Author + information
- Viviany R. Taqueti, MD, MPH∗ ()
- Heart and Vascular Center and Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Cardiology Section, VA Boston Healthcare System, Boston, Massachusetts
- ↵∗Address correspondence to:
Dr. Viviany R. Taqueti, Brigham and Women’s Hospital, 75 Francis Street, ASBI L1-037G, Boston, Massachusetts 02115.
In July 2014, I began work as a cardiologist. It happens routinely and without fanfare, but there is something worthy of pause during one’s transition to faculty from fellowship training. The world of health care that I now enter as a cardiovascular specialist is profoundly different from the one to which I was exposed as a medical student more than a decade ago. Uncertainty is everywhere, from how care should be structured, delivered, and paid for, to what constitutes appropriate care. The growing complexity has, paradoxically, but predictably, been accompanied by diminished institutional commitments to biomedical research. What does this mean for those of us just emerging from the academic medical pipeline?
As a medical student many years ago, I remember listening to Professor Eugene Braunwald as he addressed a crowd of trainees with a precursor to his lecture on “Adventures in Cardiovascular Research” (1). I was fascinated. Years later at Brigham and Women’s Hospital, I had the opportunity to interact with Dr. Braunwald during fellows’ reports. Between pages and codes, I heard him tell the stories of the advent of transbronchial and later transseptal cardiac catheterization, of defining the natural history of severe calcific aortic stenosis prior to the adoption of widespread surgical intervention, of the dramatic discovery of “functional aortic stenosis” (now known as hypertrophic obstructive cardiomyopathy) in a young patient in the operating theater, and of the realization that carotid sinus stimulation not only alleviated angina, but also normalized ST-segment elevation in a patient in the throes of myocardial infarction, leading to a revolutionary idea in thrombolysis.
The narratives were extraordinary. Speaking in a low rumble, he was crystal clear, careful to identify events by the proper chronology and to give credit to coinvestigators whom he mentioned by their full names. He referred to his colleagues and their collective scientific legacies as his “intellectual offspring.” He emphasized the importance of focusing on big questions and the act of choosing a mentor as the single most consequential decision of one’s career. He peppered his stories with personal anecdotes of unlikely collaborations started at the taxi stand or over dinner at the local housing complex of the former National Heart Institute. He then neatly summarized his “10 tips for a successful career in translational research.”
Effortlessly, industriously, he commanded a crowd, bringing together generations that included visiting students and longtime disciples. We listened in silence, amazed and delighted by the stories. In them, cardiology became personal. Ancient diagrams from seminal papers came to life. In our minds, we contrasted the world he depicted with the more familiar hospital wards and research laboratories of our day. Matter-of-factly, he recounted how, at my age, he served as chief of cardiology and, not long thereafter, chair of medicine. He talked of days when institutional review boards and informed consent did not exist. At its simplest, there was an observation, and from that careful observation, there were possibilities.
I recognize now that bearing witness to these stories was invaluable. For me, these firsthand accounts provided context for what we set out to do every day in academic cardiology. There are few examples more powerful than hearing Dr. Braunwald tell of a difficult time and watching him light up as he described how a perceived mistake blossomed into a discovery. It provided a humanizing and inspiring complement to reading about his latest successful randomized clinical trial.
As many of us wrestle with the future of academic research in an era of constraints, his words still provide perspective. Trainees of my generation grew up with the idealism of the academic physician-scientist as the “triple threat” of master clinician, scientist, and educator. Listening to Dr. Braunwald, however, I was reminded that this construct is relatively new, fashioned over the last 6 decades with the advent of hypothesis-driven research. This opened up an already rich world of clinical observations to even richer possibilities afforded by the ready path from bench to bedside, and back.
These days, it can be difficult to maneuver the wards or laboratories of academic institutions without daily reminders of the growing demands and all-consuming complexities inherent in modern clinical care, scientific research, and post-graduate training. In an increasingly scrutinized clinical environment that values volume and, in the near future, outcomes; an increasingly competitive research environment that rewards big science while remaining vulnerable to political volatility; and an increasingly strained training environment that defaults to longer, specialized tracks while simultaneously limiting hours and hands-on experience, many are questioning the viability of the path to becoming a “triple threat.”
But, as Dr. Braunwald noted, as the concept of the academic physician-scientist evolved previously, it is evolving again. The profound, perhaps inevitable, changes under way are providing new opportunities for creative thinking, including better utilization of available resources by forging new collaborations to approach existing challenges. As he hinted, the thrombocardiologist of the 20th century is becoming the diabetocardiologist of the 21st century, and so on. Opportunity is here, and those who persevere in novel ways, guided by an inner compass grounded in promoting health and healing patients, will make important contributions.
It is easy to underestimate the impact of these exchanges on those in the early stages of their careers. Through often unexpected encounters, I have enjoyed interacting informally with some of the greats in our profession, hearing from thought leaders in unconventional forums as they shared details about their experiences as they unfolded, sometimes with surprising results. These reflections are critical for fostering context, confidence, and a sense of possibility, particularly beyond the confines of any local institution. As I transition, I look to those who have come before me with gratitude for their example, inspiration, and generosity. For those who will come after me, I am reminded of this, our responsibility to inspire possibility.
An early version of this perspective was published in a 2013 conference newsletter of the American Heart Association (2). This essay has since been updated and altered.
- American College of Cardiology Foundation
- ↵Braunwald E. Adventures in cardiovascular research. Distinguished Scientist Lecture presented at: American Heart Association Scientific Sessions; November 9–12, 2007; New Orleans, LA.
- ↵Taqueti VR. Inspiring possibility: one investigator’s insights from early career day at scientific sessions. Available at: http://tristarpub.com/aha2013/?p=43. Accessed July 9, 2014.