Carl Maronich (Host): A look at cardiothoracic surgery on this episode of Curating Care, a podcast brought to you by St. Clair Health, expert care from people who care. I'm Carl Maronich, your host. And joining me is Dr. Perel Baral, a board-certified cardiothoracic surgeon here at St. Clair Health. Dr. Baral, welcome to the podcast.

Perel Baral, DO: Thank you. Thank you for having me. It's good to be here.

Host: Great to have you with us. And let me start by asking, I understand that you've wanted to be a doctor your whole life. Tell us a little bit about your early fascination with medicine.

Perel Baral, DO: Yes. So, I have to owe that in probably big part to my mother. She's a physician. She did internal medicine. She still does internal medicine. But growing up, I was just exposed to medicine from a very, very young age. I used to see her JAMAs lying around. And I used to kind of flip through them and look at the pictures. And I used to hear her talking about interesting cases or patients she'd taken care of.

And so, it was always just kind of ingrained in me. And I was just fascinated by medicine from a very young age. And I just felt I always wanted to be a doctor. And so, that's just kind of how it got started.

Host: I understand that you used to go with your mother to a biology class that she taught.

Perel Baral, DO: Yes. Very long time ago when I was probably, like, three or four maybe, she used to teach a biology class in a local women's college in our neighborhood. And I used to sit in the back of the classroom. And my only real memory that I can remember other than what people told me, is I used to remember sitting there with these giant biology textbooks and just looking at the pictures, and just sitting quietly and looking at pictures.

Host: They didn't let you actually do any dissections of frogs or anything at that point.

Perel Baral, DO: No, not then.

Host: That came later though, apparently, as a surgeon.

Perel Baral, DO: Yeah. Yeah, of course. And, you know, in biology, when I was finally in biology class as a college student, yeah, we were dissecting for frogs at that point.

Host: Well, let's talk a little bit about the P's and Q's, if you will, of your path to St. Clair. What are were some of the highlights of your clinical training that you had over the years?

Perel Baral, DO: So, I really honestly enjoyed every step of my education journey. I went to a great medical school in Chicago where I had really excellent opportunities to be exposed to a lot of different—you know, even though I actually went to medical school to be a surgeon, so I knew I wanted to be a surgeon, but I really took advantage of all the different rotations I was on as a medical student. Because in Chicago, we rotated at some various great hospitals. Like, one of the hospitals I did a lot of my rotations at was actually Cook County or Stroger Hospital, which is I think like a very well-known safety net hospital in Chicago. And you really got the opportunity to do a lot there as a medical student. I just have so many great memories of just being given a lot of responsibility, but learning so much from the residents and having a lot of autonomy.

And then, I went on to do general surgery residency at the University of Kansas Medical Center in Kansas City. That was just really such a great experience. I mean, most people maybe wouldn't think that general surgery residency is such a great experience. We worked really, really hard, but I had amazing co-residents. And I think a big part of being able to enjoy your time and training is having good coworkers and attendings who are supportive and really interested in your training and learning.

And so, I had a great time. I loved doing surgery. I loved being in the hospital. At that time, I was single. You know, I didn't have a husband or kids. And so, I was just in the hospital all the time. Came in early, stayed late, just kind of like did everything that I wanted to do and, had really, really, really good memories of my time in Kansas City. And that's also kind of where I really solidified my interest in cardiac surgery, because the cardiothoracic department there had some of the most kind, supportive, really encouraging attendings in cardiac surgery that really you could have anywhere. It was just like such a great environment to learn in. Where as a second year resident, I used to go there sometimes whenever I had a couple of free hours, whether it was like on a lighter rotation, or something like that, which didn't happen that often, but they would just welcome me into their OR and I got to scrub cardiac cases.

One of the very first cases I did in the department of CT surgery at KU was a thoracic sympathectomy. And Dr. Daon just, like, let me. He did half of this. He did one side, I did the other side. And he's just such a talented skilled surgeon. And he's like so good at teaching, that he was able to just like walk me through it. And it was just amazing. And doing heart surgeries with him, going on procurements. So, they were just very instrumental and I had such a great time there.

And then, of course, when I graduated from surgery residency or general surgery residency, I went down to Houston, Texas to train in cardiac surgery at the Texas Heart Institute and Baylor College of Medicine. And of course, you know, I mean you have like some of the greatest minds and hands in CT surgery. So, that was really a privilege to learn from everybody there. So yeah, I mean, every step of the way has been a different challenge and very enjoyable for the most part, you know? So, I've been very fortunate.

Host: So, let's really take a minute to talk about cardiothoracic surgery and what all that entails. Cardiac, obviously the heart, the thoracics, the chest. So really, a cardiothoracic surgeon does a variety of things. Isn't that the case?

Perel Baral, DO: So, it used to be, yes. It used to be that you're absolutely right, cardiothoracic means heart and chest, the thoracic cavity, which includes everything in the chest, which primarily is the lungs, the esophagus. And then, it can include what we call like the anterior and posterior mediastinum, which can include, you know, resection of tumors in that area. And it used to be that cardiothoracic surgeons pretty much all did everything. They did heart and they did lung and they did esophagus.

Now, as things have become more specialized, I would say the majority take an either cardiac path or a thoracic path. So, they either do pretty much only heart surgery, like heart and aorta—great vessels, obviously—or they do only thoracic, so only focusing on lungs and esophagus and diseases of the lung and esophagus. Most training programs have to train—all training programs—have to train you in both. But depending on whether you are planning on really focusing on one discipline or the other, sometimes dictates how much you focus on one or the other. And so, I was on the cardiac track of the cardiothoracic program at Baylor. And so, I focused a lot more on cardiac surgery rather than thoracic, because I knew that I just wanted to primarily do heart surgery.

Host: Yeah. Great bit of clarity there. Thank you for that. And I understand, in addition to your technical training, languages is another thing you've done a lot of studying of and speak several languages.

Perel Baral, DO: Yes. That's been something I've really, really enjoyed. I have not learned a new language in many years. But I really, really, love learning new languages. I think it helps to exercise a part of my brain that doesn't—you know, it's like a very specific part of your brain that doesn't normally get exercised, for lack of a better word. But, yeah, I just really enjoy it. I guess I have a certain affinity for it. And so, you know, growing up, it was a little easy for me to learn Russian because my mother is from Russia. And so, she would speak to us in Russian and my grandparents would too, and she was very adamant on us learning to read and write and stuff like that. And so, I got that experience.

And then, growing up, you know, in the Jewish community and going to Jewish day schools, I learned Hebrew a little bit that way. But then, when I spent about four months in Panama as a teenager, I learned Spanish by immersion essentially. But the family that I lived with only spoke Hebrew at home And so, I really got fluent at home that way and then spoke Spanish everywhere else.

And then, when I was in college, I went to study Arabic. And so, I learned Arabic and I was pretty fluent when I finished the course, and I could read and write and everything. That unfortunately is a language that I have not been able to use as much. And, you know, if you don't use it, you lose it. So, I have forgotten most of it. But I'm sure if I kind of got back into it, I would be able to pick it up again. But I can't really say that I speak Arabic anymore.

Host: Well, I will not ask you any questions in Arabic during this interview. I promise that. Well, that's fascinating and that has to be helpful in your work with not only with patients that may speak some of those languages, but as you're studying and conferring with other physicians.

Perel Baral, DO: Yeah, absolutely. I mean, my favorite part of being able to speak these different languages is being able to communicate with patients in their native languages. I think it really allows you to build trust and build a relationship that is very hard to do sometimes through an interpreter or a translator. And I really, really enjoyed speaking Spanish with my Spanish-speaking patients in Chicago and Kansas City and in Texas. There's not as many of them here in Pittsburgh, I will admit. But, I mean, it's like a population I really, really enjoy taking care of.

Host: Yeah. Speaking of the South Hills of Pittsburgh, maybe you could talk a little bit about some of the elements that drew you to the award-winning healthcare system here at St. Clair Health.

Perel Baral, DO: Yeah. So, really, like you mentioned earlier, Dr. Kaiser, Dr. Andy Kaiser, who's the chief of the department here. He was a big pull for me. I applied a lot of places in the country as I was looking for jobs. But he actually trained with one of my former, you know, one of my mentors and one of my former partners at this point, Dr. Lorraine Cornwell at Baylor. He trained with her in North Carolina back in the day. And so, he knew her and gave her a call and she was very kind to, you know, be very positive about me. But what really struck me about him, when he spoke with me was that he was really interested in who I am as a person and, like, my family. And I was really looking to be working in an environment where there was a more healthy relationship to people's families and their life outside of work. And he really showed me that you could have that, because it is very rare to have in cardiac surgery.

So, that was a big driver for me to come here. I mean, just like the people when I came to interview here, everybody was just like so welcoming and so kind and so positive about working here at St. Clair. And I could see that there are a lot of people here that have been here for many, many years, which is really a positive predictive factor. Because when there's not a lot of turnover, that means that people enjoy working here.

So, yeah, he brought me here and. My other partner, Dr. Salman, is also, I mean, one of the nicest, most supportive partners you could ask for. And it's really just like such a positive working environment. As a young surgeon, you really want to be surrounded by people who can be supportive and who are willing to help you when you need it. I think, a way that a lot of young surgeons get tripped up, especially in cardiac surgery, is not knowing their own limitations and not being able to ask for help when they need it. And they get into a lot of trouble unfortunately with patients and kind of not doing the right thing. And so, really, I've seen that happen. I did not want that to happen to me. And so, it was very important to me to be somewhere where I had supportive partners and I knew where I could grow as a surgeon, but also be able to enjoy my life outside of work

Host: Well, you're the newest edition to St. Clair's growing team of cardiothoracic surgeons. And in the latest edition of House Calls Magazine, you mentioned you love heart surgery, a direct quote from that article, I understand, which folks can read at stclair.org. Tell us a little more about that love of cardiac surgery.

Perel Baral, DO: So, I just think that the heart is the most beautiful, fascinating organ in the body. You know, it's always moving, it's always dancing. And I think that it's one of the organs where structure and function really come together in the most acute way more than I think any other organ in the body. Because even like small changes in the shape and the like, physical dynamics of the heart can change how it functions and how that affects a person's health, and I just find that so interesting and so fascinating.

And it really also lends itself to a very technical type of surgery. I mean, one of my favorite surgeries to do is actually coronary bypass, which is a very, very delicate operation. It can be very technically demanding, sometimes like underestimatedly so. And I just really enjoy that technical aspect. It's also still a very, I think, evolving field. I think a few years ago people thought that cardiac surgery was going to become obsolete with the advent of stents and percutaneous valves and things like that. But that has not at all been how it goes.

I think, especially here at St. Clair, we have great discussions with our cardiology colleagues about, you know, who really would benefit more from less invasive interventions versus more. And I think that that's a very important thing to keep in mind. So, there's definitely still a lot of work for cardiac surgeons to do.

Host: Yeah. Well, how impactful is it to be able to deliver advanced cardiac surgery solutions in an advanced suburban hospital setting?

Perel Baral, DO: I mean, it's great. I really, really appreciate being able to be here in this type of hospital where we have the resources that we need to deliver that type of care. And like I said, Dr. Kaiser's a big champion of, you know, if we need something, trying to help the department get it. And very grateful to be able to take care of patients here.

Host: Yeah, they say healthcare is a team sport. And you mentioned earlier all the, the physicians that you've worked with in your training and now as you're working here. So, talk a little bit about the collaboration that physicians need to go through, and not just with peers in surgery, but primary care physicians that patients may have, and really the collaboration that is needed in the patient care.

Perel Baral, DO: I would say that cardiac surgery is really the ultimate team sport. I mean, in the operating room, there's just so many different people that you need to work with well, in order for the patient to have the best outcome. But yeah, I mean, any patient that we operate on, ultimately, the goal is for them to leave our care eventually and be taken care of long-term by their cardiologists and by their primary care physicians. And so, it's really important for us to do our jobs correctly, and then to be able to entrust their care to their primary care physicians who really have the onus on them for the rest of their lives to really take care of all of their health holistically. But, you know, surgeons are generally very possessive, and they really care a lot about their patients and they want to make sure that they're doing well. So, it's very important that you communicate well with everybody that you're working with.

Host: Doctor, maybe you could talk a little bit about some of your early goals, and also your plan to continue growing your skills in your career at St. Clair.

Perel Baral, DO: Yeah, I mean, my goal right now and in general, I think, is just to be a really skilled and become experienced cardiac surgeon and to grow in my experience so that I can become as, you know, as independent as possible, and just learn as much as possible from my two partners. I mean, they collectively have just so much experience in such a variety of settings. And they really, really have a lot to offer in terms of teaching me and continuing to help me grow my skills. And so, I really am hoping to continue to develop my career and my education here and to continue to take care of patients as well as I can.

Host: Yeah. Are you finding your experience here different at all in any way from where you had worked earlier at Baylor or some of the other places where you trained and worked, be it the region of patients you're seeing or anything kind of surprise you about what you're finding now at St. Clair?

Perel Baral, DO: I wouldn't say surprise me as much. I mean, it's, yeah, it is definitely a different patient population. So back in Texas, I was taking care of a lot of veterans. You know, I worked at the VA for a while. And so, that was definitely a very different population. Like I said, I worked at Ben Taub, one of the hospitals we rotate at, it is also a safety in the hospital. They were taking care of a lot of the indigent population, very underserved community. A lot of patients who don't have access to healthcare normally, who are coming in at the very last minute when, you know, they have no other option.

And then, at the main hospital at St. Luke's, that was a tertiary, quaternary, you know, referral center. It was the end of the line. So, that was where people went when everyone else had turned them down and they had no other options and they were seeking the highest, most acute level of care.

And so, working at St. Clair is a little bit different, because it is a little bit of a smaller hospital obviously. But we still do very high level of surgery here. And I routinely tell patients, you know, like, I think that we do excellent work here with cardiac surgery. I think it runs like a very well-oiled machine. And so, if the population's a little bit different, you're taking care of patients the same way. You still want to give them the best care. You still want to do your best, have the best outcomes, do the surgery.

And your goal is to never see your patient again after the followup appointments. You know what I mean? Like, that's the ideal goal. And so, that stays the same wherever you go. Although, again, like in places where you have patients who don't have as many resources or access to resources, that dynamic changes a little bit because sometimes you are their only doctor that they ever see. And so, you have to take that into consideration, like when you're discharging a patient.

So, some things like those little things we do that change that. But overall, you know, I think it's everyone has the same goal. They just want to get healthy and get out of here. So, it's not that different in that sense.

Host: Dr. Perel Baral, the newest addition to the St. Clair Cardiothoracic team. Welcome, I'll say that. It's been a bit, but great to have you on board and a lot of great information. We appreciate you sharing that with our listeners.

Perel Baral, DO: It's my pleasure. Thank you so much for taking the time to speak with me.

Host: For more information, go to stclair.org. If you enjoyed this podcast, please share it on your social channels and check out our entire podcast library for more topics of interest.

Healing lives here. Dr. Baral practices with St. Clair Medical Group. To contact Dr. Baral, please call 412-942-5728. For more information, again, visit stclair.org. And this is Curating Care. Thanks for listening.