From the bottom of the heart

Brazilian doctor creator of famous technique of cardiac surgery confesses his passion for medicine and for two countries: Brazil and Canada.

By Fátima Mesquita

He is beloved and admired by patients and respected by the international medical community. But few people know that the director of the Toronto General Hospital is a Brazilian born in Ribeirão Preto and graduated in medicine from the Universidade Federal do Paraná. Get to know a bit about the history of Dr. Tirone David – the inveterate optimist, the skilled surgeon, the immigrant who won the highest commendation from the Canadian government, the Brazilian who still misses the people, the food and the Brazilian geography, and that above all, is a doctor absolutely passionate about it.

You were born in 1944 in the city of Ribeirao Preto, but have been living abroad for decades. Do you still have some strong bonds with Brazil and your hometown or have all these years away created a considerable distance between you and the country?
Dr. David: Although I left Brazil in 1970, I have a large family and several very good friends there. I have been back to Brazil at least once yearly to see my parents, my three brothers and two sisters and their families. Also I have some very good friends in Curitiba and often stop by to visit them. Yes, I still have “saudades da minha terra”. I love the people, I love the food, I love the geography.

Your father wanted to be a doctor and, somehow, realized his dream through you. You have three daughters. With a doctor for a father and a nurse for a mother, do any of them have a dream of following your path and being your successor?
Dr. David: My eldest daughter considered it but decided to go into business. She has a MBA. My second daughter is considering going into nursing next year. She is already a college grad. The youngest one finished college and is still “searching” for a career that she can be as “passionate about as my dad is for medicine”. None of them is interested in medicine. Too bad. I wish at least one would become a physician.

How do you compare yourself as a young medical student from Universidade Federal do Parana with the accomplished and respected doctor you are today?
Dr. David: I have not changed. My character, my values, my ambitions are basically the same. It has been 38 years since I finished medical school. I was young and naive but also smart, inquisitive, and full of dreams. I have got out of life what I put in to it. I am precisely who I always wanted to be. No regrets… perhaps a few, but too few to remember (joking…).

After graduating in Paraná, with a fresh doctor’s degree, what did you do before coming to Canada?
Dr. David: I started my internship at the State University of New York, in Brooklyn, in 1970. It was a great year. New York was wonderful for a young foreign doctor. Very cosmopolitan and one never feels a “foreigner”. From there I spent four years in Cleveland, at the Cleveland Clinic Hospital doing my residency in general and vascular surgery. By that time I had decided to become a heart surgeon and came to the University of Toronto for training. I thought I would go back to Brazil to practice cardiac surgery, but by the time I finished eight years of training I was over-trained and could not practice there any more. I doubt I would have done there what I did here. My ambitions were largely academic and the infrastructure simply did not exist anywhere in Brazil in those days. It may no longer be true, but it is certainly too late for me. But then again, no regrets… I am very happy here.

 You have been living in Canada for quite a long time and are fully adapted, a Canadian citizen with many achievements in this country. But what was the beginning of your immigration process like? What were your biggest challenges?
Dr. David: I have lived in Canada for 32 years. It is possible that I would be in Brazil today if I had not come to Toronto for training in cardiac surgery. I felt a foreigner in the USA. I never felt that I belonged. This feeling never existed here. From the moment I arrived here to the present, I have never felt a foreigner. Canadians made me feel part of them. Actually, they described themselves as a “melting pot”. I agree.

I was offered a staff position at the Toronto General Hospital by Dr. Wilfred Bigelow, then the professor and head of cardiac surgery. Immigration was extremely difficult for doctors because back then Canada had too many doctors. Dr. Bigelow and Dean Holmes (then dean of our Medical School) went to see the late Pierre Trudeau in Ottawa. Mr. Trudeau solved the problem by sending a letter to the Department of Immigration and Manpower stating the reason for my entering the country as “national interest” and the next day I became a landed immigrant. A few years later I became a citizen.

The number of Brazilians interested in having a permanent address in Canada increases year after year. What advice would you give for those who are just arriving, full of dreams and with their qualifications but little clue how to make it in the new country?
Dr. David: Canada is a wonderful country to immigrants. All you have to do is to do well at whatever is your job, be focused, and differentiate yourself from your peers as a better worker. Recognition, acceptance, and rewards follow. This is not only in medicine. It happens in every profession or career. I know numerous examples in arts, construction, advertising, sports…

 There is a famous surgical technique that carries your name – the Tirone David’s technique. Can you explain for us, in layman’s terms, what is this technique and why it’s so important to cardiac surgery?
Dr. David: Patients may develop an aneurysm at the root of the aorta, the part that contains the aortic valve that separates the heart from the aorta. The standard treatment was to replace the valve and use a tube of polyester to replace the aorta. I developed an operation whereby a tube of polyester replaces the aneurysm but the patient’s own aortic valve is saved. I called this procedure: aortic valve sparing operation. Most surgeons referred to it as “David operation”.

 Among your many achievements, one seems quite special: you have been awarded the Canada Order, the biggest honour of the country. How did you feel about receiving such an honour?
Dr. David: It is indeed a wonderful feeling to be recognized by your peers. When I first heard I had been appointed as an Officer to the Order of Canada I did not believe it because I did not think I had done anything exceptional to deserve it. But from a letter, it became a very special and elegant event at the Governor’s residence in Ottawa, and from there the satisfaction to know that what you have done is highly appreciated by your Government.

 Tell us please, about your current challenge as the head of the cardiovascular division of the Toronto General Hospital, and what are your plans for the future?
Dr. David: Cardiac surgery has never stopped changing during my career and the rate of change is increasing. This is the most difficult challenge as a leader: lots of new things to explore but many will fail. The key to success is to pick the winners, approaches that will result in improvement in the quality of cardiac care. The Peter Munk Cardiac Centre [at Toronto General Hospital] is well prepared to remain in the cutting edge of innovation, research and clinical care.

I am 62 and love what I do. I will continue carrying on as long as the passion is there and continue to provide clinical outcomes second to none. Cardiac surgery is physically very demanding and I know that eventually I will have to give. Hopefully, not very soon.

 And, finally, a question that all of us potential future patients ask ourselves: what are the general trends in the future of heart treatments?
Dr. David: Only good news: better diagnostic and treatment options and more knowledge about prevention. The future has never been brighter.