In the space of three hours, 15 minutes, the heart surgeon has repaired a hole in the heart of a 7-year-old boy, performed a double bypass on a 45-year-old man and reconstructed a valve and repaired a hole in the heart of a 10-month-old infant.
He has one more operation before noon, that of another infant. And this is a light day.
Where many heart surgeons perform 150 operations a year, Pacifico may exceed that many in six weeks. His average is 1,200 a year, with 75 percent of his patients adults and 25 percent of his patients children.
Seen on the street, Pacifico would not stand out in the crowd. He has graying hair and is of medium height. His eyes, however, hint at the intelligence and confidence a top surgeon must possess. His handshake is firm, but the hands are soft, which is not surprising considering how many hours a day he wears latex gloves.
Since coming to the University of Alabama at Birmingham in 1967 to complete his surgery training, he has become one of the most sought-after heart surgeons in the Southeast. He also performs surgery on about 150 foreign patients a year.
"He's the guy," said Jed Dunn of North Carolina. "Everybody in the trade knows about him."
Dunn credits Pacifico with saving the life of his now 4-year-old daughter, blonde-haired, blue-eyed Holt. After being turned down for surgery elsewhere, Dunn said he looked for a surgeon who would repair Holt's congenital heart defect.
Two operations later, Holt, laughing and chattering, recently was riding a tricycle down the halls of University Hospital.
"She wouldn't be here without Dr. Pacifico," Dunn said. "He takes the cases that others wouldn't take."
For investment banker Michael Morrell of Palm Beach, Florida, who needed a heart bypass operation because of a blockage, Pacifico was the surgeon's name he often heard when trying to find a doctor.
"I checked around and everybody came back with Pacifico's name," Morrell said shortly after a pre-surgery visit by Pacifico. "I elected to come here because this man has the talent."
Talent and experience. Pacifico's mentor was the internationally known heart surgeon Dr. John Kirklin, who proved the safety of the heart-lung bypass pump, which allowed physicians to stop the heart to correct heart problems.
Pacifico first trained under Kirklin at the Mayo Clinic, then followed him to Birmingham in 1967 when Kirklin was lured to UAB to head the cardiac surgery program. At UAB, Pacifico moved up from an assistant resident in surgery to senior resident, to chief resident in 1969. He became a resident in thoracic and cardiovascular surgery in 1970 and also became an instructor the same year.
From there, Pacifico moved up the ranks, becoming a professor of surgery in 1978, director of the division of cardiothoracic surgery in 1984 and chief of pediatric cardiac surgery at The Children's Hospital in 1986. He is now vice chairman of the department of surgery.
"It was obvious to several of us there (at the Mayo Clinic) he had an unusual amount of talent," said Kirklin, whose son, James, performs heart transplants at UAB. "He's a very intelligent guy and has this particular talent that he was born with and that he developed.
"I think he is generally recognized as being an expert cardiac surgeon."
Raised in Brooklyn, N.Y., Pacifico still speaks with a New York accent. He said from his earliest years he wanted to become a doctor, and a heart surgeon in particular.
Why? He's not sure, but he said having a sick mother may have had something to do with it. Seeing a steady stream of physicians while visiting his mother in the hospital may have helped, he speculated.
"When I was 4 years old, I wanted to be a heart surgeon, literally," Pacifico said. "I knew exactly what I wanted to do."
Although Pacifico performs nearly 10 times more surgeries a year than the average heart surgeon, he dismisses it as a matter of focus and training.
"Most of the reasons are intellectual; they have nothing to do with the hands, they have to do with the mind," he said.
"I was always interested in striving for technical excellence in the operating room and studied for that," he said. "If you do study it, you learn to minimize the wasted motion, then the task becomes completed sooner."
Pacifico credits the team he works with in the operating room, from anesthesiologists to scrub nurses, with making his job flow smoothly. It's especially helpful when he has more difficult cases, which is not uncommon.
"A very significant part of my practice is dealing with patients who've been declined surgery ... and that's what should exist in a medical center like this," he said. "We should be taking care of the more difficult problems than a community hospital."
Pacifico's 31-year-old son followed him into medicine. Now living in Seattle, he is an internist with a specialty in pulmonary medicine and infectious diseases. Pacifico and his wife, Vicki, also have a 14-year-old daughter and 10-year-old son.
For about 20 years, Pacifico said, he worked seven days a week, but now tries to spend Saturdays at home. He still works 5 and a half days a week, with half a day on Sunday spent at the hospital.
"Almost all cardiac surgeons do that," Kirklin said. "How do you know when someone is going to need his operation? You don't. It's a long tough job."
Mrs. Pacifico said she has adjusted to the hours her husband works.
"You develop your own routines," she said. "I wait for him to come home and we eat dinner together every night."
Getting Pacifico to relax was not something she pushed.
"I leave that up to him a lot and he's gotten better over the years," she said. "Now when we go away, he really does vacation. In the past it was hard for him to let go and relax. He's not a man who requires much vacation."
Hobbies clearly are not Pacifico's strong point. He said he likes to work when he's at home, doing jobs around the house.
What he clearly relishes is heart surgery. Questions about himself and his personal life are politely answered, but he becomes animated when asked about his surgery cases for the day.
Heart surgery, he said, is "fantastic." "In a relatively short period of time, you have a profound effect on somebody's life," Pacifico said. From surgery that turns blue babies' skin to a healthy pink to repairing the heart of a patient so that he can walk to a bathroom on his own, Pacifico is focused on the surgery:
"He clearly has an outstanding reputation as a stellar cardiovascular surgeon and is recognized far and wide," said Dr. Richard Russell, a cardiologist with Cardiovascular Associates at Birmingham Baptist Medical Center Montclair.
Russell said he has referred patients to Pacifico "because of the complexity of the problem or because I know that he has unique experience in all types of cardiovascular surgery."
Pacifico's speed in the operating room is legend, and Russell attributes that to "a very efficient team" and Pacifico's talent as a surgeon.
"Take, for example, sewing a button on a shirt," Russell said. "Some people can do it faster than others can. He has the ability ... to do the job excellently and quite rapidly."
Pacifico said the speed came as a mixture of studying techniques, focus, and "no wasted motion."
"It translates into an intense concentration, and that's a very enjoyable thing for any human being," Pacifico said.
Inevitably, some patients will die on the operating table, and Pacifico said that even after more than 20 years of experience he still is affected. About 3 percent of cases end in death, usually those in high-risk operations, he said.
"I've always been profoundly affected by the death of a patient," he said. "After I collect my emotions and thoughts, I go over the entire record very carefully to see if I could have done anything different."
For his skills, Pacifico earns more than $1 million a year, according to records of the University of Alabama Health Services Foundation.
The money, he said, "is a small fraction of what I'll term the market value of my work." That market value refers to the revenues to the hospital for bringing in patients.
"The reason that the figure is so large is that I do an enormous amount of work," he said, adding that he probably does more free medical care "on a dollar value than anybody in the Southeast."
Where many heart surgeons concentrate on either adults or children, Pacifico does both. He said it is important for a medical center to handle all types of heart problems to keep surgeons sharp.
On this Wednesday, a case in point is the 10-month-old boy he operated on earlier in the day. Although the infant was diagnosed with a hole in the heart, once the heart was opened Pacifico found a problem with a valve and also needed to repair it.
A surgeon not familiar with the valve problem would have had serious problems, he said.
This particular morning, like most, starts about 6:30. Pacifico's day is scheduled to the minute. After his operations, he returns to his office for consultations, calls and other business. By 3 p.m. he is meeting with about 15 residents, fellows and visiting foreign surgeons to talk about the next day's cases.
During one meeting in the "blue room," where film of each pending surgery case is shown, surgeons on fellowships from Chile, Japan, South Korea, Uruguay, Brazil, and Panama review Pacifico's cases with him. Seated in the middle of the group, he asks questions about cases, getting some answers, but then answering some of his own questions.
With entourage in tow, he leaves the blue room, moving swiftly through the cardiovascular floor to meet with patients he has already operated on.
Along the way, Pacifico consults his ever-present index cards, which tell him the basic details about each patient. Most patients are asleep, and Pacifico questions nurses about their conditions or peeks at the medical charts.
For those who are awake, he has a quick word, usually referring to the patient by name.
If there are questions, Pacifico takes the time to answer them. "Nice to see you," he says, moving on toward a wing where the next day's patients await a word with the doctor.
He explains the situation to a middle-aged man lying on a bed, while his wife and daughter sit alongside.
"You have obstructions of all your coronary arteries," he says. "We are planning to do three or four bypasses. The chances of survival are 95 out of 100."
After a pause, Pacifico says that he has scheduled the operation for the next day. "Want to do it? he asks.
"It looks like I've near about got to," the patient says.
"OK," Pacifico says. "Any questions?"
The man says he can't think of any and Pacifico writes on his chart. Then he and three others, a chief fellow, a fourth-year medical student and a surgeon's assistant, move on to the next room.
After meeting with patients, Pacifico moves outside the patient area to a corridor near two elevators, where family members of patients operated on earlier in the day wait to talk with him.
Index cards ready, Pacifico shakes hands and asks their names. "Hello, and you are?" he says.
After giving him their names, a young couple asks about their child's operation.
"Your baby's doing super," Pacifico says, beaming. "When we got in there it was more complicated than we thought. But I feel we have a very nice repair."
"Thank you so much, doctor," says the relieved mother, Lenetta Tubbs of Marion.
Pacifico will return to his office or attend meetings, review cases and work on administrative papers before heading home about 7 or 8 p.m.
And by 6:30 a.m. the next day, he will be back in the operating room, where his team will be waiting.
by John Staed
Birmingham Post-Herald Reporter
|Dr. Albert D. Pacifico, director
of the UAB division of cardiovascular and thoracic surgery, performs the
first surgical operation in the new University Hospital. The first
surgery, a coronary artery bypass procedure, began at 6:25 a.m. on
November 8, 2004. Pacifico lead a 13-person surgical team of nurses,
perfusionists, anesthetists and surgeons in the first procedure performed
in the $275 million, 885,000 square-foot facility. The patient, a
66-year old Gardendale, Alabama man, is in serious condition in the
cardiothoracic intensive care unit.
Photo by Steve Wood, UAB Creative & Marketing.
Dr. Albert Pacifico's Comments on His Planned Retirement
Posted on November 21, 2005 at 12:15 p.m.
“I have had a wonderful career here in Birmingham at UAB. It has been an enormous pleasure to have been able to serve so many people from Alabama and surrounding states. It has been my life, and I am very grateful for the opportunity.
“The UAB community has been immensely supportive; and as the years have passed, it has improved and updated its facilities, which are currently world-class. I am very proud of my colleagues in cardiac and thoracic surgery, as well as my colleagues in cardiac anesthesia, cardiology, pediatric cardiology and the many specialists in many different areas of medicine and surgery who support our patient care activities. UAB has provided a fantastic environment, not only for patient care activities but also for the development of new knowledge in medicine and surgery.
“Our nurses are outstanding and, through their expertise and tender loving care (not only of patients, but of myself as well), they have made my professional life a joy.
“There are many, many people who must come together to make a first-class hospital and University Medical Center. I have been so fortunate to have a very special and efficient office staff, and to be able to work in an environment where everyone is devoted to excellence. I have received countless compliments over the years from patients and families concerning their treatment and interactions with all of the people who make UAB Hospital what it is.
“I know very well that I will enormously miss coming to the Hospital and doing surgery. I am deeply grateful for all of the opportunities I have had here at UAB.”
Back to People I Admire