Wednesday, April 3, 2013


Another military genius. He was tough, compulsive, abrasive, and driven. I love this guy. I learned of him when I read a biography called The Rickover Effect. The following comes from,%20Hyman

Hyman George Rickover was born on 27 January 1900 (1898 according to school records) in the village of Makow. At the time this was in the Russian Empire, some 50 miles north of Warsaw. His father was a tailor who emigrated to New York at the turn of the century; several years later he sent for his family to join him in the United States. Hyman Rickover attended school in the Chicago area after his family had moved there in 1908.
In 1918 he entered the US Naval Academy. During the Second World War he served as head of the electrical section of the navy's Bureau of Ships. In 1946 he was assigned to the atomic submarine project at Oak Ridge, Tennessee. He was a major factor in convincing the US Navy that nuclear sea power was feasible, and directed the planning and construction of the world's first atomic-powered submarine, the USSNautilus, launched in 1954. He was also involved in many more of the US Navy's nuclear-powered ship projects.
Although no anglophile, he gave great assistance to the Royal Navy as they developed their own nuclear submarine programme. Rickover later became chief of the Naval Reactors Branch of the Atomic Energy Commission and was in charge of the nuclear propulsion division of the Navy's Bureau of Ships.
His extraordinary naval career was marked by controversy. Rickover never commanded a ship - at a time when this was thought essential for people destined for senior rank. He held outspoken opinions and would not tolerate dissent. His single-minded purpose was to drive through his own ideas for nuclear-powered vessels and to block alternative ideas. Ultimately this provided the US Navy with a powerful fleet of nuclear-powered surface vessels and submarines ,but probably at the expense of more cost-effective innovative designs.
He was finally promoted to rear admiral (1953), vice admiral (1958), and admiral (1973). In a situation unlikely ever to be repeated he was listed as on active duty until 1981. He retired the following year.


The devil is in the details, and everything we do in the military is a detail.
Unless you can point the finger at the man who is responsible when something goes wrong then you never had anyone really responsible.
Be ever questioning. Ignorance is not bliss. It is oblivion. You don't go to heaven if you die dumb. Become better informed. Learn from others' mistakes. You could not live long enough to make them all yourself.
Good ideas are not adopted automatically. They must be driven into practice with courageous patience.
Great minds discuss ideas, average minds discuss events, small minds discuss people .

Monday, April 1, 2013


Andreas Gruentzig was a wild, dynamic maverick in medicine. His work changed the face of cardiology and cardiac surgery! His work paved the way for non-surgical treatment of heart disease. You can imagine how this was received by cardiac surgeons! He was also a great teacher and left behind a legacy of acolytes. His life is beautifully documented in "Journey into the Heart" by Monagan.

From the Society for Cardiovascular Angiography and Interventions:
Twenty-seven years ago (1977), in Zurich, Switzerland, Dr. Andreas Gruentzig performed the first coronary angioplasty on an awake human patient. In doing so, he forever altered the role of the cardiologist in treating heart and vascular disease.
As part of a special tribute to “Legends in Invasive/Interventional Cardiology,” SCAI asked Dr. Gruentzig’s colleague and friend Spencer B. King, III, M.D., FSCAI, MACC, to reminisce about the years when he and Dr. Gruentzig collaborated. Here we share some of Dr. King’s recollections.

Dr. King met Dr. Gruentzig in 1976 at a medical meeting in Miami, where Dr. Gruentzig was presenting his animal work. The poster that Dr. Gruentzig showed at the conference is still in Dr. King’s office, a cherished remembrance of a good friend. The two cardiologists began talking about Dr. Gruentzig coming to the United States in 1980 as they traveled by train outside of Zurich. Dr. Gruentzig said that he would like to return to Germany or perhaps move to the United States, perhaps to join the Cleveland Clinic.
When I asked him what he was interested in doing, he said he wanted to foster the technique and that he wanted to be a professor. I pointed out that the Cleveland Clinic was not a medical school and he could not be a professor there. This was a revelation to him, and it kind of set him back.
Shortly thereafter, Dr. Gruentzig visited Atlanta, where Dr. King introduced him to J. Willis Hurst, M.D., chief of medicine at Emory University. What followed was a long and convoluted recruitment process that required obtaining a visa and a state license for someone who did not have the other usual credentials to practice medicine in the United States. Eventually all of these obstacles were hurdled and Dr. Gruentzig decided to join Dr. King and his partner, John Douglas, M.D., FSCAI, at Emory.
Andreas was an incredibly bright and intense guy and very committed to what he was doing, but at the same time he was always open and encouraging of others. That’s what all of his courses that he initially began were about—to share the knowledge. He was active in all aspects of life—work, play, anything. His motto was that if you really wanted something, you should pay the price for it and not worry. He would not have been very good at economizing on anything. He drove fast, he lived fast, and he accomplished a lot in a short period of time.
In 1980, Dr. Gruentzig joined Dr. King’s group as a full professor.
He loved teaching. He attracted students to Emory from all over the world for angioplasty. Probably half of the fellows who were trained in the early 1980s came out of our program. There weren’t other programs that large until about 1983 or 1984.
Dr. Gruentzig spent nearly five years at Emory, from 1980 until his death in 1985. During those years, Drs. King and Gruentzig and their team forged ahead, developing the specialty of interventional cardiology. Following his death, their group conducted the first randomized trial in the field, comparing angioplasty to surgery.
Andreas would be proud of the technical advances the field has accomplished. He would think these were logical steps forward. He was interested in, and had worked on, many of these things. As early as 1985, he was involved with ideas of laser technology and stents, although they were not used until the year after his death.
If he were here today, I think he would be very excited about all of the medical breakthroughs in cardiology because his principal interest was the long-term outcome and ensuring that it would benefit patients. However, I suspect he would be a little depressed about the in-fighting among the subspecialties. To Andreas, it made no difference what discipline you came from. If you were interested and involved and could master the field and techniques, then you should be able to do it.
He would also be disappointed in the lack of reflection on indications. He was always opposed to the “see it–do it” kind of thinking. He felt that you should have careful documentation as proof that what you were doing was going to be beneficial. And he probably would be disappointed that we still have not proved definitively that angioplasty has extended life. He would probably think that by this time we should have been able to do that. These, I think, would be his concerns.
Outside of work, Dr. Gruentzig was a great entertainer, a trait that was passed on to his daughter, who is a stage actress in Europe.
My wife and I went to his cabin in the foothills of Zurich when his daughter was still very young. It was great to get together with his family. His mother would be there as well as his aunt and his wife and daughter. He could do even simple things extremely well. He would concoct a spaghetti dinner, make a salad, and serve some wine. Then he would get everybody together to play music. They would play flutes and other instruments. It was great fun. Andreas had a great sense of humor. At any party, he was always having fun and dancing.
When Dr. Gruentzig first came to Emory, he and Dr. King directed demonstration courses together. The catheterization labs were wired directly into the large auditorium via closed-circuit television. Either Dr. Gruentzig or Dr. King performed the case while the other moderated. Dr. King recalled how quickly Dr. Gruentzig could assess a situation and act in response.
One day during the lunch break of the course, Andreas was leading a group of people who asked him if he would show them the cath labs. At the same time John Douglas was doing a case on a very obese woman. During the procedure, the woman had fibrillated and John defibrillated her. She literally bounced off the table and onto the floor where John was kneeling, carefully keeping the catheter in place. At that moment, Andreas opened the door and came into the lab with about 10 people trailing behind him. Within a second he assessed the situation and, before anyone else could see, he quickly turned the group around, saying “Nothing happening here,” and ushered everyone out.
Dr. Gruentzig enjoyed living in Georgia and eventually owned two homes there, one in Atlanta and another in Sea Island. He also liked flying and owned a twin-engine plane that took him back and forth between Atlanta and Sea Island. It was on one of these trips that Dr. Gruentzig was killed. He was 46 years old.
Andreas once said, “No matter what happens to the technique, I have made one contribution, and that is allowing physicians to work within the coronary arteries of the awake, alert patient.” In other words, no one had ever conceived that you could do any of the things that followed. No one had imagined that intravascular ultrasound or pressure measurements or any of the therapeutic things we do within interventional cardiology were possible. Nobody had conceived of balloons, stents, or lasers being possible. Andreas enabled the entire field of interventional cardiology to be developed.