Different Drummer

Andreas Gruentzig performed the first coronary artery balloon angioplasty (plasty) in 1977. Shortly after that, Doug completed his medical education and training and determined to contribute to the field Gruentzig's work had spawned. In 1984, just as things were taking off, Doug developed a cervical disc with neurologic impairment of his right arm. That's when his neurosurgeons broke the bad news: his interventional cardiology career was over. Or was it?

Doug elected physical therapy including cervical traction rather than the proposed surgery. The career disruption elicited a deep depression. This prompted him to seek psychiatric care. It also made him aware of the steep price many people in his field were paying for repeated exposures to life-and-death situations. This created a dilemma akin to soldiers in battle, including the associated problems of burnout, depression, substance abuse, PTSD, and suicide.

Over months, the neurologic and psychologic symptoms improved. Defying the experts' predictions, he was able to resume an interventional cardiology career and follow in the footsteps of many cardiac interventional and surgical heroes. As he describes in chapter 12: "My high-risk plasty career could not have occurred without two things:

•the shared courage of many of my high-risk patients and their families, and

•the psychiatric care I received throughout much of my medical practice."

Doug's cardiology practice included thirty-one years of care for American veterans in four different university-affiliated Veterans Affairs (VA) hospitals. The culmination of his academic and VA career was a five-year (1995-2000), sixteen-hospital, VA Cooperative randomized clinical trial. The Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) trial and registry compared plasty with bypass surgery for high-risk patients with acute coronary syndromes.

Doug followed his academic stint with fourteen years of private practice in rural America, where he applied the AWESOME hypothesis in the real world. Today, coronary angioplasty with stents has become the standard emergency care for acute myocardial infarction and other medically refractory, acute coronary syndromes. This book recounts the role Doug played in the plasty revolution, the price he paid for his success, the debt he owes to many heroes, and his hopes for the future for patients and care providers.