A toast to your health ... and then some

I went to St. Petersburg Russia last month with heart surgeon Dr. Mike Dewar and his Yale-affiliated group from the Almazov Foundation, a nonprofit group that trains Russian cardiologists and surgeons.

I met pockets of really smart doctors trying to do the right thing amid many others who didn't seem to care. Maria Nikolayvna, or "Masha," heads a team of bright cardiologists interested in learning and research, but the system is stacked against her.

Other cardiologists not on her team couldn't read ECGs and seemed to know next to nothing about patients under their care. The Russian government spends money on technology but not on training and pays its doctors less than $12,000 a year.

On rounds, I met a patient who needed a mitral valve repair, but instead got a metal mitral valve replacement simply because it was easier for the surgeon, even though it was worse for the patient. Many surgeons didn't seem interested even in learning how to do the right surgery.

In spite of this, Masha and her crew were different - energized. Their chief interest is in echocardiography, and in this they are world-class by any standard. During an examination of one patient with angina, they presented me the superb stress echocardiogram they performed, and then fired questions at me about the type of diagnostic testing we would do in the U.S. When I said we wouldn't need more testing, they kept wondering if a cardiac MRI or cardiac CT would help. (They wouldn't.) I told them to just treat the patient and stop worrying about different testing. It was a bit exasperating, but their enthusiasm was inspiring.

One night, Masha took us all to an Uzbeki restaurant. Genadi, one of the surgeons, was the toastmaster and every five minutes would call for a toast of vodka. We ate and ate and drank and drank. We ate fruits from the Caucasus. We ate tongue and sausages and horsemeat and lamb roasted on a spit. We ate spices: purple basil and dill and parsley and coriander. We had berry juices and fruits and cucumbers and wild mushrooms and fresh tomatoes with unbelievable flavor. And every five minutes Genadi insisted that one of us make a toast with the fine vodka (which to me just tasted like rubbing alcohol). I toasted "to the beautiful women of St. Petersburg and to my wife, who says, 'It doesn't matter where you get your appetite, just come home for dinner.'"

My Russian friend Igor raised his glass and said, "Well, how about breakfast?"

And we drank to new friends. And to old friends. And to our children. And to our grandchildren. And to our parents. And our students. And to our patients. It's a damn good thing I didn't drain the glass with each toast (as I had to give a lecture the next day), but toward the end of the night, I found myself draining more and more of it and laughing more and more and thinking that each new toast was so very profound. (I even started to like the taste of vodka.)

We practice superb medicine in the U.S. and I believe our system to be the best. And yet a better paradigm might be to go global with our medical education, to bring the best of what we know to where others can tell us the best of what they know about a disease that progresses the same in Russians or Chinese or Africans as it does in Americans. To that notion, my friend Genadi, I propose a toast.


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