Baylor University Medical Center Proceedings April 2017 - 240

From my little black notebook: lessons for young physicians
and medical students
John Davis Cantwell, MD

or more than four decades, I have been jotting items
in a little black notebook. I decided to leaf through the
notebook and share some thoughts, in the following categories, in hopes that they might be of help for young
physicians.
PREVENTIVE CARDIOLOGY
For over 1400 years, medical students were taught that the
liver was the center of the blood circulation and that blood
was formed in this organ from ingested food. It wasn't until
the 1600s, Shakespeare's era, that a British physician, William
Harvey, disproved the teachings of Greco-Roman physician
Galen. Harvey stated, after careful anatomical studies:
The heart . . . is the beginning of life, the sun of the microcosm
. . . the heart of the world; for it is the heart by whose virtue
and pulse the blood is moved perfected, made apt to nourish,
and is preserved from corruption and coagulation. . . .
[It] nourishes, cherishes, quickens the whole body, and is
indeed the foundation of life, the source of all action (1).

No wonder this organ has captivated the imagination of writers
and poets and has been my focus of medical interest for the
past 45 years.
Antoine de Saint Exupéry, in The Little Prince, wrote that "it
is only with the heart that one can see rightly. What is essential
is invisible to the eye." And Zelda Fitzgerald added, "Nobody
has ever measured, even poets, how much the heart can hold."
Blaise Pascal stated, "The heart has its reasons which reason
knows nothing of."
Flash forward from England in the 1600s to 1912. A
Chicago cardiologist, James B. Herrick, who was 1 year behind
my grandfather at Rush Medical School, presented a paper
before the American Medical Association (2). He stated, based
on pathology studies, that heart attacks were caused by a blood
clot that occluded an atherosclerotic coronary artery. His ﬁndings fell on deaf ears. It wasn't until 70-plus years later that
cardiologists began to recognize and understand this, and that
clot-dissolving medications and balloon angioplasty with stents
became commonplace therapies.
The problem with coronary disease, though, is that the very
ﬁrst symptom is a fatal heart attack in up to 25% of such cases.
240

Because of this, the focus of my interest has been the prevention
and early recognition of this disease. Thomas Edison, a bright
inventor, once predicted that "the doctor of the future will give
no medicine, but will interest his patients in the care of the
human frame, in diet, and in the care and prevention of disease."
And way back-325 bc-Herophilus, physician to Alexander
the Great, stated: "When health is absent, wisdom cannot reveal
itself, art cannot become manifest, strength cannot ﬁght, wealth
becomes useless, and intelligence cannot be applied."
What stimulated me to become a preventive cardiologist
was a lecture and book by Northwestern professor Jeremiah
Stamler, entitled Your Heart Has 9 Lives (3). In it, Dr. Stamler
identiﬁed the major coronary risk factors that can predispose
one to early cardiac disease and premature death. Looking back
at his book 52 years later, the coronary risk factors still apply,
especially cigarette smoking, sedentary living, hypertension,
obesity, high blood fats and sugar, and family history.
VOCATION
Vocation was described by Peter Gomes as "the place where
your great joy meets the world's great need." In choosing your
future life work, I hope you have tried to blend in your avocation
with your vocation. I like what musician Les Paul wrote at age 92:
Work is a privilege, the more so the older you get. It's a privilege to be able to do what you love to do and be good at it.
My hobby is my work, and my work is my hobby. That's the
secret. There is no distinction.

Eric Greitens is a former Rhodes scholar and Navy Seal,
now the governor of Missouri. His thoughts on one's vocation
mirror Les Paul's:
A master in the art of living draws no sharp distinction between
his work and his play; his labor and his leisure; his mind and
his body; his education and his recreation. He hardly knows
which is which. He simply pursues his vision of excellence
through whatever he is doing, and leaves others to determine

From Piedmont Heart Institute, Atlanta, Georgia.
Corresponding author: John Davis Cantwell, MD, MACP, FACC, Piedmont Heart
Institute, 275 Collier Road, NW, Suite 500, Atlanta, GA 30309 (e-mail: john.
cantwell@piedmont.org).
Proc (Bayl Univ Med Cent) 2017;30(2):240-244

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