This World Shared Practice Forum will differ
from our typical World Shared Practice Forums. This video is the first installment of our
“History of Medicine” series in which we will be discussing the history of modern medicine
with experts from around the globe. Unlike most World Shared Practice Forums, there will
be no discussion questions during this video. However, if you would like to ask a question
or leave a comment, please feel free to do so at any time. Thank you, and we hope you
enjoy this video. I’m Dr. Jeff Burns, Chief of Critical Care at Boston Children’s Hospital
and Harvard Medical School. And we’re very pleased to have with us today Dr. Aldo Castaneda.
Dr. Castaneda was, for 20 years, the William Ladd Professor of Surgery here at Boston Children’s
Hospital, and also the Surgeon-in-Chief during that time. For the past 15 years, Dr. Castaneda
has developed and lead a clinic for cardiovascular surgery of children in Guatemala and Central
America. Dr. Castaneda, it’s a privilege to have you with us today. Thank you. I wonder
if I could begin by asking you about your career. Many of my colleagues around the world
would be very interested to know what were the influences that guided you through your
career, what brought about these changes. And I know in particular that you trained
and went to medical school in Guatemala, but then found yourself doing surgery in Minnesota.
And I wonder if we could talk about that transition, what drew you to Minnesota, and really the
start of your surgical career. Well, as a medical student, I was aware that the heart
was the only organ that had not been accessible to surgery. I mean, I was interested in surgery
in general. And I receive the “New England Journal of Medicine” at the time as a medical
student. There, I learned that there was– particularly what I read– was this group
in Minnesota who somehow picked up the role of the central advances in intracardiac surgery,
they developed. The first person who was really instrumental in developing a cardiopulmonary
bypass system was Dr. Gibbon. He had been a fellow in Philadelphia, I think it was Jefferson.
And for a while, had a rotation at Mass General in Boston. And there, one night he was on
call and there was a young lady who had broken her leg, if I remember correctly, and she
developed a pulmonary embolism. And Dr. Gibbon was on call, spent all night trying to help
her. And she died. And at the autopsy, they found that the stratification of the pulmonary
artery was totally occluded by a clot. And he thought that– otherwise, it was a normal
heart that was secondary to her fracture– that if one could develop a system, a heart-lung
machine, so to speak, that would take over the function of the heart and the lungs. During
that time, you could operate on the heart, take out that clot, she would have survived.
Now, at that time, there was a Trendelenburg operation which very few people had had success
with, extracting pulmonary emboli, and so on. But that became a very interesting history.
We don’t have time to go into it. But he spent 20 years of his life in the cellar of Mass
General. The surgical hierarchy at the time was not particularly interested, and thought
the guy was a little bit out of shape. But he did get a little room in the cellar of
Mass General to do some experiments. And Harvard Medical School gave him a grant. Not a lot,
but some grant. And he started in the early 1930s to work on a heart-lung machine. It
was quite interesting. Alone, without much enthusiasm of the Dr. Churchill, I think,
was the chief of surgery. He thought that was nonsense. But he worked. Kept on working.
There was a nurse who helped him. They were there in the cellar every night. So anyhow,
they got married eventually. And also, eventually, he did the first open heart surgery using
an artificial heart-lung machine which was green oxygenated type. He did six operations,
of which only one patient survived. And there were others also. And the mortality for using
an artificial heart-lung machine at that time was about 95%. There was only one survivor.
That created a very negative atmosphere in the cardiological world. And Gibbon– Walt
Lillehei told me that– Gibbon offered himself to lead a movement through Congress of the
United States to ban or have a moratorium on open heart surgery for indefinite time
period. Really? Fortunately, it didn’t succeed somehow. Another young group of surgeons at
the University of Minnesota– and so where Minnesota comes in– led by Walt Lillehei
and Dr. Richard Varco had a different idea, which was interesting. They developed in the
lab so-called cross circulation. And Richard took a human donor, if you want to use that
word, and put cannulus through the femoral artery and femoral vein. Take out from the
venous system of the recipient of the patient. Pump it into the femoral vein of the donor
with another catheter in the femoral artery that was threaded up to the abdominal aorta.
You get red blood out, oxygenated blood out from the donor, and pumped it into a tiered
system of the recipient. So it was called controlled cross circulation. 1953. And they
did 46 cases, 46 operations on patients. They did for the first time, close the ventricular
septal defect. Atrial septal defect. Tetralogy of Fallot. And they had a few– I think there
were three– complete AV canals. The mortality was high. But nevertheless, they proved. Because
that was the question. Why did using the heart-lung machine, why did they all die? They proved
that one could do an extra corporeal circuit and open the heart, fix something, and that
the heart would tolerate that. Was the donor typically a parent? I know in one case– The
donor was mother or father. Always mother or father. Did any of the donors– No. One
of the donors, the circuit had some problem. There was some embolism with some neurologic
deficit, but not severe. But it was, of course, it was clear to everybody. It was not a permanent
arrangement, but it was a major step against the pessimism of those in the world at that
time about the feasibility of open heart surgery. It did show that you could operate on the
heart. At the Mayo Clinic, John Kirklin had gone to medical school at Harvard, whose father
was a professor of radiology at the Mayo Clinic. He had after that gone back to Rochester,
did his training, and stayed on the staff, became interested in heart surgery. And his
classmate was Gibbon here at Harvard. So he went to the engineer of the Mayo Clinic, Johnson.
Jonas. He went to Philadelphia and looked at the apparatus that Gibbon had built. They
looked at it. They found it was somewhat complicated. Too much server mechanisms involved. Anyhow,
they modified it. Came up with a Mayo-Gibbon oxygenator. It was the Rolls Royce at the
time. Very expensive, but they could do it. Mayo Clinic was richer. Went back to Rochester
and started their effort of open heart surgery using a Mayo-Gibbon pump oxygenator. In the
meantime at the University of Minnesota, 90 miles apart– Minneapolis and Rochester, they’re
90 miles apart. They then went away from the cross circulation using the human donor, and
developed a bubble oxygenator. Dick DeWall developed a bubble oxygenator, which in a
way was a version of what the physiologists had used in the 19th century for organ profusions.
For direct blood gas interface. And that was in 1954, 1955. And then they started their
series of open heart surgery using the so-called bubble oxygenator, which was plastic. The
total cost of that was unbelieveable. And unbelieveably they bought the plastic tubings
for, I think it was at that time, $30 or something like that. So there was a significant difference.
And cheap. And that really popularized cardiac surgery. But for two, two-and-a-half years,
the only open heart surgery in the world was done between the Mayo Clinic and the University
of Minnesota group. Wow. Interesting. Yes. So that was the beginning of open heart surgery.
I was a medical student. I read about that. And at that time, the medical school had a
laboratory, and I did some– I mean, I didn’t do nothing particular– but I did get the
pump from the ladies of the diplomatic corp in Guatemala. I give them a talk and said,
we need a pump. We have to buy a pump. We bought a pump. Primitive pump, but nevertheless,
we had it. And I got some bags to do the oxygenator. And there’s a thesis, medical school thesis.
I used that to do 10 dogs. We put 10 dogs on bypass, opened the ventricles, closed it.
And as I say, I did nothing particular. But nevertheless, it helped me, the thesis helped
me in part that I was accepted as a resident at the University of Minnesota. That’s how
I got– that’s the only place I applied, by the way. What did I know? I didn’t know any.
I applied to University of Minnesota. And where were two circumstances. One was that
I sent the thesis along with my application. And they apparently were quite interested
that a guy in Guatemala suddenly came up with that as a medical student. But there was an
event, there was an International Congress in Guatemala. And I was one of the interpreters.
There were simultaneous translations. And one of the people who was there was a chief
of child psychiatry at the University of Minnesota, Dr. Jensen. And he gave a talk. But he started
this talk with a joke. As you know, there are many Scandinavians in Minnesota. Many
Scandinavians. Lillehei, for example, is Norwegian. That is a Norwegian name. Between the Norwegian
and the Swedes, there was always some jokes with the Swedes, because the Norwegians are
a little dumb or whatever. So there were all these jokes. Well, this guy started his talk
in psychiatry with this joke. I didn’t understand the joke. But I told the people, now, I don’t
understand the joke. But when I tell you, you have to laugh. You have to laugh. So I
said, laugh. And ah, ha, ha. Everybody started to laugh. The guy went back to University
of Minnesota, said, there’s this genius kid in Guatemala who understands and could translate
my joke. Years afterwards, I told him that I hadn’t understand a damn thing about his
joke. But anyhow. So I was lucky to be admitted as a resident at University of Minnesota at
that time. And I did there my– it was very academically oriented program in which we
did clinical, of course. At that time, it was combined. There was general surgery, and
cardiothoracic was still all together. And I had a master’s degree in biochemistry, and
a PhD in experimental surgery and physiology. Very academically oriented for an academic
career. Dr. Wangensteen was the chief, and it was an interesting time at the University
of Minnesota. And then when I finished, the hospital stay on on the staff. I was lucky.
So I was there then as an assistant professor, associate professor, professor, until ’72
when they started– they offered me the job. Dr. Gross retired from Children’s. And they
offered me the job. I was very amazed about that. I didn’t have the slightest idea why
they would select me. To this day, I don’t know how they selected me. You don’t understand
why the search committee turned to you from Boston when Dr. Gross was retiring? I didn’t
understand. Because the names that were involved who had been already here to look at the job,
they’re all very famous guys. I was nowhere. I was nobody in Minnesota. I mean, I had published
some stuff and stuff. But I really, to this day, don’t quite know. And whether they made
a mistake or not, I don’t know that either. I don’t think it was a mistake. But anyhow,
that’s how it was. So I came here in 1972 to Children’s. So before I ask you about that
era, could I ask you this? At one extreme, someone like me looks back at that time and
says, what was it about Dr. Gibbon and Dr. Lillehei and you, that were able to move the
field forward. Does the field move forward because talented individuals move the field
forward? Or is it a combination of talented individuals and the era and the time are appropriate
for the advance? Well, it’s an interesting question. Because you see, you have two aspects
to that, and good examples. Gibbon was not supported, really, as I told you. The chief
of surgery at the Mass General, Dr. Churchill, really didn’t believe that he ever would do
that, or that this was possible. So it was in this little corner in the second floor
of the basement of Mass General. And he got the little grant from the– then finally,
he made some contact with Watson from the IBM. And they gave him some money. But he
really did not have the backing, enthusiastic backing of people. He fought for 20 years
to do that. On the other hand, at the University of Minnesota, the person who has to be mentioned
is Dr. Wangensteen. Also a Norwegian name, Wangensteen. Was a very extraordinary individual
who had trained at the University of Minnesota. And the Mayo brothers who was at the Mayo
Clinic, Charles and– recognized that this guy was special. And out of their pocket,
sent the guy– those years, you know, American surgery had to go to Europe. Was the other
way around. To become whatever chance or so at an academic appointment. And he spent two
years in Europe paid by the Mayo brothers. Interesting. And he came back and built a
very strong academic department. I mean, we all who went there, had really the moral obligation
to not go into private practice, but to do academic surgery. So the ambiance that he
created in that department was very research oriented and very innovative for innovation.
He himself was a general surgeon. He did a lot about gastric suction and stuff and cancer
surgery. And he was not involved personally. He wasn’t personally involved in this cardiac
effort, but he supported Lillehei and Varco’s idea strongly. So you had the two juxtaposed
systems. One where there was a visionary leader who supported the faculty– Exactly. Gibbon
didn’t have that. Right. What was it in you, though, that you’re in Guatemala. You’re a
medical student. And in retrospect, that’s a huge accomplishment. You put 10 animals
successfully on bypass and successfully decannulated them. By the way, I didn’t do anything. I
mean, I read “The New England Journal of Medicine,” and then I got some other reprints and so
on. And then, I mean, I copied what they did in Minnesota. But what was the motivation?
What do you think was the inner drive? Well, I wanted to do it. No. I thought, that I did.
I somehow it caught fire. I’m not quite sure how, exactly. But I mean, it just interested
me. It was the last organ that now was being attacked surgically. And I thought that was
fantastic. And since a lot of people have heart problems. In Guatemala, for example,
rheumatic heart disease was very strong or very common at that time. And people died.
So I thought that that was a fantastic opportunity. And it’s true. And to be honest with you,
I don’t exactly remember how I became so enthused about it. But I liked history always a lot.
Always I was interested in general history and in medical history. So I had seen all
that these people did, and Bill wrote for the gastrointestinal surgery and so on, and
breakthroughs. And it was very clear to me that this was a breakthrough moment. Very
important breakthrough moment in the history of surgery, that the heart could be finally
attacked. Now, the interesting thing, by the way, all of the efforts originally for open
heart surgery were for congenital heart disease. No acquired heart disease. So it was all children
initially. All children. Or adults with congenital heart disease. Now, the other thing that I
learned there, of course– I was a resident– since there are only two institutions who
did it in the world, who did this heart surgery. So they came from all over the world. I saw
that many came too late, you see. They had pulmonary vascular obstructive disease. And
Jesse Edwards was in pathology and developed an understanding of the effect of pulmonary
hypertension on the evolution of pulmonary vascular obstructive disease and so on. So
it became very clear to me from relatively early that that corrective operation had to
be done early. Because if that persisted, that cause secondary damage to the heart and
the lungs. Now at that time, what was early in your mind? Well, early, first I thought
before going to school. That was my first thing. But then slowly, we came down to the
conclusion, no, that’s too late. And then we started once I was on the staff, I had
a lab. Once we were on the staff, we already had a lab. We had to have a lab. We had to
get money from the NIH over there to do some research. So I had a lab. And there, one of
the experiments we did was important was we put two kilogram puppies to see if they tolerated
cardiopulmonary bypass. We did a lot of experiments. And came to the conclusion that they did very
well. We looked at blood. We looked at the lungs. We looked at the heart and so on, and
the central nervous system. To dissect out how they would respond to cardiopulmonary
bypass at that early age. I mean, they’re two kilogram puppies. And we developed some
instruments for infant cardiac surgery also, and stuff. So that work, we started already
in Minnesota to do earlier kinds. But when we really made the breakthrough through was
the neonate, first months of life, was here at Children’s where we did the first arterial
switch operation in neonates. It was a 10-day-old child. And we did a complete correction with
the so-called arterial switch operation. And that opened the movement of congenital cardiac
surgery towards the neonate. What year was that, the first switch? ’83. ’83. I mean,
we did experimental work from ’60. The paper, the first paper, probably was about ’66 in
Minnesota still. I came to Boston in ’72, to Children’s. And we did the first neonate,
clinical neonate, in ’82. January 2nd, ’82. So Dr. Castaneda, can I ask you this. You
just clearly described that your research was going in that direction. And so I’m interested
to know was it your accumulated belief from the observations that you’d had that they
came too late, these patients came to Minnesota too late. And that really what was driving
the movement to repair newborns was based on your observation. And candidly, everything
else had to fall into place. The anesthesia, the bypass, the pre and post operative care.
Correct. Or was it that technology was simultaneously evolving that made better pre-operative diagnosis,
better post operative care. I’m interested in which is the lead point. I mean, I don’t
try to imply that I’m the only one that did that. The Japanese had been interested in
operating, and they developed a technique of deep hypothermic circulatory arrests at
20 degrees centigrade. We used it at the beginning, but at the end, we thought it was not– we
did some studies. In particular, an associate of mine, Dr. Jonas, Richard Jonas, now in
Washington. That circulatory arrest, even at 20 degrees centigrade, if you really studied
those children post-op well, they had some neurologic deficit. And we switched again
back to cardiopulmonary bypass. That switch operation at the neonatal level, that first
kid was 10 days old. That was a breakthrough. Now, of course, in a well established unit
in the first world, the distribution is about 60% are neonates. Imagine this, It’s a tremendous
amount. And about 30% are within the first year, and only 10% are beyond the first year.
While in the third world, like in Guatemala, for example, we have about 5% in the neonate,
because the diagnosis are not being made early enough in outlying countryside and so on.
So we have a long way to go, but in a good units around the world, that’s what they’ll
do. So the neonatal surgery is here to stay. There’s no question about it. What were the
challenges as it evolved? I mean, I imagine there were challenges in making sure that
the pre-operative diagnosis was correct, that the operative technique was correct and the
best it could be. But along that chain of care, what were the particular challenges
of moving the repair ever earlier in life? Well, you know, well enough to be very clear.
And by the way, I even found it out more so when I went to Guatemala than when I was here.
The surgery is not the big hero of this whole thing. That’s nonsense. This cardiac stuff,
it requires a team. And it is like a chain. And everything works OK if all the parts of
the chain are OK. If one fails, the whole thing fails. What I mean by that is if surgeon
is no good, no good either. Yeah, but not only no good. Anesthesia, heart-lung bypass
team, post-operative management. I mean, we all dependent on one another. So I think that
people– I mean, visitors came a lot to Children’s and all that. One thing I think we did here
pretty well was that we had created an environment and everybody was recognized as equal. It
wasn’t the big surgeon because he did the surgery. You can do the best surgery. If the
pump fails, anesthesia is lousy, and the post-op management is lousy, the results are not very
good. That it obvious. So we create– and particular with nursing, you know. That was
interesting. I always felt that the nurses were extremely well educated, very capable,
but were underused in general. I mean, what they were allowed to do. And the nurses wanted
to do more. But the hierarchy, they had the chief nurse of the hospital, was very reluctant.
It was interesting. To let them think more independently and act independently? I thought
they are intensive care unit. When we got the residents every year, we had new residents.
First thing I told them, I said, listen. You might be thinking you are very smart, Harvard
graduates and all that kind of stuff. The nurses know more than most doctors. They stay
with the patient there at the bed side in the intensive care unit. They know the patient
better than we do. We waltz in, waltz out, which is almost true. And I had much respect
for the nurses. And I think they noticed that. And we created an environment in which everybody
was equal. Could I turn now and ask you some questions about what it was like for you to
be a pediatric heart surgeon? And some of the things I’m wondering are what was it like
talking to parents over time? Because when you started, the mortality rate was higher.
And yet the parents were, in the earlier part of your career, likely more deferential perhaps.
But did talking to parents change? Did it become more– That’s an interesting subject.
Some people do it well and some people don’t by nature. I don’t know exactly why. I mean,
I’ve felt that it’s tremendously complicated for a mother, for example, and the baby know
in utero for so many months, nine months. Not having the slightest idea that the child
could be born with something wrong in the heart. Who knows that? I don’t know. Almost
nobody knows that. Then suddenly, somebody comes and says, hey, there’s something wrong
with 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 think
I did well. I did have empathy, but not false empathy. but I realized it was a very complicated
thing. But I also learned it’s very difficult to teach that. I gave the example, because
I think that I did well. I spent time with patients, and I made drawings. And they wanted
to understand why and how it comes about, and so on. So I spent a good time the night
before or the day before with the patient, to go into details. But you know, there’s
some people just don’t have that empathy or whatever it is. It’s very different. It’s
much 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 the
operation, how did you handle that? How did you learn how to handle that? I mean, there
must have been some cases that were very difficult. And over the course of one’s career, were
you able to accept that more easily? Or does it remain very difficult, and there would
be cases that you’d go home and brood about in the last decade of your career as much
as 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, before
he would do another operation. And Dr. Gross, world famous. When a patient died, he would
close up the door. He would disappear for a week or two. It just shows you. And they
were tough guys, you know. They seemed to be tough guys. They were not that tough. It’s
difficult to talk to parents. I was always very frank with– well, first of all, pre-op
we 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 who
loses a child, that’s not something on a paper. That’s a fact. But I always much delve into
details. I told them why. And the overwhelming majority felt that we had done the best we
could. I must say, I didn’t– and I got very beautiful letters written afterwards from
patients. 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 mortality
for 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 group
is excellent. Especially the number of– it’s surprising low. It must be very rewarding
for you to have seen that evolve over the course of your career. Dr. Castaneda, could
I turn now and ask you, you finished your tenure here as surgeon in chief and the William
Ladd professor at Harvard Medical School. But you didn’t go take it easy. You went and
established this clinic in Guatemala, which exists to this day. And your determination
was to really bring pediatric cardiac surgery to Guatemala and Central America. Could you
talk about that? What were you thinking when you started that program 15 years ago? And
today, 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 43
years in this country. I’m not a typical product of it. On the other hand, I was grateful that
I went to medical school there and graduated, because I needed a diploma to be accepted
some place. I mean, medical schools are not very good. But I had a sense, some sense of
gratitude towards having given me a medical education. I had some offers in this country
and in Europe, but knew they didn’t really need me. I mean, I don’t think so. So I thought
in Guatemala, they had some attempt at heart surgery in children there. They had a mortality
of over 80%. So I said, “we could establish something.” It was a little optimistic. It’s
very 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 cultural
difficulties, 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, because
the 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 there
is about 10% of what it costs here. But it doesn’t offer, of course, the same. But even
the 10% is a number that’s impossible for the poor people to ever even think of being
able to pay. I mean, to the hospital. I’m not talking about surgery. That’s where I
spend 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 supports
most 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 which
is pretty good. Not comparable to here, but it’s pretty good. And there we are, struggling
every day. I didn’t think I would be still working at 84. I’m 84 years old. But you got
to 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 the
world. Well, in Europe, it’s come down. You know, in Europe, interesting even the very
Catholic countries– Italy, Spain, et cetera– the numbers, the unit, it does 200, 250 cases
a year is a big unit. They’re doing abortions for the presence of even simple defect. For
children diagnosed in utero? In utero. Dr. Castaneda, I wonder if I could turn now and
ask you some questions related to what makes a good physician. In the room today, we have
a young woman who is going to go to medical school. What advice would you have for young
doctors now? What is it about a career that they should focus on? What are the good habits
and the good characteristics? Well, I still believe that medicine is a very attractive
profession if you do it in the right way. If you are not contaminated by a pathologic
need for making money, which is a problem. But if you take it as an occupation that can
do 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 gratifying
to see somebody who was very sick that you could participate in making better. I think
that’s a very gratifying way to look at it. I think we have to be careful when now the
old age comes through, but you know, I only think that before it was good, and now it’s
not good, it’s not true. I think now it’s fantastic. But I think technology has advanced
in great measure in a very positive way. But at same time, it has eroded a little bit the
human relationship between physician and patient. I see it even in Guatemala. They come and
then they’ll do without, they don’t know the history or nothing. They’ll do an ECHO, you
know what I mean? So one has lost a little bit– no, quite a bit– the human interrelationship
with 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. So
there are many positives. But one has to find a balance with the humanistic part. He who
only knows medicine doesn’t know medicine. So I think one has to be sure that– overall
cultural 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 not
enough, I think. And that is not easy to achieve, because the time that one has to dedicate
to medicine is very high. But I always made it a point to read at night, even it was very
late. 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 about
work-life balance. Indeed, it’s even legislated in Europe and the United States that there
are duty hours that the young residents can only work for so many hours. And that’s not
for work-life balance as much as it is to make sure that they’re not fatigued. But looking
back and looking forward, first on the question of work-life balance. As a physician, especially
if 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 the
early years of your career when such a thing probably wasn’t– Well, my generation is a
bad 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 was
a fantastic atmosphere. At the expense of the family. We worked too hard. I mean, we
were on call every second night. Loving it, by the way, as residents. We loved it, because
it was fantastic. But I have to admit that much of that was also at the expense of a
family. We were not that good fathers, so to speak, playing baseball with the kids or
whatever. It’s interesting. One of my daughters, somebody asked her once, you know why your
daddy is always away? She said, well, I didn’t know any different. I thought they were all
like that. So I mean, it depends how you look at it. And somehow, they came out OK. But
it’s different. You know, I didn’t live that thing anymore, that it’s so legislated that
they 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 bit
about that. To reach excellence, you can do it on a schedule. I mean, it takes time to
think, time to do, and so on. And to be the perfect father and a perfect– Well, women
even 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 thoughts
you’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 all
the 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 wrong
approach for sure. Because first of all, then you should go into business because you’ll
never 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 would
certainly endorse that if somebody really wants to do it, has to do it well. And the
motivation has to be an intrinsic motivation knowing– but there are many other professionals
who have similar problems. I mean, none is perfect. But I still think it’s one of the
most 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 colleagues
around the world, you have our admiration for all the things you’ve done. And especially
for what you’re continuing to do to this day in Guatemala. So thank you for being with
us. Thank you very much. Thank you.