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Princess Alexandra Hospital icon and trailblazer of the specialty of Cardiology, Dr Paul Garrahy, will put aside the stethoscope after 43 years of medical practice and the creation of a world-class specialist unit made up of national and international leaders in their field.
An absolute gentleman of the industry with vocal tone that suggests an ear for musicality, Dr Garrahy marked June 30 as his final day in the hospital that he has invested almost all of his professional career.
“Many are surprised to hear that I started my career at PA as an orderly in the orthopaedic department in 1976 during the end-of-year medical summer holidays. Two years later in May I came back to commence as a first year intern,” he said.
Since 1979, treatment for a heart attack has changed dramatically even though a blocked artery was considered to be the cause of a heart attack at least 10-15 years before this time.
“It was in my intern year that my 62-year-old father came in with a big heart attack and the treatment of a heart attack in May 1979 was phenobarbital morphine - he died within 48 hours. So we’ve gone from basically watching someone die in May 1979 to discharging someone home after a successful angioplasty to live another 10 to 20 years of life in my professional career,” he said.
“Before we had treatments like emergency thrombolysis and emergency angioplasty, the hospital mortality for a heart attack was 30 per cent, now it is two per cent. Things have certainly been absolutely revolutionised over the course of my career.”
The process now is absolutely focussed on intervention. The ambulance offices are calling the hospital from three suburbs over or all the way from Ipswich or Logan about the 62-year-old having a heart attack, talking directly to the specialist at 2 o’clock in the morning and within 30 to 45 minutes a team of clinicians are assembled in the Cath lab to open up the artery that’s blocked.
Despite the death of his father from a heart attack, Dr Garrahy says his inclination for the specialty was more about applying his skills and satisfying his tactile nature.
“I need to do something with my hands,” he said. “I started playing with car engines at about five or six years old handing greasy rags to the local mechanic. I had an education as a classical musician when I was a kid which put the hands to good use. Also, I guess I like the music of heart sounds - they are all about music and timing and that’s gold for a musician.”
Dr Garrahy said Cardiology seemed to be an active specialty with the potential to do something positive for patient outcomes. He commenced registrar training at PAH which was completed at The Prince Charles Hospital. He practiced in America for four years and came back to PAH as a staff specialist in 1990 and has been here ever since.
“After becoming the Director of the unit in 1994-5, we got the go-ahead to establish a cardiac unit at PAH and that was a turning point for this hospital. After doing diagnostic angiography in the radiology department for many years, cardiac surgery was established in May 1998 alongside the first dedicated cardiac cath lab,” he said. “High level cardiac services were absolutely necessary for the move to the high acuity care PAH could provide. You can’t provide top level intensive care, vascular surgery and neurosurgery without top level cardiology and cardiac surgery.”
He said the specialty is now at the point where the cardiologist and the cardiac surgeon are sticking valves in hearts without open cardiac surgery. “This miniaturisation means vascular surgeons are doing things with wires and small nicks in legs rather than slashes in bellies to insert aneurysm sheaths and t-bar supports to improve the recovery time for patients.”
Dr Garrahy’s PAH-wide infamy for telling patients exactly how it is, is a legacy that could sound confronting if it wasn’t delivered by such a nice bloke. “A lot of people thought I was a bit nasty starting to prod someone while they are fresh off the ambulance with that dreadful pain in their chest and the suggestion that they have had their last cigarette; but it is memorable for them because of the realisation that something really dangerous is happening,” he said. “I believe in being really direct, very clear and leaving no doubt about what needs to happen to save their life. They expect the highest level of perfection from us, and I need them to understand that they need to do everything in their power to stop this from happening to them again.”
He retires in the knowledge that PA’s Cardiology Unit is run by a very strong team of first-rate clinicians who are talented with very strong leadership skills, including representation on the national and international stage.
“The department is at the top of their game, and they effectively don’t need me anymore,” he said. “It has been a privilege to spend the majority of my career at PA Hospital; it has been a strong and well-led hospital through all of those years. There is a particular spirit of PAH that we inherited from the very practical, smart, top-notch surgeons through the 70s and 80’s like Professor Strong, Dr David Theile, and before them Dr Lionel Hartley who were at the top of their game. I have to put Dr Julie Mundy in that category as well. She has absolutely superb skills, she’s very smart, and has excellent judgement.”
In wrapping up his career at PA, Dr Garrahy draws inspiration from Rafael Nadal who declared when he won the French open, that he wasn’t so much interested in the records or titles, but that he just liked going to work. “You do the job because you like the work, you think it’s a really good job, and a valid way to invest your time. I think this is the philosophy of many people who work here and it has absolutely been my story,” he said.
Dr Garrahy is not so much retiring as picking up another career. He has joined an orchestra and will be embracing his teenage aspirations with the viola now that he has made good on his promise to his father to get a real job before undertaking to become a professional musician. He also has the support of his wife, a professional viola player for the Queensland Symphony Orchestra for the past 25 years since her move from the Alabama Symphony Orchestra to make a family with Paul in Australia.
“Getting my hands back into shape in my new career is more challenging than my day job and my wife, who is now retired, delights in letting me know when I’m doing it wrong. I defer to her authority in this - she has 10 times more talent in her hands than I have ever had in mine.”
High praise from a man who has crafted his specialty of cardiology and his team at PAH into the professional influence they are today. Take a bow, Dr Garrahy.