Transcripts For CSPAN Q A 20131231 : vimarsana.com

Well, the transplant is a big team effort. So i was singly not the one responsible but i was part of the team. In this case, i was the procuring team. So myself and some of our team members flew out of state to retrieve and harvest the heart and bring it back to a patient in need. So it was a long night. How far did you have to go . Midwest. You live here in town . Yes, sir. And what was the condition of the person that you got the heart from, obviously dead but yes, you know, unfortunately its always a tragic story. A typically young person because those are the most ideal candidates for organ transplants, in particular heart, Motor Vehicle accident in this case, but thats typically what it is. Some common denominator among all of the donors is that they have a brain death. Ultimately thats what they, you know, succumb to and thats when they become candidates for organ donation. So in this case, it was a Motor Vehicle accident, sadly, and a traumatic brain injury. And then, you know, the demise was brain death and then, you know, becoming a candidate for, you know, donation. I assume the secrecy hipaa rules mean you cant go too far with this. Yes, sir. Absolutely. Because, you know, we have to protect the privacy and not only the donor and their family, but certainly the recipient as well. And, you know, its something that we regard as a very precious gift that the familys offering and the individuals offering, you know, made at the sacrifice of the passing. And so its very revered. And on the other side, its a joyous occasion but at the same time, you want to respect the privacy of all of the individuals. Without getting into the specifics, go back to the how this all started for you. Where were you when you got the call . So, thats a good question because i was at home, i was about to take my son to scouts, actually, cub scout meal last night. And we were on our way over there and i was telling my wife, i said, all right, big day is tomorrow, the interview and i need to get some rest and ill take my son, edmond, to scouts. And one of my partners called me up and he said, hassan, we have a transplant going this evening, you know, are you available to procure . Im technically oncall and i said. Ah, i am, i have this interview tomorrow. And then he said i think the timing will be such that you can get back in time and certainly it was. Excuse the specifics but what airport do you fly out of . Dulles, out of dulles. Usually we fly chartered aircraft because, you know, obviously commercial, you have to coordinate all of the timing. The issue with hearts and lungs is that they have sort of a short shelf life, if you will. You know, we have about four hours, six hours at the max to transplant the organ once, you know, we retrieve it from the donor. So what time did you take off out of Dulles Airport here . Roughly about 10 00ish, 10 00 p. M. Private jet . Yes. Yes, sir. So what time did you get the heart . Went to the o. R. About 11ish, 11 30. Started about a little after midnight. Were wrapped up at about 3 00 a. M. Im confused, though. When did you leave to go get the heart . Oh yes, i left at about, you know, we took off at about 10 00 p. M . What time did you get back here . Just about 4 00 or 5 00 a. M. , 4 30, i think it was. And then when was the operation . And then, you know, when we bring the organ back, the other team, you know, puts it into the recipient . What hospital here . Well, i can tell you that. Its with my colleagues at inova fairfax. Fairfax hospital in the suburbs. And how many people were with you to go get the heart . Just two. What do you do when you get there . Well, good question. We get a lot of information from what we call our donor network. Its actually an Automated System now so its very nice. In the past, we a lot of this was done with phone calls and facsimile and, you know, trying to coordinate things. But once we have a match and thats all based on sort of the criteria that unos establishes, unos is the United Network for organ sharing. They establish all of these criteria and we have a recipient on the list, and they have the donor as a match based on the blood type and, you know, severity of illness. And when we get there, we verify all of the things, primarily three things. The blood type, to make sure that its going to be compatible with the recipient that we have on the other side. We want to make sure that we also have proper consent and every state has a different kind of, you know, rule regarding that. And then we also want to make sure that we document and, you know, verify that there is in fact brain death, you know. And then when you get there, who removes the heart from the chest . Our team does. Yes, so myself and then my assistants. Was it in a hospital. Yes. Yes, sir. And what do you do with the heart . We pack it on ice. We preserve it with the fluid that arrests the heart. And what that does is it slows down the metabolism and the ischemia. The ischemia is the lack of blood and oxygen and nutrients that go to the muscle. And you want to make sure you preserve the heart as best as possible. So what we do is we infuse a perfusate that arrests the heart, makes it quiescent, slows the metabolism down and most importantly, we cool it. And when we do that, the metabolic rate, you know, slows down. Once you remove an organ from the body, it starts to die. And so until you, you know, you place it into a new recipient and revive the blood and start to circulate the nutrients and the oxygen again, the organ, you know, is dying. So the clock starts to tick. And thats why we dont have a lot of time. And as i mentioned, unlike, you know, organs like the liver and perhaps the pancreas and certainly the kidney that have a little bit of a longer tolerance for ischemia, the heart and lungs are not so resilient. So when you get it back to washington in the middle of the night, do you have a Police Escort to the hospital . Usually an ambulance. And then once you what happened what did you do once you got to the hospital . We bring it into the operating room and the team thats there. They have been working as well. Its actually a very wellcoordinated plan. They actually have to begin the surgery while were working on the other side often times. Depending if its local or if its out in the distance, we time and we plan. So that ideally, and in this case that was one of the situations, you want to have the heart being removed as the new heart is in the hospital and is at the operating room so you can just put it right in and then decrease the amount of ischemia time as much as possible. Personal question. On the other end of this, when you picked up the heart, was the family there . Not in the operating room, no. Did you meet them or no. Typically we dont. Although in my practice and over the years i will say that, you know, one of the things thats always very touching about transplant for me is that its one of those instances in medicine where you really see life and death, you know, firsthand. I mean, you certainly witness death on one side with the donor and then on the other side is the recipient and theres this joy and theres this new life. And over the years, ive actually received letters from both sides from the donor families and from the recipient families. Letters of thanks, letters of encouragement, letters of gratitude, actually, for what, you know, our team has done. You know, i think it helps the families that donate to have some closure and have some peace peace, that know that their death, often a tragic one of their loved one wasnt in vain and that, you know, their gift of life has now, you know, helped to serve someone else. Were recording this at 11 00 in the morning, after youve been up all night in late october. Do you know at this stage whether or not the heart has been transplanted successfully . It has. Yes. How long did that part of it take . Typically, it takes about, you know, depending on the case, a few hours, a couple of hours. How many people, total, are involved in . Oh, its a huge undertaking. You know, its a big team effort, as i mentioned, from the very beginning. No one person is the single, you know, sort of person thats done the whole job. We have nurses, we have perfusionists, we have anesthesiologists on both sides, two teams, you know, typically. And this is just for the heart team, you understand. So, you know, and on the recipient side, you know, we have the same cadre of individuals there. And then thats just the hospital teams. And then you take all of the other folks involved. The transplant coordinators, the ambulance drivers, the pilots, you know. Its a huge, huge effort, you know, and one that is one thats taken very seriously by a number of very dedicated individuals that, you know, typically work through the night and overnight and on weekends and holidays because, unfortunately, thats oftentimes when a lot of these tragedies occur. You know, trauma, its never really something predictable. Never really happens during banking hours, unfortunately. How much sleep have you had since you were with your son last night, right before you took off . Intermittent snoozing on the flight and about an hour afterwards. How often do you do this a month . It depends, you know. There could be some months where its twice, three times. It could be months where its four or five times in succession over days. Sometimes, unfortunately holidays are busier than, you know, other times of the year. Are you on the other end ever where youre actually putting the heart in . Yes, sir, i am. Occasionally. And sometimes, when you come back, you know, the team needs some help and i will come in, scrub in, and help out. Yes. So we can get to your background now. Im sure theres plenty more. I do have one quick question. Yes, sir. Do you ever put a female heart into a male . It does happen. Yes, sir. It does. And vice versa . And vice versa. The criteria, again, are compatibility with blood. But you raise a very interesting question, you know. The other thing that we take into account and consideration which is very important is the size. You know, their large individuals, their small individuals. So you want to make sure that the size is compatible. And typically, female hearts are, you know, sort of considered the smaller kind of, you know, heart for a male. So you would want to put, you know, a female heart in maybe a smaller male just typically sort of to any idea how much all of this cost . For one of these yes. Throwing everything in the middle of it. You know, there are definitely dollar amounts that are ascribed to them pretty much. Its a lot. As you can imagine, the resources. But costs are very hard to measure as i found, and ive done studies in transplant and tried to assess cost. Its difficult to quantify because of a number of things. Different hospitals have different costs for different items they use and utilize in the operating room. Different transplants, you know, depending on where youre going, whether its local or where its out of state. You know, those incur different costs. Certainly, if were local and were just going to another hospital, were not going to, you know, take a jet and incur those cost and fuel charges and pilot time, et cetera. Were talking a Million Dollars for some of these . I dont think its that much. No. But its certainly very several hundred thousand . Probably not that expensive, but, you know, certainly up in the sixfigure, maybe low six figure and maybe just under the range. I have in my hands something you know about. Its a hassan a. Tetteh and its a novel, a 150page novel called gifts of the heart. Are you dr. Elegant in this book . No, im not. No, im not. I think at times when i, you know, i read my characters sort of attributes and his qualities, i wish and aspire that i could be, you know, like him sometimes. There are certain things that, you know, i certainly had the privilege and fortune in my career to have the opportunity that sort of rise to the occasion of some of his feats. Who is he in the book and how close does this come to your story . It does come, you know, come fairly close. I, you know i relied on a lot of my experience from, you know, my practice, my experiences in the hospital. Life experiences, as well, to sort of come up with the character. So there are definitely some parallels but there is certainly some differences as well, you know, for example, my mom is still alive, fortunately. My dad has passed away. Was he from ghana . Yes, sir. And was your mother from sierra leone . She was, yes. And what measure of lebanon ancestry got into that . It was, you know, fairly accurate in some ways. My grandfather, my moms dad, was from lebanon. He was a lebanese businessman that had sort of migrated, you know, or done some business in sierra leone. Once more, your name is Hassan Tetteh but you say in here you started out as a Roman Catholic . Yes. Yes, sir. Where does the name come from . My grandfather. That was his name . Yes. So youre born in brooklyn. Where did you go to school along the way . Born in brooklyn. I would say my dad, my parents were both born in west africa, as you mentioned. And so my dad would always muse and say that i was made in the u. S. A. You know, i like to say that and i like to specifically, you know, pledge allegiance to my brooklyn roots because i think brooklyn is a very interesting place to grow up in and one that builds a lot of character and makes a lot of characters. But i went to i actually went to Catholic School for most of elementary. I transferred in middle school to a Public Middle School system. I went to Brooklyn Technical High School in the fort greene area of brooklyn. It was an amazing experience. Great, great, great high school. I recently went back, actually, for career day. We have a huge alumni network, graduate over a thousand individuals every year. Great friends from that experience in high school, still to this day keep in touch. Then i went to a small arts and science college. The background behind that is interesting because i, like many of my brooklyn tech students, you know, thought were fairly bright and in my case i thought that i would, you know, sort of do well in one of the big schools, the ivy school, so to speak. And i went to my College Counselor and, you know, i wasnt the valedictorian and certainly wasnt salutatorian. I was an ok student, probably should have applied myself a little bit more. Anyway, i went in with these grand ideas of wanting to apply to all ivy schools and he suggested that, you know, maybe i should, you know, lower my expectations a little bit and apply to some other schools. And i applied to some other schools out of state because like most kids of my in my sort of area, at least back then, we wanted to get far away from our parents. So i applied to florida and virginia and alabama. And i got accepted, surprisingly to all my schools, you know, and i always thought to myself, man, i should have just applied a little higher. I probably would have gotten in. Well, graduate from high school and turns out that i dont have the money to go. You know, they send a Financial Aid package. And the school i was supposed to go to actually was morehouse. I got accepted to morehouse, many of my friends were going to go. It was going to be very exciting and i was so happy to go and when the Financial Aid package came, you know, it wasnt much of a package. And even with loans and subsidies and, you know, everything else, you know, my mom simply said, i cant afford to send you. In fact, if i have you go to this school, i dont think i can even pay for the plane ticket, you know, for you to go to atlanta. It was that bad. So i found myself without a university and a mother who told me you cant stay here. You need to go to school. And i had not applied to any of the city schools in new york, although they were all good and i didnt apply to any suny school either because, again, i had State University of new york . The State University of new york, correct. And i went back to my high school. They couldnt much for me other than direct me to the State University of new york office in manhattan. And i went there and with my transcript in hand, sat there with a woman who ill never forget who made a phone call to almost every single one of the suny schools in late july. School was about to start in just a couple of weeks. And she, you know, sort of pitched my application to a number of the schools, the Big University School Systems in suny like the binghamtons and albany and so forth. And none of them had room. They just simply were filled to capacity. The two schools that did have a place for me were suny purchase, State University of new york at purchase, and the other one was State University of new york college at plattsburgh. And i looked on a map and the map showed that plattsburgh was up by the canadian border. And it look far away enough from home that i said ill choose that one because purchase looks too close. Where did you get your medical degree . Suny downstate. Downstate . Yes. And when did you join the United States navy . After medical school. After medical school. What year . 1998. Are you still in the navy . Yes. Are you navy fulltime . Yes. How do you do navy fulltime and private hospital fairfax . We have we have a we call it a memorandum of understanding between the Fairfax Hospital and navy hospital. And since coming to this area, ive been working with the inova group primarily because of my transplant training and wanting to keep those skills sort of fresh and current. And also, again, based on this agreement that we have, you know, to be able to cooperate if we work with each other. They help us with our cases at our institution and vice versa in my case. So when youre in the navy working, youre located where . Walter reed. Right. Correct. Yes. And bethesda . Right. Correct. Take us to the time you were in afghanistan . Yes, sir. When was that . That was in the summer of 2011, 2011. How long were you there . I was there for approximately six months. What was your purpose for being there . I was deployed to support the Second Marine Expeditionary forces. And in my case, i was there to provide medical support, specifically surgical support. Typically, when physicians and surgeons, you know, deploy, we go primarily as physicians if were physicians so were just docs and general docs and, you know, were always that as surgeons, of course. And when you go as surgeons, despite your specialty, whether it be plastics or cardiac, you know, youre main role is to serve as a combat trauma surgeon. So where were you located during those six months . In the southwest portion of afghanistan. Helmand province. Helmand province. What were the circumstances . What part of that you know, were you in a city or youre out in the country . No, we were we were out in the desert valley, very austere, role 2 base, small base, outpost whats role 2 mean . Role, well, role 2 in a sort of the hospital sense, it means that its sort of echelons of care. Again, were supporting the marines so were there to help them, you know, when they get injured, to take care of them. And there were about five echelons of care. Role one is right at the time of injury. Usually its a corpsman putting a bandage on the wound or tourniquet, thats out in the field, realtime, gunshot wound happens. We call that role one care. Role two is typically a tent or an outpost somewhere away from the, you know, the activity. Although sometimes the activity can occur right there as well. And thats where i was in that tent. And what we do there is we stabilize the patient, try to get them to a point where we can arrest the bleeding or at least temporarily stop the bleeding and then get them to a role three. And a role three is still usually within the country and its a larger facility, bastion in our case, bastion hospital, that we, you know, cooperate with the brits to run. Kandahar, you know, these hospitals that have, you know, quite visible. And then landstuhl, which would be in germany, would be a role four. So when each one of these successive stages of care, the member, the injured member is getting more and more, you know, sort of acuity of care. And then finally, a role five, which would be one of the big hospitals back stateside. Like bethesda . Like bethesda, san diego, bamsey. Had you seen combat before the six months that you were there . In some sense, yes. I spent two years on the Aircraft Carrier earlier, in the 2000 decade, 2003 to 2005 specifically. U. S. S. Carl vinson. U. S. S. Carl vinson. That was my first deployment, if you will, after, you know, some years in the navy. And my last six months on the ship, we were deployed to the persian gulf. And we supported, you know, Operation Iraqi freedom during that time. So combat but different kind of combat. You know, on the Aircraft Carrier, were launching and recovering the aircraft that theyre flying to support the mission. So 2002 in afghanistan, youre out in the field, in a field hospital, how many people are medical in that area . In our case, we deployed with almost 200 medical people altogether to support our, you know, our contingent. And we were distributed to different areas within the region. In my specific area, we had about 30 medical folks with us. Is the story in this novel pretty close to what happened in afghanistan . Yes, theres some certainly some parallels. Not exactly the same way but there are some parallels and some similarities. When do you remember the first time that battle wounds, injury, came to you and what was what were the circumstances . The most vivid was our first day. Arriving at our final location, our role two. You know, the transport there took some time between combination commercial aircraft, military aircraft, you know, going to be staged at the big base, at leatherneck, and then ultimately going to our respective fobs. So the day we arrived at our fob, we fobs are Forward Operating base. Forward operating base, yes. The day we arrive with the new, as a new Surgical Team to take over and our, you know, our colleagues that are going to be, you know, sort of that were relieving there, we saw our first, you know, real casualty that i remember vividly. What was it . Who was it . I mean, not by name. Sure. It was a young marine who had been injured by an i. E. D. , an improvised explosive device. And the young man you know, i just take a one quick step back and say, you know, i wasnt kidding when i said brooklyn was a formative place to grow up and was also a formative place to train in medicine particularly for trauma. I thought that i had seen every trauma possible gunshot wounds, stab wounds, you know, explosive injuries, even, Motor Vehicle accidents, you know, anything. And i felt very comfortable with my, you know, level of experience with trauma based on my brooklyn and kings county experience and so forth. But what i saw that day, the first day that we were there and its so hard to describe because even though i had been at walter reed for, you know, years before deploying and seeing individuals with, you know, extremity injuries and with prosthetics and some of them still undergoing some of the additional surgeries they need, i hadnt seen it raw in realtime, right after it occurred. And that was what i saw upon arriving. You know, there was no delay, you know. Some of our colleagues went to other areas where they didnt see a casualty for weeks or even months after being on station. We saw it the first day. And it just continued. And what we saw in this individual, what i saw in this individual, was someone who had, you know, who almost shouldnt be living, you know. He had no legs and, you know, the skin and the and his extremities were all charred and the clothes were tattered. And he was just so pale, just almost ghostlike because you could tell he must have lost so much blood already. And he had this sunken, hollow look in his eyes. And i could tell he probably had no idea what had happened to him. It was a shock. You know, we talk about shock from the biological sense of, like, you know, youre not getting enough blood, not perfusing yourselves but this was shock, emotional shock. And not only shock for him, it was shock for all of us. Many of us, you know, like myself, this was our first sort of experience, graphic, facetoface with what, you know, war was what war was like for us on the medical side. You know, we werent out in the wire and engaging with enemy but we were, you know, experiencing the dangers all around us but at the same time were taking care of individuals that were in that conflict. You refer in the novel the fact that even the medical people when they see Something Like this want to throw up. Absolutely. Has it ever happened . Yes, it did. And what what do you remember . Obviously, you write about these kind of things. What do you remember from that marine that was brought in . Missing legs and a missing arm . He had some fingers that were missing. Clothes all tattered. Dirt all over because you can just imagine, he must have stepped on this thing and boom. Is he awake . Barely, barely. Almost just kind of just holding on to just a little bit of consciousness. Were you in charge . No. We again, its a big team effort. And we certainly werent in charge when we first got there, you understand. We literally just rolled off of the aircraft that delivered us here. And as soon as we land, the team is awaiting a casualty, you know, to take this casualty in. And were just shellshocked, you know, literally. And, you know, were standing by and we were like fish out of water because many of us have never experienced it before. And even the people that had experienced it before in terms of deploying to other campaigns, this was different, you know, for them. And so what we did is we followed the lead of the sort of seasoned folks that were there. And what i immediately noticed was their sort of their poise and composure. And i think that in retrospect, you know, certainly, you know, sort of looking back, reflecting on that experience the first day and then over the six months and then ultimately leaving and then having other folks to come relieve us, what i think i appreciated was the fact that theres a socialization that occurs with each of us, you know. And each one has their own different kind of way of dealing and coping with it. But in essence, what happens is that you just kind of become immune to it in a way and your emotions sort of get pushed to the side and you just deal with the matter at hand. That fellow that was there, did he have tourniquets on . Yes, tourniquets. Yes, sir. Where were those put on . This is the fascinating thing. And i learned this, you know, soon after being there. Because if you look at the injury, you just think to yourself how could one possibly get something around what was left of the leg and the thigh and what the destruction around the extremity to stop the bleeding . It would be almost impossible, i would think, to do it in time to save the life, if you will. Because you, the person, were just, you know, exsanguinate out before you had that opportunity to do that. But our brave marines, i learned and discovered, would go out on their patrol and on their missions with the tourniquets already on. Not tight and not fastened but already in place. It wasnt a matter of if. It was a matter of when. And, you know, that one maneuver actually putting it on before going out, i would say, is probably responsible for saving a lot of the lives because when it does happen, that injury does occur, that explosion does injure the extremity, in that moment that it happens, you have the wherewithal as an individual to turn it and theyre designed in such a way that it only takes a couple twists and you can get, you know, very good occlusion and arrest of hemorrhage. Or your buddy thats near you or someone that comes to your aid could quickly just do this rather than fumble and try with, you know, with the injury to try and take something out of your bag and then try and get it around and tie, you just you wouldnt have enough time to do it. But the fact that they were already in place beforehand, that gave you that, you know, sort of that window to stop the bleeding to that point where you could stop it enough so that you can get to some role two echelon of care and, you know, sort of progress. Did that marine survive . He did. He did. Is he still alive today . I believe so. Thats a good question that you asked. Because many of us as care providers knew that we would go back to our hospitals, our respective hospitals, where we would be able to see some of these marines that we had taken care of because we were going back to the big hospital in san diegos, to bamseys, to walter reeds in my case. But i have to say that, you know, there was a part of me that almost didnt want to know or, you know, know what happened to them, you know. We know that we got them from the role two and we would have followup and there was a very elaborate and there is a very elaborate trauma system that provides a very good feedback in sort of a constant loop of communication among all of the echelons of care so that, you know, we can learn what worked, what didnt work, how that patient is how is that patient doing. And also just to help with, you know, morale because wed wonder if what were doing was making a difference. And we would get the feedback. We would get reports from the folks back stateside. That gentleman you took care of, that Wounded Warrior that you guys took care of last week, hes doing fine. Hes getting better. So in our case, we did get that feedback from this individual. He was in role two. How long did it take him to get back to United States . Thats another, you know, a testament to the teamwork and the orchestration and just the level of resource and, you know, lack of a better word, ingenuity, if you will, for what weve learned over this last campaign. You know, there was a time where, you know, certainly in vietnam eras and certainly wars before that, it would take months, you know, for someone to get injured for someone that was injured to get back to, you know, hospital and with their families. But in our case, you know, typically, they would get back between 36 to 72 hours from the point of injury to a stateside hospital, you know, back with their loved ones, back in a stateoftheart facility where they are, you know, they have every resource at their disposal and, you know, and a team, every specialty, you know, needed to be able and care for that individual. So i think its a great testament. And what that what has happened is that over these years, weve learned so much about, you know, the logistics, if you will, of transporting critically ill individuals and we virtually have, you know, flying i. C. U. s in the sky that can take a critically ill person, you know, from the other side of the world and bring them back, you know, safely and it sounds it may sound cruel, but has there even been a case out in the field where somebody dies, a soldier, a marine, and theyre giving their organs away and that they, they save the heart . No, no. Not in this case. No. But not in combat. I mean, thats not normally done . No. So youre there six months. How many times did you have a casualty that you dealt with medically . In our particular area where we were, we dealt with them, unfortunately, too frequently in my opinion. And what i mean by that is, you know, we, you know, typically saw, you know, one or two, three, four cases a week. Sometimes multiple in a day. You know, the longest we would go without seeing a case would may be a stretch of three or four days. So that was a lot. That was very and the injuries were not benign. They werent these werent people coming in with a sprained ankle or fractured finger or something. These were people coming in with devastating, otherwise, lifethreatening or life, you know, fatal wounds, if you will. You say there was an indifference after a while because you try to get inured to the whole situation. I dont mean about the people but about the emotion and all that. Did you ever turn to any of your colleagues and say, why are we here . Why are we in afghanistan . All the time. All the time, but not in the sense or in the way that, you know, one might think thats here is sort of in the comforts of, you know, home and, you know, with all of the, you know, removal, if you will, of what was, you know, what was more raw and more graphic for us. Our asking of why we were here, i think, was a different kind of question. You know, it was the kind of question of like, you know, were here to support a mission. Weve all volunteered to be here to serve, and thats what we are here to do. And were not questioning that. From the medical standpoint and maybe speaking for myself you know, most specifically, what i realize was that my role here was to support these injured marines and support the injured marines. And the questions you ask of why are we here, i had to lean on my colleagues all the time and ask that question, you know, just to make sense of it for myself because there was so many young people who we knew their lives were going to be forever changed because of the injury that they had. And some of those individuals that come back without the, you know, physical scars, certainly have some of the emotional scars. But yet, you know, i understood that, you know, the service that i was providing and the service that i believe my team was providing was one that was so awesome and was so needed and so much appreciated that that was what defined our purpose. So my being here was im here to help individuals that have volunteered to serve their country. And thats it. You know, that was my scope of my thinking and in talking to my colleagues and leaning on them to answer that question for myself and ask that question back and forth, that was summarily the conclusion we all came up with. And more importantly that we were there to support each other as well because we also realized that if we couldnt take care of ourselves, you know, emotionally and physically, et cetera, then we wouldnt be able to deliver the kind of care that we needed to make sure that those in need would have their care. Let me ask you more about your own background. You have a master in Public Administration . Correct. From where . From the Kennedy School at harvard university. What year did you do that . I did that in 2009. You have an mba . Correct. Master in Business Administration from . Johns hopkins. What year did you do that . I did that in 2011, right before i deploy. I completed a program right before i deployed. Youre now a congressional fellow or youre going to be. I am a congressional fellow. Im part of the Robert Wood Johnson Health Policy fellowship, yes. But that a years commitment. They said they can keep you for another year. They have a stipend involved in that. How much time do you spend on capitol hill and who do you work with . Right now i work with the Congressional Budget Office as a staffer and adviser. How long do you spend there . Thats sort of typically one of the things that i do during the day. Thats my day job, if you will. My fellowship is coming to an end at the end of the year. Chance that you might stay on longer . Unlikely. Im going to take all what ive learned and go serve the navy and, you know one thing that you might have passed on in policy that theyre using . Provided a clinical perspective. You most appropriately segued it into what my, you know, sort of identity is and that is a physician. And i had an opportunity through helping an individual who had a daughter who was interested in medicine, provide an opportunity for him to come see open heart surgery. And that lead to some other opportunities for others to come see it as well. And a program that we have at inova that is specifically designed to give people that perspective. I got to ask you about time. I mean, here you published this book yourself. Right. Correct. And the editor and the folks that i was introduced to were willing to publish it, you know, through their venue and through their company but, you know this more so than i do and sort of put my mba hat on, if you will, the Publishing Industry has changed. Its totally different than it was years and years ago. And he was very frank with me, the editor and the publishing companys owner. He said, i cant put any marketing dollars at all into your work because youre a relatively unknown author. So youre going to still market everything on your own. And im going to own all your rights to your book. And he said, if you are willing to put up the cost of the production, then you will have it on your own and you still have to put in all the marketing. My point though was how many years in the United States navy . If you count since 1998, so about 15. And how long are you going to stay . I plan on make a career of it. And how much time do you spend at Fairfax Inova hospital . Intermittently, a couple hours a week and then certainly sometimes overnights. But with these so you dont go there everyday . No. No. And how much time do you spend at walter reed or bethesda . Minimal time at this point. Most of my time has been focused during this fellowship year on the hill. And you have a website and you tweet and you speak and all that. When do you have time to do that and when do you have time to write . So writing, for me, you know, the mechanical process of doing a book really occurred for me over about a six to sevenmonth period and mostly in the middle of the night, between 2 00 and 4 00. That was the time when it was quiet in the house and my two children were sleeping and my wife was ok with the absence of me for a little bit and i could work during that time. Obviously, youve listed all of the other things and responsibilities that i have. So i didnt have time to work on it during any of those other waking hours, if you will. How much sleep do you need a night . Typically, i do about three or four . Do you exercise . I do. I had to run two miles this morning so i could wake up and be fresh for you. Well, most doctors would tell you that sleep is more important than anything. They do. I have to agree with them to some extent. I just know that over time and over all of my training and being in the hospital and during my fellowship and the nature of cardiac surgery and so the demanding schedule and, you know, it just imposes on an individual, it just necessitates that, you know, you have to operate and work on less sleep than most people. And maybe my bodys acclimated to it. I certainly feel im getting older and its harder and harder to do it over these years but yes. I dont know. I certainly dont advocate doing it, you know, because i know there are certain people that just dont function without a good amount of sleep and it certainly is important so i would never, you know i would never purport that people do it. Where did you meet your wife . I met her in my first year out of medical school in the hospital. Its kind of the same story in here . Different, because the timing for this particular character happens much later in his career. In my case, i literally met my wife right out of medical school and she was right out of nursing school. And what is she doing now . Shes actually the school nurse at our childrens school. And how old are your kids . 9, my son, and 7, my daughter. This is a really open question, but how have you done all this . Because i have a very supporting wife, very supporting family. And i think that i have always felt that, you know, my parents sacrificed so much to sort of help me be successful that if theres any moment of idleness in my life, then im sacrificing a gift and im sacrificing an opportunity. And i think thats whats driven me and thats what i think continues to drive me. And i also know that i have through the various things that ive been able and have been fortunate enough to be involved in have helped a lot of people and that has been very, very rewarding. So why did you decide to go public . You speak a lot and you have a website and all that. What drove you to do that . Well, i dont know if id gone public so much as i think that ive come to maybe appreciate that a lot of people could use some inspiration and ive been so blessed and fortunate to have been inspired by a lot of people. And i want to, in turn, help as well and maybe contribute to that. You know, the main purpose, i think, of writing the book for me was several fold. One was it was a way to release a lot of that indifference. I came back from afghanistan very changed in terms of my feelings about, you know, what i had experienced and, you know, the trauma of taking care of trauma. You know, that was a really difficult time. And it wasnt until i was leaving that i really kind of, i think, had the emotional, you know, release that i probably should have had all along or maybe that i should have had from the first day but i just couldnt because i realized that if i had done that, then i wouldnt be able to perform, i wouldnt be able to help, i wouldnt be able to contribute and do what i needed to do to help those individuals that were relying on me. But as i came back and i sort of, you know, adapted and sort of integrated back into the real world, if you will, or our world here, it dawned on me that there was this whole other experience that many people were having and continue to have when they come stateside that no one knows about. And i dont mean that they should know about it in a political or geopolitical way. I mean, just they dont know that lives have changed, people have served, people have contributed and they werent asked to do that. They volunteered to do that. And i think in those stories and in the stories of the people that have helped those individuals, i think theres a lot of inspiration there and theres a sense that we should not take for granted what we have, you know. And ive read lots of books. I read a lot when i was there. I continue to read every day. And one of the things and one of the pearls of wisdom that i always, you know, came away with is this and its that, you know, wisdom only comes through suffering. And i really believe thats true. And, you know, i wont say that i was tortured or i suffered during deployment but it was uncomfortable. It certainly wasnt comfortable, it wasnt pleasant, it wasnt fun to be away from my family, it wasnt fun to be away from my children, it wasnt fun to be away from my wife and my friends. But yet when i came back, i had such a tremendous amount of gratitude for them and for my, you know, my comfortable life here, if you will, that i think some people take for granted. And i thought that in some small measure writing about some of these experiences will maybe impart a sense of humility and some gratitude to individuals that read it, inspire them, and also maybe have them look introspectively and say, you know, well what am i doing with my life here and how can i help some individuals that may need some help in any way that i can by using my talents and using my background to be able to do that. And ill give you a story of what i mean by this lack of appreciation for what we have. We did, on rare occasions in my particular case but on some occasions, took care of afghan locals. And it dawned on me that they have no healthcare system. They have no 911 system. If you get in a and you be in in a car accident in afghanistan and this is true for lots of third world country, you could die. I mean, just because you were in an accident, you had the misfortune of being in an accident in a country that doesnt have a 911 system and it could be from something thats so benign but you would die. We were taking care of these individuals and it dawned on me that just because you had the luck or a misfortune or you were unlucky enough to be born in a certain place in this world, you could have a totally different life than you would if you were born just by circumstance and by chance and by luck in this country that does have a lot it has its issues but it has a lot. And i dont know if people understand or appreciate that. And its unless you travel and you see other things and you get a different perspective that you really appreciate that. And so a very illustrative point of this came back to me when i came back home and now understand that ive come back sort of jaded and ive had this tremendous experience and ive had this sort of uncomfortable time and ive seen so many people just totally changed. And when i got back, it was just maybe within my first couple of weeks, i got on an elevator and i was going somewhere with i cant remember where my destination was, but two individuals got on the elevator with me, two young ladies. And one of them was so distraught. She just kept saying i cant believe this happened. You know, my day is just awful. And i felt, you know, i felt like this i felt like so much empathy and i was like, my gosh, i hope did someone die . Parents . Maybe shes sick. Maybe her child is sick. Maybe she just got some bad news about her health. But it was so much pain in her voice, you know. And again, im thinking in my context of like, transplant, death, you know, what i just saw in afghanistan. And we get to the floor and shes getting off and she turns to her friend and said i cant believe they didnt have my flavored latte at the starbucks. And i said to myself, what a country that we live in that that could be the biggest problem that you have today . And then think about what i saw in the last six months and what i see in transplant and the trauma that rips a patient, you know, rips the patient from the familys life. And all these trauma patients that we ultimately, you know, have as organ donors. They werent expecting or planning for something bad to happen to them, typically not. It was a trauma, Motor Vehicle accident. How many of us get in a car everyday and dont even think about it. But, you know, that could just end. And so, i guess, it comes back to my whole, sort of, you know, explanation for why do i do what i do. I always feel like theres limited time. And some of us maybe feel like we have all the time in the world but i dont think so. Maybe because ive been so close to death and i keep seeing it and i keep reliving it and certainly my time in afghanistan made it graphic for me, you know. It wasnt sanitized like it is with the operating rooms and, you know, different transplant teams and things like that. It was more raw and it was more visceral. But yet the common understanding that i come away with is that, you know, we dont have a lot of time here. No one knows how much we have. And it sounds clicheish and it sounds like ive heard that before, but i feel like ive lived it and i continue to live it all the time. In the book, you described with the main character, dr. Elegant, that he actually put his hands around the heart and massaged the heart with the chest cavity open. How many times have you done Something Like that . Every time we do a case thats a heart case. Explain how that works. Well, it depends why youre doing it. But almost any heart surgery, you have to manipulate the heart as a surgeon whether youre putting a valve in, youre doing a cabg, coronary artery bypass graft, and certainly if were transplanting the heart, we have to remove it from the patient and we put it back in and we implant it. And, you know, its one of those things where its going to sound strange to say this but its routine for us, as cardiac surgeons, to do that. But i remember the very first time that i had to handle the heart. I was very afraid with the extreme trepidation was how i was manipulating it, you know, and i was scared to touch it because i felt like, you know, this was the this was it. This was the engine of life. You know, im very biased, by the way, because of what i do. But, you know, i felt like this was the engine of life. You cant touch it. You cant manipulate it. You cant, you know, this is too sacred. And then, you know, just because of the symbolism. The heart has so much attached to it for so many people. You know, talk about, you know, that person has heart. You know, they have the heart of a lion, you know. The heart and, you know, wheres the location of your soul . Its in the heart. So theres so much thats just thats just in the heart, you know, in terms of like its connection to so much that you just cant separate it. So what i was trying to convey in the book was some of that, you know, awesome experience that from time to time i still, you know, i step back and i think about it, like, just last night. You know, we took a heart from an individual and we brought it back. And now someone else has a new lease on life. And thats amazing. How often does that not work . Rarely, rarely. I mean, it usually does and thats why we do all this sort of preplanning to ensure that thats going to be the case and that things will go well. But it does happen on occasion but rarely, fairly rarely. If you go back to the afghanistan experience, the impression is left from the book that its not the most sanitary situation out in the field. Not at all. Not at all. And thats another sort of another dimension of it is that, you know, most of us in our training, you know, certainly me, you know, where everything has to be sterile, this is high risk of infection. Were in the desert and theres dust everywhere, i mean, you inhale it, it goes everywhere, you blow and you could see dust, you know. So, you know, certainly theres this, you know, sort of conventional wisdom where you just take that and kind of throw it away because in this, you know. This particular circumstance, you just have to work with what you have, you know, and, you know, you work with what you have and you try and be as resourceful as possible. But yes, theres certainly a high rate of infection just given the nature of whats going on. But thats not uncommon in any one of our war campaigns. I mean, thats just sort of comes with the territory. How did you cope with that First Experience in afghanistan where you had a man on the a gurney, yes. Gurney with two missing legs and a missing hand, part of his hand. How did when it was all said and done, how do you deal with that when you walk away, walk out of that tent . Yes. Well, thats good question because, you know, there was this initial shock like i said. It was like shock and awe. I saw it. That look that he had on his face and i could close my eyes and i could see him on the stretcher right now. I could see him putting his hand up. I could see his eyes. I could just close my eyes and i could just see it. And ill never forget that first case, that sort of bringing me to reality of what was going on here. And after you got into the tent, you know, there was this initial sort of, like, triage. Its get to there we get the report, we see him, and he goes into the tent, everyone starts to work, the other team starts to work. We got pulled in, myself and actually my colleague that wrote the foreword. We both got pulled in because the other team wanted us to begin right away. They didnt want us to bystanders. They said you guys have to get involved right away. And once they did that and they pulled us in, it was like a jolt. There was like, wake up, you know. Now you have to act. You have to be a doctor. You have to be a surgeon. You have to be a care provider. You have to dismiss your emotion. You have to, you know, tuck that away what you are feeling and just work now. You have one objective. You have to save this guys life. You have to stop the bleeding. You have to get him back home to his family. And when we were done, it was almost surreal. And you try to start thinking about it again but then somebody else would come in. And then, you know, and in maybe a gap of a couple of hours and somebody else came in and then you got a couple of days and in between were talking about like that last case and then someone else comes in. And over time, you just you just kind of get desensitized and thats why i say that, you know, there was, certainly for me, a wall that was erected. But there were others that, you know, would cry every time they saw them. You know, some of the providers would cry every time they saw someone they would get choked up every time. They would still feel like that urge to, you know, to heave, because it was still real, it was raw every single time. We are, unfortunately, are out of time and before we do if somebody wants to read your blogs and all, where do they find it . So, doctor tetteh, doctor tetteh. The book is available at politics and prose, catholic information center, and online. Amazon. And online, amazon. And it called gifts of the heart. Thank you very much for joining us. 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