the 64 bulletin
SCTS-Ethicon 2019-2020 Cardiac Surgery Fellowship at Massachusetts General Hospital, Boston, USA Rizwan Q Attia BMedSci (Honours), MBChB (Honours), MS, MD, PhD, FRCS-CTh “Ars longa, vita brevis, occasio praeceps, experimentum periculosum, iudicium difficile” - Life is short, the art long, opportunity fleeting, experiment treacherous, judgement difficult Hippocrates
I
flew to Boston in autumn of 2019 as an ST8 London deanery trainee. Undertaking Step 2 and 3 in the United States allowed me to travel the country and speak to surgeons at major cardiac centres. Whilst presenting at the AATS I met Dr. Thor Sundt, chief of division of cardiac surgery and director of Corrigan Minehan Heart Centre. Following this, a visit to the unit affirmed my belief that this was the right place for me. As a major academic cardiac unit performing around 2000 cases annually, it is recognised as a globally premier medical institution. It delivers excellent research programmes, a high degree of specialisation and an emphasis on teaching. The unit is staffed by eight cardiac surgeons undertaking complex aortic cases, minimally invasive surgery, advanced heart failure treatments and transplants. The next steps were the unglamorous mountains of paperwork required for accreditation, licensing, certification and visa. After this was organised, I could look forward to the fellowship. I rented an apartment a short walk away from the hospital as my working day began with rounds at 5:30, ICU handover at 6:30, starting in the operating room at 7:15. I operated 4-days a week with 1st on-call (24-hour shift) once a week, 2nd on-call from home and procuring organs (once a week). This in effect implied a 1/3 on-call commitment. Procurement required flying off to various locations in New England to get heart and lungs. This turned out to be
a wonderful way to see the country and visit the surrounding hospitals. The cardiac surgery operating rooms are affectionately called ‘The Big Red Machine’ and it certainly does not disappoint! Day one involved me placing an axillary Impella in a patient with an ejection fraction of 10%. There is no end time to the day, we finish when we finish and help others out till everyone is done and we start again the next day. Sending for add-on cases at 7pm without the
theatre team batting an eyelid was one of the stark cultural differences that made an impression on me. The operating extending 7-days a week with extra cases for bank holidays. The expectation for residents and fellows being that they will be the primary operator for the vast majority of cases. The work schedule was organised in firms where I rotated through aortic surgery service first. I have had the absolute privilege of being trained by Dr. Duke Cameron in performing valve sparing root replacements,