This week Dr. Nadine Choueiter of Mount Sinai hosts a special episode of Pediheart: Pediatric Cardiology Today in which we speak with emeritus Professor of Pediatrics at the University of Toronto, Dr. Brian McCrindle about his career and life. How did he develop a love of pediatric cardiology? Who were some of his early mentors? How did he develop the international Kawasaki Disease Registry and how has he cultivated it despite minimal funding? How did he develop an interest in preventive cardiology? How can a young person make their clinical work also their academic work? Dr. McCrindle also shares some insights into navigating a successful life as well as retirement. This is a rare opportunity to be inspired by one of the great pediatric cardovascular researchers of the past 3 decades.
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Episode Transcript
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Speaker 1 (00:16):
Welcome to Pdheart Pediatric Cardiology Today. My name is doctor
Robert Pass and I am the host of this podcast.
I'm Professor Pediatrics at the Icon School of Medicine here
in New York City. This week we have a very
special episode in which I have the great pleasure of
introducing doctor Nadine Schwader, who will be interviewing the incredible
and prolific cardiovascular researcher and pediatric cardiologist Emeritus Professor of
(00:38):
Pediatrics at the University of Toronto, doctor Brian macrindall. Doctor
mccrindall will be interviewed by doctor Nadine Schwader and doctor
Schweeder will also introduce doctor mccrindall for those who might
not know. Doctor Schwater is Professor of Pediatrics at the
Icon School of Medicine at Mount Sinai, where she's the
director of the Congenital Cardiac MRI Program as well as
director of the Kawasaki Disease Follow Up pro at the
(01:01):
Icon School of Medicine at Mount Sinai. Doctor Schwader is
a graduate of the American University of Beirut, where she
received her bachelor's degree as well as doctorate in medicine,
and she completed her training in pediatrics at Children's Medical
Center in Dallas, followed by fellowship in pediatric cardiology at
Seattle Children's Hospital and then non Invasive Imaging fellowship at
Children's Hospital Boston. Following that, doctor Schwader worked for ten
(01:24):
years at the Children's Hospital at mantafor where she was
the director of non invasive Pediatric Cardiac Imaging as well
as the director of the Fetal Heart Program and the
miss C follow Up Program. It is a delight to
introduce my friend and colleague, doctor Schwader. In the interest
of time, I think I'll stop at this point and
let's go straight into doctor Schwader's introduction of doctor mcrendall
(01:45):
and the wonderful conversation they have.
Speaker 2 (01:47):
Today's guest is doctor Brian McCrindle, a world renowned pediatric cardiologist,
clinical scientist, and mentor whose work has shaved modern pediatric
cardiovascular care. He is recognized for his contribution to Kawasaki disease,
prevent of carriology, congenital heart disease outcomes, and pediatric thrombosis.
Having led numerous multi center clinical trials and authored over
(02:10):
seven hundred peer reviewed publications. Doctor McCrindle has served as
chair of the twenty seventeen HA Guidelines on Kawasaki Disease,
founded the International Kawasaki Disease Registry, and has been a
long standed Principal investigator with the NHLBI Pediatric Heart Network.
He joined the Hospital for six Children in Toronto in
(02:32):
nineteen ninety two, where he held several key leadership roles
over three decades, including Section Head of prevent of Carreology
at the Labat Family Heart Center and the CIBC World
Markets Children's Foundation in Dowt Chair in Child Health Research.
He is currently Professor Emeritus of Pediatrics at the University
of Toronto. A dedicated mentor, doctor mccrindall has guided generations
(02:56):
of trainees and received numerous honors, including the Aha Younghart
Distinguished Achievement Award and the Canadian Cardiovascular Society is Harold
Segall Award of Merit. Doctor mcrendall, we are excited to
have you with us today to reflect on a remarkable
career that continues to shape the field of pediatric cardiology.
Speaker 3 (03:18):
Welcome, Doctor mccrindall. Thank you.
Speaker 2 (03:21):
So we're going to start at the beginning and specifically
about what drew you to medicine and to pediatric cardiology.
What can you tell us about that?
Speaker 4 (03:29):
So I'm actually Canadian, and I grew up in like
a small towns in western Canada and Alberta. And actually
one of the towns I grew up in was high River,
which was actually Smallville in the Superman movies. And you know,
when I was growing up, I was quite introverted, so
(03:51):
I read a lot, and I was always interested in
science and was reading ravidly about geology, and.
Speaker 3 (04:00):
I was into dinosaurs long before it was fashionable to
be into dinosaurs and astronomy. But I also read specifically
about medicine from.
Speaker 4 (04:09):
A very young age, particularly biographies of medical pioneers.
Speaker 3 (04:15):
And at one point.
Speaker 4 (04:17):
I was reading a book called Heart Pioneers, which included
things about the discovery of the circulation, the first heart surgery,
the first transplant. I must have read that book about
eight times, and then it kind of went into the
back of my mind.
Speaker 3 (04:35):
You know. I carried on.
Speaker 4 (04:36):
I did very well at school, but I was hesitant
about considering a career in medicine because I honestly thought
I did not have what it takes to be a doctor.
Speaker 3 (04:46):
So when it came.
Speaker 4 (04:47):
Time for me to go to university, I told my
father that I was going to university. I was going
to do a Bachelor of Fine Arts degree in acting.
And he said said, okay, you're out of the family,
and so I said, okay, I'm going to do a
degree in honors biochemistry, and he was okay with that.
(05:13):
But I didn't get much guidance on my entry into university.
I was really the first person in my family to
graduate high school.
Speaker 3 (05:21):
So I was on the university.
Speaker 4 (05:22):
Campus and I'm thinking, I don't even know what a
degree is. So I thought I'll meet with one of
the counselors. And this was at University of Alberta and
kind of get the poop on all of this. And
so I walked into this counselor and he had my
university application on his desk and he didn't even look up.
He said, yep, you're going into pre med. You'll never
(05:47):
get a job in biochemistry. You'll always have a job
as a doctor.
Speaker 3 (05:51):
And so I thought, okay, well I'll go into pre med.
Then two years later, I was accepted in a medical
school and it was at that point that I met
my fellow students, and they ran the whole gamut from
the most extreme introvert to the most extreme extrovert, and
I figured, yeah, I guess I do fit in here.
Speaker 4 (06:16):
And then at the end of my second year of
medical school, I felt that during the year I hadn't
done very well in the cardiology part. So I decided
to sign myself up to do a summer research program
and I wound up getting matched up with the pediatric cardiologists,
which was Neil Duncan and Ruth Collins NIKAI at the time,
(06:39):
and they were more interested in giving me a broad
clinical exposure to pediatric cardiology than they were in me
doing a research project. I did do a project, but
it sort of inspired me to commit to a career
in pediatric cardiology. As a third year medical student. I
(07:00):
wound up influencing how I set up my clinical rotations
and that for example, I did my surgery with the
pediatric surgeon, I did my.
Speaker 3 (07:12):
My psychiatry with a child psychiatrist. But at the end
of it I at medical school, I wasn't quite ready
to commit yet, so I did a year as of
rotating internship and then hit the road to look for residencies.
I had my heart.
Speaker 4 (07:27):
Set on going to Boston, but Johns Hopkins actually offered
me a position outside of the match, and that's kind
of how I wound up there.
Speaker 3 (07:39):
That's that's great.
Speaker 2 (07:40):
You know, was there a moment in training that confirmed
that you were on the right path, specifically when you
moved from pediatrics into pediatric cardiology.
Speaker 4 (07:51):
So you know, as I mentioned, I've had a long
standing kind of commitment to pursuing pediatric cardiology, but I
did actually briefly deviate.
Speaker 3 (08:01):
So somehow during my.
Speaker 4 (08:03):
Residency, I kind of got the idea that pediatric cardiology
was an intensive care medicine field and I hated the ICU,
so I took a deviation and instead did a general
pediatric academic development fellowship of Robert with Johnson fellowship at Hopkins,
and part of that was I was to take courses
(08:26):
in statistics and epidemiology at the School of Public Health,
and I really enjoyed the courses and started auditing more
courses and ended up taking courses in prevention and then
preventive cardiology with people like Tom Pearson and started thinking
about pediatric cardiology again. And then I was standing in
(08:47):
the lineup at the cafeteria one day and Langford Kid,
who was the head of pediatric cardiology, was ahead of me,
and I said.
Speaker 3 (08:53):
Hey, Langford, how's it going?
Speaker 4 (08:55):
And I said, I asked him who the head of
a pediatric cardiology at Toronto Sick Kids was And he said,
Bob Freedom.
Speaker 3 (09:04):
Why do you ask? And I said, well, you.
Speaker 4 (09:07):
Know, I've been thinking about doing pediatric cardiology and he said, okay,
we'll take you.
Speaker 3 (09:15):
And I said, whoa.
Speaker 4 (09:16):
So we did work out a deal where I agreed
to do the pediatric Cardiology fellowship and he agreed to
provide me funds to finish off officially my Master Public
Health degree, but I think he took took the funds
out of my first year salary.
Speaker 2 (09:35):
That's that's great, and that's a that's a nice segue
into my next set of I guess you know interests
in your career. It's you know, from Kawasaki disease to
preventive cardiology to congenital heart disease outcomes. Your research portfolio
is incredibly broad and I you know, you just told
me you did an MPH as well. So how did
(09:57):
you decide what areas pediatric cardiology to focus on and
how to use your skill set in those areas.
Speaker 4 (10:05):
So as part of my pediatric cardiology fellowship, I actually
had a strong interest in interventional cardiology and worked very
closely with Gene Kahn, who actually did the very first
balloon pulmonary valve laplasty, and she was sort of leading
a registry at the time to track complications of these
(10:28):
new interventional procedures, and since I knew some stats and
I actually knew how to work at computer, she kind
of recruited me to help her, and eventually she actually
gave that up and had me take it over, So
that was kind of my first foray into multi institutional research.
(10:52):
I also was sort of inspired by the career pathway
of Jane Neuberger in that she also had an MPH
and was pursuing clinical research. She had published a New
England Journal article about the role of ECA cardiography in
(11:12):
murmur evaluation, and so I actually did a similar study
during my fellowship, So it sort of set me up
to do these kinds of things.
Speaker 3 (11:25):
But mostly my research.
Speaker 4 (11:27):
Program as my career progressed, was really driven by the
clinical populations that were assigned to me, specifically, which was
the Kawasaki disease patients.
Speaker 3 (11:39):
And the limpid patients, but also.
Speaker 4 (11:41):
Through projects that were brought to me, usually by trainees
who working with other supervisors, both within pediatric cardiology and
more broadly in the institution.
Speaker 2 (11:56):
So you just told me in a way you answered
kind of my question in terms of how did you
decide on those specific areas and focusing a little bit
more on Kawasaki disease. You know, many people know that
you founded the International Kawasaki Disease that I just see
and if they don't, they do now it's a major
collaborative effort in Kawasaki disease. What were your goals for
(12:19):
this initiative and how do you think it's shaping right
now the future of Kawasaki disease research globally.
Speaker 4 (12:25):
The International Kawasaki Disease rgically really started as a sort
of collaboration between me and Niji da Da where we thought, well,
the outcomes of aneurysms are somewhat unknown, and therefore, you know,
why don't we pull our patients together and take a
(12:47):
look at things. And then so we decided to do this,
and then Penny Joan found out what we were doing,
said can I join?
Speaker 3 (12:55):
And then I thought, well, you know.
Speaker 4 (12:57):
If she's interested, there might be other Kawasaki cardiologists we
know who might be interested. So I surveyed about and
a lot of people were interested in joining. And then
I thought, well, what about those programs where I don't
know if there's a cardiologist specifically doing Kawasaki disease. So
(13:17):
I reached out to division heads and again made further
connections and recruited more centers. You know, eventually we did
achieve our goal of publishing a paper about factors associated
with the outcomes of patients with andyeurisms, specifically those with
(13:39):
larger giant aneurysms.
Speaker 3 (13:42):
But then the organization evolved.
Speaker 4 (13:45):
During the pandemic to look at both the miss associated
with COVID together with acute Kawasaka disease patients, and I
think that's when things really started to take off in
a big way. So it's it's really was started as
(14:05):
a grassroots thing but quickly grew. The thing that's made
it successful is that it's been governed by some core principles,
you know, the most important of which is that everybody
gets treated equally and everybody gets recognition for their contribution
in a fair way. So, you know, one of the
(14:28):
most the tests for everyone for them to participate it, it
has to pass the kind of what's in it for
me tests, and I.
Speaker 3 (14:35):
Think we've succeeded in doing that. But it has shown.
Speaker 4 (14:40):
That the way forward in KYWASUC disease is really going
to be broad collaboration, you know, And that's the key.
Because we're dealing with a rare disease with rare complications
associated with rare outcomes.
Speaker 3 (14:56):
We need to band together. Plus there's also lots of
inter institutional and geographic variation that we need to take
an account and as important as well.
Speaker 2 (15:09):
And now that we are twelve years into the IKDR,
did you see did you see it grow.
Speaker 3 (15:19):
This much and this fast? Were you expecting this?
Speaker 4 (15:23):
I think because I had the magic formula, I think
it works.
Speaker 3 (15:28):
And this is despite the fact that we have no money.
Speaker 4 (15:34):
I mean, this is all done on the good, on
the kindness and resources.
Speaker 3 (15:40):
Of the contributors.
Speaker 2 (15:42):
You know.
Speaker 4 (15:42):
I've had some kind of leftover grant money and leftover
chair money that I used to keep the Data Coordinating
Center afloat. But it's really you know, a labor of
love for the people that are involved that's going to shift.
Speaker 3 (15:58):
In that you know, we are starting to apply for
grant money and more broader.
Speaker 4 (16:06):
Representation, so it's still going to grow and evolve.
Speaker 2 (16:12):
That's true, and it's important to note that, as you said,
it is a labor of love for the centers that
are participating and the leading centers, and it is on
our own time and dime, as they say. So shifting
gears a little bit and moving into preventive cardiology, your
two thousand and seven circulation paper on childhood obesity and
(16:33):
Cardiovascular risk factors was a wake up call for many.
What led you to focus on prevention in youth and
how did that work shape policy and what's your take
on where we stand today with implementation.
Speaker 3 (16:48):
So, I mean that's a very important question.
Speaker 4 (16:51):
As I mentioned, I became interested in prevention and preventive
cardiology during my mph studies at Johns Hopkins' School of
Public Health, during my cardiology fellowship, And it was also
during that time that I was also part of a
group that managed to get smoking band from the Children's hospital,
which was successful. And also during that time I did
(17:14):
some basic science work with Peter Quitervich, who was a
pioneer lipid researcher. So but Nonetheless, when I started at
Sick Kids, I actually inherited the lipid clinic because one
of the senior cardiologists had retired and she happened to
run the lipid clinic. So I actually turned that and
(17:38):
developed it into an academic endeavor, and I participated and
led some clinical trials of the lipid bowering management, including
such things as complementary therapies like garlic tablets.
Speaker 3 (17:52):
And fla seed and lifestyle interventions.
Speaker 4 (17:56):
Eventually, my work came to the attend of the AHA
and I became a member and eventually the chair of
the Ohoi Committee, the Athroscosis Hypertension and an ABC and
Youth Committee, which started me on sort of a policy pathway.
I was then recruited to be on the lipid team
(18:17):
for the NIH Pediatric Prevention Guidelines, which were actually were
the first guidelines to recommend universal lipid screening for all children,
as well as providing some specific guidance as to how
additional risk factors and conditions might influence your decision making
regarding the need for drug therapy. I was also acted
(18:42):
in the pediatric obesity world, and I was a strong
advocate for physical activity promotion in pediatric cardiology and the.
Speaker 3 (18:51):
Development of exercise medicine programs.
Speaker 4 (18:55):
However, progress regarding the widespread up take an implementation of
these things has been somewhat disappointing, and this is still
very much an uphill battle. Despite you know, accumulating support
of evidence and a worsening public health problem. You know,
hypoplastic left heart's syndrome continues to dominate the focus of
(19:18):
pediatric cardiologists and trainees. However, we will have an article
coming out soon in Nature Reviews Cardiology which actually advocates
for a stronger voice for this area to come from
the adult cardiologists.
Speaker 2 (19:35):
That's that's quite interesting. And what do you think are
some of the challenges in terms of widespread implementation because
it is a major public health issue.
Speaker 3 (19:45):
Yeah, so it is a major public health issue, but it's.
Speaker 4 (19:49):
One for which, you know, there's been some sense of
futility around moving the needle and actually implementing change, you know.
Speaker 3 (20:03):
And also, you.
Speaker 4 (20:04):
Know, general practitioners and family physicians and pediatricians who see
this population may not be equipped to provide the kind
of counseling that these patients require in the setting that
they have multiple other competing things that they have to
cover in an encounter. So the other thing is that
(20:31):
you know, some providers are hardline liners about the evidence,
and you know, there's never going to be this sixty
year long randomized trial of intervention in the pediatric populations
to see if it impacts cardiovascular outcomes in adults. And
(20:52):
but what we do have is a very nice chain
of evidence that's been very consistent and becoming increasingly comp
and certainly for conditions such as familial hyperchluster lemia, we're
now gaining some evidence that intervention with statins during childhood
(21:13):
actually allows the child to exceed the age of which
their affected parents first had events. So we may not
have the trial, but we are developing an increase imperative
to act.
Speaker 2 (21:28):
You know, it's it's quite interesting when I when I'm
asking you these questions, I've noticed this the kind of
thing where you know, you have access to a patient
population or someone asks you to run a clinic, and
then it goes from that to a niche to papers
to policy. And so whether it's through the Pediatric cut Network,
(21:52):
the IKDR, the Fontaine Anti Coagulation group, you have led
several multi center studies and what advice would you give
to young investigators who would like a similar cardio trajectory
or who would like to launch similar work.
Speaker 3 (22:10):
Yeah. So I think the first point I'd like to
make is that it's.
Speaker 4 (22:14):
Very efficient to make your clinical work also work academically
for you. You know, it's a c and it actually
then feeds back and helps you to improve the clinical
care for these patients. Regarding the multi institutional aspect, I
(22:34):
think that anyone can do it. However, if you're going
to be a leader in it, you really have to
take the time to develop some solid clinical research and
statistical skills. So you really need to do further clinical
research training. It's very frustrating when people think that they
(22:58):
can do clinical research just because they see patients. That's
not Yeah, they can do clinical research, but it's not
going to be the best clinical research. You really need
to be You need to be adequately trained. The other
thing is that if you're going to go multi institutional,
you need to be.
Speaker 3 (23:15):
A collaborative leader.
Speaker 4 (23:17):
And part of being a good collaborative leader is you
have to be a good team player. At the same time,
as I mentioned before, you need to make sure that
what you're doing passes the what's in it for me,
tests for everyone, and sort of the final thing is
that you need to be the person who gets things done.
Speaker 3 (23:39):
So you need to be.
Speaker 4 (23:40):
The person who ensures that there's going to be output
that is relevant and rigorous.
Speaker 3 (23:48):
You need also to know when to pass it on
and let it go.
Speaker 4 (23:54):
I've seen a lot of multi institutional efforts die and
become less relevant because they fail to evolve, you know,
and I think you know that may be, you know,
one of the challenges that the IKDR, the Kawasaka Disease
Registry may face in the future.
Speaker 3 (24:15):
But you know, if you turn it.
Speaker 4 (24:17):
Over at the right time and you put it in
the right hands with someone who's doing something new, then
the likelihood of ongoing success.
Speaker 3 (24:27):
Is much higher.
Speaker 2 (24:28):
You know, you've touched a little bit upon some of
the things that I'm interested in asking about, but specifically,
what are the qualities do that you look for in
the next generation of clinical scientists and how do you
help cultivate them?
Speaker 3 (24:45):
So that's a very good question.
Speaker 4 (24:48):
This actually goes into sort of my part of my
decision making process when I'm considering whether or not to
take on someone as a new graduate student. So the
key quality I look for is initiative, So I ask,
is this a person who waits.
Speaker 3 (25:08):
Around to be told what to do?
Speaker 4 (25:10):
Or is it someone who actively comes up with new
ideas and pursues it. Is this someone also who when
they encounter a problem, brings it to me, but brings
it to me with some solutions that they've actually thought about.
Is this someone who has the drive, who has a
clear goal, who has a reason for what they're doing,
(25:30):
who knows their pathway? Is this someone who will be
an effective team player, meaning that they're not only interested
in their own development but that of the team, and
that they act with compassion. Is this someone who is
committed to their own development, someone who has a keen
eye for opportunity.
Speaker 3 (25:52):
You know, the.
Speaker 4 (25:52):
Big question will eventually be is this a person who
has the capacity and skills to be an independent investigator?
Which usually means that they can see where the next
question lies and do they have the ability to focus
on that but to maintain some flexibility and willingness to
(26:16):
accommodate additional opportunities.
Speaker 3 (26:19):
So successful clinician scientists.
Speaker 4 (26:22):
Tend to have these characteristics, and they tend to hit
the ground running, and they importantly are able to maintain momentum,
which is very very important to get from that kind
of precarious early to mid career stage. So I've seen
many struggling mid career scientists who will assert that the
(26:44):
reason that they aren't producing is because they lack resources,
when in truth, what they lack is some of the
characteristics I've just described, and throwing more resources at them
is unlikely to improve their productivity. Tessful scientists become self sufficient,
and however, if you give successful scientists more resources, it
(27:08):
actually accelerates their productivity and impact.
Speaker 2 (27:12):
So I think this is going to be valuable information
for our young listeners. And I know that you've been
at the helm of the cardiovascular clinical research unit for
many years at Sick Kids, and you've witnessed tremendous changes
over the last few decades. What do you think will
define the next era of pediatric cardiology.
Speaker 3 (27:35):
That's a very interesting question.
Speaker 4 (27:38):
So I think right now we're in the middle of
an omics revolution, GENOMICX, proteomics, et cetera. And we also
have this artificial intelligence thing going on, and the next
advances in the field are really going to come from
that intersection. And this intersection will broaden the understanding of
(28:01):
disease mechanisms, particularly potentially giving us the ability to prevent
disease and to enhance health. It will also enable us
to achieve the goal of precision medicine and also lead
to the discovery and development of patients specific therapies, especially
(28:22):
for those with rare conditions, including things like genetic interventions
aimed at giving patients both the ability to correct the
genetic defect or to insert treatment producing edits that commensate
for or ameliorate the.
Speaker 3 (28:40):
Path of physiology. So I think that's where the real
changes are going to happen.
Speaker 2 (28:46):
And are these what are the unanswered questions in our
field of pediatric cardiology that still keep you up up
at night or excite you the most as a researcher,
or want you not to retire. I know you're retired,
but what are some of those unanswered questions?
Speaker 3 (29:03):
Yeah?
Speaker 4 (29:03):
So, I mean the things that keep me up at
night are not research issues per se, although like the
cuts to research funding and the qualifications and agendas of
administrators in healthcare agencies are likely to be devastating, and
I think that's insomnia producing.
Speaker 3 (29:23):
You know.
Speaker 4 (29:24):
The real challenge for us is that we're seeing unprecedented
inequities in access to healthcare which are expected to worsen,
leading to probably real world inequities in outcomes. So we're
part of a healthcare system now that may impede not
only our ability to answer pressing questions, but to implement
(29:46):
the answers. And the attacks on things like diversity, equity,
and inclusion, and the cancelation of years of what has
been very slow progress is also likely to affect the field,
so you know, remembering that society is judged by how
we hold up our most disadvantage members. Nonetheless, you know,
(30:09):
I'd like to believe that despite these setbacks, that progress
is actually relentless and will proceed underneath and in spite
of what is currently happening. But we must act, and
we must act with you know, empathy and compassion, which
actually are the foundation of our profession.
Speaker 2 (30:28):
That is that is quite true. And I hope they
all challenges and setbacks that we can overcome. And I'd
like to thank you for sharing your story and your
wisdom with us, And I wanted to know what are
you looking forward for the most during your retirement and
any final thoughts for our listeners, especially those just starting
(30:51):
their journey.
Speaker 3 (30:52):
Well, you know, despite.
Speaker 4 (30:55):
A slowing of my research program, you know, I'm still
finishing up lots of papers and things to tie up,
so I'm still partially in the game.
Speaker 3 (31:07):
You know.
Speaker 4 (31:08):
However, you know, I did slide gradually into retirement, and
I think that I timed it well. You know, I
had time to get used to the concept of letting
things go and time to explore what my next stage
might look like. So I've spent my working life in
the sciences, but I would like to think that my
(31:29):
CV is not is only.
Speaker 3 (31:31):
Part of who I am.
Speaker 4 (31:33):
So my non work interests have always been pursued in
parallel to my academic interests at all stages through my life,
and I'm not retiring from those. So you may not know,
but I have a mountaineering an ice climbing resume that
is pretty substantial. I have studied, collected and donated art.
(31:58):
I'm a theater buff. I study music history. I love
to travel, and we'll do a lot more traveling with
a focus on history, art and culture.
Speaker 3 (32:09):
So I think that I have enough threads to pursue
and enough ways that I can look towards forwards, towards
giving back.
Speaker 4 (32:17):
So I guess my final thought would be to convey
that you don't need to give up your identity and
interests to your job. So this is more than recommending
that you strive for work life balance, but actually ensuring
that your life is stimulating, rewarding and enlarges your worldview.
Speaker 3 (32:42):
So you shouldn't view.
Speaker 4 (32:45):
This aspect of your life as extra curricular activities, but
as an essential part of your life curriculum.
Speaker 2 (32:53):
Well, you know, I have to say it was a
pleasure getting to know the person behind the science and
getting to know all the things that you'd like to
do outside of medicine. I would like to thank our
listeners for tuning in to Pdhart Pediatric Cardiology Today podcast
and until next time, thank you.
Speaker 3 (33:12):
Thanks.
Speaker 1 (33:13):
To conclude this three hundred and forty seventh episode of
pet Heart Pediatric Cardiology Today with our guest host, doctor
Nadine Schwader and guest doctor Brian McCrindle, I thought I
would play a singer who represents a part of both
of the discussings of our podcast, given that doctor Schwader
was born and raised in Lebanon and doctor McCrindle in Canada,
and so who better to usher at our episode than
(33:35):
the wonderful Lebanese Canadian soprano Joyce el Kouri. Miss el
Couri lived the first years of her life in Lebanon.
Having been born in Beirut, her family emigrated to Ottawa, Canada,
where she grew up. She studied voice at the University
of Ottawa and also at the Academy of Vocal Arts
in Philadelphia. Miss Olkouri has sung at most of the
great opera houses in the world, and today we hear
(33:57):
why when we hear her sing the wonderful little Aria
from Puccini's opera Johnny Skeikey entitled Omeo Babinocadro. Thank you
very much for listening, and once more special thanks to
doctor Schweider and of course doctor McCrindle for sharing his
insights into a career in cardiology and also navigating life.
Speaker 5 (34:16):
I hope I'll have a good week ahead if you.
Speaker 6 (35:00):
B to misable little back
Welcome to Pdheart Pediatric Cardiology Today. My name is doctor
Robert Pass and I am the host of this podcast.
I'm Professor Pediatrics at the Icon School of Medicine here
in New York City. This week we have a very
special episode in which I have the great pleasure of
introducing doctor Nadine Schwader, who will be interviewing the incredible
and prolific cardiovascular researcher and pediatric cardiologist Emeritus Professor of
(00:38):
Pediatrics at the University of Toronto, doctor Brian macrindall. Doctor
mccrindall will be interviewed by doctor Nadine Schwader and doctor
Schweeder will also introduce doctor mccrindall for those who might
not know. Doctor Schwater is Professor of Pediatrics at the
Icon School of Medicine at Mount Sinai, where she's the
director of the Congenital Cardiac MRI Program as well as
director of the Kawasaki Disease Follow Up pro at the
(01:01):
Icon School of Medicine at Mount Sinai. Doctor Schwader is
a graduate of the American University of Beirut, where she
received her bachelor's degree as well as doctorate in medicine,
and she completed her training in pediatrics at Children's Medical
Center in Dallas, followed by fellowship in pediatric cardiology at
Seattle Children's Hospital and then non Invasive Imaging fellowship at
Children's Hospital Boston. Following that, doctor Schwader worked for ten
(01:24):
years at the Children's Hospital at mantafor where she was
the director of non invasive Pediatric Cardiac Imaging as well
as the director of the Fetal Heart Program and the
miss C follow Up Program. It is a delight to
introduce my friend and colleague, doctor Schwader. In the interest
of time, I think I'll stop at this point and
let's go straight into doctor Schwader's introduction of doctor mcrendall
(01:45):
and the wonderful conversation they have.
Speaker 2 (01:47):
Today's guest is doctor Brian McCrindle, a world renowned pediatric cardiologist,
clinical scientist, and mentor whose work has shaved modern pediatric
cardiovascular care. He is recognized for his contribution to Kawasaki disease,
prevent of carriology, congenital heart disease outcomes, and pediatric thrombosis.
Having led numerous multi center clinical trials and authored over
(02:10):
seven hundred peer reviewed publications. Doctor McCrindle has served as
chair of the twenty seventeen HA Guidelines on Kawasaki Disease,
founded the International Kawasaki Disease Registry, and has been a
long standed Principal investigator with the NHLBI Pediatric Heart Network.
He joined the Hospital for six Children in Toronto in
(02:32):
nineteen ninety two, where he held several key leadership roles
over three decades, including Section Head of prevent of Carreology
at the Labat Family Heart Center and the CIBC World
Markets Children's Foundation in Dowt Chair in Child Health Research.
He is currently Professor Emeritus of Pediatrics at the University
of Toronto. A dedicated mentor, doctor mccrindall has guided generations
(02:56):
of trainees and received numerous honors, including the Aha Younghart
Distinguished Achievement Award and the Canadian Cardiovascular Society is Harold
Segall Award of Merit. Doctor mcrendall, we are excited to
have you with us today to reflect on a remarkable
career that continues to shape the field of pediatric cardiology.
Speaker 3 (03:18):
Welcome, Doctor mccrindall. Thank you.
Speaker 2 (03:21):
So we're going to start at the beginning and specifically
about what drew you to medicine and to pediatric cardiology.
What can you tell us about that?
Speaker 4 (03:29):
So I'm actually Canadian, and I grew up in like
a small towns in western Canada and Alberta. And actually
one of the towns I grew up in was high River,
which was actually Smallville in the Superman movies. And you know,
when I was growing up, I was quite introverted, so
(03:51):
I read a lot, and I was always interested in
science and was reading ravidly about geology, and.
Speaker 3 (04:00):
I was into dinosaurs long before it was fashionable to
be into dinosaurs and astronomy. But I also read specifically
about medicine from.
Speaker 4 (04:09):
A very young age, particularly biographies of medical pioneers.
Speaker 3 (04:15):
And at one point.
Speaker 4 (04:17):
I was reading a book called Heart Pioneers, which included
things about the discovery of the circulation, the first heart surgery,
the first transplant. I must have read that book about
eight times, and then it kind of went into the
back of my mind.
Speaker 3 (04:35):
You know. I carried on.
Speaker 4 (04:36):
I did very well at school, but I was hesitant
about considering a career in medicine because I honestly thought
I did not have what it takes to be a doctor.
Speaker 3 (04:46):
So when it came.
Speaker 4 (04:47):
Time for me to go to university, I told my
father that I was going to university. I was going
to do a Bachelor of Fine Arts degree in acting.
And he said said, okay, you're out of the family,
and so I said, okay, I'm going to do a
degree in honors biochemistry, and he was okay with that.
(05:13):
But I didn't get much guidance on my entry into university.
I was really the first person in my family to
graduate high school.
Speaker 3 (05:21):
So I was on the university.
Speaker 4 (05:22):
Campus and I'm thinking, I don't even know what a
degree is. So I thought I'll meet with one of
the counselors. And this was at University of Alberta and
kind of get the poop on all of this. And
so I walked into this counselor and he had my
university application on his desk and he didn't even look up.
He said, yep, you're going into pre med. You'll never
(05:47):
get a job in biochemistry. You'll always have a job
as a doctor.
Speaker 3 (05:51):
And so I thought, okay, well I'll go into pre med.
Then two years later, I was accepted in a medical
school and it was at that point that I met
my fellow students, and they ran the whole gamut from
the most extreme introvert to the most extreme extrovert, and
I figured, yeah, I guess I do fit in here.
Speaker 4 (06:16):
And then at the end of my second year of
medical school, I felt that during the year I hadn't
done very well in the cardiology part. So I decided
to sign myself up to do a summer research program
and I wound up getting matched up with the pediatric cardiologists,
which was Neil Duncan and Ruth Collins NIKAI at the time,
(06:39):
and they were more interested in giving me a broad
clinical exposure to pediatric cardiology than they were in me
doing a research project. I did do a project, but
it sort of inspired me to commit to a career
in pediatric cardiology. As a third year medical student. I
(07:00):
wound up influencing how I set up my clinical rotations
and that for example, I did my surgery with the
pediatric surgeon, I did my.
Speaker 3 (07:12):
My psychiatry with a child psychiatrist. But at the end
of it I at medical school, I wasn't quite ready
to commit yet, so I did a year as of
rotating internship and then hit the road to look for residencies.
I had my heart.
Speaker 4 (07:27):
Set on going to Boston, but Johns Hopkins actually offered
me a position outside of the match, and that's kind
of how I wound up there.
Speaker 3 (07:39):
That's that's great.
Speaker 2 (07:40):
You know, was there a moment in training that confirmed
that you were on the right path, specifically when you
moved from pediatrics into pediatric cardiology.
Speaker 4 (07:51):
So you know, as I mentioned, I've had a long
standing kind of commitment to pursuing pediatric cardiology, but I
did actually briefly deviate.
Speaker 3 (08:01):
So somehow during my.
Speaker 4 (08:03):
Residency, I kind of got the idea that pediatric cardiology
was an intensive care medicine field and I hated the ICU,
so I took a deviation and instead did a general
pediatric academic development fellowship of Robert with Johnson fellowship at Hopkins,
and part of that was I was to take courses
(08:26):
in statistics and epidemiology at the School of Public Health,
and I really enjoyed the courses and started auditing more
courses and ended up taking courses in prevention and then
preventive cardiology with people like Tom Pearson and started thinking
about pediatric cardiology again. And then I was standing in
(08:47):
the lineup at the cafeteria one day and Langford Kid,
who was the head of pediatric cardiology, was ahead of me,
and I said.
Speaker 3 (08:53):
Hey, Langford, how's it going?
Speaker 4 (08:55):
And I said, I asked him who the head of
a pediatric cardiology at Toronto Sick Kids was And he said,
Bob Freedom.
Speaker 3 (09:04):
Why do you ask? And I said, well, you.
Speaker 4 (09:07):
Know, I've been thinking about doing pediatric cardiology and he said, okay,
we'll take you.
Speaker 3 (09:15):
And I said, whoa.
Speaker 4 (09:16):
So we did work out a deal where I agreed
to do the pediatric Cardiology fellowship and he agreed to
provide me funds to finish off officially my Master Public
Health degree, but I think he took took the funds
out of my first year salary.
Speaker 2 (09:35):
That's that's great, and that's a that's a nice segue
into my next set of I guess you know interests
in your career. It's you know, from Kawasaki disease to
preventive cardiology to congenital heart disease outcomes. Your research portfolio
is incredibly broad and I you know, you just told
me you did an MPH as well. So how did
(09:57):
you decide what areas pediatric cardiology to focus on and
how to use your skill set in those areas.
Speaker 4 (10:05):
So as part of my pediatric cardiology fellowship, I actually
had a strong interest in interventional cardiology and worked very
closely with Gene Kahn, who actually did the very first
balloon pulmonary valve laplasty, and she was sort of leading
a registry at the time to track complications of these
(10:28):
new interventional procedures, and since I knew some stats and
I actually knew how to work at computer, she kind
of recruited me to help her, and eventually she actually
gave that up and had me take it over, So
that was kind of my first foray into multi institutional research.
(10:52):
I also was sort of inspired by the career pathway
of Jane Neuberger in that she also had an MPH
and was pursuing clinical research. She had published a New
England Journal article about the role of ECA cardiography in
(11:12):
murmur evaluation, and so I actually did a similar study
during my fellowship, So it sort of set me up
to do these kinds of things.
Speaker 3 (11:25):
But mostly my research.
Speaker 4 (11:27):
Program as my career progressed, was really driven by the
clinical populations that were assigned to me, specifically, which was
the Kawasaki disease patients.
Speaker 3 (11:39):
And the limpid patients, but also.
Speaker 4 (11:41):
Through projects that were brought to me, usually by trainees
who working with other supervisors, both within pediatric cardiology and
more broadly in the institution.
Speaker 2 (11:56):
So you just told me in a way you answered
kind of my question in terms of how did you
decide on those specific areas and focusing a little bit
more on Kawasaki disease. You know, many people know that
you founded the International Kawasaki Disease that I just see
and if they don't, they do now it's a major
collaborative effort in Kawasaki disease. What were your goals for
(12:19):
this initiative and how do you think it's shaping right
now the future of Kawasaki disease research globally.
Speaker 4 (12:25):
The International Kawasaki Disease rgically really started as a sort
of collaboration between me and Niji da Da where we thought, well,
the outcomes of aneurysms are somewhat unknown, and therefore, you know,
why don't we pull our patients together and take a
(12:47):
look at things. And then so we decided to do this,
and then Penny Joan found out what we were doing,
said can I join?
Speaker 3 (12:55):
And then I thought, well, you know.
Speaker 4 (12:57):
If she's interested, there might be other Kawasaki cardiologists we
know who might be interested. So I surveyed about and
a lot of people were interested in joining. And then
I thought, well, what about those programs where I don't
know if there's a cardiologist specifically doing Kawasaki disease. So
(13:17):
I reached out to division heads and again made further
connections and recruited more centers. You know, eventually we did
achieve our goal of publishing a paper about factors associated
with the outcomes of patients with andyeurisms, specifically those with
(13:39):
larger giant aneurysms.
Speaker 3 (13:42):
But then the organization evolved.
Speaker 4 (13:45):
During the pandemic to look at both the miss associated
with COVID together with acute Kawasaka disease patients, and I
think that's when things really started to take off in
a big way. So it's it's really was started as
(14:05):
a grassroots thing but quickly grew. The thing that's made
it successful is that it's been governed by some core principles,
you know, the most important of which is that everybody
gets treated equally and everybody gets recognition for their contribution
in a fair way. So, you know, one of the
(14:28):
most the tests for everyone for them to participate it, it
has to pass the kind of what's in it for
me tests, and I.
Speaker 3 (14:35):
Think we've succeeded in doing that. But it has shown.
Speaker 4 (14:40):
That the way forward in KYWASUC disease is really going
to be broad collaboration, you know, And that's the key.
Because we're dealing with a rare disease with rare complications
associated with rare outcomes.
Speaker 3 (14:56):
We need to band together. Plus there's also lots of
inter institutional and geographic variation that we need to take
an account and as important as well.
Speaker 2 (15:09):
And now that we are twelve years into the IKDR,
did you see did you see it grow.
Speaker 3 (15:19):
This much and this fast? Were you expecting this?
Speaker 4 (15:23):
I think because I had the magic formula, I think
it works.
Speaker 3 (15:28):
And this is despite the fact that we have no money.
Speaker 4 (15:34):
I mean, this is all done on the good, on
the kindness and resources.
Speaker 3 (15:40):
Of the contributors.
Speaker 2 (15:42):
You know.
Speaker 4 (15:42):
I've had some kind of leftover grant money and leftover
chair money that I used to keep the Data Coordinating
Center afloat. But it's really you know, a labor of
love for the people that are involved that's going to shift.
Speaker 3 (15:58):
In that you know, we are starting to apply for
grant money and more broader.
Speaker 4 (16:06):
Representation, so it's still going to grow and evolve.
Speaker 2 (16:12):
That's true, and it's important to note that, as you said,
it is a labor of love for the centers that
are participating and the leading centers, and it is on
our own time and dime, as they say. So shifting
gears a little bit and moving into preventive cardiology, your
two thousand and seven circulation paper on childhood obesity and
(16:33):
Cardiovascular risk factors was a wake up call for many.
What led you to focus on prevention in youth and
how did that work shape policy and what's your take
on where we stand today with implementation.
Speaker 3 (16:48):
So, I mean that's a very important question.
Speaker 4 (16:51):
As I mentioned, I became interested in prevention and preventive
cardiology during my mph studies at Johns Hopkins' School of
Public Health, during my cardiology fellowship, And it was also
during that time that I was also part of a
group that managed to get smoking band from the Children's hospital,
which was successful. And also during that time I did
(17:14):
some basic science work with Peter Quitervich, who was a
pioneer lipid researcher. So but Nonetheless, when I started at
Sick Kids, I actually inherited the lipid clinic because one
of the senior cardiologists had retired and she happened to
run the lipid clinic. So I actually turned that and
(17:38):
developed it into an academic endeavor, and I participated and
led some clinical trials of the lipid bowering management, including
such things as complementary therapies like garlic tablets.
Speaker 3 (17:52):
And fla seed and lifestyle interventions.
Speaker 4 (17:56):
Eventually, my work came to the attend of the AHA
and I became a member and eventually the chair of
the Ohoi Committee, the Athroscosis Hypertension and an ABC and
Youth Committee, which started me on sort of a policy pathway.
I was then recruited to be on the lipid team
(18:17):
for the NIH Pediatric Prevention Guidelines, which were actually were
the first guidelines to recommend universal lipid screening for all children,
as well as providing some specific guidance as to how
additional risk factors and conditions might influence your decision making
regarding the need for drug therapy. I was also acted
(18:42):
in the pediatric obesity world, and I was a strong
advocate for physical activity promotion in pediatric cardiology and the.
Speaker 3 (18:51):
Development of exercise medicine programs.
Speaker 4 (18:55):
However, progress regarding the widespread up take an implementation of
these things has been somewhat disappointing, and this is still
very much an uphill battle. Despite you know, accumulating support
of evidence and a worsening public health problem. You know,
hypoplastic left heart's syndrome continues to dominate the focus of
(19:18):
pediatric cardiologists and trainees. However, we will have an article
coming out soon in Nature Reviews Cardiology which actually advocates
for a stronger voice for this area to come from
the adult cardiologists.
Speaker 2 (19:35):
That's that's quite interesting. And what do you think are
some of the challenges in terms of widespread implementation because
it is a major public health issue.
Speaker 3 (19:45):
Yeah, so it is a major public health issue, but it's.
Speaker 4 (19:49):
One for which, you know, there's been some sense of
futility around moving the needle and actually implementing change, you know.
Speaker 3 (20:03):
And also, you.
Speaker 4 (20:04):
Know, general practitioners and family physicians and pediatricians who see
this population may not be equipped to provide the kind
of counseling that these patients require in the setting that
they have multiple other competing things that they have to
cover in an encounter. So the other thing is that
(20:31):
you know, some providers are hardline liners about the evidence,
and you know, there's never going to be this sixty
year long randomized trial of intervention in the pediatric populations
to see if it impacts cardiovascular outcomes in adults. And
(20:52):
but what we do have is a very nice chain
of evidence that's been very consistent and becoming increasingly comp
and certainly for conditions such as familial hyperchluster lemia, we're
now gaining some evidence that intervention with statins during childhood
(21:13):
actually allows the child to exceed the age of which
their affected parents first had events. So we may not
have the trial, but we are developing an increase imperative
to act.
Speaker 2 (21:28):
You know, it's it's quite interesting when I when I'm
asking you these questions, I've noticed this the kind of
thing where you know, you have access to a patient
population or someone asks you to run a clinic, and
then it goes from that to a niche to papers
to policy. And so whether it's through the Pediatric cut Network,
(21:52):
the IKDR, the Fontaine Anti Coagulation group, you have led
several multi center studies and what advice would you give
to young investigators who would like a similar cardio trajectory
or who would like to launch similar work.
Speaker 3 (22:10):
Yeah. So I think the first point I'd like to
make is that it's.
Speaker 4 (22:14):
Very efficient to make your clinical work also work academically
for you. You know, it's a c and it actually
then feeds back and helps you to improve the clinical
care for these patients. Regarding the multi institutional aspect, I
(22:34):
think that anyone can do it. However, if you're going
to be a leader in it, you really have to
take the time to develop some solid clinical research and
statistical skills. So you really need to do further clinical
research training. It's very frustrating when people think that they
(22:58):
can do clinical research just because they see patients. That's
not Yeah, they can do clinical research, but it's not
going to be the best clinical research. You really need
to be You need to be adequately trained. The other
thing is that if you're going to go multi institutional,
you need to be.
Speaker 3 (23:15):
A collaborative leader.
Speaker 4 (23:17):
And part of being a good collaborative leader is you
have to be a good team player. At the same time,
as I mentioned before, you need to make sure that
what you're doing passes the what's in it for me,
tests for everyone, and sort of the final thing is
that you need to be the person who gets things done.
Speaker 3 (23:39):
So you need to be.
Speaker 4 (23:40):
The person who ensures that there's going to be output
that is relevant and rigorous.
Speaker 3 (23:48):
You need also to know when to pass it on
and let it go.
Speaker 4 (23:54):
I've seen a lot of multi institutional efforts die and
become less relevant because they fail to evolve, you know,
and I think you know that may be, you know,
one of the challenges that the IKDR, the Kawasaka Disease
Registry may face in the future.
Speaker 3 (24:15):
But you know, if you turn it.
Speaker 4 (24:17):
Over at the right time and you put it in
the right hands with someone who's doing something new, then
the likelihood of ongoing success.
Speaker 3 (24:27):
Is much higher.
Speaker 2 (24:28):
You know, you've touched a little bit upon some of
the things that I'm interested in asking about, but specifically,
what are the qualities do that you look for in
the next generation of clinical scientists and how do you
help cultivate them?
Speaker 3 (24:45):
So that's a very good question.
Speaker 4 (24:48):
This actually goes into sort of my part of my
decision making process when I'm considering whether or not to
take on someone as a new graduate student. So the
key quality I look for is initiative, So I ask,
is this a person who waits.
Speaker 3 (25:08):
Around to be told what to do?
Speaker 4 (25:10):
Or is it someone who actively comes up with new
ideas and pursues it. Is this someone also who when
they encounter a problem, brings it to me, but brings
it to me with some solutions that they've actually thought about.
Is this someone who has the drive, who has a
clear goal, who has a reason for what they're doing,
(25:30):
who knows their pathway? Is this someone who will be
an effective team player, meaning that they're not only interested
in their own development but that of the team, and
that they act with compassion. Is this someone who is
committed to their own development, someone who has a keen
eye for opportunity.
Speaker 3 (25:52):
You know, the.
Speaker 4 (25:52):
Big question will eventually be is this a person who
has the capacity and skills to be an independent investigator?
Which usually means that they can see where the next
question lies and do they have the ability to focus
on that but to maintain some flexibility and willingness to
(26:16):
accommodate additional opportunities.
Speaker 3 (26:19):
So successful clinician scientists.
Speaker 4 (26:22):
Tend to have these characteristics, and they tend to hit
the ground running, and they importantly are able to maintain momentum,
which is very very important to get from that kind
of precarious early to mid career stage. So I've seen
many struggling mid career scientists who will assert that the
(26:44):
reason that they aren't producing is because they lack resources,
when in truth, what they lack is some of the
characteristics I've just described, and throwing more resources at them
is unlikely to improve their productivity. Tessful scientists become self sufficient,
and however, if you give successful scientists more resources, it
(27:08):
actually accelerates their productivity and impact.
Speaker 2 (27:12):
So I think this is going to be valuable information
for our young listeners. And I know that you've been
at the helm of the cardiovascular clinical research unit for
many years at Sick Kids, and you've witnessed tremendous changes
over the last few decades. What do you think will
define the next era of pediatric cardiology.
Speaker 3 (27:35):
That's a very interesting question.
Speaker 4 (27:38):
So I think right now we're in the middle of
an omics revolution, GENOMICX, proteomics, et cetera. And we also
have this artificial intelligence thing going on, and the next
advances in the field are really going to come from
that intersection. And this intersection will broaden the understanding of
(28:01):
disease mechanisms, particularly potentially giving us the ability to prevent
disease and to enhance health. It will also enable us
to achieve the goal of precision medicine and also lead
to the discovery and development of patients specific therapies, especially
(28:22):
for those with rare conditions, including things like genetic interventions
aimed at giving patients both the ability to correct the
genetic defect or to insert treatment producing edits that commensate
for or ameliorate the.
Speaker 3 (28:40):
Path of physiology. So I think that's where the real
changes are going to happen.
Speaker 2 (28:46):
And are these what are the unanswered questions in our
field of pediatric cardiology that still keep you up up
at night or excite you the most as a researcher,
or want you not to retire. I know you're retired,
but what are some of those unanswered questions?
Speaker 3 (29:03):
Yeah?
Speaker 4 (29:03):
So, I mean the things that keep me up at
night are not research issues per se, although like the
cuts to research funding and the qualifications and agendas of
administrators in healthcare agencies are likely to be devastating, and
I think that's insomnia producing.
Speaker 3 (29:23):
You know.
Speaker 4 (29:24):
The real challenge for us is that we're seeing unprecedented
inequities in access to healthcare which are expected to worsen,
leading to probably real world inequities in outcomes. So we're
part of a healthcare system now that may impede not
only our ability to answer pressing questions, but to implement
(29:46):
the answers. And the attacks on things like diversity, equity,
and inclusion, and the cancelation of years of what has
been very slow progress is also likely to affect the field,
so you know, remembering that society is judged by how
we hold up our most disadvantage members. Nonetheless, you know,
(30:09):
I'd like to believe that despite these setbacks, that progress
is actually relentless and will proceed underneath and in spite
of what is currently happening. But we must act, and
we must act with you know, empathy and compassion, which
actually are the foundation of our profession.
Speaker 2 (30:28):
That is that is quite true. And I hope they
all challenges and setbacks that we can overcome. And I'd
like to thank you for sharing your story and your
wisdom with us, And I wanted to know what are
you looking forward for the most during your retirement and
any final thoughts for our listeners, especially those just starting
(30:51):
their journey.
Speaker 3 (30:52):
Well, you know, despite.
Speaker 4 (30:55):
A slowing of my research program, you know, I'm still
finishing up lots of papers and things to tie up,
so I'm still partially in the game.
Speaker 3 (31:07):
You know.
Speaker 4 (31:08):
However, you know, I did slide gradually into retirement, and
I think that I timed it well. You know, I
had time to get used to the concept of letting
things go and time to explore what my next stage
might look like. So I've spent my working life in
the sciences, but I would like to think that my
(31:29):
CV is not is only.
Speaker 3 (31:31):
Part of who I am.
Speaker 4 (31:33):
So my non work interests have always been pursued in
parallel to my academic interests at all stages through my life,
and I'm not retiring from those. So you may not know,
but I have a mountaineering an ice climbing resume that
is pretty substantial. I have studied, collected and donated art.
(31:58):
I'm a theater buff. I study music history. I love
to travel, and we'll do a lot more traveling with
a focus on history, art and culture.
Speaker 3 (32:09):
So I think that I have enough threads to pursue
and enough ways that I can look towards forwards, towards
giving back.
Speaker 4 (32:17):
So I guess my final thought would be to convey
that you don't need to give up your identity and
interests to your job. So this is more than recommending
that you strive for work life balance, but actually ensuring
that your life is stimulating, rewarding and enlarges your worldview.
Speaker 3 (32:42):
So you shouldn't view.
Speaker 4 (32:45):
This aspect of your life as extra curricular activities, but
as an essential part of your life curriculum.
Speaker 2 (32:53):
Well, you know, I have to say it was a
pleasure getting to know the person behind the science and
getting to know all the things that you'd like to
do outside of medicine. I would like to thank our
listeners for tuning in to Pdhart Pediatric Cardiology Today podcast
and until next time, thank you.
Speaker 3 (33:12):
Thanks.
Speaker 1 (33:13):
To conclude this three hundred and forty seventh episode of
pet Heart Pediatric Cardiology Today with our guest host, doctor
Nadine Schwader and guest doctor Brian McCrindle, I thought I
would play a singer who represents a part of both
of the discussings of our podcast, given that doctor Schwader
was born and raised in Lebanon and doctor McCrindle in Canada,
and so who better to usher at our episode than
(33:35):
the wonderful Lebanese Canadian soprano Joyce el Kouri. Miss el
Couri lived the first years of her life in Lebanon.
Having been born in Beirut, her family emigrated to Ottawa, Canada,
where she grew up. She studied voice at the University
of Ottawa and also at the Academy of Vocal Arts
in Philadelphia. Miss Olkouri has sung at most of the
great opera houses in the world, and today we hear
(33:57):
why when we hear her sing the wonderful little Aria
from Puccini's opera Johnny Skeikey entitled Omeo Babinocadro. Thank you
very much for listening, and once more special thanks to
doctor Schweider and of course doctor McCrindle for sharing his
insights into a career in cardiology and also navigating life.
Speaker 5 (34:16):
I hope I'll have a good week ahead if you.
Speaker 6 (35:00):
B to misable little back
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