Thomas H. Lee, a professor at the Harvard Medical School, has written an absorbing biography of one of our premier cardiologists, Eugene Braunwald. It is a great success story, which reveals how much clinical practice and research have changed since the mid-20th century.

Eugene Braunwald was born in Vienna, Austria, in 1929. His Jewish family fled the Nazis in 1938 and settled in Brooklyn. Young Eugene was always an exemplary student, but the year he graduated from Brooklyn Tech in 1946 was the very year the newly returned veterans of World War II were entering college on the GI bill. For a New York high school graduate, especially a Jewish one, it was very difficult to get accepted at any college or medical school at that time. As the table of acceptances to New York Medical Schools, (Lee, 34) shows that Jewish quotas—as well as similar, if less punishing, Catholic quotas—were very much in force. Braunwald did get into New York University (NYU) and then, at the zero hour, into NYU Medical School, but the experience of almost being rejected was evidently painful and made him all the more ambitious. His college years, he later remembered, were not especially happy except for one thing: he met his future wife Nina Starr who was to become a very successful cardiac surgeon.

From NYU on, however, it has been uphill almost all the way. At Mt. Sinai, where he interned (and where I had the pleasure of being his colleague), Braunwald quickly emerged as one of the top interns and then as an outstanding fellow. He and his colleagues uncovered early evident of the role of inflammation in the development of atherosclerosis, but his special interest was in a new area—hemodynamics. The laboratory of André Courand at Bellevue included the beginnings of cardiac catheterization, a major turning point: in 1955, Eugene and Nina moved to Bethesda, where the newly established National Institute of Health (NIH) proved to be the promised land for medical research. “I had always felt like an outsider,” Braunwald remembers, “But when I got to Bethesda, I got a different kind of feeling, a very good feeling” (p 75). He was to stay for 13 years.

The NIH afforded unmatched opportunities. Charles Hufnagel, an innovative cardiac surgeon at Georgetown, developed the first artificial cardiac valve, a ball-and-cage apparatus. It was while working in the laboratory of Stanley Sarnoff, a cardiovascular physiologist from Harvard, that Braunwald first met an even more prominent physiologist, the legendary Carl Wiggers. Then, there was Andrew Glenn Morrow, a Hopkins-trained cardiac surgeon, who became Eugene’s mentor. In his second year at the NIH, Braunwald had met a young surgeon named John Ross: together, they achieved major breakthrough—transseptal left-sided cardiac catheterization.

The NIH offered Braunwald a long-term position, but he felt the need for more clinical training. Because he did not want to move far from Washington, where Nina was doing her cardiac surgical training at Georgetown University, he chose Johns Hopkins, one of the most prestigious training programs in the world, famous for the work of William Osler, William S. Halsted, and Helen Taussig. One of Braunwald’s major goals at Hopkins was to learn about congenital heart disease from Helen Taussig and Alfred Blalock.

But in the 1950s, medical culture at Hopkins, as Lee notes, was quite different from that at the New York Hospitals and the NIH. “My co-residents called all patients ‘Sir’,” Braunwald recalls. Formality was the rule; it went hand in hand with a lingering racism: there was, in these years, open segregation of patients on the ward by race. Until 1958, Hopkins had a segregated blood bank. These things disturbed Braunwald; then too, there were literally no days off: residents had to live in the hospital. After a productive year, he was thus happy to return to the NIH for what were to be the golden years for medical research.

This was the era of the so-called triple threat—the physician who excelled in clinical medicine, research, and teaching. The fields of cardiology and cardiac surgery were exploding. In 1958, Robert Berliner offered Braunwald the position of Chief of Cardiology at the National Heart Institute. John Ross had been a surgical trainee but became a leading cardiologist instead of a surgeon. Meanwhile, Nina Braunwald became the first woman heart surgeon, and she too was offered a position at the NIH. Soon she performed the first mitral valve replacement.

The NIH chapter details how, among the other major discoveries, Braunwald came to understand that myocardial infarction was not a bolt out of the blue; damage did not occur in an instant but was a dynamic process that played out over hours. “And he immediately began to wonder whether this dynamic process might be influenced— hugely influenced—by interventions that improved blood flow or lowered oxygen consumption. Decades of research by Braunwald (and many) others would stem from that moment.” (pp 135–136).

Bliss was it in that dawn to be alive! However, there were also tragedies. Glen Morrow had developed a surgical approach to hypertrophic obstructive cardiomyopathy. In what was a terrible irony, Morrow himself became the victim of the disease that he and Braunwald had discovered. Being a heavy smoker—these were the days when physicians still smoked!—he became very ill. Braunwald told Morrow that he had to be catheterized and undergo surgery, but Morrow refused. He eventually developed atrial fibrillation and died in 1982.

In 1967, the first human heart transplantation was performed by Christian Barnard in South Africa. A whole new era of cardiac surgery had opened. “There was this cockiness of the Kennedy era that infected us all,” Braunwald recalled (p 165). He and his colleagues had almost unlimited resources and fascinating patients. And Braunwald, as William C. Roberts, another major figure in cardiology at the NIH, remembers, “was completing a significant paper almost every week.” And he presided over the legendary Friday afternoon cardiac catheterization conference, to which I regularly brought my fellows from Georgetown. It was the high point of the week.

Still, the golden years at the NIH could not last forever. Other research centers were receiving major funding and beginning to compete with the intramural NIH program. Much to everyone’s surprise, in 1968, Braunwald announced that he was leaving to become a chairman of a new department of medicine at the University of California, San Diego (UCSD). His concern was that if he stayed at the NIH, his forties and fifties would feel like a reenactment of his thirties. Although he, Nina, and their 3 daughters were very happy in Washington, it seemed time to move on.

As someone who was also to leave the East Coast—in my own case, the University of Pennsylvania—for California (in my case, University of California Los Angeles), I wonder if founding a new department in a brand new and untested branch of the UC system was not something of a mistake. For one thing, UCSD’s medical school did not have a hospital. Difficulties with deans and provosts multiplied; although Braunwald recruited a number of stars from the NIH and elsewhere, financial troubles were brewing. Ronald Reagan, who had become the governor in 1966, started pushing for budget cuts, and as a result, the planned construction of the new university hospital was put on hold. Another major problem was that Nina’s professional situation, which had been so optimal at the NIH, was quite problematic because the chairman of surgery, who viewed Eugene as a rival, did not want Nina in his department and made her life miserable. When the chairmanship of the department of medicine at Harvard became available in 1971, Braunwald accepted it. He was to be the tenth Hersey Professor of the Theory and Practice of Physic (Medicine) at Harvard Medical School—the oldest “named” chair at an American medical school—and the fourth physician-in-chief at the Peter Bent Brigham Hospital. In 1972, 4 years after arriving at the UCSD, the family returned East. Braunwald was 43 years old.

The rest of Lee’s biography details the extraordinary leadership Braunwald has supplied at Harvard. Despite personal tragedy—Nina died of breast cancer in 1992 at the age of 64 years, just 3 months after Eugene’s beloved mother Claire passed away—Braunwald continued to be astonishingly productive and successful. What he considered his single most important research paper—the “Factors Paper,” written with Peter Maroko and published in 1971 just before Braunwald moved to Harvard, showed that the size of myocardial infarction could be modified by interventions over the next few hours. At the Brigham, the implications of this paper were brought to fruition. Braunwald created a primary care residency, one of the first in the country. And—perhaps most significantly—he followed in the steps of his idol Charles Friedberg, the author of what was to be the last American single-authored textbook of cardiology, Diseases of the Heart , and in 1978 launched the new multiauthored textbook Heart Disease . For the first edition of this Saunders classic, he wrote or coauthored more than half of the chapters.

Lee gives a fascinating account of just how Braunwald did all this work: on a 1-year sabbatical, he would begin work at about 7:00 a.m. and work 16 hours a day, 6 and 1/2 days each week for an entire year.

He would write by hand on pads of lined yellow paper, and would list articles that he would ask his research assistant to photocopy at the Harvard Medical School library. Each morning, a taxi would pick up his drafts and requests for articles, and bring them to Mary Jackson, his secretary at the Brigham… At 6:00 P.M., another taxi would bring his typed manuscript pages and photocopied articles back to [his home in] Weston.

Braunwald lived like a hermit during that sabbatical year… On many days, he did not shave. He took no vacation and accepted no invitations to speak anywhere. His research program went into hibernation. But he finished the manuscript of the book within hours of the June 30, 1979, deadline. Its release was timed to coincide with the November meeting of the American Heart Association. (pp 323–324).

Reading this in 2013, I am left wondering whether such complete dedication to the task could be duplicated in our time. When I was writing the first edition of my own The Clinical Recognition of Congenital Heart Disease in the late 60s, I also went into the monastic mode, although never quite as completely as did Braunwald. Does anyone today—in the age of the Internet—work this hard? Can major accomplishments be made without such absorption? And could someone who did not have a spouse and/or household help to cope with the necessities of daily life, do it?

It is, in any case, heartening to read about the career of such a great figure—a medical giant who, in his mid-80s, is still going strong and constantly stretching his mind. Thomas H. Lee’s account of Braunwald’s life is sober and straightforward—it is by no means hagiography—but his is a rare story of near-total success and satisfaction. It is a pleasure and inspiration to read.