19 Jul 2012

Cardiac Catheterization

In 1929, a 25-year old German surgical resident Werner Forssmann wanted to solve a clinical problem: How to improve the delivery of resuscitating medications to the heart? At that time, direct injection through the chest wall into the heart was an accepted practice, though it was largely ineffective and dangerous. On the other hand, cardiac catheterization was met with much skepticism. Dogma had it that touching the inside of the heart would lead to arrhythmia and death.

At that time, several groups had tried cardiac catheterization in animals, but no one was brave enough to test it in humans. Forssmann approached his boss with the idea of a human study and was immediately rejected. The senior surgeon knew he would not listen and even went at length to forbid everyone in his department to let Forssmann touch the surgical instruments.

Forssmann was not easily deterred. With much perseverance, he managed to persuade a surgical nurse named Gerda Ditzen to unlock the surgical instruments and offer herself as the first study subject. Forssmann tied her on a table and left the room. Ditzen waited and waited and wondered what was happening. Eventually, Forssmann reappeared with a catheter up his basilic vein and blood all over his body. The nurse angrily scolded him for betraying her. Yes, Forssmann only tricked her for the instruments and never intended to risk his colleague. He untied the screaming Ditzen and ordered her to take several x-ray pictures. That made history.

Looking at the bright and enthusiastic youngsters who were applying for the medical school, I could not help but wonder: Should we recruit people who would abide to the rule, or should we choose those who would challenge the rule? Can we afford to have doctors running around the hospital trying to tie up nurses?

P.S. Although Forssmann did not hesitate to risk his life, he never did the same thing on others. Serving in the German army during World War II, he was offered the opportunity to do experiments on prisoners. He promptly refused. “To use defenseless patients as guinea pigs was a price I would never pay for the realization of my dreams,” he wrote later. Unfortunately, his pioneering work was ridiculed by his colleagues as circus work. He was denied academic posts year after year and had to do urology instead. When he finally received the Nobel Prize in 1956 and was offered professorship in cardiology, he found himself cut off from the field for too long and could only serve as a “living fossil”.

1 comment:

  1. Would you recruit people who would abide to the rule and become a "key opinion leader" in the future, or would you choose those who would challenge the rule and become a "living fossil" in the profession?
    Perhaps we should recruit the third group of people who abide to the rule but are actually determined to challenge and overthrow the system. But.........isn't it what had happened in Soviet Union under Mikhail Gorbachev?