For Michael Carboni, MD, the call to medicine was a multi-step process but his specialty interest was always cardiology beginning in dissection labs in high school and college. In this week’s faculty spotlight, Carboni talks about his love of technology, engineering and biological sciences; how he most enjoys his work when the art and science of medicine come together to help make kids’ lives better; and his passion for racing anything with 4 wheels, an engine, and a steering wheel.
How long have you been at Duke?
I have been at Duke for just over 22 years. I started my fellowship here in 1994 and became junior faculty in 1999 (yes, I did a 5-year fellowship by choice, thank you very much). I did that until 2002 when I left to work in a program with world renowned congenital heart surgeon, Dr. William Norwood. I returned to Duke in 2004 and have been here ever since. Duke has a way of drawing you back.
How did you decide to come here?
My wife and I had friends living in Apex, that’s 1989 Apex when Interstate 40 was only a 4-lane highway (and you think traffic is bad now). I spent a month doing a nephrology elective at UNC, and we fell in love with the area. When I decided to look for a pediatric cardiology fellowship, Duke had recently recruited some of the most prominent faculty in the country and had become one of the strongest fellowship programs. The philosophy of the program, the hands-on-learning, and the expert faculty were just what I was looking for. All qualities that still exist in the program today (especially the expert faculty).
What are your current responsibilities within the Department of Pediatrics? What does your typical day look like?
When I returned to Duke, I was hired to head the Pediatric Heart Failure & Transplant Program. I was actually the only pediatric transplant cardiologist here at that time, so in charge of a team of one. I also specialize in electrophysiology, as well as exercise physiology. So, on any given day I am covering the heart failure & transplant service, or doing electrophysiology and cardiac catheterization procedures, or covering the exercise lab, or doing cardiology clinic, or rounding in the pediatric cardiac ICU, or some combination of any of those. I can sometimes be found hiding out in the. . .wait, I don’t think I should give that away.
How did you first get interested in medicine? What made you decide to pursue pediatric cardiology in particular?
This was a multi-step process. I initially wanted to be a biomedical engineer and astronaut growing up. We took the “what should I be when I grow up tests” in high school, and something medical was always a common theme in the results. As I looked more into it, I realized that all my academic interests were covered within the field of medicine. I was interested in accelerated programs and got accepted into a 6-year BS/MD program (I did 7 because I always like to add an extra year to all my training, plus I got summer off).
My specialty interest was always cardiology. The heart is a truly remarkable organ (no offense to the other organs). It represents the best of anatomy, physiology, physics, biology, genetics, development, mathematics, chemistry, and engineering. In dissection labs in high school and college, I would always go for the hearts. The younger version of myself could be found dissecting the heart from the Thanksgiving turkey (that’s how it all really started). There was also never a question that I would work in pediatrics. As cliché as it sounds children need our help. They deserve better. I want to make it better for them. Besides, as anyone will tell you, I can barely tolerate healthy adults.
What’s one thing you wished more of your patients knew about pediatric cardiology or medicine in general?
I would want them to know that as advanced as medicine has gotten over the years, there still is only so much we understand and only so much we can do. That even though there is an ever-increasing focus on the science of medicine, there is still an art to using that science. Experience and judgement still have a role in care of our patients, and shouldn’t be replaced totally by the science.
What are your specific interests in the field of pediatric cardiology medicine? What do you enjoy most about your work?
I love technology and engineering. I love gadgets and gizmos. Cardiology provides me with the opportunity to work with mechanical and electrical devices, such as ventricular assist devices and pacemakers. I also love biological sciences. Transplantation brings the fields of cardiology, immunology, pharmacology, genetics, and others all together into one “package”. I like what I do because I get to use all that science-y, nerdy stuff to help make kids’ lives better. I enjoy it when the science of medicine and the art of medicine meet to make kids better. In the words of the great Hannibal Smith (from the 1980’s TV show “The A-team” for the younger crowd), “I love it when a plan comes together.”
Is there any research or other special projects you are doing or plan on doing?
We are part of a clinical trial for use of an adult heart failure drug in pediatric patients and a trial for using a pediatric designed ventricular assist device. I would like to do more research into the mechanisms of rejection in heart transplantation and ways of avoiding the long-term complications of immunosuppressant therapy.
You completed your fellowship here at Duke--do you have any advice for trainees?
In some ways medical training is akin to an apprenticeship. There is a particular set of skills and fund of knowledge you need in order to feel comfortable caring for patients (the discussion as to whether the ability to use Google, Medscape, and the like are one those skills we can save for another time). All that is to say, you can’t go wrong getting as much experience and hands-on training as possible. So, make good use of your limited time in training. Spend it watching and doing. Ask questions. Be a pain, a respectful one. One of the reasons I came back to Duke was that I missed my interactions with residents and fellows (I’ll deny I ever said that).
What passions or hobbies do you have outside of work?
Ok, now we’re talking. Racing, or as some call it, motorsports—NASCAR, IndyCar, Formula car, GT, GTA, GTP, road, oval, Talledega Nights. Anything with 4 wheels, an engine, and a steering wheel. Drive them, watch them, even smell them. The physics of cardiology is pretty awesome, but the physics of racing, c’est manifique. And yes, sometimes race cars turn right for those of you from the south. I also fence foil and epee, keep trying to play guitar—failing, and help my kids navigate early adulthood—hopefully not failing. I am a foodie and a tequila-ie. Yes, the right tequila can be consumed without asking how the floor got so close to your face. We should get together sometime to discuss it.