Part I – Dr. Ismael Nuño
Dr. Ismael Nuño had a 35-year career as one of America’s leading heart surgeons and throughout his career he experienced his fair share of loss and triumph. He details his incredible journey as a heart surgeon in his new book The Spirit of the Heart: Stories of Family, Hope, Loss, and Healing.
Caryn Hartglass: Hello, everybody! I’m Caryn Hartglass. You’re listening to It’s All About Food. And I am actually in Florida and ready to do the show from here. It’s been really a great tour. I premiered the Swingin’ Gourmets last week, which was really fun. And now I’m in Florida doing a number of talks in a variety of places and it’s always fun to meet the community and the people that are interested in food the way I am. Okay. So, interesting show today. I’m looking forward to getting started so let’s do that, why don’t we?
My first guest is Dr. Ishmael Nuno. And he’s the author of the book, The Spirit of the Heart. He has had a 35-year career as one of America’s leading heart surgeons and throughout his career he had experienced his fair share of loss and triumphs. He details his incredible journey as a heart surgeon in his new book, The Spirit of the Heart: Stories of Family, Hope, Loss, and Healing.
Dr. Nuno, are you with us?
Dr. Ishmael Nuno: Yes, ma’am. I’m in Los Angeles and I am hearing you from Florida.
Caryn Hartglass: You know, it’s crazy. I love technology. It brings us all together. It’s a good thing and a bad thing. I talk about this all the time and what we really need is balance but I love the way I could speak to people all over the world.
Dr. Ishmael Nuno: Absolutely.
Caryn Hartglass: Okay. I read your book and I really was touched by all your intimate thoughts about your career and the people you connected with. It’s a fascinating thing doing heart surgery.
Dr. Ishmael Nuno: Yes, it is. I wanted to do heart surgery ever since I was a kid. My entire life was oriented towards one day becoming a heart surgeon. My high school projects, my science projects, were heart. My papers in college were in the heart. My training and surgery was in the heart. It was a very fulfilling career. We operated on a lot of patients, saved a lot of life. We lost some but there some learning in that so that’s why I wanted to produce the book. And the most important part of it was losing an 18-year-old daughter.
Caryn Hartglass: Yeah. I cannot imagine what that feels like. And I imagine, just writing about it and sharing your thoughts and keeping her spirit alive is somewhat helpful.
Dr. Ishmael Nuno: Yes, it is. It was very … it brought back a lot of memories. I keep on thinking about it. I can now speak with other parents who are having the same problems with their children. And I think it is very beneficial so even though she’s not with me physically I keep her in my heart and I talk to her, deal with her, you know, get angry with her still.
Caryn Hartglass: Well, one of the things that I enjoyed about your book, there were a number of things, but one was the fact that you were open to some metaphysical thoughts about spirits leaving and connecting, which I think is so important, especially in the medical profession because so many doctors turn off to that possibility because there’s no scientific evidence for it.
Dr. Ishmael Nuno: Right. It’s difficult to talk, even amongst colleagues, when you sit there having a cup of coffee and you’re discussing certain events. They’re looking at you like, “Yeah, you’re nuts!” And you’re absolutely correct. They do turn it off but I think that those of us who are in the business, we really learn to respect the sensitivity of not only a life but a death, just in the blink of an eye. I opened up the book with my sister. We were flying to Paris and her heart stopped and I had to give her … I had to resuscitate her at 35,000 feet. Luckily, things turned out well for her. But it’s a blink of an eye. And that’s exactly what happens when a family takes a loved one for heart surgery and everything is going well, and you’re patting yourself on the back, and everything turned out fine and then all of a sudden, their heart stops. It promotes an entire philosophy, not only existential but spiritually, what happens. I’m not talking about really what happens after death; I know nothing about it. And like you said, it’s not scientifically proven but there is a transition, as you go from life to death, that I think that can be a very, in a way, beautiful aspect of it when a patient I know is going to die and then they’re dying and bringing the family in, they can touch him, they can tell him how much they love him. And there’s a lot to that that we ordinarily miss. When you have a loss, which is sudden, that is horrible and everybody understands that but if you know that it’s coming and then I think you can make appropriate changes in that moment so that you can help that person: put them at ease, tell them that you love him. What’s a better way of leaving this life than knowing that you have loved ones around you? I asked my wife, I said, “When your time comes, if you have a choice of time and place, how would you do it?” And she said, “I would love to have my grandchildren around my bed.”
Caryn Hartglass: Yeah. You had mentioned how many hospitals don’t want young children in the presence of people who are sick.
Dr. Ishmael Nuno: Right. For a couple of things, a couple of reasons. One of them is the fact that we used to have the epidemiologic thoughts that a child was a harbinger of a lot of viruses and that if you brought them in, they could create and epidemic, that sort of thing. And so there were hospital policies against a child coming in. I will believe that a child can bring a lot of happiness to a person who is gravely ill, especially if they can make contact and they’re not in a coma. But even in a coma, you never really know how much people are taking it in, the patients take in, the love that comes from family.
Caryn Hartglass: That’s right. Well, I know when I’m around small children, even if I’m a bad mood, all of a sudden my mood changes. Young children, we can learn so much from them. We forget how to be like children and we really should pay more attention to their child-like manner, where everything is new, and fresh, and joyful.
Dr. Ishmael Nuno: I agree entirely.
Caryn Hartglass: Now, another thing that I like is when you talked about seeing the other side as a patient. A friend of mine, Dr. Robert Quitman wrote a book, When Doctors Become Patients. And I think it’s something that doctors need to learn in their education, becoming a doctor, what it’s like to be a patient because there’s so much arrogance and …
Dr. Ishmael Nuno: Yes.
Caryn Hartglass: And the patients do not benefit from it.
Dr. Ishmael Nuno: Yes, I agree with you entirely. I learned a lot being in the hospital, just observing the way I was treated: the poking of the needles, the attitude that some of them had. It was a truly learning experience. And when I was told I was going into liver failure and that I was up for liver transplant. It was so bizarre, Caryn, sitting there all night, waiting for somebody to die so I can have his liver. It was an incredible experience. When morning came I realized I didn’t die. Number one and number two, nobody gave me their liver, which was a good sign. And I learned a lot. Some of those moments when the sun comes up and you’re thinking about your own life and your own mortality, they’re beautiful moments, and moments that you just never forget.
Caryn Hartglass: I’ve done a bit of reading about transplants and maybe you’re familiar with this but I’ve heard incredible stories about how there is memory, not just in the brain but in all parts of our body. And people who had transplants sometimes experience the memory of the person that they got their organ from.
Dr. Ishmael Nuno: You know, when you take a look at couples, all of us throughout the world, you begin to observe that, perhaps, the male begins to look like and the female begins to look like the male. It’s like all of us who have dogs; the dog has a certain characteristic that our character has. But my thought is that through intimacy, for example, you are going to transfer cells from one body, from one organism to the other and those cells are going to replicate, which is the basis for stem cells. You take a few originating cells and they develop into an organ and that’s what can happen between human beings, such that the wife can give her cells to the male and I think that’s how it’s going to develop. Same thing with transplants. When we used to put in the organs into patients and eventually they would develop certain traits that were different. And I had women ask me if their husband was going to develop the, perhaps, an ugly, mad character the originating patient had. It’s hard to say that but I think there are some changes that undergo to the body. Now, technically, what we do is we wash out this organ so that we wash out a lot of the cells, the debris, and going to the organism so that there is no host organ or organ against the host. So yeah, that can happen. I believe in that.
Caryn Hartglass: Yeah, it’s pretty wild. Well, there are clearly so many things that we don’t know. You’ve had a long career as a heart surgeon, 35 years. I imagine things have changed incredibly over those 35 years.
Dr. Ishmael Nuno: Yes. Number one, the most common surgery that was performed in the United States until recently was coronary artery bypass. And when I began, we were making cuts from the neck to the abdomen, and through the groin, to the ankle and there were huge, huge cuts. And now we have technology by which, thank God we have it, through a small little hole, you can do the bypass. You can take out the vein leg … leg vein, I’m sorry. So there’s a lot of new advances that are putting us in the right direction. We do robotic surgery through small little holes. Pretty soon we’re going to have, once we work out this indigenous aspect we have in America, a surgeon in Los Angeles or New York can be doing the Columbus surgery in another city or country and that’s going to come, hopefully, in a shorter while from now. We just have to work some books from it.
Caryn Hartglass: Yeah, isn’t that crazy? It’s just mind-boggling. And we know that it’s going to happen and it’s going to happen soon.
Dr. Ishmael Nuno: It’s progressive. Absolutely. We’re going to get there.
Caryn Hartglass: All right. We know that there are over 600,000 deaths from heart disease every year. I think it’s 650,000; it’s probably increasing. And there are many, many people that suffer from Type II adult on-set diabetes. And my passion is food. And we’re learning more and more about the power of food and how it can prevent and often reverse heart disease and diabetes. You never mention food in your book.
Dr. Ishmael Nuno: No, but it’s an important aspect of it. I learned a lot through my daughter. She was fighting anorexia nervosa, number one. Number two, as a heart surgeon, I do recommend certain diets. One of them is the Mediterranean diet, which is very good. And the Societies of Cardiology of America voted it as the most preventive and health-wise diet for cardio-vascular disease. It’s a mixture of fish and some white meat, with nuts, vegetables and a little bit of red wine. So the American Heart Association recommends about 4 oz. of wine a day. You can go up to 8 oz. a day but you just have to be careful about it. But yeas, there are certain diets that we do recommend for cardiovascular health. And in the long run, it has created some improvements in longevity in patients that are studied. So there’s a lot to be said about that for diets and the way that we … You have to recommend exercise, of course, which is an important aspect of heart health. But we can do better in America and throughout the world as far as improving or decreasing the number of deaths from heart disease.
Caryn Hartglass: Yeah, I think we definitely can do a lot of improvement and the thing is, our technology is so incredible and so advanced and we can do so much. And what frustrates me is that we can be doing much more for diseases that we know are not preventable and take that technology and us that for those things like paralysis and other things, where people have accidents or really bizarre diseases.
Dr. Ishmael Nuno: I agree.
Caryn Hartglass: But heart disease …I personally don’t think the Mediterranean diet is the best diet. I’m a vegan and I come from the plant-strong world. I don’t know if you’re familiar with Dr. Caldwell Esselstyn who wrote Preventing Heart Disease and there’s a documentary called Forks Over Knives, but there’s this big movement now to focus on the power of plant foods and how it can really reverse heart disease. I really think that that’s some of where we’re really going to improve in the future. I mean, I hope so because those things are easy.
Dr. Ishmael Nuno: I think we’re well. I think it’s up to us as physicians and people like you helping in trying to put the word out that it can be done. I was present at the American Heart Association and I suit up one day at the conference room and I said, “People, we’re dealing with a lot of the population that when they go to the grocery store, they’re going to get bread and milk for their kids and that’s it.” That’s what they care about: feeding their kids. Those of us who are better off socio-economically, yes, we do take a look at the labels, at the calories, at the nitrates, and all of that but I think that there’s a lot of room, like you said, so we can push it. There are vegetarian diets that, I think, will help us. You’re in a better position to tell me that, If you have any particular suggestions.
Caryn Hartglass: Yes! Well. There’s two great books out. One is called The End of Diabetes by Dr. Joel Fuhrman and he talks from a really detailed perspective. I had him on the show about a few weeks ago about medication and how some of it actually increases cardiovascular disease and the things you can do to really … If you have Type-I diabetes, to reduce your insulin requirement. If you have Type II, how you can totally turn it around. It’s really fascinating and powerful stuff.
Dr. Ishmael Nuno: Excellent, excellent.
Caryn Hartglass: Yeah. And I have a few other questions I want to talk about. You mentioned privilege; how some of us have more privilege and we can choose better foods. But also in the medical environment there’s a great deal of privilege. And I remember you mentioned when you were an intern, I think, or a new physician and you had to take someone off life support and you wanted to resuscitate him but his choice was “Do not resuscitate.”
Dr. Ishmael Nuno: Correct, yes.
Caryn Hartglass: I wonder about those who don’t have access to great health care, they end up just dying and then those who have access to good health care have a choice: they could not have to be resuscitated or they could be put on all kinds of machines to keep them going.
Dr. Ishmael Nuno: Yes, absolutely. The advance directive, you can write one as you go into the hospital, whether you want a tube or medication. I think we’ve gotten to the point where we can be selective. The only problem is the degree of information the patient has. It’s our duty to make sure that they understand fully what they’re getting into. We, as children of parents, I don’t think we have that hard of a choice when we see if they’re suffering, if their life has become so limited, we can say, “Okay, that’s enough. Stop. Let them be at peace.” For our children, I think, it’s a lot different. I think we’re learning a lot from the cancer patients, how their survival now is getting better, thank God. I think it’s great! I think that the choices that we’re having to make for our younger patients, for our children, are getting better. So we’re learning, we’re getting better, and I think we’re going in the right direction.
Caryn Hartglass: Another thing you mentioned was that early on in your career, you put in very long hour-days and now there are more restrictions about doctors spending so much time in the hospital because it’s not good for anybody; everybody gets tired.
Dr. Ishmael Nuno: Yes, we do.
Caryn Hartglass: But there’s all kinds of things in hospitals. We’re seeing so much these viruses, the hygiene problems. Do you see some hope there? Because some say that the second greatest cause of death is hospital care.
Dr. Ishmael Nuno: Yes, absolutely. Don’t go to the hospital; they’re dirty. They really are. The accumulation of pus, the terrible things that are around, especially some of the viruses. I’m a Republican by vote. We won’t talk about politics but as a physician I do have to understand the Obamacare that’s coming, how we’re going to best deliver it best to patients, how we’re going to take care of them from now on. And one of the directions that we’re going is to decrease the size of hospitals and to have, as much as we can, care as an outpatient. So we’re going to have to reinvent the machines of the care for some of these patients, such that we can deliver it at home. We’re going to have to have a series of health care delivery agents, excuse me, people out to the homes and take care of them. So things are going to change and it’s coming; there’s no question about it. I think that it’s going to be re-distributed, such that all these infections that you hear about …One went into open-heart surgery and they got staph at the hospital. That’s a terrible thing! I can’t imagine being more sorrowful than to think that I made the cut, it’s my patient, and my patient coming in a better situation in than I left him in. It’s a huge promise and sometimes that promise if broken and that’s a terrible thing to happen.
Caryn Hartglass: The last thing I want to talk about is love because I believe, above all else, love heals. And it’s so important to have love, be surrounded by, supported by friend and family. And it’s really magical at some point. I remember reading in your book when you talked about this wife who brought a rabbi in to speak to her husband Larry, who wasn’t stable and all of sudden, he was stable. It’s kind of a … I mean, you really have to realize there’s so much more that’s bigger and greater than all of us out there when you see something like that happen.
Dr. Ishmael Nuno: Absolutely.
Caryn Hartglass: So my prescription for you, Dr. Nuno, is lots of dark leafy green vegetables, onions, mushrooms, raw nuts and seeds.
Dr. Ishmael Nuno: Thank you so much.
Caryn Hartglass: Okay, thank you for joining me on It’s All About Food.
Dr. Ishmael Nuno: I will take your advice. Thank you so much!
Caryn Hartglass: All the best with your book.
Dr. Ishmael Nuno: Thank you. Bye-bye.
Caryn Hartglass: Well, there you go. I’m Caryn Hartglass and you’re listening to It’s All About Food. Now, you know you can call in to this show if you have any comments or questions. And the number is 1-888-874-4888. I don’t say that very often because I usually get wrapped up talking to my guest but I’m always happy to hear from you. And you certainly can send me an email at info@RealMeals.org. And if any of you are in the South Florida area I’m going to be speaking this Friday night. I’m looking right now at the information. May 3rd. It’s a vegan potluck for EarthSave Miami at the Tamarac Community Center. You can find out the specifics if you visit my website, responsibleeatingandliving.com and click on the “Talks” tab. That’s going to be lots of fun. Lots of information out there about heart disease. We talked awhile ago about this new study that came out linking carnatine and how it changes into something… what are the initials, something like TMAO, T … you know what I’m talking about. But it develops arterial sclerosis and there’s all kinds of back and forth conversation about this now because there are people that don’t want to know that their meat and eggs might be causing arterial sclerosis and now having more scientific proof on that subject. But when it all comes down to health, for me, it’s dark leafy green vegetables because people have been asking me about it and aren’t sure where to find it so I just put it right back, front and center, on the front page. It’s all about juicing, blending, what’s the difference, steamed greens, salads. Just get more greens in your diet. Just remember, there’s nothing kale can’t do.
Okay. Let’s take a break and we’re going to be back and talking with Harold Brown of Farm Kind. So a few more minutes and we’ll be right back.
Transcribed by Dianna O’Reilly, May 15, 2013