In the screenplay “Calling Dr. Meadows,” a cardiac surgeon — killed in a carjacking — spends time in purgatory attempting to fix the moral dilemmas he created while alive. The screenplay made it to the finals in the Cinema St. Louis/St. Louis International Film Festival screenwriting contest.
Apt to pique the interest of doctors anywhere, the screenplay might get extra attention at the School of Medicine. That’s because it was written by one of its own: Marc R. Moon, M.D., professor of surgery and a cardiothoracic surgeon.
Fast-talking, quick-thinking and full of restless energy, Moon seems thoroughly capable of putting in a full day of surgery or research before sitting down to write a movie scene. He can talk his way through an involved description of aneurysm repair while taking a little detour for a wry anecdote.
“I was a computer programmer for one year at the Ford Motor Company,” Moon reminisces. “All the other computer programmers smoked to kill time. We all sat in cubicles, and you could tell if someone was in because there would be a plume of smoke above his walls. If I’d stayed a programmer, I’d be a smoker today.”
Tough choices
Fortunately now a nonsmoking surgeon, Moon largely focuses on two types of procedures: treatment of diseases of the aorta and repair of defective mitral valves, which are located between the upper and lower chambers on the left side of the heart.
“Dr. Moon’s areas of clinical expertise ensure that he is continually operating on the most difficult, critically ill patients seen here,” says Michael K. Pasque, M.D., professor of surgery.
Moon directs the Center for Diseases of the Thoracic Aorta, and he asserts that maintaining a dedicated center for aortic conditions is the best way to keep up with the latest treatment options.
Cases are rare enough that an internist or cardiologist on his or her own may see only one or two patients a year, whereas the center sees about a hundred in that time.
“With such a large patient base, we can collect information to develop algorithms for treating aortic conditions,” Moon says. “We can design protocols to decrease risks and complications.”
Complications of aortic surgery can be extreme. And because most aneurysms don’t cause overt symptoms, patients may face daunting medical choices while feeling fairly healthy.
“It’s easy to decide to operate on someone who has a heart-valve infection and feels like they’re dying,” Moon says. “But aneurysm patients are often asymptomatic, and you have to balance the potential complications of aortic surgery against the difficult-to-predict chances of aortic rupture without surgery.”
Moon’s second area of specialization, mitral valve repair, is no less of a test of skill and character. Here, Moon can opt to replace a defective valve with a mechanical valve or one from a cow or pig.
But he feels the more surgically demanding choice — that of repairing the existing valve — is often much more desirable.
“We’ve developed a passion for surgical repair of the mitral valve here,” Moon says. “We may struggle to repair valves when it would be technically easier just to replace them because the long-term outcome of repair is substantially better than replacement.”
A good match
Moon speaks of his early career as a succession of almost fateful events. While training in general surgery at the Medical College of Wisconsin, he met a visiting lecturer, Craig Miller, M.D.
He was impressed with Miller’s maverick personality — and with his work as a cardiac surgeon — so he went to work with him at Stanford University.
A dyed-in-the-wool cowboy who grew up on a California ranch, Miller is known for wearing a cowboy hat everywhere — which Moon soon found was more than a simple affectation.
“One day a favorite calculator of his went missing from his desk,” Moon says. “It turns out Miller also has a gun and a holster. He went walking around the hospital with his gun in his holster looking for his calculator.”
Moon worked in Miller’s lab and trained in cardiothoracic surgery for two years at Stanford before spending a year training in vascular surgery at Oxford University.
He completed his cardiothoracic surgical residency at Stanford with specialized training in thoracic organ transplantation under Bruce Reitz, M.D.
When it was time for him to look for a permanent position, Moon called Joel Cooper, M.D., then the chief of the Division of Cardiothoracic Surgery at the School of Medicine. He asked if there were any jobs available in the division. There were, and Moon was soon hired.
“Washington University has always had a reputation as one of the leading academic programs in cardiothoracic surgery,” Moon says. “I considered it an honor just to come on an interview.
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Marc R. Moon Family: Two sons — Tyler, 12 and Justin, 8 “I came to St. Louis because Washington University is the best place to practice — I wouldn’t even say in the country — in the world. We’re surrounded by intelligent people in the medical school and have all sorts of resources. But I also want to stay because of the great school options for my kids here — they are amazing. “I wouldn’t encourage my kids to become cardiac surgeons because it’s a shrinking field. And that’s not a bad thing. Cardiac surgery is done for drastic reasons, and if it’s decreasing that means we’ve got some better ways to treat cardiovascular diseases.” |
“It turned out well,” he adds. “We’ve had a good match.”
Pasque would second that statement.
“When it comes to academic cardiovascular surgery, Dr. Moon does everything exceedingly well,” Pasque says. “Let there be no question, he is the real deal and truly one of the crown jewels of this medical center.”
Looking after the future
In addition to surgical duties, Moon conducts clinical research in cardiothoracic surgery and laboratory research on the treatment of chronic pulmonary hypertension (high blood pressure in the lungs).
Pulmonary hypertension has a poor prognosis and is associated with emphysema, some heart diseases, HIV infection and the use of the diet drug fen-phen.
The right side of the heart is placed under extra stress as it tries to push against the high pressure in the lungs. Moon’s research focuses on treating the cardiac consequences of the disease and on relieving the pressure on the heart.
He is studying the effect of shunting blood from one side of the heart to the other in laboratory animals with pulmonary hypertension.
“Dr. Moon’s NIH grant-supported laboratory research is world-class,” Pasque says. “And he does all of this while maintaining the busiest clinical practice in our division.”
With a career that continually exposes him to the fragility of human anatomy, it’s not really surprising that Moon’s well-received screenplay deals with the consequences of a physician’s choices and his role in the destiny of others.
Maybe it also has contributed to a pragmatic outlook that comes with a tinge of irony — an outlook that becomes evident as Moon describes a lesson in personal dispensability he learned from watching academic life: People leave the division, a goodbye party is thrown, and in a couple of days someone new is occupying a former colleague’s office. It’s made him think carefully about the future.
“I realize I’m going to retire someday,” Moon says. “The most important thing for anyone is to make sure things are prepared for success once they are no longer contributing.”
“When it comes to academic cardiovascular surgery, Dr. Moon does everything exceedingly well. Let there be no question, he is the real deal and truly one of the crown jewels of this medical center.”