COMMENTARY

Life and Times of Leading Cardiologists: Mary Norine Walsh

Interviewer: E. Magnus Ohman, MD; Interviewee: Mary Norine Walsh, MD

Disclosures

March 07, 2019

Editor's Note: This interview took place in November 2018 during the American Heart Association Scientific Sessions. This transcript has been edited for clarity.

E. Magnus Ohman, MD: Hello. I'm Magnus Ohman. Welcome to another edition of Life and Times of Leading Cardiologists. I'm very fortunate to be here today with Dr Minnow Walsh, who is a cardiologist at St Vincent Heart Center in Indianapolis, and she is also former president of the American College of Cardiology (ACC). Welcome, Minnow.

Mary Norine Walsh, MD: Thank you very much.

An Irish Catholic Upbringing in Minneapolis

Ohman: Why are you called Minnow when your name is Mary?

Walsh: That is the most common question I'm asked. I was born Mary Norine and was called that until I was about 6 weeks old. My older brother, who is my Irish twin, was unable to say that so I became Minnow and it stuck.

Ohman: I have an Irish heritage and I believe you have a strong Irish heritage. Could you tell people what is an Irish twin?

Walsh: An Irish twin is a sibling who is born within 12 months of you. I was born, exactly to the day, 10 months after my brother was born. There were four more after that. It was a busy house.

Ohman: Fantastic. Your family is from Ireland?

Walsh: Originally. My great-grandparents were all from Ireland. Two of my grandparents were born in the United States. My grandmother on my mother's side was born in Edinburgh and immigrated through Ellis Island, and my grandfather was born in England and immigrated through there as well.

Ohman: Wow, so they allowed an Englishman into the mix—that's great. Where did you grow up in the United States?

Walsh: I grew up in Minneapolis.

Ohman: We always talk about the Midwest being Scandinavian. I have not heard too much about Irish settlers in cold Minnesota because it's really very foreign from Ireland, which is much warmer.

Walsh: Minnesota is a more ethnically diverse state now. But when I was growing up in St Paul, Minnesota had almost as many Walshes as Boston did at the time. There were little enclaves of Irish.

Ohman: A little-known fact about St Paul. Did you go to a Catholic school?

Walsh: I did for elementary school, and for high school I went to an all-girls Catholic school. During the time I was there, all of the Catholic schools started to merge and to go co-ed, which was a really big deal. That was the beginning of the thought that co-ed education was maybe better than single-sex education in high school. But it did not happen for our school until after I went to the university for undergrad.

Ohman: Is it stressful when you suddenly have boys appear? I remember hearing things like, "They are very noisy."

Walsh: Having spent all of high school learning and going to class without the thought of, Oh, that guy is cute to then suddenly being in university class, where everybody was there, was just something that we had to get used to. And it was good.

Choosing a Career in Medicine

Ohman: Tell us a little bit about your family. Six kids is a large family. By today's standards it's a huge family. Were your parents in medicine?

Walsh: Nobody in my family was in medicine. I had bad asthma as a kid and was hospitalized at the age of 7; I came out of that hospitalization wanting to be a nurse. I used to bobby-pin an envelope on my head to be a nurse's cap. Once I got to high school, I really liked biology and started rethinking whether to go into nursing or medicine. I decided to be premed once I got to the university.

Ohman: It's a sign of the times back then that if you're a girl you think nurse. In high school, was there somebody who was sort of pushing you toward the sciences?

Walsh: My biology teacher. Another thing about my high school in Minneapolis is that we had an entirely ungraded high school. It was very avant-garde. We also had modular scheduling, so it was this sort of "free" education where you figure out your own path. There was this core group of kids who were into the sciences. My biology teacher was somebody who I admired a lot, and it was really through her that I started thinking about medicine. Also, I was a nurse's aide in high school and in college. I worked in a nursing home for 3 years, taking care of elderly people. During my freshman year at the university, I applied at the community hospital and became a nurse's aide in the emergency department in Minneapolis. I was working with family medicine residents and that solidified it. I was like, "Yeah, I really want to be a physician."

Ohman: Let's go back to your biology teacher. I presume that most girls' schools in those days only had women teachers.

Walsh: Right.

Ohman: How did she stimulate you? Was it that she felt that women should have a more prominent role in society? In the sciences?

Walsh: The final decision came from interacting with physicians. I realized that they made the decisions, and that had a big influence on me. I loved nursing. I learned a lot from nurses, and I still am a huge supporter of the care team, especially in cardiovascular medicine. But I realized the difference in the role once I started working with the physicians.

University of Minnesota for Undergraduate and Medical School

Ohman: At the University of Minnesota, I presume you did a sciences undergrad.

Walsh: Actually, no—I was a French literature major.

Ohman: What a wonderful opportunity. Why did you pick that after the wonderful biology teacher?

Walsh: I was premed but ended up taking French and being told by my teacher that I had a gift for it. I did a parallel track of all the sciences that I had to do, and by the time I graduated I was taking graduate-level courses in French literature. I had the best of both worlds. I went from the competitive premed students in the organic chemistry lab to the very intellectual discussions of Voltaire. It balanced my life out very well and still does.

Ohman: Did you go to France as part of your practice?

Walsh: I did not go to France until I was a resident.

Ohman: Where did you head to medical school?

Walsh: University of Minnesota.

Ohman: In those days, Minnesota had some really terrific leaders in medicine.

Walsh: Right. I did my cardiology rotation at the VA with some really talented fellows [and attendings]. I was only a third-year student when I did cardiology. Ideally you were supposed to do your sub-internship before you did cardiology, but some people had to do electives, so I did it as my second rotation and I absolutely loved it.

Ohman: This was your ticket into cardiology.

Walsh: I was going to try to double-board in internal medicine and emergency medicine. Back to being a nurse's aide, I eventually got to the trauma hospital emergency department in Hennepin County, and two people were training in both and I thought they had it all. I thought they knew everything about all of the myocardial infarctions (MIs) that came in along with the trauma. But once I got to internship at University of Texas (UT) Southwestern, which was a really intense program, I realized that I would have to do two internships and thought Nope, I'm not going to double-board. I'm going to go into cardiology.

Residency at UT Southwestern, Fellowship at Washington University

Ohman: You were at UT Southwestern for your residency, another place with great leaders at the time.

Walsh: Absolutely. The number of prominent cardiologists in my year, and the 2 years on either side of me, was just enormous due to the leadership of Dr Seldin, who was our chair of medicine, and Dr Jim Willerson, our chief of cardiology. It was kind of a hotbed. I'm dating myself, but the TIMI trial started during my internship year.

His insistence on us starting in the lab changed my life dramatically. Rather than a clinician, it made me into a clinician scientist.

Ohman: That is the Thrombolysis In Myocardial Infarction trial, even before primary angioplasty completely revolutionized how we thought about MI at the time. This was a hotbed of activity. You were heading toward trauma—I would have guessed that you would become an interventional cardiologist. But there is the French literature to balance that out. Where did you find yourself in all of this?

Walsh: When I was looking at cardiology fellowships, I went to Washington University, where Dr Burt Sobel was the chief and the program director. At the interview, he offered me a position and told me that I had 3 days to decide. There was no Match—that's the way it was then. It was bird in hand or continue on your journey and look at other places. I went to WashU, and Burt preferred that fellows start in the lab and do some research first. I'd just gotten done with UT Southwestern, Parkland Hospital, and wanted to be a cardiac care unit fellow and put Swans in and do that kind of thing.

His insistence on us starting in the lab changed my life dramatically. Rather than a clinician, it made me into a clinician scientist. I began to work with Steve Bergmann on clinical PET studies. Steve had a very productive lab with animal work in PET flow and metabolism, with O-15 water and palmitate. The translation into human studies had not been done robustly, so for 2 years that is what I worked on at WashU. It made me love research. In fact, Burt initially only required a year of us, and about halfway through I asked if I could do a second year. That was back in the days of the training grant and the score grant, and I did not even have to write a grant to support my year. He said, "Sure, if you want to."

Ohman: You had enormous flexibility. You could decide exactly how your fellowship program was put together—something we do not have these days, unfortunately.

New Family, New Position

Ohman: Somewhere along the line you met your husband?

Walsh: I met my husband during my medicine training in Texas. He is also a physician. I already had my fellowship by the time we met, so we did long distance for about a year and then he transferred to WashU.

Ohman: Having a young family as part of your training is stressful.

Walsh: I had our first child when I was almost finished with fellowship. When starting a new job at the University of Pennsylvania, we had a 4-month-old. That was tough.

Ohman: At that stage, you had a focus on what we now call radionuclide medicine, right? Is that a field of cardiology that you are continuing in your career or did you make a switch?

Walsh: I have continued, to some extent, and was very happy to have participated a lot in the American Society of Nuclear Cardiology. I was on the board a number of years ago. I had done an extra month or so of transplant at WashU as a fellow, and so I continued to do biopsies and involved myself a little bit in the program at University of Pennsylvania. When I left there and came to St Vincent 26 years ago, we had a very small transplant program and I began seeing those patients with my colleague, who had been there for a few years prior to my getting there. I just loved heart failure, and we did not have any organized heart failure initiative, nor were we doing any research. I set about trying to get the infrastructure for opening up a disease management program for heart failure.

Ohman: That is an interesting path and career. Let's go back to when you went to Penn. You must have interviewed while being pregnant. That must have been hard.

Walsh: Yes, it was well received by some but not by others. One interview did not go well because I think the person interviewing me did not think a pregnant cardiologist was who he wanted to hire. But on the good side, Mark Josephson was our chief when I was interviewed by him, and subsequently for the next couple of years. He cared so little about the fact that I was pregnant that I remember walking a half-mile or so in downtown Philadelphia to a restaurant (when I could hardly walk), thinking, He's paying no attention to this. This feels like a home. This is good.

'Enormously Beneficial' Mentoring

Ohman: A true scientist. Very focused on the science. In your cardiology training, who do you feel were your mentors? You worked with Dr Bergmann, but did you interact much with Burt Sobel as well?

Walsh: Burt was the editor of Circulation while we were there and he used to have us review. I'm sure he had us review papers he had already decided to reject. He would have already made a decision but would give you a paper to review and see what you thought, and that was enormously beneficial. He was brilliant and he had a big effect on me.

Burt [Sobel] and I had an argument over whether you could start a sentence with 'nevertheless.'

Ohman: Literature comes back in the form of writing and maybe a little bit of editing. Did you keep that up?

Walsh: I did. Actually, Burt and I had an argument over whether you could start a sentence with "nevertheless." He called up his editor to find out the answer.

Ohman: Who was right?

Walsh: The diplomatic answer was, it could be done either way. But traditionally not.

Family Life

Ohman: Very funny. Your husband was able to follow this path?

Walsh: People who have dual careers have to decide, so we took turns. The first turn, even before we were married, was mine because I had already accepted my fellowship at WashU, so he followed me. He had the prime deciding role in going to Philadelphia, where he got a healthcare MBA at Wharton, and when we moved to Indianapolis it technically was my turn. So now we say, "Is there another turn?" and we do not talk about that too much. It's been 26 years; I think we are planted for now.

Ohman: How many children do you have?

Walsh: We have two.

Ohman: Is either of them growing up in the medical field?

Walsh: Neither of them were interested in medicine. My son just passed the bar, so I'm proud to say that he has a job and is off the payroll; and my daughter has done various restaurant work and other things.

Ohman: It's hard; they see parents working hard and then they say, "That is for somebody else."

Professional Societies and Leadership Roles

Ohman: How did you get into the ACC and to that very high level?

Walsh: I tell a lot of young people that I figured out fairly early on that the ACC was, as a society, the place I wanted to put some effort into.

People ask, 'How did you decide that you wanted to be [ACC] president?' It's a time commitment, but I began to think I'd do a good job and put my name in that hat.

Ohman: Even though your two first papers, I believe, were in Circulation?

Walsh: They were. I love the American Heart Association, American Society of Nuclear Cardiology, and the Heart Failure Society, too, and I'm active in all of those. But I was very interested in the practice of cardiology and somewhat in the business of cardiology, so I felt very at home in the ACC. The very first thing I did was be on a committee, the beginning step for most people. Once the chair position of that committee came open a few years later, I'd been on the committee and I put my name forth for that. I chaired a first committee and after that came other committee work. I also was very active in our Indiana chapter and was encouraged to run for the position of governor. It's the only elected position in the college, and so I ran for governor.

Ohman: Just to point out, the governor of the ACC.

Walsh: Not the governor of Indiana. Although my daughter was young enough at the time that she thought that I had been elected the governor of Indiana and was very disappointed that I was not. Once I was on the board of governors, then I better understood what the board of trustees was and I put my name forth for that. People ask, "How did you decide that you wanted to be president?" It's a time commitment, but I began to think I'd do a good job and put my name in that hat.

Next Steps

Ohman: Looking forward, what is the next step in your career, and what do you want to do next or contribute to?

Walsh: Thanks to the team I work with, who have undertaken a lot of work in my absence [as ACC president], I am really happy this year to be back doing a little more clinical. We have a very large transplant ventricular assist device program, and I want to continue to work there and reengage in a lot of different research activities. I want to continue to contribute to the college and do other volunteer efforts. But I don't know; I still have a very busy year, being the past president, so I think time will tell exactly what I do next.

Ohman: It's been an incredible story from cold Minnesota. I want to thank you for your time today. It was terrific to hear your story.

Walsh: Thank you. Thanks for having me.

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