Humanitarian Missions Give Cardiothoracic Surgeon An Opportunity to Give Back

reprinted from the Society of Thoracic Surgeons Spring Newsletter at www.sts.org

As a cardiothoracic surgeon, Emily A. Farkas, MD has the typical busy schedule. However,she manages to make time to do what she loves best—participate in humanitarian missions.

“This is the fundamental reason we all go into medicine, to use our skill set to benefit those who need it the most,” Dr. Farkas said. “Patients in the U.S. are understandably frustrated when their options are limited, yet there are places in this world where there are no options at all. If I don't do a valve replacement in St. Louis, there are 20 other surgeons who can. In some corners of this world, the only treatment offered for advanced cardiac disease is a circle of prayer."

As a child growing up in Pennsylvania, Dr. Farkas was more interested in ballet and the creative arts than math and science. She ultimately majored in sports medicine at Pepperdine University prior to attending the Chicago Medical School. She went on to be the first female graduate of the cardiothoracic surgery residency program at Yale University, and she is now in her third year on the St. Louis University faculty.

“After I started medical school, I immediately favored surgery,” she said. “To me, cardiothoracic surgery was the ultimate opportunity to have a meaningful effect on peoples' lives. I also admired the esprit de corps of the cardiac team and the way each person—from nursing to anesthesia to perfusion—contributed his or her own expertise toward the outcome."

It was between her first and second year of medical school that Dr. Farkas participated in an Operation Crossroads Africa mission to Kenya, Tanzania, and Uganda, performing basic medical care and delivering the first baby of her career. During her fourth year of medical school, she spent her elective time in Sri Lanka assisting with general surgical procedures and perioperative care. And in 2008, she began her affiliation with CardioStart International, embarking on the first of two trips to Peru to perform cardiac surgery on children and adults. Dr. Farkas had planned to participate in a mission trip to Ghana in February, but instead is registered for a tentative rotation to Haiti following the country's devastating earthquake on Jan. 12.

“CardioStart and other similar non-profit organizations are truly remarkable in their selfless mission to assemble medical and non-medical volunteers from all over the world to come together in those places where the need is the greatest,” she said. “Imagine the effort, ingenuity, and leap of faith it takes to do something as complex as cardiopulmonary bypass in places with no resources and little support. You learn to 'MacGyver' just about everything from using a gigli saw to open the chest, tablespoons attached to external defibrillators to apply to the heart, or a plug-in coffee pot to provide hot water to warm the tubing. It takes some adaptability to be out of your comfort zone like that, but I'm confident that I'm a better surgeon because of it.”

There are also some ethical struggles inherent in this setting. “One of the most difficult realities is deciding who can be best served with our limited supplies,” Dr. Farkas said. “For instance, should we implant a mechanical valve in a patient who may have unreliable access to anticoagulation, or should we be using a tissue valve in a 25-year-old patient who will require another surgery down the line? Can we wait another year in a child with a septal defect and only mild compromise so that we can repair another child's more advanced lesion? These are hard questions, and we don't always know if we've chosen the right answer.”

Yet the rewards far outweigh the sacrifices, according to Dr. Farkas. On her most recent trip, she noticed that family members of different patients repeating the same phrase when speaking to them after completing an operation. Finally she asked for a translation of “Dios te tenga en sus manos,” which means “May God hold you in his hands.”

“I'm just so grateful for the training I've been given and the opportunities I've been afforded because they have allowed me this incredible privilege of affecting peoples' lives in a profound way every day,” she said. “Humanitarian work is the greatest extension of that, and I think it's one of the best ways that I can do my part to pay it forward.” I