My First Introduction to the Heart.

I was fortunate to discover my interest and affinity to medicine at an early age. When I was 15 years old, I was living in Phoenixville, Pennsylvania; a suburb of Philadelphia. My friend and I joined the local volunteer fire department. It was truly a wonderful experience, and interestingly, all these years later, my friend is still a firefighter, albeit for the significantly larger Philadelphia Fire Department.

At the time, the Phoenixville Fire Department gave us a positive place to spend time. We would maintain the equipment, wash the trucks, and undergo various training exercises, etc. There were community education events, fundraisers, and various social outings. The other members of the department where gentlemen (well…most of the time) and role models. We would go on various calls, some routine, some extraordinary. I was exposed to people’s lives at their worse and best.

My friend, Joe, and I attended the Pennsylvania Fire Academy and became certified firefighters. The calls were exciting, especially for a teenage boy. However, the calls I enjoyed the most were not the fires, but those in which we assisted the paramedics and emergency medical technicians. Our role on these ‘medical’ calls, while important, was peripheral.

We would force a door when the person behind was unresponsive or unable to reach it. We would hold lights so that the medics and EMTs could work if the power was out. We would help administer CPR. On the scene of severe automobile accidents, we would extricate trapped victims as the medics worked diligently to save their lives. When a patient required helicopter transport, we would assure a safe landing zone was established.

Our job was important. We were part of an extraordinary team. However, looking back at the scene, stepping outside myself, it was the EMTs, the paramedics, the flight nurses who were directly responsible for actions that determined if a person would live or die. I was playing an extremely important role, but I wasn’t at the center of the events. I was a peripheral character in this play. I wanted to do more.

The Phoenixville Fire Department was composed of three separate firehouses. Joe and I had joined ‘Friendship Fire Company #2’ on the Northside of Phoenixville. In the center of town was, ‘Phoenix Hose, Hook, & Ladder Co #1’ and further across town was ‘West End Fire Company #3.’ It was the latter at which the departments ambulance services were housed. It was there I would get my first taste of providing medical care.

After expressing my interest, the department granted me the privilage of starting to ride along with the emergency medical technicians at West End. I found even greater enjoyment there than I had found while at Friendship. The whole department would train together, and admittedly I got some slack from the guys at Friendship about being an 'ambulance jockey'.

But I didn’t care, I was having the time of my life. I met another great friend, Pete Savarese, while at West End. He was in paramedic school, and took me under his wing. Pete and I, and all the others at West End, became quite close. There were many sleepless nights with time between calls spent playing cards in the bay, watching TV in the crew room, and sharing jokes and personal jabs. There is no denying that you need thick skin at the firehouse.

When I turned 16, I took a emergency medical technician course at West Chester University. The medical concepts and knowledge came easy to me; giving credit to the saying, ‘It’s easier to study something you enjoy.’ I finished the course, completed the necessary ride-time with an ambulance company in West Chester, and took the state certification test.

A few weeks later when the results, and my certificate came in the mail, I was so excited that I tore the damn certificate as I was opening the letter. I was a emergency medical technician; PA #089499! This was great. Shortly after I began picking up shifts at West End as the EMT on duty. My confidence and prehospital skills grew with the help of Pete and others. I responded to hundreds, if not thousands, of emergency calls. Looking back, I kinda wish I had kept a log.

I remember a few months in, responding to a ‘fall.’ A elderly women had fallen and could not get up (insert mental image of that horrible TV commercial…Who do you think had to pick her up?). When we arrived on scene, the guys from Friendship had just arrived. We went to the callers apartment, but her door was locked. Her voice from the other side informing us that she could not reach it, and that no one else had a key. Joe and the guys forced the door. We entered and I began to assess the patient. She was so happy to see us. She had been down on the floor for almost 24 hours and had just been successful in reaching the phone to call for help. She had struck her head, and was complaining of left hip pain. I was doing the normal EMT things, and remember looking up to see Joe, shining a flashlight in my direction as I assessed the kind old lady on the floor. I was really glad I was doing what I wanted to do…I was proud of myself.

The years past. High school was a pain. I knew what I loved, and ‘Latin 2’ was not it. I spent essentially all of my free time at West End, answering calls, gaining experience, reading any topic I happened to come across while out on the squads.

One night, I brought a woman who was in decompensated CHF into the Phoenixville Hospital ED, alongside the hospital-based paramedics. My partner that evening was named Leo. He was a firefighter at heart, and did the ambulance stuff on the side. He was waiting in the ambulance bay at the hospital when I returned from giving report to the receiving ED physician. I remember him asking me, ‘You think she will be alright?’ I responded, ‘Yeah, just decompensated heart failure. They will give her some IV diuretics, adjust her meds, and she will be just fine.’….I really hadn’t said anything profound. Just briefly described the probably early hospital course. But Leo paused. He looked at me and said, ‘Shit, Matt…you are going to be a doctor.’

I was 17. I honestly hadn't thought about it before. I was content, as I imagine most young men are, living in the moment. I hadn’t given much thought to the future, and what life would hold for me after high school. Mabye Leo was right? Why not? I really loved medicine. I was good at it. The thought, placed there by a simple statement, began to percolate in my mind. Yeah. I should do it.

My high school had a program that allowed seniors to spend the last 6 weeks at the end of their secondary education, assuming their GPA was at an appropriate level, doing what they called a ‘career elective.’ Whatever you were intereseted in…they would helped you arrange additional exposure. You had to keep a log, and write a paper, but you were not in ‘Latin 2 or 3 or whatever I was taking at the time.

They arranged for me, and a small group of other students, to shadow doctors at Paoli Hospital. It was a grand experience, and further solidified my desire to go into medicine. I shadowed a few different doctors. I spent time in the ED, which I was already somewhat familiar with, and time in the OR, which I instantly fell in love with. My career path was becoming increasingly clear. Not only would I become a doctor…I would become a surgeon. Now how to do that?

I graduated from Conestoga Senior High School in 1996. Prior to graduation, like everyone going on to college, I had the big question of where to go. My good friend Pete, had since completed his paramedic education, getting his degree in the process. He had attended MCP Hahnemann University in Philadelphia, and his lead gave me an idea.

I could do the same. I had since become one of the paid EMTs working at West End. Why not go to MCP Hahnemann University, get my paramedic certification while completing my undergraduate course work. This way I could work as a paramedic during medical school for some extra cash. It was the perfect plan. I applied and was accepted. I was thrilled.

Shortly after graduation, I moved to the city. I had a studio apartment a block-and-a-half away from city hall, in a building called the Metropolitan. It was initially relatively affordable, small…but home. School hadn’t started yet, so I spent a lot of time exploring the city. I discovered a bar several blocks down 15th street called Westy’s Tavern. They never asked if I was 21, and I didn’t see the need to tell them I was not. I started to make some great new friends. I would travel the 30-40min back to Phoenixville frequently to pick-up a shift at West End. It was the beginning of an exciting adventure.

Orientation day came quickly. There is a funny story about this day that I will need to write-up later. I met even more new friends and quickly became enthralled with all the course materials I needed to master.

Across the hall from my apartment at the Metropolitan lived two MCP Hahnemann medical students; Cory Goldstein and Marty Martino. Cory loved to play the drums. Marty was the quintestial physician/business man. He seemed to always be into something. Cory ended up going into Psychiatry, and Marty became a surgeon. To any extent, we stuck up a friendship, and I had two new mentors. My first physician friends; or soon to be anyway.

In 1996, MCP Hahnemann University Hospital had an extensive advertising campaign for cardiology and cardiac surgery. ‘The Heart Hospital at Hahnemann University’ It seemed like it was every third commercial on television. I remember thinking: Wow…that is pretty cool. That is were I go to school. I am going to be a doctor. I loved surgery. I should take advantage and go observe some heart surgery. It is decided. I will track down the offices tomorrow.

The following morning I tracked down the Cardiothoracic Surgery offices at MCP-Hahnemann University Hospital – 7th floor. I introduced myself to the secretary, Michelle, sitting at the first desk. Explained who I was, and that I wanted to observe a procedure. She kindly took my number, and said that she would pass it on.

I left feeling great!!!! I was so excited. I half expected to be laughed off or told that it wasn’t possible for some reason or another. But she had said, that she would take my number and have one of the surgeons call me. How great is that!

Later that evening, I was talking with Cory and Marty. Marty listened, kinda chucked, and said, ‘Matt…they aren’t going to call you. These guys are busy. If you want to observe [heart surgery], you are going to have to speak with them directly.’

He was right. I felt the wind fall out of my sails a bit. I would have to go back tomorrow. The following afternoon, I returned to the 7th floor Cardiothoracic Surgery offices at MCP Hahnemann University. There was Michelle. I said hello again, and asked her if there was any surgeon around that might have a second to talk currently. She said, ‘hold on.’ And left to check. A few minutes later she returned. ‘Yes, come this way. Dr. Samuels said he would be happy to meet with you.’ I was a bit nervous. Who am I? A college freshman…talking to a heart surgeon. Geez. I hope this goes well.

Upon walking into the office of Louis Samuels, I was met with an extremely personable gentleman with a warm smile under a large mustache. He was seated behind a large wooden desk. We shook hands, and as directed I took a seat on the leather sofa opposite the desk. I explained who I was, and expressed my request to observe. He quickly looked at his planner, and informed me that he had a case tomorrow morning and I was more than welcome to observe. WOW!!!! AWESOME. I thanked him, told him I would see him tomorrow, and departed.

Back at my place, I ran into Marty, and thanked him for his good advice. He smiled saying ‘no problem, have fun tomorrow.’ I couldn’t sleep a wink. I was too pumped. I read everything I could about heart surgery. I finally fell asleep for a few hours, only to awake and look at the clock reading 4:00am. What? I had slept for 2 hours? Oh well….I felt refreshed. There was no way I was going to be able to fall asleep again. I got up, showered, ate a bowl of cereal, and made my way to the hospital one block North.

The OR was empty. Eventually people began to enter. I introduced myself and was warmly welcomed. I was lead back the the operating room. I met the nurses, the resident assigned to the case, the anesthesiologist. The patient was rolled into the operating room and drifted off to a gentle anesthesia induced slumber. As the circulating nurse finished opening the last of the supplies, she asked me ‘Are you going to be scrubbing in?’

‘Am I allowed?’

‘I will ask Dr. Samuels when he calls in.’

I was on pins and needles. The phone rang. After a brief conversation, she turned to me, smiled, and said, ‘He said it would be fine.’

‘Great. Now how do I do that?’

I was met with two smiles. One from the nurse, the other from the resident. As he walked out, the resident said, ‘Just follow me, I’ll show you.’

I watched him like a hawk, listening intently to his instructions, and followed them exactly. We re-entered the operating room. I was assisted into my gown and gloves. I was told were to stand. What I could touch, what I should not. I was a statue. A very happy statue, but also a terrified one.

This was completely unexpected. I was positioned at the patient’s thighs, between the scrub nurse and the resident. Dr. Samuels entered the room a minute or two later. He said ‘Good morning’ to the room and quickly exited to the scrub sinks. He returned and doned his scrub suit and gloves with a swift and confident ease. I was introduced again by the scrub nurse, and he welcomed me to the room. The resident and Dr. Samuels began the procedure. The two of them, and the entire operative team worked swiftly with only the slightest communication. It was impressive. Like watching all the intricate parts of a extremely complicated machine seamlessly interact with eachother.

Before I knew it the chest was open, the mammary was down, and the pericardial cradle fashioned. The heart beating quietly in the chest. THIS WAS AMAZING! It was truly the most amazing thing I had ever witnessed. The resident placed the sutures in the aorta under Dr. Samuels watchful eye. Shortly after, as he was preparing to cannulate, Dr. Samuels paused and turned to me. ‘You have to be really careful when you put this tube in the aorta. You can’t get any air in. Because if you do…it will go to the brain. Then you know what the patient becomes?’

Oh crap. He expects a response. Do I discuss my rudimentry understanding of cerebral air embolism or do I complete the joke he so blatantly set-up? I am going to try the joke….

“They become an air-head?’

Dr. Samuels literally laughed out loud. [It is really not that funny of a joke]. He paused [the first hint of a pause since the operation began], and looked directly at me over his loupes. “Did someone tell you to say that?”

“No”

“You’re the first person to ever get that right.” [laughing] He then quickly and quietly returned to the operation at hand. The patient was placed on cardiopulmonary bypass. The heart arrested. It sat quieted in the chest. I was astounded. The distal coronary anastomoses were begun. The right coronary was sewn first. The heart was lifted, and the circumflex territory was exposed. After choosing and opening the target coronary, Dr. Samuels again looked at me. ‘Hold the heart like this?’

Wait. Was he talking to me? He wants me to do that? I was WAY out of element. This day was already the best of my life, and now I am going to touch another human’s heart. I began moving my hand slowly toward the operative field, tenatively. I guess too slow though. Dr. Samuels grabbed my hand mid-path. I froze. He looked at me over his loupes, and told me three things I will NEVER forget. He said, “I am going to tell you three things I never want you to forget.”

I nodded.

“1. In cardiac surgery, as in life, you always move with purpose and confidence.

2. You need to be aware of your surroundings. Everything that is going on not only at the field, but throughout the entire room. You need to respect everyone else’s line-of-sight.

3. And most importantly, you need to understand that I would never ask you to do something that you are not more than capable of doing. If you are nervous, just remember...There is nothing that you can do that I can’t fix. [although I couldn’t see his face, I could tell he was smiling] Now hold the heart like this.”

He positioned my hand. And said, “Now repeat after me…I am a statue…I will not move.” I repeated it. I held the heart as Dr. Samuels and the resident sewed the distal coronary anastomosis. It was this moment that solidified it in my mind…this is what I will do with my life. All questions, all doubts I ever had about my future faded away. I will be a cardiac surgeon.

After the case was completed, the team rolled the patient out of the room. Dr. Samuels asked me, ‘Well, what did you think of that?”

[What do you say to someone who just changed your life...gave it direction? ]

“It was the most amazing thing I have ever seen. Thank you so much. Is there anyway I could observe you again?”

“Sure. I have a case tomorrow. I’ll see you then.”

And so it went. Practically everyday for the rest of my college career. With the same final conversation occuring after each case. Dr. Samuels would go on to represent more than a heart surgeon to me. He would became my boss, my role model, my mentor, my compass, and my friend. He is the man that introduced me to my life’s passion, and for that I will be eternally grateful.

This was my first introduction to the heart, and a moment I can remember as clearly today as the day it occurred.

TO BE CONTINUED…