Deep Impact

His primary goal from the outset of medical school was to return home and join a group surgical practice.

Yet today, Edwards finds himself running a top university medical program as chairman of the surgery department at the University of Arkansas -- a job he calls "tremendously rewarding."

What happened?

In a name, Hiram C. Polk, M.D., chairman of the surgery department at the University of Louisville. "Hiram just has this way of bringing out the best in people," says Edwards, who completed his residency in general surgery under Polk at UofL in 1986 and was strongly influenced by his mentor.

"He stimulates young men and women to become people they never would have become otherwise. In my own case, I would be in private practice in Gainesville, Ga., today as opposed to a guy who wakes up every morning and comes to work at a major academic medical center."

By his own admission, Edwards was a disinterested medical student, having earned a "B" in surgery at Emory and placing in the middle of his class rankings. He certainly wasn't the kind of motivated student who typically was accepted into UofL's nationally competitive surgical residency program.

But Edwards had an ally in his corner - an Emory professor named Harlan Stone, M.D., who saw untapped potential and knew Polk well enough to suggest that the UofL surgeon take a second look.

Polk agreed with Stone's assessment, and he accepted Edwards into the program here, beginning a transformative process that ultimately would produce another stellar UofL surgeon.

"There were a number of kids in whom Hiram saw potential beyond anything they had already demonstrated, myself included," Edwards says.

"He has a way of winnowing the wheat from the chaff when it comes to figuring out if your parents raised you right.

"He can tell if you have a sense of integrity and honor, a sense of character and commitment. I think that's mainly because those are qualities he also exemplifies."

Edwards says he felt obligated to work doubly hard at UofL because he had been granted a second chance. By no means was it an easy road.

One morbidity and mortality conference stands out in particular, Edwards says. It was standard practice for Polk to review patient charts in an open forum so he and others could discuss the care that patients received and suggest options for improvement. This common teaching tool is similar to Polk's technique of questioning his residents during morning rounds to ensure they always consider a patient's best interests when making every treatment decision.

"I will never forget that morbidity and mortality conference, when Hiram got those charts out and started quizzing me about them," Edwards recalls. "He questioned every single decision I made. It was one of the most contentious, difficult discussions I've ever seen.

"But it was not done in any demeaning or berating sort of way. He was calling on honorable and sacred missions. He was saying, 'How can we allow this to happen to a patient who deserves so much better?'

"And it came from the heart of a man who you knew always put the patients first. That kind of experience changes your life."

Edwards, in fact, discussed this very topic recently with another UofL surgery alumnus.

"I asked him if he thought we were different from people who train in other places, and he said, 'Oh absolutely. I know surgeons who are quick to attribute a bad patient outcome to disease. But when you train at the University of Louisville, you never attribute a bad patient outcome to disease until you've exhausted all other possibilities in terms of what you could have done differently.'

"That's because we've been there before," Edwards says. "We've been there when it was easy to say a patient died because he was 75 years old and had a burn over 60 percent of his body, which is almost uniformly lethal.

"But we also knew that, for the next 15 minutes, Hiram was going to tax the limits of our knowledge to figure out what we could have done differently, if not to cure this patient then to push back the frontiers of what it meant to treat all burn patients.

"That's the only way to advance medicine -- or anything, for that matter. You focus on your mistakes if you want to improve, and Hiram is a master at that."

Following his residency at UofL, Edwards completed a three-year fellowship in general surgical oncology at M.D. Anderson Hospital in Houston, Tex., where he also began teaching.

Then, in 1989, Polk and another UofL faculty member, David Richardson, M.D., invited Edwards back to Louisville to accept a teaching job as an assistant professor of surgery in the Division of Surgical Oncology. By 1995, he had risen to the rank of associate professor, and in 2001 Edwards was named division chief.

"I really enjoyed my time as a faculty member at UofL," Edwards recalls. "Hiram was patient with me, and I learned how to conduct research. Then I learned how to become a better teacher. The next thing I knew, I figured out that I was in a surgical chairman's training program."

Edwards accepted his current post in 2002, thanks in large part to the guidance of Polk.

He now has published more than 130 papers or journal articles and currently is the principal or co-principal investigator in several major medical studies with more than $11 million in funding.

Edwards also holds leadership positions in several professional organizations, including the current presidency of the American Society of Breast Surgeons.

None of this, however, means as much to Edwards as the satisfaction he gains from helping train tomorrow's surgeons.

"I am empowered every day by leveraging my influence through the young men and women who train here," he says.

"I just never considered teaching as a career until I saw the gratification that Hiram got out of it, and I wanted to have that, too.

"He's had a tremendous positive influence on me, and I hope to pass that on to others here at Arkansas. I'm very happy where I am today."

When Mark A. Malangoni, M.D., began looking for a stepping stone from his first job in academic medicine, a professorship at the Medical College of Wisconsin, he considered many respected schools.

They all offered unique benefits, he says, but only one could deliver Hiram C. Polk, M.D., a highly regarded leader who has chaired the surgery department at the University of Louisville for more than 32 years.

"When I started at UofL in 1984, I viewed it as an exciting opportunity to work in an outstanding department of surgery," recalls Malangoni, who is now surgeon-in-chief and chair of the Department of Surgery at MetroHealth Medical Center in Cleveland.

"UofL was nationally known for its excellence in surgical care, and the chance to work in a first-class trauma unit had been a goal of mine.

"More importantly, it gave me the chance to work with Dr. Polk. He and I share some interests in surgical infections, and he certainly is an international authority in those areas. It was a tremendous opportunity for me to learn from one of the leaders in the world."

Malangoni praised Polk's early research into the use of perioperative antibiotics as a landmark event that has impacted everyday surgical practice.

Polk's subsequent search for novel agents that fight infection has led to key discoveries about "what works to treat infection, what doesn't work to treat infection and, more importantly, what things allow infections to become established in the first place," he says.

"This research has changed the way surgeons approach a variety of infections."

Polk also has made important contributions to the advancement of trauma care in the United States, Malangoni says.

"His greatest contribution in trauma care has been the tremendous support he's provided to the trauma unit at University Hospital and to the faculty who have staffed the trauma unit over three decades.

"That unit, which is probably one of the best in the world, really functions as a human laboratory where faculty do a variety of clinical studies. And without Dr. Polk's support and encouragement, many of the advances we've had in trauma care over the past 30 years would never have occurred."

Malangoni described his years at UofL, from 1984 to 1990, as "a very productive and rewarding time."

"I thought I received a tremendous amount of professional guidance and enhancement, both by working in the department and by being associated with the people in the department, including Dr. Polk," he says.

"Seeing his passion for investigation and leadership in discovery was very stimulating and exciting. It's something I hope to emulate in my professional life."

Malangoni says he especially appreciated Polk's regard for the opinions of his colleagues.

"Dr. Polk was a mentor, an adviser and a colleague. We cared for each other's patients, and we certainly exchanged ideas. I benefited from that exchange a lot more than he did, but it was an interactive experience -- he would not only express his own thoughts, but he was also very open to others' thoughts and ideas about important topics.

"Often, he incorporated those into what he was doing. That was gratifying to us as faculty because we really felt like we were making strong contributions to surgery and patient care."

Malangoni says this interactive approach mirrors Polk's teaching style.

"He's an enthusiastic, stimulating teacher who is very interested in creating dialogue in the teaching environment."

Polk was an equally strong role model in the area of research.

"I would look at my accomplishments as being based in part on what I learned from him," Malangoni notes.

Among these are advances in the management of soft tissue infections, improved understanding of wound infection following operation and contributions to trauma care, particularly in the management of splenic injuries.

"These are all based on studies that either began when I was at the University of Louisville or were enhanced while I was there and have been carried on since I left," says Malangoni, who has published more than 130 peer-reviewed papers, two medical books and 35 textbook chapters.

Polk's influence was formative in other areas, too.

"He's an outstanding surgeon, an outstanding teacher and an outstanding researcher," Malangoni says. "Besides that, he's an outstanding leader who is stimulating to others and looks after the people who work for him. He isn't interested in self-aggrandizement, but rather in helping to improve the surgical skills, patient-care skills and leadership skills of others.

"Those are all things I've tried to incorporate into my professional career, too."