Seeing and saving â€˜the beat of the soulâ€™

Dr. Cary S. Passik has operated on a few thousand beating human hearts, and he is still awed by its mystery and design. “The first time you see a heart beating is magical,” he said. “You do it so often, it”™s easy to lose sight of how magical it is. It”™s like seeing the beat of the soul.”

Passik, the new chief of cardiothoracic surgery at Danbury Hospital, said the heart “is about the size of a fist, probably a little bigger. It beats about 70 times a minute, about 100,000 times a day for 80 or 90 years. It just wants to beat.”

The magic goes beyond the beating heart, however. “When you operate on people and open them up, sometimes you see a little tiny blood vessel with no name in the certain corner of the chest,” he said. “Somebody had to sit down at a computer and say, ”˜Put a vessel here.”™ The magic is how it”™s all put together and how it works. We still don”™t understand most of it.”

One thing Passik does understand is the workings of a hospital”™s cardiovascular program. Most recently, he was associate section chief of cardiothoracic surgery at Yale-New Haven Hospital and an attending surgeon at the Hospital of Saint Raphael in New Haven. He completed his cardiothoracic surgical residency at the Mayo Clinic and Foundation in Rochester, Minn., which had an integrated-team approach to patient care similar to what he found at Danbury Hospital.

“This place has a great open-heart program that was set up by a team from Montefiore Medical Center” in the Bronx, he said of Danbury Hospital. Danbury uses collaboration among cardiology, surgery, anesthesiology and nursing staffs for its cardiac services “for the best thinking and the best outcomes.”

Passik became chief of cardiothoracic surgery last month, just a few months after his predecessor, 51-year-old Dr. Michael Frymus, died unexpectedly of a heart attack in Norwalk. “That shows you how treacherous coronary disease can be,” he said.

The hospital “was in a bit of a quandary,” he said. The cardiovascular program was only 2 years old when Frymus died. “They were looking for a good heart surgeon to bring the program forward,” Passik said. “I think they wanted somebody in the state who had a reputation.”

The best thing, he said, is that Danbury Hospital sought him out: “They called me. That”™s the best way to get a job.”

Death isn”™t optional

As a boy, Passik loved to fix things. “When I was 4 years old, I would take apart radios and toasters,” he said. “As I grew older, it was televisions and cars. I loved to see how things work inside, and I think that”™s what eventually motivated me to go into surgery.”

He grew up in Queens and attended the Bronx High School of Science, graduating in 1974. Then he took a six-year experimental medical program at the City College of New York and the New York University Medical School, from which he graduated in 1980 at 22. “When I was in high school, I was introduced to both the sciences and the law,” he said. “I had a great law professor, and the class visited the Supreme Court in Washington and had a private audience with Thurgood Marshall. It was amazing.”

As impressive as that was, however, Passik chose medicine over lawyering. “I thought it would be more useful to be a doctor for 50 years than an attorney, and deal with issues made by God, not by man.” Nothing against lawyers, he said, but “I feel medicine is a higher calling, a more useful thing to do for a lifetime.”

As for becoming a surgeon, that decision came during “an epiphany while I was a medical student at NYU,” he said. “I was sitting in a conference room outside the ICU at Bellevue discussing this patient who ”“ it was clear to me ”“ was going to die, even though the attending physician was brilliant. I thought I could have a huge impact on a person”™s life as a surgeon, rather than just giving medicine.”

Heart surgery appealed to him because “it was clean, technically challenging and it looked like fun,” he said. “Back in the early1980s, heart surgeons were the kings of the hospital. It was a glamorous specialty.” Now, however, some of the fun has dissipated. “Patients are much sicker and much older,” he said. “It”™s a sign of our success.” And of medicine”™s inevitable failure.

“A few minutes ago I saw an 87-year-old lady who needs a redo heart operation,” Passik said. The elderly woman has had a stroke and cancer and “can barely walk.” The re-operation “would be a very big risk, but there”™s an expectation we can tackle these problems, and to some extent we can. But Americans can”™t cheat death. America is a society that thinks death is optional.”

His best shot

Passik specializes in adult cardiothoracic surgery for patients 55 and older, with an emphasis on the geriatric population. He decided to concentrate on the elderly during residency after taking six months of training in surgery of children with congenital heart problems. Passik and his wife, Marion, had just had their first child, a daughter, and experienced “a few difficult, tragic cases” with children during the training period. “I thought losing a child surgically would be too difficult to bear on a regular basis,” he said.

But losing any patient is hard. Should he decide to operate on that 87-year-old woman, “I”™ll give her my best shot, but I can live with myself if she doesn”™t make it,” he said. “I”™ll agonize over it and have to talk with the family,” but “if the patient is supportive and has a twinkle in their eyes and I think there”™s a chance to pull it off, I”™m willing to do it.”

Passik should have no dearth of patients in the future. “The way people eat and exercise in this country is a disaster,” he said, despite the growing awareness of the need for healthy diets and cardiovascular exercise. “Obesity is epidemic. Walk in the mall and you”™ll see the majority of people in this country are obese.”

And while open-heart surgery and angioplasty can produce dramatic results in heart patients, “we”™re challenged more and more because of our success” as heart surgeons, he said. But as the sudden death of Passik”™s predecessor proves, “we should live our lives as if we have coronary disease.”

And for those whose hearts are failing, there”™s Danbury Hospital”™s heart program as a fallback. “It”™s a really good hospital,” Passik said. “I had an inkling that it was before I came here, but I found that it really is a good hospital. It has good leadership, and is small enough that if somebody has a voice, they”™ll listen to you. I think I can actually make a difference working here.”