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Dr. Antonio Cabrera checks in on a tiny patient in Le Bonheur's pediatric ICU.

In 1970s Guatemala, premature babies weren't given a high prognosis for survival, but there was one baby, Antonio Cabrera, who had a strong will to survive.

This newly hired medical director of the upcoming cardiovascular ICU at Le Bonheur Children's Medical Center has come a long way from his days as a sickly child.

In Guatemala, high school graduates who decide to become doctors enter an eight-year medical school program directly after high school. Cabrera became inspired by the work of his great grandfather, who was a National Institute of Health director. They never met because he died at the age of 56 from a myocardial infarction. As a result, his great grandfather's research and untimely death were part of the fueling motivation for Cabrera to pursue cardiology.

Music was the other part. Cabrera's parents both strummed classical guitar as a hobby, but it was his mother who taught him to play. She gave him a love for how music initiates feeling, which fostered a talent for singling out the intricacies of sounds.

"I was fascinated by music," Cabrera said, adding that he plays music by ear. "I was fascinated by the fact that I could hear things other people didn't have much of an ear for. The flow of (music) is so soothing and it's the same when you listen to patients, listen for murmurs. You have to get a sense for timing, a sense for tone."

At 17, Cabrera, now 33, entered the Facultad de Medicina de la Universidad Franciso Marroquín in Guatemala. That program, he explained, was very different from American medical schools in that students took an active role, early on, in assisting with procedures, plus spending six months in every subspecialty. This is where he was exposed to the realities of a struggling country.

"We had one or two pediatric cardiologists in a hospital that had 1,000 beds, which is the only pediatric hospital in that part of the region," Cabrera recalled, noting it was in the middle of his medical school training that he decided upon pediatrics. "A lot of kids didn't have heart surgeries. You saw patients dying all the time."

His first fellowship was in critical care cardiology in the department of pediatrics at Rainbow Babies and Children's Hospital in Cleveland, Ohio. There, he modeled his work after cardiologist Dr. Joel Liebman, who was obsessed with a stethoscope. He could make diagnoses without any outside help, and today, Cabrera wears Liebman's stethoscope around his neck.

When Cabrera leans in on a tiny patient and puts the stethoscope up to her chest, he closes his eyes and takes a long listen to the music her heart is playing. He explains it as dissection with the stethoscope.

"First you get a sense for timing, like a metronome," he said. "Everyone gets seduced by the murmur, talks about the murmur. I listen for the first heart sound, if it's loud or not, if it's split or single." He continues this method with the second heart sound, and possibly the third and fourth.

"Does it change with inhalation or exhalation?" he continued. "If there is a murmur, I listen to the murmur after I do those things because it's so easy to get seduced by the (noises) that are louder. I try to define, every time, the frequency — high, medium or low? — and rate and listen for murmurs everywhere else. There is much more information than just a murmur."

Dr. Cabrera's next fellowship was at Arkansas Children's Hospital in Little Rock, where he honed specialized skills in cardiac intensive care with the help of a valued mentor. When his fellowship came to an end, he had to make a decision. It so happened that Le Bonheur's new director of pediatric cardiothoracic surgery, Dr. Jeff Myers, asked Cabrera to interview for the position as medical director of the newly established cardiovascular intensive care unit.

"I came and interviewed and realized, because I reviewed the history of the cardiac program and it had been through so many transitions, that I could assist the hospital and assist the patients in a way that would provide a new milieu for the patients to be taken care of," he explained. "I can provide a little bit extra expertise, and also, it's combining all the resources into one area in which we have residents and fellows who train more in cardiac."

Le Bonheur's commitment to galvanizing the cardiac program, along with the high mortality rate in the Delta, became the deciding factors for Cabrera.

"This task is a dream for anybody who feels some degree of civic responsibility," he added.

His goals for the new CVICU are to help integrate all the services and empower everyone at the bedside. He said Myers and the staff understand what it takes to make the CVICU a top quality facility.

"We need to have concentrated expertise in a well defined area with defined people," he explained. "It also makes for the role of accountability better and tracking down and keeping numbers and having statistics and a real quality improvement process.

"(Le Bonheur's) value of having an institution to define a vision of commitment is what matters the most. I can be individually committed and I wouldn't take the program anywhere."

Before the unit is ready, now is the time, he explained, when he and the cardiac staff will be spending time at bedsides in the pediatric ICU to inform people of the new services and try to instill an integrated CVICU way of thinking. Ultimately, his vision is for Le Bonheur to be a place where kids from all the surrounding areas can be treated for any cardiac disease, surgery or not.

Cabrera remains humble about his career and doesn't take his talent for granted. The families of these sick children deeply trust and support the work of the cardiac team, even when things don't go as planned, and that keeps him grounded.

"As much as you want to feel great about saving somebody, you were just allowed that day," he said. "It makes you see how little you are. You would be blind to say it's not in God's hands. You've been given some talent and you have a responsibility to use it."


February 2007

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