Mending Broken Hearts
Cardio/thoracic surgeon, Dr. Leland Siwek’s heart for his work
“I told my third grade teacher I was going to be a heart surgeon,” says Dr. Leland Siwek. A cardiovascular/thoracic surgeon practicing at Northwest Heart & Lung Surgical Associates, Siwek has been part of the Spokane medical community for 28 years, and has been named a Best Doctor by the Best Doctors in America® every year since Spokane Coeur d’Alene Living first presented the list in 2005. An integral part of the Spokane medical community, his heart for medicine and for his patients is easy to see.
“The heart interested me,” he says of what drew him into medicine. “When I was a kid, heart surgery was just beginning; it was cutting edge stuff, so I thought it was really cool. I remember writing a paper in third grade about the different heart surgery repairs for congenital disease. My interests waxed and waned over the years, but I always came back to heart surgery and working with people.”
Siwek has always had a heart for the heart.
It was a pretty straight path for the kid from New York, who went to both college and medical school at Harvard University, with one goal in sight. “I was always really good with my hands,” he says, “so I wanted to be a surgeon. I wanted to fix things.”
After cardiac surgery training at Massachusetts’s General Hospital in Boston, one of the most sought after cardiac surgery fellowships in the country, Siwek could have gone anywhere, but a desire for a busy, high-level private practice brought him to Spokane in 1988. “Spokane has been on the cutting edge of heart surgery since the beginning of heart surgery,” he says of the attraction to a mid-sized city on the other side of the country from where he grew up. “I had no reason to come to this part of the country, but the practice and the partners attracted me.”
Siwek’s interest early on was in congenital heart surgery, working on the tiniest and most vulnerable of cardiac patients: babies. He was a go-to surgeon for congenital heart conditions for almost 15 years, before he began transitioning more and more into minimally invasive, or robotic, heart surgery, for which he is now well known around the country and sought after for his expertise. 2002-2010 were years of incredible growth in the use of robotic surgery for cardiac patients, and Siwek was at the forefront, training visiting teams from Japan, Korea and China, as well as from Texas Heart Institute, Mayo Clinic and Cedars Sinai in LA.
“Heart surgery is very effective, it does a good job of fixing things, but nobody wants it,” says Siwek. “It’s traumatic, it’s scary to people and it’s a big procedure. In general, it is worth it because of the excellent results and outcomes, but if we can make it easier on the patient to tolerate, [which robotic surgery does] it makes it more acceptable and also makes their outcomes and recovery better.”
Providence Sacred Heart, where Siwek operates, has the largest heart surgery program in the state and has been incredibly supportive in the development of the program. “Patients can get heart surgery at many facilities in the Northwest, but if they do a little research and want to have their mitral valve repaired robotically, they come to Sacred Heart,” he says.
Always seeking the newest, most effective and safest option for his patients, Siwek has expanded his skills in minimally invasive heart surgery to include Transcatheter Aortic Valve Replacement (TAVR) technologies. This enables surgeons to replace the aortic valve not with open-heart surgery, but with a catheter-delivered valve that travels up through an artery and pushes the damaged valve to the side, setting the new valve in place. Right now the procedure is limited to high-risk patients who wouldn’t be able to handle traditional valve replacement surgery, but the Sacred Heart team does about 120 of these procedures per year.
Though heart surgery in any form – open-heart, robotic or transcatheter – sounds incredibly stressful to perform, Siwek is not phased. “I have non-medical friends who always think doing heart surgery has got to be really stressful, but it is what I do,” he says. “I have stress in my job, but it’s usually not in the operating room, it’s not the actual procedure because I know I can do that. Like most of us, the things that stress me are the things I don’t control.”
One situation that does cause stress for Siwek is something that he considers one of the great challenges in his job. “The hardest part of my job is dealing with a patient I don’t think can be helped,” he says. “Having a patient who has a serious problem, who knows you are their last hope that it can be fixed— if you have to say, this is not fixable, that is the hardest thing.”
For every challenge he faces though, Siwek is well aware of the joy that can be found in his work. “It’s a cliché really, but the joy is in knowing you are helping somebody and, not always, but oftentimes, truly saving someone’s life,” he says. “A lot of the stuff we deal with is either immediately life threatening or life threatening if left untreated. Knowing you have the skill to intervene to actually fix the problem, and then have that patient send you a Christmas card 10 years later saying thank you for what you did, that really is what this is all about.”
From the baby he operated on whose arteries were on the wrong side of his heart, to the 28-week pregnant woman with an aortic dissection, who had to be flown in for emergency surgery, many of Siwek’s patients weigh on his heart and his mind, and he finds joy in being able to help them.
In each victory though, he recognizes and emphasizes that heart surgery is a team sport. “A lot of the focus gets put on the surgeon, and the skill of the surgeon is a big deal,” he says, “but there are a lot of other people involved: our Physician Assistants, the operating room staff, anesthesia and the ICU nursing staff. The whole process is complicated. One of the things I think we’ve done well here is really getting the team integrated well.”
Residents in Spokane and Coeur d’Alene ought to know how fortunate they are to have the kind of cardiac care in this area that is available, something not all communities this size have. “This has been a very well-known and very highly functioning cardiac community for many years,” says Siwek. “It is one of the reasons I came here, because Spokane already had a good reputation for that. I’ve helped enhance that reputation, but it didn’t start with me. Compared to the cardiac services that are offered elsewhere, I’m confident there is no place in the country that does it better than we do. Even the famous places people hear about all the time, we have that quality of care right here in our backyard. I think people in this region know that, but I’m not sure they always recognize what a big deal that is. The Society of Thoracic Surgeons gave us the highest ranking in all aspects of cardiac surgery – placing us in the top 1.2% of all heart surgery programs in the country. The community is fortunate to have that level of care here, both in terms of the physicians, facilities and the hospital system that is willing to invest in providing the best care that there is.”
The funny thing about cardiac physicians, says Siwek is that they spend a lot of time trying to put themselves out of business. “You’d rather patients not need your services,” he says. Particularly difficult to see are cases where a patient’s lifestyle choice has damaged their heart. “I think what we see a lot of in Spokane, that is too bad, is that a lot of people are still smoking. It is probably one of the biggest things people can do something about. It bothers me the number of young people I see out in the community smoking. Most people in their 20s and 30s think they are invincible, but we see the 50 year olds who have been smoking their whole lives. You think would have learned that by now, but it is a little disheartening that young people still smoke.”
This is the heartfelt message from the man who has devoted himself to mending broken hearts of all kind. He longs to see his patients healthy and happy.
Let’s just say he has a heart for them.
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