Of the many highlights cardiologist Julian Aroesty, MD, has had during his stellar 45-year career at BIDMC, there is one that overshadows all others - "Getting a job here in the first place!"
Aroesty's eyes light up with a bright smile as he recalls the day he came to Boston to interview for a senior resident position. He met with Hermann Blumgart, MD, George Kurland, MD, and A. Stone Freedberg, MD, who told him there were three things they expected of every physician who worked at Beth Israel Hospital.
"First, they said that everyone has to be a good physician and take care of patients; even those who worked in the labs had to rotate on the medical service for two months so they'd never forget this job is about taking care of patients," he said. "Second, they said you have to love to teach because our job is to teach the next generation. Third, they said we all have to advance medicine and basic science. Well, after the interview I said to myself, 'This is the place for me.'"
But it wasn't as easy a choice as he makes it sound. Aroesty is a first generation American who comes from a small community of Spanish-speaking Jews in Rochester, NY. The community traces its lineage back to those who were expelled from Spain in 1492 and went to Turkey where they continued to speak Spanish for 500 years despite being in a non-Hispanic country.
"I thought about staying in Rochester and being the first physician to the community, but the offer to come here was so good I decided to take it," he said. "My mentors were men like Drs. Blumgart, Kurland, Freedberg and Paul Zoll - millions of patients the world over have been saved by Zoll's research (heart monitors, pacemakers and defibrillators). Working with people who love to teach is such a huge thrill."
The cardiac catheterization lab had only recently opened when Aroesty accepted an attending position. "My job was to make it busy, make it high quality," he said. "I went out and spoke at all the neighboring hospitals. I was half-time person, half-time in the lab and half-time in my private practice. My wife said this was actually double-time. She was right, of course, because most days I would leave at 7 in the morning at get home around 9 at night. But it's been a wonderful, thrilling career."
Aroesty met his wife, Elaine, a nurse practitioner, when she was a nurse at BI. "She's gorgeous and wonderful," he said with a smile. "I met her, wooed her and married her. Everyone was chasing her, but I caught her - I still don't know how, but I did."
Now, at age 78 and-a-half, Aroesty says he's starting to slow down so he can spend more time with his grandchildren. "My wife calls this retirement on training wheels," he joked. In fact, that's why he wasn't able to attend this year's Service Awards event - he was visiting his grandchildren in San Francisco.
Among the other highlights Aroesty recalled was the day in the mid'80s when Mike Lipman, then director of admissions, called him into his office and said, "I want you to know you're the number one admitter to the hospital. What's more is that you admit 50 percent more patients than the number two admitter.' I did that by establishing relationships with doctors in the community who knew I never turned off my beeper and I never had an unlisted phone number - and my patients knew that too. I never took off Wednesdays, never joined a country club. I just devoted myself to the job -- and I loved it!"
He also loved the people he worked with. "This is a wonderful hospital because of all the people who work here," he said "The nurses are truly dedicated and absolutely wonderful, and so are all the people who work on the floors. They're the reason this is such a special place."
Changes in the Lab
There have been many changes in the lab over the years, but one of the most important is in imaging. "The big difference is that going from film to digital gives us a much lower radiation exposure - to the patent and to us," he said. "My first experience with cardiac catheratization, in the early-'60s, I actually had to look into the X-ray tube to guide what we were doing. It wasn't on a separate monitor. So the X-ray beam was coming up through a florescent screen into my eyes. I was reasonably protected, but this is what we had to do at the beginning."
Over his career, Aroesty has performed more than 20,000 cardiac catheterizations and more than 2,000 angioplasties. "I was always very cautious and not afraid to send a patient to surgery if I felt it posed a better outcome," he said. "I always said to myself, 'If this was my father, or if this were me, what would I want?'"
That's a guiding principle he strives to teach his students.
"Sometimes you'll see something that we could easily fix with a stent, say a proximal LAD lesion in a young guy," he said. "And the fellow standing next to me says, 'Let's go for it.' I say, 'No, we're going to send this guy to surgery for a LIMA.' He says, 'Why, we can fix it.' I say, 'I know we can fix it. The risks of both procedures are about the same, but he's 50 years old. The LIMA lasts forever. The stent doesn't. If this were you, which one would you want?' He says, 'Well, I guess I'd take the LIMA.'"
It's these lessons (being thoughtful about what modality is best for each patient) that returning students say they appreciate most from their time as fellows.
"When they come to talk to me the thing that really pleases me is that they tell me the most important thing I taught them was judgment," he said. "They say, 'You taught me to really think about what I was doing rather than just going forward with the lesion-fix. Knowing that there are many ways to fix a lesion and that we have to choose the best one.'"
Aroesty also jokes that his lessons don't always have their intended effect. "I once heard that a fellow who was on duty when I came in at 3 a.m. to help a patient decided to switch from cardiology to anesthesiology," he said. "This fellow said that if this is what Aroesty is doing at 3 a.m. when he's in his 60s, then I want to be doing something else. I laughed when I heard that, but honestly, it's energizing to get up in the middle of the night and save a life. How many people have a job where you can do that?"