Methodist Journal



The Burgeoning Field of Cardio-Oncology

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Barry H. Trachtenberg Leads Issue on Cardio-Oncology

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Heart Failure in Relation to Anthracyclines and Other Chemotherapies

Heart Failure in Relation to Tumor-Targeted Therapies and Immunotherapies

The Role of Cardiovascular Imaging and Serum Biomarkers in Identifying Cardiotoxicity Related to Cancer Therapeutics

Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity

Cardiovascular Toxicities of Radiation Therapy

Electrophysiologic Complications in Cancer Patients

Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment?

Future Directions in Cardio-Oncology


A Rare Case of Pancreatitis-Induced Thrombosis of the Aorta and Superior Mesenteric Artery

Anomalous Origin of the Right Coronary Artery from the Left Main Coronary Artery in the Setting of Critical Bicuspid Aortic Valve Stenosis

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure


Do Not Pass Flow: Microvascular Obstruction on Cardiac Magnetic Resonance After Reinfarction Following Primary Percutaneous Coronary Intervention



Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg


Onconephrology: An Evolving Field


Herbal Nephropathy


Rolling the Dice on Red Yeast Rice


Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 10, Issue 2 (2014)

Humanities Full Text


Ask, Why?

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Article Citation:

Sana Khan (2014) Ask, Why?. Methodist DeBakey Cardiovascular Journal: April 2014, Vol. 10, No. 2, pp. 135-135.

“The man who lets a leader prescribe his course is a wreck being towed to the scrap heap…”

—Ayn Rand


Leadership in its ideal expression is beautified in one who embodies a set of characteristics that by their very nature must exist in mutual dependence. It necessarily demands fulfillment of the hopes and dreams of those it serves while being thoroughly unconcerned with the attainment of prestige that drives the altruistic dictator. A force that has no need of deriving its influence from the mediocrity of others, it continually enforces the existence of excellence and makes use of every opportunity to illustrate the universal possibility of its achievement. But most importantly, by virtue of its inherent nature, it refuses to be personified by Rand’s antihero, a mindless “wreck being towed to the scrap heap.” For true leadership does not simply repeat; it questions. Not easily satisfied with the path in front of it merely because it exists, and not concerned about creating an image that may please others, it works hard, using the human faculties of mind and soul, to seek true knowledge. For more than anything else, transformational leadership is, in a word, intellectual.

I darkened the room. The patient, a 38-year-old man with diabetes, was seated at the edge of the exam table. We both stared at the single bright beam of light originating from the ophthalmoscope I held in my right hand. Right hand, right eye, I mentally reminded myself, left hand, left eye. Standing at a distance of roughly 15 inches from the patient’s right eye, I positioned the instrument at the medial aspect of the orbit, tilted it laterally about 20 degrees from the vertical position, and instructed the patient to look over my shoulder at the wall behind me. Maintaining the laterality of the scope, I placed my left hand on the patient’s brow bone and inched in as close to his right eye as I could. I saw vessels of different sizes, varying hues of red, forming angles with each other, some acute, others obtuse. Stepping back from the patient, I switched the scope to the other hand and repeated the exam, following each step as I had been taught, down to the precise degree, doing my best to approximate a distance of 15 inches from the patient’s eye—not an inch more, not an inch less.

Sana KhanD.O.


The room was bright again. I had finished the eye exam and was ready to present my findings to the attending. The red reflex was present, diabetic retinopathy was absent, I reported. She stopped me and asked, “Can you describe to me exactly what you saw that brought you to those conclusions?” I had performed the technique perfectly, just as I had seen it being done by others innumerable times. But what had I actually visualized? What would I have to see to conclude that the patient truly did not have retinopathy?

Fortunately, the attending is required to repeat a physical exam conducted by a third-year medical student, and fortunately “The man who lets a leader prescribe his course is a wreck being towed to the scrap heap…” —Ayn Rand for me that day, the patient did not have diabetic retinopathy. But what I consider most fortunate is the beginning of a realization that was born that day: that the art of medicine is not about mindless repetition but, rather, that the true leaders in their respective fields are the ones who ask “Why is this true?” They are the ones who are not satisfied with simply going through the motions to create an image of competence. They are the ones who read, research, practice, draw, and think in an effort to understand, to grow, to produce not only great work but work that rings true to them by virtue of their intellectual investment in it. It is only such men who are driven not by the truths of others but by a personal desire to explore and mature their own intellects in order to reach excellence who in turn can motivate others to discover and cherish these faculties that are within each of us by virtue of being human.

Most discourses on leadership revolve around its externalization; in our emphasis on acquiring skills believed to be common among great leaders, we hope to become like these figures who led movements that changed the course of our thoughts, our hearts, and our future. Observed skills, such as eloquent oration and sensible delegation, hold an undeniably important place in these discourses; however, it is the depth of one’s internal consciousness that truly sets the foundation for successful leadership. One of the most influential leaders in history, Prophet Muhammad, before taking on his prophetic role, spent hours of his free time meditating, pondering on the meaning of life, and questioning the truth of the traditions being blindly followed by those around him. His success as a revered and inspiring leader thousands of years later is in direct correlation to his intense introspection, his courage to question the truths of the people of his time, and his desire to know more, to be more.

No transition other than the one from being a student of medicine to a resident physician is more instructive in conveying the core importance of intellect in the achievement of excellent leadership. The privilege of immense power over another human being’s health inspires honest self reflection on one’s knowledge base, deficiencies, and gaps; it serves as an impetus to greatness based in true competence and achievement rather than merely for show. As a provider whom patients depend upon and look to for answers, it is imperative that excellence and not mediocrity be the standard of achievement, that genuine and not borrowed thought be the basis of learning, and that the desire to progress and grow come from within and not without. Intellectual leadership in this sense not only enables each of us to be leaders in our daily lives but also paves the way for us to lead movements that may forever change the course of our world.