Heart 2 Heart

Although Sundlof and Wald both chose cardiology, they picked different sub-specialties. Wald also does catheterizations, inserting a long, thin, flexible tube into a blood vessel in the arm or groin and threading to your heart. "But for the most part we do minimally invasive procedures," Wald said.

"My sub-specialty is heart failure and heart transplants," Wald said. "I'm not a surgeon, so I don't do any cutting. But we do the rest of it. So, if there is a patient, we treat them beforehand, try to find a way to avoid a transplant. But if it's needed, we then screen to see if the patient is an appropriate candidate. And after the surgery we treat them with medications and follow up with their care."

Sundlof sub-specializes in non-invasive cardiology, and does echocardiograms, stress tests, and similar tests and procedures. "And I'm director of our Women's Cardiovascular and Wellness Center," she said. "I have nine male partners. It's a very maledominated field." The center is associated with Lehigh Valley Cardiology Associates.

Every day is different

Although Sundlof and Wald live near each other, they work at different hospitals. Wald, who admits she is more the "city girl," lives near Philadelphia and is part of a cardiologist team at the University of Pennsylvania. Sundlof, who lives in in the Lehigh Valley, is associated with Lehigh Valley Cardiology Associates and works with Lehigh Valley Hospital-Muhlenberg and St. Luke's Hospital in Bethlehem.

Both also teach - though Wald was quick to add, "as a physician you're always learning and you're always teaching. There's always something new. It's a very humbling field. So, we have students, residents, and fellows that rotate with us. We teach in both the hospital and in our offices."

The days are long. "A normal day is 11 to 14 hours," Wald said. Added to that is emergency work when on call at night or on the weekend. For the most part, the work is divided between hospital service followed by patients in the office. "The office work is very structured," Sundlof said. "We just see patients as they are scheduled. But when you're in the hospital, you're taking care of the sickest of the sick. You're taking care of emergencies, heart attacks, heart failure."

Sundlof gets some relief from the busy schedule as she only works part time - which is still considerable. She works a full week, then only Monday, Wednesday, and Friday for three weeks. "It gives me six extra days a month," she said - time she enjoys spending with her two children, Annika (age 12) and Erik (age 11). Wald also has a daughter and a son, Ashley (age 7) and Andrew (age 4). And both Sundlof and Wald find it difficult at times, even with working part time, to balance the demands of job and home life.

Despite the stress, neither would change what they are doing. "It's fun and exciting," they both said together when asked about the pressures of the job. And Sundlof added, "if you can't handle stress, this is not the medical profession for you. There are people who don't choose cardiology because they can't handle it when a person is literally having a heart attack in front of you and you have to stay cool and get them through it. But it is exciting. And every day is different."

The patient's health

In the end, however, it's not excitement that makes Wald and Sundlof so dedicated to their profession. It is the people they treat. "Our patients become family," Sundlof said. Wald quickly added, "We're about treating the whole person, which was our training in osteopathy. We were taught to evaluate muscle, the skeleton system..." "And we interact with the patients' families, ‘how's the sister,' ‘how's the dog,'" said Sundlof. "It's about the complete person and the quality of life."

A case in point was a 69-year-old man whom Sundlof saw in the hospital. "He was young, but for a heart transplant, relatively old," she said. Wald continued the story: "He was so debilitated and at first was discharged on home IV medicines. He then alternated visits between my sister and me, and we started evaluation for a VAD (ventricular assist device) - which former Vice President Dick Cheney also recently received."

But before the device could be implanted, the patient suffered a setback. His heart began to fail even though he had an implantable cardioverter-defibrillator, similar to a pacemaker. Sundlof and Wald arranged for evaluation at the University of Pennsylvania to see if the VAD could be implanted earlier. "And just last Tuesday he called and said, ‘thank you so much, I'm getting my VAD on Monday,'" said Sundlof. "He called to thank me and my sister, and I just wanted him to get better and take care of himself." And shortly after the patient called Sundlof, Wald went to visit him in the hospital.

Without the VAD, Sundlof and Wald said, the patient was unlikely to live more than six months. With it, he has a good chance to live at least another three to five years. "And the quality of his life will be good," Wald said. "When you have all of this technology to offer, you still need to make sure it's appropriate for the individual. It's not about extending life for two or three months. It's about the quality of life the person will have."

"That quality of life is the most important thing," Wald continued. "I had another patient who for 13 years I was always telling to stop eating Pepperidge Farm cookies because her cholesterol was so high. They were her favorite thing. But now she's 85 and dying from other complications, so the last time when she came for an appointment I gave her a huge box of Pepperidge Farm cookies. And she and her daughter laughed that the cardiologist was giving her cookies."

Focusing on the quality of life and the whole person empowers patients to make decisions, the twins agreed. "I had a patient the other day who didn't want a certain type of stress test," Wald said. "She was afraid. And I told her, ‘whatever you're comfortable with, we'll do. This is a team effort. My job is to tell you what I think you should do and what's available to you, and then we'll pick the right thing between us.' All of our patients are involved in the decisions we make. Our goal is the patient's health."