Reflections upon receiving a Lifetime Achievement Award

“Behind every great man is a wife rolling her eyes.” —Jim Carrey

Several years ago, I was fortunate to receive a Lifetime Achievement Award from the Georgia chapter of the American College of Cardiology. I was asked to reflect upon some highlights in my 46 years as a heart specialist. I’ll begin with my family history.

FAMILY HISTORY

My grandfather, William Hamilton Cantwell (Figure 1), was the youngest son of an Irish sharecropper (who was rendered homeless during the potato famine of the late 1840s and somehow made it to Wisconsin). After brief jobs as a postman and a druggist, Grandfather enrolled in Rush Medical School. He was in the class ahead of James B. Herrick, the first to describe coronary thrombosis as the cause of many heart attacks and to observe sickle cells.

Figure 1.

My grandfather, William Hamilton Cantwell.

In 1888, his first year of practice, Grandfather became the manager and team physician of the local baseball squad (Figure 2). The team presented him with an inscribed gold-headed cane, which I later passed on to our son, Ryan, when he became a team physician for the Atlanta Braves.

Figure 2.

Grandfather as manager and team doctor for 1888 baseball squad.

After 50 years of medical practice (including the first 20 in the horse-and-buggy era making house calls in sometimes sub-zero weather), his hometown of Shawano, Wisconsin, wanted to honor him for his service. Grandfather was close to 80 then, the same age I am now. He initially refused to participate, stating that he was only doing his job. His three doctor sons made him attend, however, and he thoroughly enjoyed visiting with many of the 2000 babies he had delivered and countless others he had treated through difficult times, including the flu of 1918, a world war, and the Great Depression of 1929.

I initially thought about rejecting my honor, agreeing with my grandfather about just doing what I was trained to do. However, when my wife, Marilyn, heard the occasion included a complimentary presidential suite at the Ritz-Carlton Oconee, she vetoed that.

EARLY YEARS

My mother was a former nursing supervisor and my father a physician, so I grew up in a medical household and observed the joys and challenges the profession offered. When I graduated from Northwestern Medical School, Dad gave me a used red 1965 Ford Mustang convertible (Figure 3) as a present. I often wish that I still had that car.

Figure 3.

My father, Arthur Cantwell, and me, with my medical school graduation gift.

At Northwestern, I began a long habit of jogging on the nearby track. A seed was probably planted in a lecture by Jeremiah Stamler, extolling the importance of preventive cardiology. I later devoured his book on this topic, which I find still appropriate 50 years later.¹

During a 2-year medical residency at the Mayo Clinic, I needed to do a research project. Aided by several attending physicians, I decided to start an outpatient cardiac rehabilitation program, mainly to see if a year of supervised exercise would enhance coronary artery collateral circulation based on pre- and postcoronary angiograms. We weren’t able to demonstrate that but did observe a number of subjective and objective benefits from the program, such that it still exists 50 years later.

After Mayo came a year of cardiology fellowship under Gene Braunwald in San Diego. I met a young member of his faculty, Jere Fletcher, MD, who would be returning to Atlanta as I would at the end of a year—he to become program director of internal medicine at Georgia Baptist Medical Center and I to serve 2 years in the Public Health Service, as an internist-cardiologist at the Atlanta Federal Prison.

I stayed in Atlanta after the military service to complete my cardiology fellowship under J. Willis Hurst, MD, at Emory. On our first day, Dr. Hurst asked the new fellows to stand and state where they had just come from. It was an impressive array—places like Harvard, Duke, Johns Hopkins, etc. I was last. I stated that I had just gotten out of the federal prison. Everyone laughed, thinking that I was joking.

In 1970, reunited with Dr. Fletcher in Atlanta, we toured the Georgia Baptist Medical Center together and noticed the wonderful gym and swimming pool, built for the School of Nursing and underutilized. We decided to start an outpatient cardiac rehabilitation program, based on the Mayo model. It became highly successful over the ensuing years, with as many as 225 patients on the active roll (Figure 4). A recent article indicated that such programs have a class 1 recommendation for many cardiac conditions.²

Figure 4.

Cardiac rehabilitation at Georgia Baptist Medical Center.

In 1972, aided by a sports orthopedist and a businessman, I opened a preventive cardiology clinic in Atlanta, building upon Dr. Stamler’s teachings. The office was located in a Howard Johnson motel near the Atlanta Braves baseball stadium (Figure 5). I was promptly called before the local medical board because someone had complained “that some guy was doing exercise treadmill tests in a motel.” After explaining who I was and what I was doing, the board seemed satisfied.

Figure 5.

Preventive cardiology clinic.

We had few patients to begin with. One day I received a call asking if it were possible to get an appointment to see me. I asked why they thought I was so busy. They responded that they had checked in the yellow pages of the phone book and saw that I was the only cardiologist listed in Atlanta. The combination nurse-office manager that my sponsor hired had put an ad in the yellow pages, without my knowledge, something that was frowned upon back then. I reassured the patient that I would be happy to see him and that there were a number of other cardiologists in the area.

My office visits cost $15 then. One lady always wrote her check for $20. I asked her why. “I pay $20 when I take my dog to the vet, and I’m not paying less for my own care” was her response.

My phone number was listed in the regular directory. One day a patient called a J. D. Cantwell and heard an unfamiliar voice. “Are you the doctor,” my patient asked. “Sort of,” was the response. “What do you mean by that?” “I’m a tree surgeon.”

A BRAVES TEAM DOCTOR

In 1976, David Watson, MD, was doing the Atlanta Braves internal medicine care by himself, along with keeping up with his busy medical practice. We had become friends through the Atlanta Clinical Society, so he asked me to join him. I did so and for the next 41 years enjoyed the run of 14 straight postseason appearances and the opportunity to work with six future Hall-of-Fame members, including Greg Maddux, John Smoltz (Figure 6), Chipper Jones, Tom Glavine, Bobby Cox, and John Schuerholz.

Figure 6.

With (a) Greg Maddux and (b) John Smoltz.

Other highlights included annual spring training visits with my son, Ryan, and later grandson Cameron (Figure 7). The World Championship in 1995 was a family affair. It was especially fun for me to share the team physician job with Ryan for the past 15 years of my tenure.

Figure 7.

(a) With son, Ryan, and grandson Cameron at Braves spring training. (b) With Ryan when Braves honored our years of service.

Georgia TECH

In 1980, athletic director Homer Rice, basketball coach Bobby Cremins, and football coach Bill Curry asked me to screen freshman athletes at Georgia Tech for any underlying cardiac problems. In 38 years, we screened a variety of athletes, the largest being 6′8″ tall and weighing 360 pounds (Figure 8). The only problem is that each year I am a year older and the athletes are always age 18.

Figure 8.

Examining a Georgia Tech athlete.

I have only had to reject two athletes from competition all those years, one because of hypertrophic cardiomyopathy and another due to asymptomatic myocarditis (later documented on a cardiac magnetic resonance imaging scan). One other athlete was found dead in his dorm room. An autopsy revealed a heroin overdose.

PROGRAM DIRECTOR IN INTERNAL MEDICINE

When Dr. Fletcher resigned in 1982, I took his place and held that post for 11 years, until I stepped down to become the chief medical officer for the 1996 Olympic Games. I thoroughly enjoyed working with the residents and tried to give them a more complete education by including such things as a classic-a-month reading list and cultural enlightenment lectures, ranging from classical music to art appreciation. We also created a Chekhov Society, named after the Russian physician, author, and humanist, to encourage medical volunteer experiences such as helping the homeless. Six of my residents went on to become cardiologists.

OLYMPIC MEDICAL EXPERIENCE

I received a call from the Atlanta Committee for the Olympic Games in the early 1990s, requesting my resume. They didn’t indicate why, and I didn’t ask. Several months later I received another call from committee member Morris Dillard asking if I would be a co-chair of the new Olympic Medical Support Group. The other co-chair was Dr. James Goodman, president of the Morehouse Medical School. Our task was to coordinate the effort to build a medical staff that would take care of the 10,000 athletes and the 1.5 to 2 million spectators. We would become members of the International Olympic Committee’s Medical Commission and attend the three Olympic Games preceding Atlanta’s to learn the ropes.

We both went to Albertville, France, for the Winter Games in 1992. Shortly after, Dr. Goodman resigned, as he was accepting a job in another state. Bill Cleveland, MD, was later appointed as his replacement. In 1994, I was asked to become the chief medical officer. It was a great experience, working with an outstanding team of medical volunteers. Among their brightest moments was during the Centennial Park bombing, where they efficiently evacuated (as we had rehearsed) the 110 wounded to area emergency rooms within a 30-minute period.

I couldn’t resist, at one of the venues, standing on the victory podium (Figure 9), watching the American flag hoisted to the top level and trying to feel some of the joy Olympic champions experience.

Figure 9.

Me on the Olympic victory podium.

CARDIOLOGY OF GEORGIA

I knew that my job status at Georgia Baptist Medical Center would be in jeopardy after the Olympics as I had given up the residency program director’s position. With the assistance of Drs. Charles Wickliffe, Joe Wilson, Jr., and Allen Dollar, I joined the Cardiology of Georgia group at Piedmont Hospital. (The group has since become the Piedmont Heart Institute.) This has been the single best thing that has happened to me as a physician. It greatly expanded the scope of my cardiology cases and surrounded me with excellent colleagues. I learned as a youth the merits of being a member of championship basketball teams and realize that medicine is the ultimate team sport, relying on the skills and interaction of talented medical personnel.

MORE RECENT HIGHLIGHTS

In 2011, my wife Marilyn and I made a medical mission trip with the Flying Doctors of America to the Himalayan Kingdom of Bhutan (which has a goal of gross domestic happiness). One cardiologist serves the whole country of 800,000. Two years later we made a similar trip to Cambodia, in the region of Angkor Wat.

In 2014 I served as the team medical doctor for the Major League baseball all-star squad that competed with the Japanese all-stars (including teenage superstar pitcher-outfielder, Shohei Ohtani). Games were held in Osaka, Tokyo, Sapporo, and Okinawa. Our team included future world series MVP Ben Zobrist (of the Cubs) and the 2017 Sports Illustrated Person of the Year Jose Altuve. Our ambassador to Japan, Caroline Kennedy, hosted both teams in a reception at the US Embassy.

MEDICINE AS A PROFESSION

Physician-author William Carlos Williams captured some of the essence of medicine as a wonderful profession when he wrote:

It’s the humdrum, day-in, day-out, every day work that is the real satisfaction of the practice of medicine; the million and a half patients a man has seen on his daily visits over a forty-year period of weekdays and Sundays that make up his life. … The actual calling on people, at all times and under all conditions, the coming to grips with the intimate condition of their lives, when they were being born, when they were dying, watching them die, watching them get well when they were ill, has always absorbed me.³

He went on to conclude that “medicine was the thing which gained me entrance to these secret gardens of the self.” F. Scott Fitzgerald also alluded to this when he wrote of “privileged glimpses into the human heart” (both literally and figuratively).

In my case, medicine has taken me into the locker room of the Atlanta Braves, to prison hospital cells, to Olympic sports medicine clinics, to homeless health centers, and to medical mission experiences in countries like Bhutan and Cambodia, but mainly it has involved the care of common, ordinary, rock-solid people who simply trust in my ability to help them. I treasure each and every experience.

RETIREMENT

When should a physician decide to retire from active practice? It is a personal thing, I guess. As long as one enjoys it and can do the job well, he or she should persevere.

I once spent part of a day with Leila Denmark, MD (Figure 10), still practicing pediatrics at age 100. I asked her how much longer she planned to work. She turned to me and stated, “This isn’t work! Work is something you have to do. I don’t have to do this.” It was an epiphany for me, as I realized that with what my prudent wife and I had saved, I really didn’t need to keep working either.

Figure 10.

Leila Denmark, MD.

J. Willis Hurst, MD (Figure 11), who taught so many of us at Emory, was once asked by a cheeky medical student how much longer the 88-year-old planned to keep working. His response: “Son, I’m going to keep working as long as my memory is better than yours.”

Figure 11.

J. Willis Hurst, MD.