Dr. David has been a role model for me since I finished my training with him in 1993. He is a spirited innovator whose contagious passion catalyzed a generation of surgical innovation…. Tirone showed us a broader vista of the horizon than any of us could have imagined, and he lit the lights on the path toward the future so we could walk in the right direction. – Dr. Mehmet Oz, "The Dr. Oz Show"
Since moving to Toronto in 1978, Dr. Tirone David has performed more than 10,000 open-heart surgeries, taught hundreds of students, published 300 scientific papers, and travelled the globe delivering lectures and demonstrating complex surgical procedures. But after 30 years, what drives this cardiac surgeon to continue working through the wee morning hours, just days before he celebrates his 65th birthday?
Passion, dedication and creativity.
"I can't see myself not doing this. Nothing turns me on with the intensity that cardiac surgery does," says Dr. David, who heads the TGH cardiovascular surgery division.
This commitment motivates him to spend hours in the operating room treating patients with advanced heart disease, educating young surgeons, and furthering UHN's mission of achieving global impact.
"Innovation is how a hospital achieves global impact, but locally, it is about outstanding patient care," says the surgeon, who inspired Canadian philanthropist Peter Munk to give $45 million in the 1990s to what became the Peter Munk Cardiac Centre at TGH.
Read about the recent fundraising gala in honour of Dr. David, which raised $4.3 million for PMCC!
Growing up, Dr. David's lifestyle was far from that of a millionaire. He was born and raised in Ribeirão Claro, Brazil, eventually leaving to study general surgery at the State University of New York and the Cleveland Clinic. His parents' influence defined his character and moulded his perfectionism, obsession and passion for medicine.
"My father told me I had to go into medicine. I told him I didn't like medicine, but he said if you want us to support you, you'll become a doctor."
As it turned out, during medical school, Dr. David fell in love with surgery and later with cardiac surgery.
"Heart surgery is mechanical, simple, and gratifying; its problems are highly technical. With heart disease I can more easily transform a patient's life. I can save someone who's about to die."
His understanding of heart anatomy led him to explore and invent different surgical techniques—some while operating—particularly in the area of heart valve repair. Dubbed the David Operation, it uses a Dacron graft (a plastic insert tube) to re-implant the aortic valve, resulting in better blood flow and function. It had never been done before, and is now used worldwide.
"The valve itself was normal, but the tissues around were abnormal, so I had to copy nature and insert a fabric around the aorta to protect it," he recalls of the young patient's heart on which he first performed the technique in 1989. "The next week, an echocardiogram showed the valve looked completely normal. I have seen her every year for the past 21years and it is still perfect."
His inner circle of colleagues and students eventually coined the term "The Tirone Factor" to describe his imaginative surgical style.
"The Tirone Factor is simply a reflection of his tremendously creative imagination that is at its best in the OR," says Dr. Christopher Feindel, Clinical Director, Cardiac Surgery, PMCC. "The Tirone Factor is part of his gift to his patients and students, and he has been generous with it over the years."
Recently, a surgical fellow found Dr. David at a patient's bedside late in the evening and asked how his family (a wife and three daughters) manages without him.
"I operated on this patient and I'm not going to pass it on, even if it means staying by his bedside all night," he said, to which the fellow answered, "You're not like most surgeons and I don't know if I want to make that sacrifice."
The response? "It is a sacrifice, and if you're not willing to make it, you will never be able to push the envelope in cardiac surgery."
Joanne Bos, his surgical assistant of 27 years, understands why he sets such high standards for himself and those around him.
"Working for a perfectionist can be challenging at times, but you know it's for the patient so you try your best and it feels so good seeing his patients do well after surgery," says Joanne, who is responsible for consistency and flow in Dr. David's OR – a unique job that no one else has at TGH. "He is focused, concentrated and confident in the OR; that's why his patients do so well."
It's not just his Canadian colleagues who recognize Dr. David's dedication to his craft. Dr. Mehmet Oz of "The Dr. Oz Show" trained with Dr. David and was eager to share his reflections:
"Dr. David has been a role model for me since I finished my training with him in 1993. He is a spirited innovator whose contagious passion catalyzed a generation of surgical innovation, including the Columbia University laboratories where I pursue my research. Tirone showed us a broader vista of the horizon than any of us could have imagined, and he lit the lights on the path toward the future so we could walk in the right direction."
Although highly regarded American institutions, including Harvard and the Cleveland Clinic, beckoned, offering large salaries and houses, he's remained loyal to TGH.
"I had freedom at TGH and the infrastructure to support me so I thought I'd accomplish more here. It's better to be a big fish in a smaller pond than a shark in the ocean."
What's next for Dr. David? He realizes his surgical career is drawing to a close and is searching for a surgeon to pass on the torch.
"My time has passed now. Creative people are usually young people and we might lose the cutting edge unless we bring in young minds," he says. "My role now is to find someone to replace me to carry on the program and make it even better than it is."
