Certainly the patients that stick out the most to me, and I’m thinking of one in particular, are patients who are devastated by an electrical problem, that their quality of life had been good and that, particularly with atrial fibrillation, patients often have normal strength of their heart and it’s just that the electrical pattern of their heart and their rapid pulse, the lack of coordination between the top and bottom of the heart – this plays havoc with their ability to do things, their wellbeing, fatigue, shortness of breath. There’s a lot of angst that goes on when you have something going wrong with your heart. And I think that psychic weight of that is also devastating often. So the patient I was thinking of was a grandfather who is a very active person who had had heart surgery and had actually been doing well for a number of years before the electrical problems began to happen and he enjoyed going to Cardinals games with his grandchildren and was unable to walk in the stadium, so the most significant physical activity that he has was doing this and it was really devastating to him that he was sort of recognizing his mortality in this and his problem was complex and required about eight hours of treatment but we persisted and it actually worked. And he was so grateful and he is doing very well and is now two years out of that but he stays in touch and it gave me a great feeling that we persisted through a long procedure.

When I was in undergraduate, I got interested in a research project on the neuromuscular junction and studying that and studying electrical activity in nerves and muscles and the interface in between those. The university I went to had an associated veterinary school, so I thought the best way for me to pursue that was to be a veterinarian and do research in that area and so I went to vet school for a year and as I thought more about what I was interested in and how I could pursue that, it became clear to me that I should go into medicine as opposed to veterinary medicine. So I jumped from there to Washington University and pursued a combined degree in neuroscience, a PhD in neuroscience and a medical degree with an intent to be a neurologist who studied activity of nerve cells but as I became involved in the clinical training, I really enjoyed doing procedures and taking care of patients and was attracted to cardiology and sort of incorporated my interests in electrical activity and the research I had done in the area of cardiac electrophysiology, so it’s been sort of a steady evolution of interests but I think I’ve always been interested in electrical behavior of cells, particularly heart cells.

I think the problems we face are becoming more and more common because of overall health care, particularly in cardiology, is allowing people to live longer but as we found out, part of that is we are dealing with more and more electrical problems as these patients who have sick hearts or weakened hearts to some degree experience these electrical problems and the problems that go with that. We’ve been challenged to find ways to help them to deal with those problems and hopefully get rid of them. We’re seeing a revolution in the ability to see electrical patterns, to see the anatomy through MRI, through electrical imaging that we have that gives a 3 dimensional picture. All of those pieces are coming together right now I think and the future is bright about what we can do, what we couldn’t do, even when I trained, the techniques were pretty rudimentary.

I take the responsibility of taking care of people very seriously and I worry about the impact of the treatments on patients. It’s certainly easy to recommend treatments for patients who are very healthy and have a single problem but often patients have a complex mix of problems and it’s not always clear what the best source of, what the best route to take for patients and I’m certainly considering what I’d want for my family members. I think a rapport with the patient and an understanding of their experiences with the diseases they see is an important part of trying to make the right choices, to help them make the right choices, particularly in the area of atrial fibrillation.