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Robert Michler, M.D., '81: Captain of the ship

By Jennifer Durgin

Dr. Robert Michler's headlamp keeps slipping out of place. It may seem a tiny matter in this high-tech operating room, but the light needs to be at exactly the right angle to illuminate the area of the heart he's operating on. Each time the lamp shifts, he carefully adjusts it again with a surgical tool he keeps nearby just for that purpose. So when the cardiothoracic surgery fellow assisting him leans a little too close and bumps Michler's lamp with his head, Michler scolds, "Come on. You've got to be careful about hitting my light. . . . Look at the monitor."

Everything that Michler sees is being filmed by a small camera on his headlamp and projected on a monitor above the operating table. There's not enough room for two people to peer into the body cavity itself at the same time, but the monitor provides a magnified view of the fine, delicate movements of Michler's scalpel as he cuts away thickened muscle from the interior of the patient's aorta.

The patient, a man in his mid-fifties, has multi-vessel coronary artery disease (a condition that reduces the flow of blood to the heart muscle), a thickening of the heart wall (a condition called idiopathic hypertrophic subaortic stenosis), and several blockages in the heart itself. After Michler carves away excess muscle tissue from inside the man's heart and aorta, he and the surgical fellow will perform a quadruple bypass. A vein taken from the man's leg will be used to create four alternate routes for blood to bypass the clogged portions of the coronary arteries and flow into the heart tissue. It's a complex case but a typical one for Michler, who is chair of cardiothoracic surgery at Montefiore Medical Center in the Bronx.

"There is nothing in the field of heart disease and heart surgery that I haven't seen or dealt with," he states matter-of-factly. "That is a wonderful place to be in one's career. There is nothing that I can see today that would surprise me or throw me for a loop. That's great for patients. [And] great for my team, because they learn."

Nearly all of the cardiothoracic (CT) surgeons currently at Montefiore trained under Michler at some point during their careers and have come to the institution since Michler arrived there in 2005. Knowing the capabilities of his team so

DMS graduate Robert Michler, chair of cardiothoracic surgery at New York's Montefiore Medical Center, is all business in the OR but all heart underneath.

well is "huge," he says. "I know what will happen at 2:00 or 3:00 in the morning . . . when all hell breaks loose." When asked whether his superiors are concerned about the almost complete turnover of CT surgeons since his arrival, he gives a coy smile and quips, "The good news is I am my superior," as if to say he takes a buck-stops-here, captainof- the-ship responsibility for his work. But Michler actually has two superiors: the CEO of the medical center and the dean of Albert Einstein College of Medicine, the primary medical school affiliated with Montefiore.

Although direct and brusque in the operating room, Michler is warm and engaging when he's talking with colleagues, leading a meeting, advising a patient, or chatting with a potential trustee of the medical center. His boyish face, friendly manner, and broad smile temper his take-charge personality and towering six-foot-four frame. (He usually operates barefoot; otherwise, he explains, it's hard to get the table high enough.) He can be humble, too. "I have been given a gift," he

says, while scrubbing his hands and forearms outside of the operating room. "I love what I do." Being a surgeon gives "me an incredible sense of being able to make a difference every single day."

By any measure, Michler does make a difference in the world—a huge difference—in the lives of the 300 to 400 patients a year on whom he operates, in the research projects that he leads, and in a nonprofit called Heart Care International that he founded with his wife, Sally, in 1995. Each year, Heart Care International sends 150 heart surgeons, nurses, perfusionists, and other specialists—along with 15,000 pounds of equipment—to impoverished countries to perform cardiac surgery on children.

Humanitarian work is not usually associated with "the high-powered field of heart surgery," Michler notes. "Yet what I've found is that there are many, many people who are interested in this sort of work at all levels and are committed to doing it. They just

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Jennifer Durgin is Dartmouth Medicine magazine's senior writer.

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