In the spring of 2005, I wrote the below letter to Anh Chanh, as to a big brother. Now Anh Chanh would like to print the letter so it becomes a public property. This letter may contain no truth, partial truth, or half truth. If the material is offensive to you or it is to boring or the letter is so stupid, please turn to another page. Remember this letter is full of imaginations, illusions and false statements. You are reading this page at your own risks.  TN

Midwest, September 2005

Dear Anh Chanh and Dieu,

I received the letter of Anh Dieu, C/C Anh Vinh Chanh. I did not know what Anh Chanh wrote but the letter of Anh Dieu was so full of praise: It made me blush. So I would like to write this letter explaining my real position in the US cardiology world. This is not an apologetic essay, this is a real life thought between friends and colleagues. Usually, I did not say much when these praises came from the first generation immigrants like Anh Chanh and Dieu, because I believe they don’t understand all the horrors of the real life, the struggle, and the throat-cutting fight in the academic or scientific world. However, I don’t like second generation Vietnamese abroad to think that what I achieve is their goal. My achievements may look big to the first generation immigrants but it pales in comparison to those of the second and third generation. So what should I do and say? This is the secret of my happiness (or success) in professional life. I did talk about these in veiled terms in many lectures in Vietnam, Taiwan or China, because they are the keys for success in the US. The intelligent ones in Asia would understand them.

How Does One Stand Tall Between The Giants?         

In 2002, at a first meeting of the editorial board of the Journal of Geriatric Cardiology, of which I am the co-editor, Dr Eugene Braunwald (Harvard) asked me: There are 76 English language journals in the world, why you do plan to publish another cardiology journal?  What are the special characteristics of the journal that will make it prosper and survive? I did not know the answer at that time. So Dr Braunwald gave me the answer. However, I would like to have an answer from young second generation Vietnamese-Americans in the YKH readership. As I mentioned in my previous letter, I like to challenge people, especially young people who think they are smarter than their elder’s generation. I believe they should, however they have to prove it. This attitude fosters deeper thinking and advances in science.

Then, in 2002, I went to Asia to give lecture with a very special friend, Dr Michael Gibson from Harvard. He is an interventional cardiologist like all of us, but what is special is that he invented many things that we are now doing (practicing) in interventional cardiology (the TIMI flow, the TIMI frame count, the myocardial blush etc.). What I learned from him is how to see what the other people do not see. We talk about science here. For example, this is an elephant. If all of us stand at the side of an elephant, we only see the belly of the elephant. If we move to the front or to the back or below or above the elephant, we will see many things else. It is the same in science. Thousands and thousands of cardiologists looked at the coronary angiogram and how many people ever thought about the blood flow and the frame count?

So in my book, when I review my chapters or these of other authors, all the times I ask the question: what is new in here, what is special in here, what is the new message that nobody talked about before? If there is no new message, what should I write it for?

Right now, I am preparing my lectures for the 4 major cardiology meetings in Yangon, Myanmar, Shanghai and Beijing, China (November 2005) and Busan, Korea and Beijing China (December 2005), I keep asking myself, what are the new ideas you would like to introduce to the audience? New here is really new, critical, or provocative. It is not just because the people from Asia did not have the chance to read these from somewhere else. Here in the US, the key question for success is: What is your new idea? If there is nothing new, then you are a follower. It is fine, if this is your plan or your priority or goal.  So I like to read a lot but not too much. You cannot just only absorb what you read, you have to produce something new, provocative too, or earth-shaking by thinking about it yourself or initiating it by yourself. It is more important than to digest many things. Here in the US, working hard is not enough. To be intelligent is important, to be smart is much better. So in the US, either you make a living by selling your labor or selling your ideas (like Bill Gates said about Microsoft: this is a factory for ideas)
So things that I did in the past, research, writing, lecturing, making money (the Americans are very practical), are simple achievements of many cardiologists here. Surely, one cannot achieve everything. It is difficult to be a big scientist and make a lot of money at the same time. We have to choose one or another.

What I love is that my interventional cardiology book is ranked top ten since it was published. Many people bought the book not because of my name (whoever heard about a cardiologist with the last name Nguyen?). They bought the book because of the content, the new ideas and the provocative way we present it. It is the same for my clinical cardiology book.

Last year, when I submitted my manuscripts for the Journal of Interventional Cardiology, my senior author asked me why I did NOT have an introduction and a conclusion. I answered that the title is the introduction. When I write, I go directly to the problem without beating around the bush so we have no need for an introduction. We face the problem head-on like when we do angioplasty. This is a preferred way for aggressive cardiologists (who are in the majority here in the US). Then I do not have a conclusion, because I expect readers to have a conclusion after they read my articles. The most difficult question is how I write so readers will arrive at the conclusion I expect. If the readers have a wrong conclusion, then either I did not write clearly enough or they are not up to the level of the article.  It is a constant and exciting challenge.

Last March, during the American College of Cardiology meeting, I went for a reception and dinner with the leadership team. It was a very special and awesome experience. Here are the people who made or are making history in medicine. They discovered many things in cardiology and set the standard of cardiac care in the US and the world. How Do I Stand Tall Between These Giants? Surely, I enjoyed listening and was not afraid of tell my part of the story with new ideas and ways of looking at things. I learned a lot too. As the US social system is open to anybody with a brain, it is possible to participate in any section of the US society (social, medical, political, entertainment, etc. This is why I like to see many young Vietnamese cardiologists or cardiologists-to-be at the ACC. You can, should and will be an active participant of history in the making. You don’t passively watch it. You are the one who will make history if you want to.

So from the social part of my work, for the first generation immigrants, we arrived here empty handed, so everything is a success. However, the second generation Vietnamese-Americans with the best education in the world have the chance to develop their own way of thinking; they did and do a lot of very amazing things. This is what I consider success. So success is not measured by bank account (even though it pays the bills) or a long list on the curriculum vitae. Success is treasured by contributing to society with your ideas, thoughts and (mental or physical) labor.

How to Face the Future? Face it Head-On.

Each year, there are more than 25000 cardiologists who are very successful in life coming for the ACC meeting. There I enjoy meeting friends, colleagues, do the networking, discussing and challenging them. It is fun. This is why I like to see many young Vietnamese cardiologists or cardiologists-to-be there. At the meeting of the International Committee of the Society of Cardiac Angiography and Intervention (SCAI), the US host will meet all the presidents of the interventional cardiology societies of the world (SOLACI, South America; Canadian, European, Asia-Pacific). Let see what they have to say (or what they have in their head? or here in the midwest we use to tell a joke that they are like a bottle of beer: it is empty from the neck up). If you like to join, you can come and listen as my guest. This is an open meeting like any meeting in the US.

On Sunday, at 6:30PM, at the ACC president’s reception, as my accompanying guest, you will meet many giants of cardiology such as Spencer King (Angioplasty), John Douglas, Pam Douglas (echo), Rahimtoola (mitral and aortic valve), Chatterjee (Heart failure), Ted Feldman (mitral valvulopalsty and mitral valve clip for MR). All these people, we only know them from the textbook. Now, it is fun to challenge them and see what they have in their head. I remember in 1998, I was at the temple of Confucius in Beijing with Dr Eugene Braunwald. We took a picture with his wife in front of the statue of Confucius. His wife said to him: you look like Confucius. Dr Braunwald answered: I am confused, not Confucius.
On Monday, at 11:00AM I will meet with a representative of Blackwell, Oxford UK, to discuss the new edition of my book. There I have to explain what is special about the new edition. Why would they want to print it? What are the new ideas which will sell the book well? Isn’t it challenging?

Then there is the editorial board meeting of the Journal of Interventional Cardiology. The new editor in chief, Dr Cindy Grines will be there. If you would like to hear about the harsh reality of the medical publishing world, then you can come with me. The real life is not rosy as we thought.

I believe that Anh Chanh and Dieu have up to their ears about what happens in the cardiology world. It is always challenging. Is it time to go to sleep yet?

With my warmest personal regards,

TN