Every week he operates on four to five such hopeless cases that no other physician wants to touch - from a patient who refuses blood transfusions because of religious convictions to someone who's 85 years of age and has already received three valves, a bypass and needs a re-operation. Says Jeevanandam, "A lot of our patients had already been written off and been referred to a hospice and we take them on and they actually do very, very well."Jeevanandam is one of nearly 100 Indian American physicians listed in Castle Connolly's America's Top Doctors, a leading source for the most eminent medical specialists across the United States in 25 specialties and 90 subspecialties identified by The American Board of Medical Specialties. The 2007 edition lists nearly 5,000 doctors from among 650,000 practicing physicians nationwide, the top 1 percent. The nearly 30,000 Indian American physicians constitute nearly 5 percent of the profession, so the 2 percent of the Indian physicians are significantly underrepresented on the list. Jeevanandam, who hails from Curin in Tamil Nadu, is an acknowledged rainmaker for the hospitals, driving up volume with difficult cases that other hospitals often pass on. After his fellowship at Columbia Presbyterian Medical Center, he went to work at Temple University Hospital in Philadelphia just as the whole transplant program moved to a competing hospital. He was thinking of leaving when he was made director of a new heart transplant program. He recalls, "So we started doing transplants then and a lot of it was learning in the line of fire, because we didn't have a cardiologist, there was no infrastructure. I was the infrastructure for about two years." Jeevanandam mastered the complete management of a transplant station, creating the program from scratch, going from zero cases to 54, surpassing the 30 cases the hospital had done the previous year. He recalls, "Everybody was kind of shocked, including myself, because I didn't think we'd be that successful." In fact, Temple, although a relatively small hospital, hit the ranks of the top four hospitals nationwide for heart transplants and even led the rankings a few times. He performed over 100 transplants a year there. Since not every case was suitable for transplants, Jeevanandam came up with creative restructuring and the whole area of operating on inoperable cases became his speciality.At the University of Chicago Hospitals, where he is professor of surgery and chief of Thoracic and Cardiac Surgery, he performs over 30 transplants a year and 250 heart repair surgeries a year. As he told Business Week, "Think of us as Ellis Island - send us the patients you don't want to operate on, the difficult cases, the complicated patient, give us your worst. We'll take care of them!"
"The big advantage of the CardioVad is that you can turn it on and off," says Jeevanandam. "It gives patients a great psychological boost because they feel they are in control and we are the only site in the entire world doing it. It's kind of my baby, from taking it from a very early stage and hopefully getting it in a year to general clinical practice." From the hospice we move to the delivery room. At the Texas Nerve & Paralysis Institute in Houston, Tex., Dr. Rahul Kumar Nath, who is founder and director, often deals with patients only a few days old who suffer a particular kind of nerve injury at birth, which affects the growth and function of the arm and hand. Not all the nerves may be as severely injured as others, so half the arm might grow quite normally and the other half may not. This brings about imbalances and abnormalities, known as twisting deformities at the bone. Similar injuries can also occur in adults who are involved in road accidents. Brachial Plexus Palsy is a rare injury affecting 3 in 1,000 U.S. births, giving rise to nearly 15,000 such births annually. A similar numbers of adults are affected from injuries every year and often it's difficult to get help locally. The most common of the injury is Erb's Palsy, paralysis affecting the shoulder and arm. Normally these injuries are addressed with nerve grafting, but Nath has developed new nerve transfers, and for children specifically he's developed special surgeries for the muscle and bone deformities. Traditional surgeries take 8 to 9 hours to perform but Nath has fine-tuned the process to just over an hour. Recently he had a 4-year-old patient whose arm was paralyzed after a fall from a motor scooter. She had seen four different physicians before being referred to him. After the one and a half hour operation, Nath had her arm moving again in a few months.Nath, who was with the Texas Children's Hospital for many years, is chairman of the International Society for Brachial Plexus and Peripheral Nerve Injury and also founder and co-editor of the only journal addressing this issue. He's also the only surgeon in the U.S. who's developed a special surgery for Foot Drop, an injury to nerves in the foot. His research has led to the creation of equipment and techniques for difficult nerve repair, which have been patented by him. Currently he's working on developing artificial DNA in the lab to block scar production in wounds, surgical areas and nerves and ultimately in the skin as well. "It's a fascinating field. Earlier people had thought that paralysis could not be cured, but it's absolutely the opposite," he says. "It's an absolute revolution in that particular field. The key thing though is that patients have to be evaluated by a specialist within 3-6 months of the onset to get the best results, so there is a time limitation.