Second Opinion

I had just completed my residency in cardiovascular and thoracic surgery when I received a call from the young, brilliant and determined surgery department chair in 1974.

Hiram C. Polk, M.D., had been at the University of Louisville for only three years at the time, but he already had a stellar reputation and exciting ideas for growing the Division of Thoracic and Cardiovascular Surgery.

Thirty years later I can say that I have never had reason to regret my choice to run a practice, educate future surgeons and conduct research in Hiram Polk's Department of Surgery.

Hiram's significant accomplishments and contributions have often been overlooked in favor of the latest headline announcing a surgical advance, research award or successful alumnus.

However, the success of the Department of Surgery -- and the Division of Thoracic and Cardiovascular Surgery -- can be directly tied to Hiram's leadership and core belief in the three-pronged mission of education, research and care.

Education

Dr. Polk's commitment to higher education and the education of residents has directed every decision he has made as a leader in academic medicine.

The surgical residency program has expanded tremendously since his arrival -- not without some growing pains -- and the scores of residents who trained at UofL over the years were all beneficiaries of his stern determination to produce the finest, best-prepared surgeons in the world.

The educational example that Dr. Polk sets permeates every division in the department. I enjoy teaching very much because it forces me to keep up with medical advances.

The residents keep making me justify what I do, which is one of the reasons I've had to change my surgical techniques over the years.

Research

In the 32 years of Dr. Polk's directorship, the UofL Department of Surgery has grown into one of the most prominent surgery departments in the United States. Indeed, I would argue that the foundation built through his vision, dedication and hard work is largely responsible for the current era of unprecedented clinical and research success that we are enjoying here at UofL.

To be sure, research is the foundation of every advance that we've made over the last three decades in heart surgery. Many of those advances might not have been realized without our chairman's support.

In 1984, for instance, we were completing research and clinical preparation to perform the first heart transplant in the state. While it may be hard to imagine that the standard of care in 2003 was ever controversial, news of the research and impending clinical experience stirred up significant opposition. Dr. Polk was 100 percent supportive of the work of our faculty, the experience for our residents and the promise for our patients.

Later that same year, I approached the Food and Drug Administration with an idea about using new Ventricular Assist Devices as a way to keep critically ill patients alive until they could undergo heart transplantations.

Eventually, the FDA gave me and another doctor, Don Hill, permission to do the procedure, which is now known as a "bridge to transplant." Don Hill implanted a left ventricular assist device and bridged to a heart transplant out in San Francisco, and about a week later, I put in a bi-ventricular assist device here in Louisville at Jewish Hospital. These were the first truly successful bridge-to-transplants in the world.

The concept of implanting a temporary mechanical heart-support system, to be followed by the clinically new notion of a heart transplant, was considered radical by many -- and plain crazy by others. Once again, Hiram Polk never blinked.

Today, we are actively working with our partners from UofL, Jewish Hospital and Kentucky's Office of the New Economy to develop the Cardiovascular Innovation Institute -- an entity whose sole purpose is to imagine, create, research and test the next generations of cardiac devices.

The advances made in surgery under Dr. Polk's leadership also owe a great deal to his own research in the prevention and management of surgery-related infections, which has steadily been ahead of the curve throughout his career. He nearly single-handedly built the foundation and reputation of UofL's Price Surgical Research Institute and continues to be active in its groundbreaking work to this day.

Patient Care

The purpose of academic medicine is, of course, to improve the quality of life for patients. That is mostly accomplished through research, the activity that consistently advances the standard of care, and education, the way we teach bright young physicians to deliver that care.

UofL has been especially successful at translating research from its labs to its operating rooms because Dr. Polk understands that the needs of patients trump almost every other traditional supposition about the business of health care.

Through his powerful personality and keen understanding of the business of health care, the Department of Surgery has enjoyed long-standing, mutually beneficial relationships with all three hospitals in the Louisville Medical Center -- Jewish, Norton and University -- as well as other hospitals throughout the city. His support has allowed us to grow the Division of Thoracic and Cardiovascular Surgery to a professional staff of more than 30 that performs well over 2000 open-heart surgeries at several hospitals each year.

Laman Gray Jr., M.D., is a professor of surgery and director of thoracic and cardiovascular surgery at the University of Louisville.