Wednesday, April 12, 2006

Dog Lab Memories

The dog lab is where I first heard the siren song of surgery. I well remember the great interest the budding surgeons in my medical school class had in our dog labs during our first and second years ---- and, in retrospect, the disinterest of those who chose a nonoperative specialty! It was truly an excellent experience for me, with physiology "on display" in a manner that allowed exceedingly inexperienced hands to put some of our learning into practice. Even though I had little personal experience with him, the uncrowned king of the dog lab at my medical school was the burn surgeon and physiologist extraordinaire Charlie Baxter, M.D. The late Dr. Baxter is well known for other exploits, but he clearly valued the dog lab experience for medical students. Later on, during a research year in residency, I had plenty more dog and pig lab experience, doing work with laparoscopic and thoracoscopic techniques, teaching courses, etc. I definitely preferred the dog lab --- ever had to intubate a pig? Ugh.

Ask SWIMBO --- I love my dog! DogSurg and I are fairly inseparable (mainly because he won't leave my side when I go home). Now, I'm not going to get into the whole "dog labs are evil," PETA-esque thing; if you are interested, just Google "dog lab" medical school to find our just how cruel I really am. But a recent event reminded me of just how much we in health care, not to mention society, have gained from the experiments of a few surgical pioneers in what were then fairly rudimentary dog labs.

I know that it is dangerous for me to crank up the few remaining synapses in my head, but the death of Dr. Norman Shumway got me thinking. Most folks outside of medicine probably don't know much about Dr. Shumway, and I'm certainly no authority on his career. We should remember him, however, as a true American pioneer, who garnered a bit less acclaim than one might expect because he "came in second place" to this guy:
Dr. Christiaan Barnard, of South Africa, performed the first heart transplant in December of 1967, pulling a Sputnik so to speak, after Dr. Shumway's team at Stanford had announced plans to do the same. By the time a donor and recipient became available, Dr. Barnard had performed three such procedures; one survived 18 months. The first American heart transplant recipient was this gentleman:
Mike Kasperak, a 54-year-old steel worker, lived 14 days postop. Dr. Shumway had run headlong into the unseen glass wall of heart transplantation -- the operation was relatively easy, in comparison to many of the concurrent advances in heart surgery that were being made at the time, but the patients succumbed to organ rejection. According to the Times Online, "by 1971 there had been 170 operations, and 146 patients were dead....Heart surgeons despaired, and called for a moratorium."

This is where the mettle of a man is tested, over and over. Where the quality of persistence in the face of failure is viewed contemporaneously as lunacy, and retrospectively with admiration --- but in neither instance with the understanding of the sheer enormity of the work involved to get continuously better results.

And this is where those who don't understand the importance of animal experimentation in medicine should probably stop reading. Dog and other animal labs were essential to the development of the operation itself; the development of minimally invasive cardiac biopsies to survey for rejection; the development of antirejection medications, such as cyclosporine, which are critical for transplant recipients; etc.

Dr. Shumway's career was a rich one, and certainly not limited to cardiac transplantation. It is a shame that more people don't know who he was and what he accomplished. While it is largely unspoken, his legacy lives in the hearts (as well as kidneys, livers, lungs, etc.) of thousands of transplant recipients across the world today.

And just to get your PETA panties in a wad, just remember that none of this was possible without the simple tools available to us in the dog lab. Maybe the PETA folks should ask the people on this waiting list what they think about it all.