Winding Down

The+Countdown+Five+countdown_5The countdown clock app on my phone reads 73.6 days.  That is the number of days until January 1, 2014.  My retirement day.

It has been a good run.  I graduated from Dartmouth Medical School in 1976, got married, and have practiced medicine ever since.  I went through internship and residency in Rhode Island, thought cardiology was pretty neat, and did a fellowship at the Medical College of Pennsylvania in Philadelphia.  The week before my fellowship started, one of the faculty, Dr. Toby R. Engel, was seriously injured in a car crash on East River Drive.  My first day of fellowship was memorable for two reasons.  My car was stolen, and I had to take care of one of my attendings, Dr. Engel, who was in a coma in the ICU.  It took about a year, but he did fully recover (I never saw my car again, however).   I developed a certain fondness for Dr. Engel, who became my fellowship mentor.  During my second year of fellowship (believe it or not, the average cardiology fellowship was only 2 years back then), I looked to him for career advice.  Dr. Engel was a devotee of the then fledgling field of cardiac electrophysiology.  He thought I had a knack for the electrical end of cardiology and urged me to go into it.  He gave me a list of programs to look into.  I ended up in Houston, Texas at Baylor, with another great mentor, Dr. Christopher Wyndham — Australian and protege of another early EP pioneer, Dr. Ken Rosen.  Chris was/is incredibly smart, but also very mild-mannered in a Crocodile Dundee sort of way and a gentleman with a great sense of humor.  He was a role-model for me, demonstrating that one doesn’t have to be a jerk to be a physician, despite the prevailing wisdom.   With limited success, I have tried to pattern my doctorly personality after his.

I didn’t mean to turn this into a life-story.  I’ll fast-forward through a year of electrophysiology fellowship at Baylor, 3 years working there on faculty, then 18 years of academic medicine at the University of Colorado Health Sciences Center in Denver, culminating in a fully tenured, Professor of Medicine position which I then cast aside to become a private practice cardiologist in Louisville, Kentucky.  Now after 10 years of that I have decided it is time to hang up the skates.  There are only so many atrial fibrillation ablations, biventricular ICD implants, and call nights one can do in a lifetime.  I would rather leave on a relatively high note than linger on to the point where someone has to drag me away for the good of the patients.

I have seen a lot happen in the last 30 plus years in the EP business.  I entered the field not exactly at the dawn of EP  but close to it.  ICDs were just coming out (circa 1980), and the field of electrophysiology was just a few steps away from pseudoscience.  The main thing we did back then was drug testing guided by programmed stimulation, something current electrophysiologists never do, thanks to studies like ESVEM from the 1990s that I participated in.  EP was only an academic field in those days.  There were no EP docs in private practice then, and the entire membership of NASPE (predecessor of HRS) could fit into one medium sized hotel meeting room.  Interventional EP, meaning practical ablation and ICD implantation by non-surgeons, was still years away in the future.   But all the time that we were giving patients false hopes that quinidine would cure their sustained monomorphic ventricular tachycardia, we were also learning a lot about the mechanisms of abnormal heart rhythms, until the right tools (mapping and ablation) were developed that allowed us finally to defeat these noxious arrhythmias and really help our patients.

I have had some accomplishments I have been proud of.  As a fellow I wrote and presented at the AHA the first paper analyzing the use of triple extrastimulation for inducing ventricular tachycardia.  I wrote the first paper that suggested that the characteristics of entrainment changed depending on the relationship between the pacing site and the reentry site, an important concept which led to entrainment mapping, though it took smarter people than I to grasp the full implications of this.  I also first reported giving a shock internally through an electrophysiology catheter to rescue a patient from refractory ventricular fibrillation.

I started this blog, not because I was interested in social media, but because I was interested in computers and needed a justification to run my own web server.  Looking at the blog, the first post is dated August 22, 2006.  This would make EP Studios  one of the earliest medical blogs, except I rarely have blogged much about medicine, especially back in the beginning.   So this blog is a big gemisch of topics: fantasy and science fiction, movies, 1960s TV shows, classical music, computer programming, politics, and, once in while, some medicine thrown in.  With a little more self-promotion, focus, and hard work I might have developed a more high-profile medical blog, but “I am what I am” as both God and Popeye have stated.

I am hoping that once I do retire and am away from the “Stop the World, I Want to Get Off” life I have been leading, I can spend a little more time writing about the things that interest me, including some more of my thoughts about the medical world of yesterday, today, and tomorrow.

About David Mann

I am a retired cardiac electrophysiologist who has worked both in private practice in Louisville, Kentucky and as a Professor of Medicine at the University of Colorado in Denver. I am interested not only in medicine, but also in computer programming, music, science fiction, fantasy, 30s pulp literature, and a whole lot more.

2 thoughts on “Winding Down

  1. I remember the drug trials with the patients that had survived SCD and how they had to stay in the hospital to be repeatedly brought to the lab for testing. It was before we started using Versed so many of them knew they were probably going to be shocked. Try to explain this today to people that work in EP and they say “you did what to them”?

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