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Children’s groupis excellent

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I mean,I’ve felt that it’s tremendously complicated for a mother, for example, and the baby knowin utero for so many months, nine months. Not having the slightest idea that the childcould be born with something wrong in the heart. Who knows that? I don’t know. Almostnobody knows that. Then suddenly, somebody comes and says, hey, there’s something wrongwith the heart of your child. It needs an operation. I mean, it’s a mind boggling situation.So I was always very– as I told you, many things I didn’t do well. But that, I thinkI did well. I did have empathy, but not false empathy. but I realized it was a very complicatedthing. But I also learned it’s very difficult to teach that. I gave the example, becauseI think that I did well.

I spent time with patients, and I made drawings. And they wantedto understand why and how it comes about, and so on. So I spent a good time the nightbefore or the day before with the patient, to go into details. But you know, there’ssome people just don’t have that empathy or whatever it is. It’s very different. It’smuch easier to teach surgery than to teach human inter-connection, human relationships,I think. I’m trying to find the words to phrase this. When things wouldn’t go well in theoperation, how did you handle that? How did you learn how to handle that? I mean, theremust have been some cases that were very difficult.

And over the course of one’s career, wereyou able to accept that more easily? Or does it remain very difficult, and there wouldbe cases that you’d go home and brood about in the last decade of your career as muchas you did in the first decade of your career? Well, that, again, depends on individuals.You might be surprised to know that Dr. Varco, who I already mentioned, was a tough guy.He couldn’t live with that. He would stop operating for about a month, for a week, beforehe would do another operation. And Dr. Gross, world famous. When a patient died, he wouldclose up the door. He would disappear for a week or two. It just shows you. And theywere tough guys, you know. They seemed to be tough guys. They were not that tough. It’sdifficult to talk to parents. I was always very frank with– well, first of all, pre-opwe already talked about. You know, about the complexity of the cases and stuff.

And here,we did mostly complex cases. I mean, we got referred mostly complex cases, not easy cases.But mortality was relatively low. But it might be very low on paper. But for a parent wholoses a child, that’s not something on a paper. That’s a fact. But I always much delve intodetails. I told them why. And the overwhelming majority felt that we had done the best wecould. I must say, I didn’t– and I got very beautiful letters written afterwards frompatients. As a matter of fact, maybe better letters from patients where their child died,and that they knew that we had tried our very best. And they wrote very beautiful letters.But I mean, it is a difficult issue. But fortunately, on the other hand, the incidence, the mortalityfor cardio operation went down tremendously over time.

Right now, at good institutions,it’s about 1%, something like that. To a very complex cases right now, the Children’s groupis excellent. Especially the number of– it’s surprising low. It must be very rewardingfor you to have seen that evolve over the course of your career. Dr. Castaneda, couldI turn now and ask you, you finished your tenure here as surgeon in chief and the WilliamLadd professor at Harvard Medical School. But you didn’t go take it easy. You went andestablished this clinic in Guatemala, which exists to this day. And your determinationwas to really bring pediatric cardiac surgery to Guatemala and Central America. Could youtalk about that? What were you thinking when you started that program 15 years ago? Andtoday, it’s a thriving center.

Well, I tell you, first of all, I’m not typically Guatemalan.I was born in Europe, grew up in Europe. Trained in this country for 40– I mean, I spent 43years in this country. I’m not a typical product of it. On the other hand, I was grateful thatI went to medical school there and graduated, because I needed a diploma to be acceptedsome place. I mean, medical schools are not very good. But I had a sense, some sense ofgratitude towards having given me a medical education. I had some offers in this countryand in Europe, but knew they didn’t really need me. I mean, I don’t think so. So I thoughtin Guatemala, they had some attempt at heart surgery in children there. They had a mortalityof over 80%. So I said, “we could establish something.” It was a little optimistic.

It’svery difficult. It proved very difficult. And the circumstances are such that we never,ever duplicate at, say, Children’s Hospital or any other good hospital. It’s culturaldifficulties, economic difficulties, and so on. But we established a pretty good unit.I mean, for Latin America, we are on the map. And by the way, we only operate on poor people.I have no salary. I mean, I work without salary or anything. Pro bono everything, becausethe people with money– which is the very few– they go to the States or to Europe.I don’t blame them. So we operate on only poor who cannot pay. Imagine the cost thereis about 10% of what it costs here.

But it doesn’t offer, of course, the same. But eventhe 10% is a number that’s impossible for the poor people to ever even think of beingable to pay. I mean, to the hospital. I’m not talking about surgery. That’s where Ispend most of the time. I’m trying to get money all over the place, just like a beggar.Then we have a foundation here, as you know, maybe. So the Aldo Castaneda Foundation supportsmost of that center. Yeah. What the government gives is insufficient, highly insufficient.Oh, it’s a struggle. It’s a major struggle. But I mean, we have established a unit whichis pretty good. Not comparable to here, but it’s pretty good. And there we are, strugglingevery day. I didn’t think I would be still working at 84. I’m 84 years old. But you gotto do something, otherwise you’ll die.

Well, and die anyhow. How many surgical procedures–About 500 a year. My gosh. That’s a big program. That’s a big program almost anywhere in theworld. Well, in Europe, it’s come down. You know, in Europe, interesting even the veryCatholic countries– Italy, Spain, et cetera– the numbers, the unit, it does 200, 250 casesa year is a big unit. They’re doing abortions for the presence of even simple defect. Forchildren diagnosed in utero? In utero. Dr. Castaneda, I wonder if I could turn now andask you some questions related to what makes a good physician. In the room today, we havea young woman who is going to go to medical school. What advice would you have for youngdoctors now?

What is it about a career that they should focus on? What are the good habitsand the good characteristics? Well, I still believe that medicine is a very attractiveprofession if you do it in the right way. If you are not contaminated by a pathologicneed for making money, which is a problem. But if you take it as an occupation that cando good and try to do with as much as you can, it’s very rewarding from a point of view.And whatever speciality makes no difference, what speciality it is. You know, it’s gratifyingto see somebody who was very sick that you could participate in making better.

I thinkthat’s a very gratifying way to look at it. I think we have to be careful when now theold age comes through, but you know, I only think that before it was good, and now it’snot good, it’s not true. I think now it’s fantastic. But I think technology has advancedin great measure in a very positive way. But at same time, it has eroded a little bit thehuman relationship between physician and patient. I see it even in Guatemala. They come andthen they’ll do without, they don’t know the history or nothing. They’ll do an ECHO, youknow what I mean? So one has lost a little bit– no, quite a bit– the human interrelationshipwith physician and the patient. And I think that’s universally true. Now at the same time,of course, much more accurate diagnosis are being made than ever before.

And so on. Sothere are many positives. But one has to find a balance with the humanistic part. He whoonly knows medicine doesn’t know medicine. So I think one has to be sure that– overallcultural backgrounds. Be that in art, be that in literature, be that history, whatever.Beyond medicine, I think it’s important. If you only know medicine, as I say, that’s notenough, I think. And that is not easy to achieve, because the time that one has to dedicateto medicine is very high. But I always made it a point to read at night, even it was verylate.

I would read non-medical stuff. And I think one has to have extracurricular interests.And have a general cultural baggage to carry around with you. We hear a lot nowadays aboutwork-life balance. Indeed, it’s even legislated in Europe and the United States that thereare duty hours that the young residents can only work for so many hours. And that’s notfor work-life balance as much as it is to make sure that they’re not fatigued. But lookingback and looking forward, first on the question of work-life balance. As a physician, especiallyif you’re going to be dedicated to being the best you can be, is it possible to be dedicated,fully absorbed, and yet to maybe more have a balance of work, family life, than in theearly years of your career when such a thing probably wasn’t– Well, my generation is abad example because there’s no question.

You see, for me going to the hospital in Minnesota,it was like Christmas every day. Everything new. Something new was coming about. It wasa fantastic atmosphere. At the expense of the family. We worked too hard. I mean, wewere on call every second night. Loving it, by the way, as residents. We loved it, becauseit was fantastic. But I have to admit that much of that was also at the expense of afamily. We were not that good fathers, so to speak, playing baseball with the kids orwhatever. It’s interesting. One of my daughters, somebody asked her once, you know why yourdaddy is always away? She said, well, I didn’t know any different. I thought they were alllike that. So I mean, it depends how you look at it. And somehow, they came out OK. Butit’s different. You know, I didn’t live that thing anymore, that it’s so legislated thatthey have to go home, the residents and stuff. We wouldn’t have liked it, that I know 100%.But it’s better, I don’t know. I don’t know. To reach excellence, I thought a little bitabout that. To reach excellence, you can do it on a schedule. I mean, it takes time tothink, time to do, and so on.

And to be the perfect father and a perfect– Well, womeneven more so. Some colleagues, told me, said, well, you know you can’t be a good mother,doctor, and wife. There’s no way they can do all three equally well if you’re a doctor.Very difficult. I think they’re right. Dr. Castaneda, do you have any final thoughtsyou’d like to share with us about your career, the evolution of congenital heart surgery,or final thoughts to young people starting out on their career? I think that with allthe different circumstances that time brings to any profession right now, and then here–insurance and so on– despite all that, it’s still an extremely attractive profession.

Now, one has to love it because if you go into it for money-making, that’s the wrongapproach for sure. Because first of all, then you should go into business because you’llnever make it as well as some business people. But I think it’s a fulfilling profession.It’s the most humane of societies and the most scientific of humanities.

So I wouldcertainly endorse that if somebody really wants to do it, has to do it well. And themotivation has to be an intrinsic motivation knowing– but there are many other professionalswho have similar problems. I mean, none is perfect. But I still think it’s one of themost rewarding things. And I personally, looking back, don’t regret one second of it. Well,Dr. Castaneda, thank you for being with us today. And I know I speak for my colleaguesaround the world, you have our admiration for all the things you’ve done. And especiallyfor what you’re continuing to do to this day in Guatemala. So thank you for being withus. Thank you very much. Thank you.

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