Life and Times of Leading Cardiologists: Cindy Grines

Interviewer: E. Magnus Ohman, MD; Interviewee: Cindy L. Grines, MD


January 17, 2017

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Editor's Note:
The following interview was recorded on October 31, 2016, during the Transcatheter Cardiovascular Therapeutics meeting in Washington, DC.

E. Magnus Ohman, MD: Hello. I am Magnus Ohman, and I am here once again on the Life and Times of Leading Cardiologists. My guest today is Dr Cindy Grines from Detroit. She is the vice president of the Heart Hospital at Detroit Medical Center. She has been a leading international cardiologist for a few years.

Cindy, what I thought was so interesting in your career—and we are going to get to that part in a little bit—is the fact that you really led the charge on primary angioplasty in acute myocardial infarction (MI). This was unusual because at the time, mostly men were doing that procedure. You stood up and said, "What is wrong with you people?" Welcome.

Cindy L. Grines, MD: Thank you.

A 'Worldly' Small-Town Upbringing

Dr Ohman: Cindy, where were you born?

Dr Grines: I was born in a small town in western Michigan called Sparta. I grew up on 80 acres. My driveway was a quarter-mile long to get to a dirt road.

Dr Ohman: Wow, and did your parents farm?

Dr Grines: We called it "the farm," but both my parents were from Chicago. We have a family history of buying farms in Michigan just so we can have the farm life with the city life. And that is how I grew up. It was really great. We did not grow anything, but we had horses, peacocks, goats—fun animals. Then every summer, I would take the train to Chicago to stay with my grandparents, so I could become more worldly and sophisticated.

Dr Ohman: City life.

Dr Grines: Yes, civilized. That is what my grandparents said: "You need to become civilized."

Dr Ohman: Do you have brothers and sisters?

Dr Grines: Yes, I have four siblings: one brother and three sisters. I am the middle.

Dr Ohman: That's unusual.Most people who are very successful like you are the first- or the last-born. Did anyone in the family have a background in medicine, or were they in business?

Dr Grines: No; my father is a civil engineer, and my mother took 2 years of college and did accounting. She was math, and my father was science and math, so they worked really hard on the science and math education.

Dr Ohman: Did you go to high school in Sparta, too?

Dr Grines: No. I moved to Ohio in high school, and I ended up going to college at Ohio State.

Dr Ohman: You are truly a Buckeye.

Dr Grines: The majority of my life has been in Michigan. I was born in Michigan. It was a temporary move to Ohio, but it's great because I can cheer for both teams now.

Dr Ohman: You went to Ohio State for undergrad. What was your major?

Dr Grines: Microbiology.

Dr Ohman: You were already into science.

Dr Grines: Yes; I always was very interested in science, but I was never a premed student. You are going to find this very hard to believe, but the only reason I ended up going to medical school was because I was taking courses that I thought were interesting, such as vertebrate zoology and organic chemistry. Strange, right? I was in those classes with all the premed students, and I performed much better than they did. It was those competing students who encouraged me to apply to medical school. I had never even thought about it.

Dr Ohman: Wow, that is fascinating. How much did farm life influence you to think in biology terms, do you think?

Dr Grines: I thought I had a great childhood, to be honest. Living in a rural environment gave me a lot of independence. I could leave the house in the morning, go horseback riding, explore, and do everything I wanted to do. It kind of led me on my path where I was strong-willed, an independent thinker, and thought I could do everything.

Dr Ohman: Did you do horseback jumping?

Dr Grines: Yes, I jumped a little bit. I remember cracking my skull once against the side of a jump, but I did more trail riding.

Thriving at Ohio State

Dr Ohman: Wow. When you realized that you were a lot smarter than the rest of them at Ohio State (no offense to those who are Ohio State fans), where did you go to medical school?

Dr Grines: Ohio State. I also did my internship and residency there. It was a great place to be trained because they gave us a lot of responsibility. For example, throughout the 3 years of my residency, I called in a cardiology fellow only once. I got to do everything—Swan-Ganz catheterizations, complete management of cardiogenic shock, and acute MIs—because nobody was doing primary percutaneous coronary interventions at the time.

I was so afraid when I was on rounds with him that I would spend a lot of time studying about my patients.

Dr Ohman: Who were your role models then? I am trying to think whether I know of a female cardiologist at Ohio State at the time.

Dr Grines: There were none.

Dr Ohman: That is what I thought. Who were your role models that you worked with when you were a resident?

Dr Grines: I hadmale role models. I found medicine very interesting and logical—physiology-based. That is primarily the reason I went into it.

One of my biggest role models was Charlie Wooley, because he was so demanding. I was so afraid when I was on rounds with him that I would spend a lot of time studying about my patients. When we would be making rounds, he would ask the intern a question, but the intern could not answer it. He would ask the resident the question, but the resident could not answer it. But guess who could answer it because she stayed up all night studying? I realized that if you worked hard, you could succeed.

Dr Ohman: Where do you think this drive for knowledge came from? If you ask most people now, they would not stay up all night.

Dr Grines: I am just a curious person. It is not just about medicine; it is about a lot of different things.

Dr Ohman: Curiosity was driving all of this. You finished your residency. Now, you have to go to a fellowship in cardiology.

Mentors at Michigan

Dr Grines: I applied in the Midwest, because at that time I was married. My husband could not move out of the Midwest, because of his career. I applied to all of the different Midwest schools. When I interviewed at the University of Michigan, I was very struck by how they were on the ball. They were doing a lot of different research projects; the people there were very smart. I ended up going to the University of Michigan.

Dr Ohman: Step back for a second now. You got married in medical school?

Dr Grines: Residency. This was my college boyfriend.

Dr Ohman: You went to Michigan to do cardiology. There were some people at Michigan at the time. Tell us about those people.

Dr Grines: There were so many incredible people at Michigan. It was a fabulous era. Eric Topol, Bill O'Neill, Betsy Nabel, Steve Ellis, Eric Bates, and Bertram Pitt were there. The number of high-powered individuals who were there was just incredible. Some of these people are not interventional cardiologists, but each influenced me in their own way.

Dr Ohman: Betsy was probably the first woman role model that you came in contact with, right? She was very successful at the time. Did you interact much with her on a career-path level?

Dr Grines: Actually, no, because she came when I was in about the third year of my fellowship. By that time, I was working in interventional cardiology and had a career development award from the Veterans Administration (VA). I wrote and got a 3-year grant and worked a lot at the VA. Interestingly, they could not give me the award unless I was an attending, so they made me an attending at the same time I was a fellow.

Dr Ohman: Those rules have all gone by the wayside. That is not possible anymore. In a way, it is a shame, because people like you who clearly had the drive and the ability could take advantage. Lack of flexibility worries me a little bit about our society now.

For interventional cardiology, you must have interacted with Bill O'Neill, who was a legend at the time (and still is). When did you first meet Bill in the cath lab?

Dr Grines: I must have met him during my interview, but of course I mostly remember him from when I was working there. He was the cath lab director at Michigan. It was an incredible time, because we were doing a lot of the original thrombolytic trials that required angiography. We would do a 60-minute angiogram, a 90-minute angiogram, and then we would do rescue balloon angioplasty. We were getting called in all the time because we had a very active research program. We had a helicopter that would retrieve these patients.

Dr Ohman: The famous Michigan helicopter. It went everywhere.

Dr Grines: It retrieved patients from all over. Most people would complain when they had to come in at 2:00 in the morning, but I thought it was really invigorating. There was such camaraderie. I would come in with grocery bags filled with Diet Coke and Doritos, and give it to the entire lab. We turned it into a really big party. No alcoholic beverages, but it was fun. We really loved what we were doing.

Dr Ohman: In a way,you are describing a pioneer spirit, because basically you were at the forefront of a lot of things. How was working with Bill? He has a skill set that is amazing, and he is a hard worker too. You must have recognized that.

Dr Grines: He was quite inspirational, obviously, and I learned a lot. If you look at technical skills in the cath lab, he was absolutely by far the best interventionalist. We worked together closely and did some publications together. I worked a lot with Eric Topol as well on some of the thrombolytic trials. We did a paper on the TAMI studies.[1]

Starting a Family While Working in the Cath Lab

Dr Ohman: That is fantastic. Have you had children at this stage?

Dr Grines: No, but I got pregnant while I was in the cath lab.

Dr Ohman: Oh my God. How did you handle that? That is actually difficult, right?

Dr Grines: It is only difficult if you do not have the data right. I went to two different radiation physicists, and they both told me that the protection offered by the lead aprons allow almost nothing to get to you personally. The baby is also shielded by your abdomen, uterus, and amniotic fluid. The chance of the baby getting any radiation is really nonexistent.

I worked all through my pregnancy in the cath lab.That was back when we had the real heavy lead. I think it was wrap-around lead in the front. You wore a radiation monitoring badge, and it never had any detectable radiation.

I did not tell anybody that I was pregnant. I just showed up to work at my new job at the University of Kentucky...I figured it was my business and nobody's else's.

Dr Ohman: You must have taken some time off for delivery, I hope?

Dr Grines: I have to tell you this story. I got pregnant during my last year of fellowship, and then I got my first job. I did not tell anybody that I was pregnant. I just showed up to work at my new job at the University of Kentucky. It was my first faculty position. I figured it was my business and nobody's else's.

Dr Ohman: Good for you.

Dr Grines: I just showed up pregnant and worked up until the day I delivered.

Dr Ohman: My goodness. Was this your first or second child?

Dr Grines: First. Then I delivered at a different hospital from where I worked, because I did not want people gossiping about me. I did not know whether I would be one of those women that screamed during labor because there was so much pain. So I went to a different hospital. Isn't that funny?

Dr Ohman: It is privacy, which I like. Now, you have a child and you are still on call?

Dr Grines: I think I got 1 month of maternity leave, but unfortunately my daughter, Jessica, was born a week before the cardiology board exams. I had to go to Chicago to take the board exams. I do not know about your wife, but when you are pregnant, you are kind of demented to some extent. I would leave my purse everywhere I went. I could not even carry a purse after a while, because I was constantly leaving it behind.

I flew to Chicago to take the test, I signed into the hotel, and the test started at 8:00 AM. I went down there at 10 minutes to 8:00, and there was no test anywhere. I was in the wrong Hyatt hotel. The test was being held a mile and a half away. I went outside at 8:00 in the morning in Chicago, and the taxis zoomed by. It was raining, and nobody stopped. Just 5 days after I delivered, I had to run a mile and a half to where the test was being held.

Dr Ohman: Those years on the farm helped?

Dr Grines: Exactly. You learn how to be tough.

Dr Ohman: That is amazing. In the first few years, did you work predominantly in the cath lab, or did you do a mixture of things?

I think it is important to leave the place where you trained. When you come back, you are more respected.

Dr Grines: I was always an interventional cardiologist. As part of that, you make rounds in the coronary care unit (CCU), and you have a clinic. I was trying to build an interventional program there with Steve Nissen, and we developed our own helicopter program. We went out on the helicopter to every little town in rural Kentucky with our slide carousel. Remember those slide carousels? And we also gave lectures.

Dr Ohman: Yes. Then, you got people to come to Kentucky.

Dr Grines: We had a huge response, and all these people started sending their acute MIs to us. I was able to develop our own trial called KAMIT—the Kentucky Acute MI Trial.[2]

Dr Ohman: You stayed with academics when you finished your fellowship and worked with Bill, and you did some publication with the TAMI studies. From being a fellow with people around you to moving to another place is a hard transition. How did you manage that?

Dr Grines: I think it is important to leave the place where you trained. When you come back, you are more respected. I know so many examples of good people who stayed at a center where they did their fellowship, and they are perpetually treated as the fellow. It was good that I left, and it was good that I showed that I could do something on my own: develop my own research program, develop my own interventional cardiology program, and do some publications.

I stayed at Kentucky for 3 years, and then Bill O'Neill recruited me to come back to Beaumont Hospital in Michigan.

Dr Ohman: Where he had moved subsequently. Now, you had young children.

Dr Grines: I had one young child at that point.

Dr Ohman: How did you manage caring for her in the midst of all of this? How did you juggle that piece?

Dr Grines: I had a babysitter during the day, and my husband would help out at night. There were times when he would have to travel, and if I got called in at 2:00 in the morning, I just put my daughter in the car seat and brought her into the cath lab. She would sit at the CCU on the desk with all the nurses, or she would be in the control room of the cath lab. Steve Nissen actually has a lot of photos of him with my daughter because he was the CCU director.

A Clinical Trialist

Dr Ohman: Wow, what an amazing story. Then, you became one of the leaders in the PAMI[3] trials—the primary angioplasty trials. Tell us a little bit about how that came about.

Dr Grines: At the time, I think Bill O'Neill was doing a registry called PAR. It was just a registry of primary angioplasty, but of course, 99.9% of the population was being treated with thrombolytic therapy. From my days at Michigan and Kentucky, you see how often it failed. Even if you had some reperfusion, it was frequently Thrombolysis in MI (TIMI) 2 flow.

Our thought was, why are we even doing this? [The patients] are bleeding like stuck pigs, and we are not getting adequate perfusion. Why not just skip that step? Thrombolytics, at the time, were really expensive too. They caused bleeding and intracranial bleeding.

We had done some studies looking at rescue angioplasty, and we just decided to use the primary angioplasty. On a shoestring budget, Bill and I designed the PAMI-I trial,[4] which compared primary angioplasty with intravenous tissue plasminogen activator (tPA). We had some centers that agreed to participate, and since we really did not have much budget, they just did it out of the goodness of their heart, because they felt strongly that it was the right thing to do. Again, it was an amazing time where we were able to pull this off.

Dr Ohman: You were not dependent on industry.

Dr Grines: Not at all, zero.

Dr Ohman: That it is truly remarkable. The trial was a success.

Dr Grines: Right. It showed that primary angioplasty was superior and was published in the New England Journal of Medicine. But it was still a battle. It was probably another 8 years or so from the time the study was published to the time it became mainstream.It was a constant battle. Big bucks from the pharmaceutical industry were funding trials, and there was a huge campaign against primary angioplasty. It was challenging.

Dr Ohman: It was another challenge that you overcame by independence. That is a real step forward. Then, you continued in academics. You have been very involved with the American College of Cardiology.

Tell us about your children who grew up in the cath lab. What happened to them?

A Growing Career, and a Growing Family

Dr Grines: No radiation damage that I know of. It was so funny. Once I was in the bathroom brushing my teeth and my little toddler Jessica toddled in carrying her Mickey Mouse. She goes, "Mommy, Mickey is really sick." I ask, "What is wrong with Mickey?" She says, "Mickey has a dissection." Jessica is like 2 years old, can barely speak, and she is spouting off these cardiology terms.

As soon as I delivered Derek, I snuck off to my office to work on my slides.

Dr Ohman: Did Mickey have a dissection?

Dr Grines: No, she was just pretending. When I was leaving Kentucky, I was pregnant with Derek. I showed up at Beaumont Hospital, and I did not tell anybody, including Bill, that I was pregnant. Once again, it is none of their business, right? I work hard. It is not like I am going to be a burden to anybody being pregnant. I worked in the cath lab. The day I delivered, I actually walked down from my office and said, "I need to be induced. I am going to the American College of Cardiology meeting in 1 week."

Dr Ohman: Where you presented a big paper, as I recall.

Dr Grines: I did, yes.

Dr Ohman: Wow. I do not think anybody knew that backstory. That is fantastic.

Dr Grines: Actually,I was overdue by a week. I got induced and had Derek. As soon as I delivered Derek, I snuck off to my office to work on my slides. They were furious, because they could not find me anywhere on the floor.

The day I was discharged, I got called back in to do an emergency case, because Bill was out of town. At the time, there was a big spiral dissection, and nobody knew how to use this laser balloon angioplasty. It was before we had stents to treat dissections, and so I got called back in to do that case.

The point I am trying to make is that you have to do what is necessary.My pregnancies and deliveries, and my family, are very important, but you prioritize. If there is nobody else who can do it, I do not care if it is the day that I was discharged from the hospital; I go back in to help out.

Dr Ohman: Good for you. Then, of course, your rose in the ranks. You moved to Detroit Medical Center and did some really amazing things. What is next on the agenda for you?

Dr Grines: I publish a lot of papers, and I am at the stage in my career where I really enjoy helping other people. I am very generous when it comes to letting people be first authors on papers. I help them write and edit them. I am the head person for WIN, which is Women in Innovations. It is part of SCAI, the Society for Cardiovascular Angiography and Interventions. We are really trying to promote and mentor other women and are developing a lot of programs to do that.

Dr Ohman: I think it is sort of a recipe: You grow up on a farm, be independent, and then you become a successful woman. There is no doubt, based on your history.

What would you tell young women who want to go into interventional cardiology today? What is the message you would tell them?

Advice for Young Women Considering Interventional Cardiology

Dr Grines: You should do it, absolutely. There are examples of me and others, where you cannot do it all. My entire life, I always felt deficient. Maybe it is just the female personality. We have a big joke among my girlfriends about being bad moms. We are all bad moms. I never felt that I was the best mother. At the same time, I never thought I was the best clinician or the best researcher. But you do what you can do and try not to compare yourself against a man who is doing better in one area, because he is not doing everything else that you are doing. You absolutely have to work hard and do what you think is right.

Dr Ohman: On "not being the best mom," having met your children, I think you should take that off your list. The point is, you are right. It is a multifaceted task, and you have done extraordinarily well.

Dr Grines: The other thing I did was drag my kids along to a lot of things. I did not necessarily have time to be home with them all the time, but they could come to work with me. I would bring them into the cath lab in the middle of the night or on weekends. I would travel with them to meetings. Bill O'Neill, who is one of my great mentors, would babysit my kids in conferences. I would be up there on the podium, and he would be back in the audience holding my kids.

Dr Ohman: That is fantastic.

Dr Grines: Once I was up on the podium, and he was not there. I said to the kids, "You have to sit here until Mom is done, and do not say anything or do anything." I was speaking, and after I sat back down, there was a panel discussion. I forgot to tell them about the panel discussion. Derek, 3 years old, sees that I sat down and marches right up there—walks right up on the stage—and sits on my lap.

Dr Ohman: That is a great story to end with. I want to thank you, Cindy, for sharing your life with all of us. It is a really fantastic tribute to you. We have learned a lot from you about primary angioplasty.

I want to thank you, our audience, for participating with us today in the Life and Times of Leading Cardiologists. Thank you.


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