by Sam McElwee, MD, Chief Cardiology Fellow and CMR 2014-2015

My introduction and interest in cardiology came during my first year of medical school at UAB however, it was during the second year, when I was introduced to Dr. Robert “Bob” Robichaux, that my love for cardiology began. Dr. Robichaux served as my Introduction to Clinical Medicine preceptor and was responsible for teaching the basics of history-taking and the physical exam. We met on a bi-weekly basis and after our first few sessions, I began to notice a pattern. The beginning of our meetings were spent discussing LSU and Alabama football, his love being the Bengal Tigers and mine the Crimson Tide. The middle was focused on what we were actually assigned to talk about. The end, and usually where we spent the most time, was devoted to any and all aspects of cardiology. I was amazed and inspired to see Dr. Robichaux’s excitement as we inundated him with questions about auscultatory findings or quizzed him on the nuances of a cardiac-focused history. In seeing how much he loved his chosen field, even after 25 plus years of practice, how could I not love it as well? Our interactions over the course of that year solidified my passion for cardiology and also served as the foundation for my desire to become a clinician educator.

I was fortunate enough to be able to stay at UAB for my Internal Medicine residency and it was during that time that I discovered how much I enjoyed taking care of critically ill patients. I found a strange sense of calm and fulfillment during my time in the intensive care unit (ICU). Not only did I enjoy the procedural aspects of the unit months, but I also appreciated the challenge of the acutely ill patient and the personal satisfaction that came from caring for some of the sickest patients in the state. In addition, I found a strong sense of purpose in helping guide patients and families through some of the most trying times in their lives. In my second year of residency, one of the cardiology fellows sent me an AHA Scientific Statement by Morrow et al entitled “Evolution of Critical Care Cardiology.” As I read it, I knew I had found what I wanted to do with my life. 

The concept of the Coronary Care Unit (CCU) was established in the early 1960’s with the purpose of continuously monitoring patients in the post myocardial infarction setting and to quickly react with CPR and closed chest defibrillation when needed. As time went on, the unit’s philosophy changed from being reactive to proactive, trying to foresee and prevent adverse events in post MI patients.

Over time, the demographics of the patients cared for in the CCU have changed. Patients are increased in age, usually plagued with more comorbid conditions, and are admitted with more non-cardiac critical illnesses than in years past. As a result of this demographic shift, the modern day CCU now shares more similarities with a medical ICU. In addition to the ever-changing patient population, the tools we have at our disposal to care for patients have continued to evolve. The advancements in coronary reperfusion therapies, hemodynamic monitoring tools, mechanical circulatory support, and percutaneous technologies for valve replacement and repair have revolutionized the field of cardiology. But as these tools have provided us with more ways to help our patients, they have also substantially increased the complexity of our practice.

This combination of increasingly complicated patients and complex technology necessitates an evolution in the physician as well. Accumulating evidence suggests that ICU outcomes improve when critical care is provided by specially trained providers. Therefore, just as our patients are evolving, so should the training of those that care for them. To this end, I have chosen to do an additional year of training in Critical Care Medicine at the close of my Cardiology fellowship. My goal is to continue to work to obtain the skill set and perspective I need to best equip myself for the challenges I will encounter in the ever-changing face of the contemporary Coronary Care Unit.

I am very fortunate to have had the privilege to train at UAB for my entire medical career. The mentorship and support I have received from my peers and attendings are the very reason that I am here today. The Department of Medicine as well as the Divisions of Cardiology and Pulmonary & Critical Care Medicine have been instrumental in allowing me to pursue my goals of training as a cardiovascular intensivist. I look forward to my additional year of critical care training at UAB and have no doubts that I will emerge ready to help our institution continue to evolve and continue to provide excellent care to its patients with cardiovascular disease.