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Saturday, September 26, 2009

Cinema Paradiso, a Blast from the Past

There is nothing better than that feeling you get when you come across something from the past. I don't know, I guess this may be the appeal, the incentive, or maybe the lure, that makes people dwell in it so often, and sometimes indefinitely. Ranging from that once-in-a-while sweet, harmless nostalgia to downright pathological, disabling failure to progress, this feeling of familiarity and comfort found in one's past is probably, and to my experience, the reason why so many people struggle or fail to move on to new pastures.

The other day I tagged along with M. for a short DVD shopping trip. We were both flipping
through the monumental stacks of DVDs, and were ready to go home, nothing of note having been caught in our respective nets, when I heard the clerk making a recommendation to a girl (and a nice looking one at that!). I overheard: "you should try Cinema Paradiso..."

Instant flashback to 1990. I was eight years old, and we had just moved to a new place in Beirut. A brand new TV set, a brand new VCR and a nice VHS to christen it with.
Cinema Paradiso, an award-winning film by Italian filmmaker
Giuseppe Tornatore. I remember it so vividly; it was late, one of the first quiet nights in the post civil war era. The living room engrossed in the somber yet elucidating light provided by a solitary candle placed on top of a run down coffee table, I waited, anxiously observing the clock's every move, in anticipation because at midnight, we get to enjoy the luxury of electricity again.
I fell asleep on the couch, to be woken up at midnight by my mother, who was just as anxious as I was to watch that new movie.

Perhaps ironically, the theme of the movie circles around letting go of one's roots, of one's past and all that it entails, as it so powerfully follows the life of Salvatore di Vita, affectionately called Toto, as he morphs from that 5 year-old kid with so little on his mind, through a hormone-laden teenager, and into a grown man with aspirations to a career and success.
Always the sucker for blasts from the past, I jumped on that thing like there was no tomorrow; I drove back home in a daze, and the mere sound of the two words "Cinema Paradiso" brought my mom to tears. To say that watching this movie 20 years down this long road was an emotional experience would be a masterpiece of understatement. So many powerful scenes, and a theme and topic that remind me so poignantly of my own childhood, my own journey through life, proved to be nearly too much to handle. I guess that my having been through the experience of leaving home and loved ones behind meant that I identified with Toto in the movie.
Ironically, a movie riddled with nostalgia, departures, and separation from the past, has reunited me with mine in a way my clumsy words will never be able to describe.

Why so afraid of the past?

Monday, September 7, 2009

First LVAD implant in Lebanon - The misconceptions surrounding a highly successful operation

"A team of AUH surgeons has successfully carried out the first artificial heart implant operation in Lebanon, saving the life of a 37 year-old man and father of four".

That is the claim of many renowned media sources in Lebanon. Click here to read the official AUB article by Maha al-Azar.

I'm currently, and incidentally, on the Cardiothoracic surgery rotation at AUH. Yey me. I was surprised by a phone call on Thursday night and a friend screaming at me for not telling them that the first "Heart Transplant" in Lebanon was performed at AUH. Shocked, I thought to myself, there's no way I didn't hear about that one!! Then came another call, another newspaper article, another overheard conversation... All with one, or two, or three things in common... The misconceptions, the misconceptions, and the misconceptions. I just thought there were too many scientific blunders on the part of the media and their reports have been massively misleading at best. The following is a roundup of the misconceptions I thought people should be aware of...

Misconception 1 - This is NOT a Heart Transplant...

...And even if it were, it would not be the first one in Lebanon. The first heart transplant in Lebanon (a real heart transplant) was performed at the Hammoud hospital in 1999. Click here to read about that.
This is an LVAD, or Left Ventricular Assist Device (more on that later) implant. The original heart is still in place!

Misconception 2 - This is NOT and Artificial Heart Implant...

This is an LVAD (Click here), NOT an artificial heart. Let me explain. An LVAD, as its name implies, is a pump that merely assists the biologic heart in its function. It neither takes over its function nor does it replace it or completely take over its role. It ONLY assists it in its function by taking some of the work off its back... The biologic heart is still in place, functioning properly with the help of an assistant, if you will.
The implanted LVAD.
An Artificial heart, the Jarvik.

In contrast, an "Artificial Heart" is... well... an artificial heart! It is a complete heart-like pump that replaces the biologic heart, which is taken out of the patient on the OR table. It is still an experimental technology with only limited success in the United States.

Misconception 3 - This is NOT a life-saving device...

The AUB article also states that the operation saved the life of the 37 year-old patient. I am sad to point out that this is not the case. An LVAD implantation is what we call a "bridge to recovery" or "bridge to transplantation" procedure. This device is designed to help keep cardiac performance at an acceptable level for a limited amount of time pending one of two events:

- The recovery of a mildly diseased heart as a result of decreased workload afforded by the LVAD: Bridge to Recovery.
- The availability of a matching donor heart for transplantation: Bridge to Transplantation.

The LVAD used in this case was the Heartmate II by the Thoratec corporation and is claimed by Thoratec themselves to be able to provide circulatory support for only up to ten years. Now keeping in mind that these ten years are the result of the most optimistic and optimized calculations, it is clear that we should be expecting 5 to 10 years, more realistically, before there is a need for a new intervention. And we would still be optimistic in that we are neglecting all the possible complications that the poor guy could face.

I am not trying to rain on anyone's parade, and least of all the patient himself or the thousands of others with heart problems. I just think it's a shame how the media are having a field day with his story and modeling it, be it willingly or unknowingly out of lack of scientific knowledge, to fit the textbook picture of a world-class achievement in medicine, or that of the wonderful doctor or hospital saving lives by the millions. That this life has been saved is simply not true, and while I am truly ecstatic that this operation took place where I work, and even more ecstatic to see its success and the time it gave our 37 year-old father of four, I cannot emphasize enough how much of a temporary solution this is for our patient, who is, at the end of the day, whom we should think about before anyone or anything else. I can only hope he and his family know what the future holds for them.

This is a milestone in the practice of Cardiothoracic surgery in Lebanon, one that I am proud to witness during my young career. I just can't stand it being taken out of context in this manner. The authors of these articles and their sources shoud be reviewed.