There’s no question that heart surgery is an art form, but Vanderbilt’s David Bichell, MD, has taken that to a new level. The chief of Pediatric Cardiac Surgery for Monroe Carell Jr. Children’s Hospital at Vanderbilt is an accomplished surgeon, professor and medical illustrator, and he uses all those gifts to educate and inspire patients and staff.
Art & Medicine Collide
Bichell graduated from Columbia University’s College of Physicians and Surgeons in 1987. As a post-graduate, he worked his way up to chief resident in cardiac surgery in pediatrics through Harvard Medical School at Boston’s Brigham and Women’s Hospital and at Harvard’s Children’s Hospital. But the road to medicine was a winding one for the Maryland native. As a fine art major at Johns Hopkins University, Bichell stumbled across the school’s medical illustration class and soon became the program’s only undergrad. “The program included an overlap of curriculum with medical students, and I thought, ‘what a funky and odd and esoteric thing to be doing,’” Bichell recalled.His medical path narrowed further when asked to illustrate pediatric heart transplantation for a textbook publisher. “I watched this surgery that few people get to see, and I thought, ‘Well this is the coolest thing,’” Bichell said. “You’re doing a highly technical, demanding and exhilarating operation that few can do and turning this child into a possible Olympic athlete. What can possibly be better than that?”
The Road to Nashville
Bichell trained and remained on staff at Boston Children’s Hospital, where he immersed himself in the elite field of pediatric congenital heart surgery. That path led to appointments in cities including San Diego, Chicago and Boston before landing in Nashville in 2006.“Vanderbilt seemed like an extraordinarily collaborative and civilized gem of a place, with the entire spectrum from basic science to clinicians working collaboratively in a scientific enterprise that’s top in the country for NIH funding,” Bichell said. “There had always been a strong cardiology program thanks to (division chief) Scott Baldwin, MD, and (former chief of cardiology) Tom Graham, MD, and I attribute much of the strength of cardiology here to what they’ve built.”Fast-forward eight years, and Vanderbilt’s pediatric heart program boasts some of the best outcomes in the country. Arterial switches, hypoplastic left heart operations and heart transplants are among the more common procedures accounting for some 500-plus operations each year.
Beating the Odds
Bichell said patients with hypoplastic left heart syndrome typically have a 75 percent survival rate, with 85 percent survival considered rare. In 2013, Monroe Carell Children’s Hospital saw a 100 percent survival rate among these patients. “After 25 years, we’ve honed things down to the finest they can be with a team of specialists who live and breath pediatric heart surgery,” Bichell explained. “That’s what you have to have to get those kinds of outcomes. This also speaks to the teamwork here. There’s not one individual who accounts for the success of that. It truly is a coordination of services, from intensivists to anesthesia.”
Advances in Heart Transplantation
While the hospital averages 10 pediatric heart transplants each year, Bichell said advances in medication and technology, such as ventricular assist devices, mean more patients are living longer, more productive lives without surgery. “We’ve seen so much success in ‘destination therapy’ that it may be the future of heart replacement,” Bichell said. Still, the majority of technology is developed on the adult side, and Bichell noted the innovation required to adapt those tools to the pediatric realm is much more complicated. More than half of the program’s surgery patients are under a year old, and a quarter are younger than one month.“In the past, the success of transplant was hinged on cardiology … and it still is … but an awful lot of advances are on the surgical and technical sides, which is where change is taking place,” Bichell said. “It’s become a big segment of what we do.”Bichell and his research team also participate in multi-center clinical trials, and the surgeon has created a heart tissue bank to help researchers better understand the genetics behind pediatric heart disease and abnormalities.
Healing through Art
Through it all, the father of five continues to draw. While his images have been published in countless journals and textbooks, Bichell’s most enthusiastic fans are his patients. “I’ve really gained appreciation for the adage that a picture is worth a thousand words,” said Bichell, who carefully sketches each patient’s heart condition while explaining the diagnosis for patients and families. “Unless someone’s in the medical field, it’s hard not to lose them within a few minutes. If you can make a drawing as you’re talking, it’s amazing how they get it and appreciate it.” Families have asked Bichell to sign his drawings, commissioned him for projects and have even turned his drawings into tattoos to commemorate their child’s surgery.“There’s a great appreciation for it among colleagues and patients … and more importantly, it lets me convey information in a way few people can,” concluded Bichell.