John Mathai, M.D., F.A.C.S., F.A.C.C.

The 23-year-old young man arrived at midnight in Pune after a fifteen-hour train ride from Trivandrum.  He slept on a bench on the platform and awoke to someone sticking him in the side. He looked up and the policeman said, “You have a suitcase. Put your feet on top of it so  no one will steal it.”   He left the station and thought, “What have I done now?"  His appointment was in a few days.  He washed up and walked into the main parking area of the busy Indian railway station.

Coastal SW India

With no hotel reservations, he looked around.  He spotted a priest and thought to himself, “He must be an honest guy.”  He went up to him and told him that he was there for an interview and was looking for a place to stay for a few nights. The priest said he had a friend at the university who could give him a room. He was instructed to take a bus and to meet him at a specific stop.  It was very hot, and, after arrival, the young man looked around anxiously for the priest and waited, and was relieved when he finally saw him on his bicycle.  

Lodging at the empty school was arranged (it was summer) and he was told where he could get his suit pressed.  He did what was suggested and he had the interview.  With a “first place” in surgery and “second place” in medicine he was, of course, selected.  He would go to the States for a general internship at Somerset Hospital in Somerville, New Jersey.
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John Mathai, M.D.

Dr. John Mathai was that young man with dreams. He finished medical school in lush Kerala on the southwest coast of India in 1962 and decided to go into surgery like his father, a tuberculosis specialist. The hope was to leave India and study and practice in Great Britain where he could learn from the best, and be one of them. He would be a Fellow of the coveted Royal College of Surgeons.  

That would be nice, but he didn’t have the right contacts.  However, he could first get to the U.S. through an Indian foundation and then go to England from there. Thus, the preceding little story.

Yet, arranging the trip to New Jersey was not so simple. India was at war with China and doctors were being denied passports; maybe he would have to stay.  But “someone with money,” noted Dr. Mathai, petitioned the Supreme Court, and it was decided that “it was everyone’s right to get a passport.” He did that and was on his way.

With the help of the then-current “Fly Now; Pay Later” program (this was before credit cards, so we can all “fly now and pay later” ), and a split ticket, he left Bombay.  He flew from there through Cairo to Rome on TWA, and then to New York City on Pan Am.

With the help of his cousin who worked for the Federal Reserve Bank, he had filled out the proper governmental forms so he could take money out of the country for travel. How much did he have with him? Why, the maximum, of course...75 rupees (about fifteen dollars!).  And one flimsy suitcase.

Approaching New York in winter the pilot announced,"Even with snow on the ground we will be landing on schedule."  Dr. Mathai was puzzled at first and didn’t recognize the last word since he was used to the British (and Indian) pronunciation of it as “shedule.”  Was “Skedule” another city? He thought for a moment and then understood.  

More connections…

A sign held up by an airline employee alerted him that the assistant director of the hospital was there to greet him, and he was ready. Walking through the terminal together to get to the car they came upon an escalator.  Having not seen “this animal” before he was baffled as the moving steps appeared and disappeared. Dr.Mathai said, “I watched how these guys got on this thing and I got up my courage and stepped on.”   He was a quick learner.

Mumbai, not N.J.

The director drove through New York City and Dr. Mathai witnessed some of the things he had read about while he was in India, and that was fine. But the most impressive sight by far was the scene when they got to the turnpike.  He was utterly “amazed” by the orderliness of the traffic, with all the cars in a line, and all going in the same direction!  This was not the chaos that he felt in India.
   
After the internship year in Somerville his plan was still to go to England, of course.  So, at a camera shop just off Times Square, he bought a fine Voightlander (he still cherishes it) to preserve his memories of being in America.  Of being in a country where, he noted, “Everything works.”

As it turned out, though, Dr. Mathai didn’t leave after his internship.  There were four years of general surgery at Albert Einstein Hospital in Philadelphia,“York and Tabor,” (where I, the writer, just happened to have been whelped).  He then needed to specialize, and first considered neurosurgery; it was fascinating, but too “depressing.”  But “somehow” he was “attracted to Dryden Morse” a heart surgeon at Hahnemann who had worked with Dr. Charles Bailey (“the father of direct heart surgery” according to Dr. Denton Cooley).   

Pioneer: Dr. Favorolo at Cleveland

Dr. Morse took a special interest in Dr. Mathai and mentored him in the exploding field of open heart surgery in the mid-1960s. The young surgeon considered going to the Cleveland Clinic next, where bypass grafting was being perfected, but was convinced instead to pursue his passion at the university level, and he planned to go to the University of Maryland with the renowned trauma innovator Dr. R Adams Cowley.

Not so fast, buddy boy!  This was the time of the Vietnam Tet Offensive in 1968 and Dr. Mathai was called to serve his new country. He passed his perfunctory physical (”Can you see? Can you walk?”) at the Draft Board in Philadelphia and was ready to go to war, but Dr. Cowley “needed” him in his program.  He pulled strings and used his military contacts and, as a result, Dr. Mathai was able to start his Thoracic Surgery residency.

After completing that grueling program Dr. Cowley steered him to York where he joined the staff in 1970.  He  started work ominously (he felt) on August 6th, “the date of Hiroshima,” and soon realized that he was, in his words, “the only foreigner” on the clinical medical staff, and that “nobody looked like (him).”

Surgical Team in Cleveland

He quickly fit in, however, and was urged by Dr. Jack Gracey (of Cardiology) and Paul Keiser (the CEO of the hospital) to start a full cardiac surgery program.  This had to be approved by the medical staff but they were bitterly divided and needed to be convinced. So Dr. Mathai took a fellowship at the Cleveland Clinic where he met Dr. Joe Hooper.  They became friends and decided to work together to start things in York.  With chutzpah, they brought the Clinic’s Cardiac OR nurse manager, and the capable Physician’s Assistant working with her, to the York Hospital.  The plan was to “duplicate exactly” what was done in Cleveland, and the program here began in 1975.

Two Types of Bypasses

The team was very careful in selecting patients, and the statistics for the first year were excellent.  The service then continued with several other surgeons (including Drs. Peter, Levin, Fried, Haupt., etc.), and Dr. Mathai practiced open heart surgery at York day and night until 2007 when the health system changed.  He then did cardiac procedures for several productive years at  Holy Spirit Hospital in Camp Hill and Pinnacle in Harrisburg with Dr. Brad Levin before unforeseen circumstances forced him in another direction.  After a few months, he started a practice limited to vein surgery, and he enjoys seeing patients even now. 

Dr. Mathai returned to India several times a year for 30 years to work with a Hindu charity, and for the last 20 he went to private hospitals, mostly the Kerala Institute of Medical Sciences.  He has seen many changes over the decades and notes that the facilities in his homeland are now comparable “and sometimes a little better” than hospitals here.

Today, at 79 (that’s correct), Dr. Mathai can look back at his own career and see the history of coronary artery bypass graft surgery.  The first successful CABG was done by Dr. Robert

Goetz (from Frankfurt by way of South Africa) on May 2, 1960, at Albert Einstein in New York.  Unfortunately, his “colleagues were violently against the procedure” and, as a result, he was not permitted to further pursue his exciting technique (the actual artery-to-artery anastomosis itself took...are you ready?...17 seconds!).  

Time passed before Dr. Rene Favorolo (a fiery Argentinian) at the Cleveland Clinic did the first aortocoronary bypass using the patient’s own saphenous vein as the donor vessel in 1967, and by 1970 he and his colleagues had performed more than 1,000 such procedures.  

A Robotic Procedure

Surgeons throughout the United States adopted this technique and have been modifying and perfecting the operation ever since. The number of bypasses performed yearly in the U.S. peaked in 2000 at around 500,000 and has steadily declined since as advances in coronary stenting (by clearing the blocked artery from within rather than going around it)  and preventive therapies (to halt progression or even reverse some of the plaque build-up) have appeared. In fact, coronary artery bypass grafting is now often done robotically, without the need to split the sternum, without the need to open the chest, without the need for the surgeon to touch the patient.  

When It's Over...

Over his nearly 40 years practicing heart surgery, Dr. Mathai has seen and done much as he has been part of and has adapted to changes in medicine.  As stated by the Nobel Laureate cardiologist Dr. Bernard Lown, "No doubt what one does is largely the result of who one is." This is clearly so for the resourceful and resilient Dr. John Mathai who noted that change is woven into the fabric of life, that the trace of the heart’s rhythm changes moment to moment, until one day it doesn’t.

Complex open heart surgery and, specifically, coronary artery bypass, like all significant medical interventions, has been the product of the prodigious talents and sustained efforts of many dedicated individuals. Individuals whose path may not be a straight line, and whose journey may start in a faraway land, on a train platform, in the dark of night.  

We thank them all.