddle the dials
(32:46):
and tell us what was going on and then have
us do the measurements. And so that's how Ed and
I kind of learned our epore before we did other things.
So thank you to both of you for training us
in for the other two for Patty hadn't ever heard it,
for all you've did.
Speaker 7 (33:02):
Okay, the ekg's had to be cut up and pasted
on the paper and then you know, machines didn't read them.
The first week I was in cardiology, I remember doctor
Gamble took us all up on there were just four
fellows that year. It took us up on the fifth
floor and took us to a little room and he said,
(33:23):
doctor just wants to make sure you all know how
to choose KG paper because I could get in an emergency. Uh,
I don't know how to do it. That was one
of my first introductions to doctor Gamble. But the Wholter
monitors in those days, I remember normal Restio was sitting
in a room watching this thing go by for hours.
(33:46):
You read Wolter monitors hour by hour. They weren't read
by machine. The second floor cath lab when I came
there as an intern, used to not have the only
floral you was click on, click off for about two seconds,
and the X rays were piled up and were pushed
(34:07):
in with a broomstick. Go bang bang bang bang bang.
By the time I came back from my fellowship, that
lab had floral and the baby lab was in the
basement was about bilateral sinnies. That's how things have changed
in years.
Speaker 2 (34:28):
Wow, very interesting. Phil was mentioning an unknown skill of
Barry to the younger people that he was the initial electrophysiologist. Here.
Many of us in the audience remember another thing that
Barry used to do for us, which was to keep
us healthy by playing squash with us. And I just
wanted to thank Barry for beating me routinely consistently at
(34:51):
least two or three times a week all the years
I was a fellow. Was one of my great memories.
Never minded losing to you. Even when you would play
me in a five point game, spot me four points,
so I would still lose by far.
Speaker 10 (35:06):
I just have one Doctor Nadas comment, I don't know
how many people in this room had to do the
trip to Greenfield duty. What you would do is doctor
Natus would pick one of the first year fellows, and
I got picked. I had only been up here for
about two weeks. And you would go to doctor Natus's
(35:30):
house in Wellesley. He would look at your car, and
if it was a piece of junk like mine, you
would take his car and then you would drive him
out to Greenfield. He would see a few patients have lunch,
and then drive back and he would grill you the
whole time. And it was very intense actually. And the
(35:53):
other thing, unbeknownst to me, he would time how long
it took you to get from Greenfield back to Wellesley
and calculate what your average mile per hour speed was.
And I think if you were over a certain number,
there would be a black mark put next to your
name in his.
Speaker 6 (36:11):
Book, Can I mention a little bit about Natus's driving ability.
Speaker 2 (36:20):
Only because he's not here?
Speaker 7 (36:22):
Oh, yes he is.
Speaker 6 (36:26):
That man would put his foot down accelerate and to
take it off and put his foot down accelerate, and.
Speaker 7 (36:36):
He just drove.
Speaker 4 (36:39):
Like that the whole way.
Speaker 7 (36:41):
It was just it was crazy.
Speaker 5 (36:46):
Roberta has a problem with driving because she was on
the sidewalk on a Longwood Avenue once in her little
car trying to get to the ICU. Because there's too
much traffic. She decided to go on the sidewalk and nobody.
Speaker 6 (37:00):
Stopped her right Brookline in Longwood.
Speaker 7 (37:03):
Yeah, that was rush hour.
Speaker 11 (37:08):
My name's Lori Armsby, and I just had a question.
It's just fascinating for me to hear that Natus picked
you out of other trainees or somehow saw something in
you that caused him to make that phone call to
say come to Boston. It might not be fair to
(37:29):
ask you, you know, what about you did he see?
I'd loved if you have that insight. I'd love to
hear what about you did he see? And did he
value as a really young person and that showed him
that you had promise. If you don't know that about yourself.
I just wonder if you could comment what did he
(37:50):
see in young people that he valued and saw that
promise that turned out to be careers like you all have.
Speaker 6 (37:58):
He had great insight, He did.
Speaker 2 (38:09):
Well certainly with this for I think true words were never.
Speaker 11 (38:14):
Spoken, yes exactly, And it just fascinates me that he could, maybe, Patricia,
what did he see in you as a young trainee
in that lunchtime that that he wanted to continue did.
Speaker 7 (38:29):
Quite a bit that day, He said, I was a
hard worker. Some of the things they put up their
curiosity had our to take care of people and help
people and not communicate, I guess.
Speaker 6 (38:43):
I argued with him about whether the second heart sound
uh with an ASD could move point two seconds, and
we discussed those kinds of things quite a lot.
Speaker 2 (39:03):
Seems to me like the standards felt quite substantially from
her to me, Well, I think at this point we're
going to wrap this up. I want to thank our
esteemed guests. It was really delightful to learn about that era.
Speaker 8 (39:25):
Well.
Speaker 1 (39:25):
As I record this now a day or two out
from the event in Boston and back in New York,
so many thoughts go through my mind. It was so
inspiring to hear from doctors Williams, romp Hogen and Keen,
and so interesting and fascinating to hear about the early
days of cardiology at Boston Children's and how much of
an impact doctor Natas had on each of their lives.
(39:47):
It seems that doctor Natis was quite a wonderful arbiter
of cardiology potential, as evidenced by the careers of these superstars.
It was a particular joy to see my old friend
and mentor, doctor Keene, who was always so kind to
me and all of our cofellows. The entire weekend was
really a special one, and what a wonderful idea doctors
(40:08):
Gava and Walsh had in organizing this. Some of you
may know that I am a big baseball fan, and
particularly a fan of the New York Yankees. Love the
Yankees or hate them. One thing that they've always done
each year that everyone loves is the so called old
Timer's Day, in which the older players of yesteryear are
invited back to come out on the field and hear
(40:31):
the cheers of their old fans and also congregate and
relive their past lives. As many young boys, I wanted
to be a New York Yankee, but my talent was
woefully inadequate to ever seriously entertain that idea. However, for
just one weekend, I think I had a sense of
what it might be like to be a former Yankee
and come back for the weekend and hang out with
(40:53):
the friends of my youth, the people who you fought
battles alongside. Maybe I never hit a pinch hit home
run a World Series game, but the stakes back in
the mid nineteen nineties were even higher when we were
caring for HLHS patience or doing some of the first
oblations ever performed in children. Though I never will have
the joy or feeling of being a Yankee, I do
(41:15):
feel that I did get that joy that the older
players must feel when they come back and relive their
youth and retell the old stories on Old Timer's Day.
I had that feeling this past weekend, and for this
I am profoundly grateful to the organizers of this conference.
I am also grateful to the admission board of that
Fellowship program at that time, headed by doctor Michael Freed,
(41:38):
who was so good as to take a chance on
a kid from Brooklyn. I hope I've made them proud
to conclude this three hundred and fortieth episode of Pete
Heart Pediatric Cardiology. Today, I've chosen to pick one of
the favorite artists of one of today's guests, Professor Barry Keene.
Like Doctor Kean, the great lyric tenor John McCormick was
(41:59):
born born in Ireland, and he started his early training
in Ireland and had a notable career in opera for
the first decade of that career. However, he was really
always more drawn to the concert stage, and though having
one of the truly glorious operatic tenor voices of the
first part of the twentieth century, he focused his efforts
on concerts and recitals. Today we hear McCormick in a
(42:22):
very rare live nineteen twenty nine recital with his longtime
recital pianist Edwin Schneider singing what was one of McCormick's
signature great hits, I Hear You Calling Me, which was
written in nineteen oh eight by Harold Hartford and Charles Marshall.
After today's brief interview, Doctor Keene reminded me of his
(42:43):
love of McCormick, and so I thought who better than
to usher out today's episode Thank you for joining me
for this wonderful step back into time, and thank you
to the organizers of this Boston Children's Symposium for inviting
me to interview these giants of cardiology. I wish all
good week.
Speaker 3 (43:06):
Call me.
Speaker 12 (43:15):
You called me when abou moon had been on light.
Before I went from you in a too long night.
Speaker 8 (43:30):
I came.
Speaker 13 (43:33):
Bet you remain.
Speaker 8 (43:38):
To you before the water last, to be.
Speaker 13 (43:47):
The car the stars.
Speaker 4 (43:52):
Long Ah, you call.
Speaker 8 (44:08):
Ling me, not at all caring inladness of your voice,
the worse that made my longing heart to rejoice.
Speaker 7 (44:23):
You spoke.
Speaker 13 (44:25):
To you emanber Mo Steals they.
Speaker 8 (44:39):
Music you all.
Speaker 12 (44:53):
Ah.
Speaker 3 (44:56):
You let me.
Speaker 8 (45:08):
Oos have a strang we re length between.
Speaker 12 (45:19):
Bad your gras for mussy grassy green, I stann.
Speaker 8 (45:33):
Do you behold me?
Speaker 12 (45:37):
Leave me you revots through all the.
Speaker 3 (45:52):
Between.
Speaker 8 (46:06):
Oh reely me
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